Reduced Cholesterol Levels during Acute Human Babesiosis.

BACKGROUND: Babesiosis, an intra-erythrocytic protozoan disease, is an emerging zoonotic parasitic disease worldwide. Cholesterol levels are correlated with severe infections, such as sepsis and COVID-19, and anecdotal reports suggest that high-density lipoprotein (HDL) cholesterol declines during acute babesiosis. Our aim was to describe the cholesterol levels in patients with acute babesiosis diagnosed in an endemic area in New York, hypothesizing that HDL levels correlate with the severity of infection. METHODS: We reviewed the medical records of adult patients with babesiosis diagnosed by identification of Babesia parasites on a thin blood smear and confirmed by polymerase chain reaction from 2013 to 2018, who also had available a lipid profile drawn at the time of clinical presentation. Additional lipid profile levels were considered as "baseline" if they were drawn within 2 months before or after the infection as part of routine care. RESULTS: A total of 39 patients with babesiosis had a lipid profile drawn on presentation. The patients were divided into two groups for comparison based on the treating physician's clinical decision: 33 patients who were admitted to the hospital and 8 patients who were evaluated as outpatients. A history of hypertension was more common in admitted patients (37% vs. 17%, p = 0.02). The median levels of low-density lipoprotein (LDL) and HDL were significantly reduced in admitted patients compared to non-admitted patients (46 vs. 76 mg/dL, p = 0.04; and 9 vs. 28.5 mg/dL, p = 0.03, respectively). In addition, LDL and HDL levels returned to baseline values following resolution of acute babesiosis. CONCLUSION: LDL and HDL levels are significantly reduced during acute babesiosis, suggesting that cholesterol depletion may predict disease severity. Pathogen and host factors may contribute to a reduction in serum cholesterol levels during acute babesiosis.

Infant and early childhood mental health consultation in a diverse metropolitan area.

IECMHC can and should be a vehicle that promotes greater equity in access to high quality relationships within an early classroom environment. It is important to consider consultation through a racial equity lens to ensure that it is integrated in all levels of work. The goal of the study was to replicate the results from other IECMHC programs with a diverse, largely Latinx, population. The Jump Start program was given the unique opportunity to adapt the Georgetown Framework of Infant and Early Childhood Mental Health Consultation to a multicultural population in Miami. A total of 88 early learning programs and 244 teachers participated. Services were provided in English, Spanish, and Creole at the program- and classroom-level. Pre- and post-data were collected at both levels. Significant improvements at the program- and classroom-level were found post-consultation. Consultants demonstrated fidelity to core program practices while providing culturally and linguistically competent service. The current study replicated findings regarding the effectiveness of IECMHC while expanding results to a diverse metropolitan community. Key features of program success may be attributed to the use of highly trained consultants, action planning, fidelity monitoring, and enrollment of programs that were ready and have a champion for IECMHC.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study.

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

Cluster-randomised trial of the impact of an obesity prevention intervention on childcare centre nutrition and physical activity environment over 2 years.

OBJECTIVE: The prevalence of obesity among pre-school-aged children in the USA remains unacceptably high. Here, we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a childcare centre (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over 2 school years. DESIGN: This was a cluster-randomised trial with twelve CCC receiving the HC2 intervention arm and twelve in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over 2 school years (Fall 2015, Spring 2016 and Spring 2017). Changes in EPAO physical activity and nutrition score were analysed via a: (1) random effects mixed models and (2) mixed models to determine the effect of HC2 v. control. SETTING: The study was conducted in twenty-four CCC serving low-income, ethnically diverse families in Miami-Dade County. PARTICIPANTS: Intervention CCC received (1) teachers/parents/children curriculum, (2) snack, beverage, physical activity, and screen time policies, and (3) menu modifications. RESULTS: Two-year EPAO nutrition score changes in intervention CCC were almost twice that of control CCC. The EPAO physical activity environment scores only slightly improved in intervention CCC v. control CCC. Intervention CCC showed higher combined EPAO physical activity and nutrition scores compared to control CCC over the 2-year study period (ß = 0·09, P = 0·05). CONCLUSIONS: Obesity prevention programmes can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCC may need consistent support to improve the physical activity environment to ensure the policies remain intact.

An Implementation Approach Comparison of a Child Care Center-Based Obesity Prevention Program.

OBJECTIVE: To compare the effectiveness of the Healthy Caregivers-Healthy Children (HC2) phase 1 (2011-2014) and 2 (2015-2018) child care center (CCC)-based obesity prevention intervention(s) on child dietary practices and body mass index percentile (PBMI) outcomes over 2 years. Phase 1 was implemented via a university-based research team, and phase 2 was delivered via a train-the-trainers approach (university-based research team trains preschool-based coaches, who in turn train CCC teachers to implement and disseminate HC2). METHODS: Phase 1 and 2 were both cluster randomized controlled trials of the HC2 obesity prevention intervention. Phase 1 was composed of 1224 children in 28 CCCs (12 intervention and 16 control). Phase 2 was composed of 825 children in 24 CCCs (12 intervention and 12 control). Both phases included CCCs serving low-resource, predominantly ethnic minority families. RESULTS: The mean rate of weekly fruit consumption significantly increased (ß = 0.16, p = 0.001) in phase 1, whereas vegetable intake significantly increased (ß = 0.16, p = 0.002) in phase 2 intervention CCCs. Fried (ß = -0.36, p < 0.001), fast (ß = -0.16, p = 0.001), and other unhealthy food (ß = -0.57, p < 0.001) consumption significantly decreased in phase 1 only. The mean rate of snack food consumption significantly decreased in phase 2 (ß = -0.97, p < 0.001). Mean child PBMI remained in the healthy range over 2 years for all groups in both study phases. CONCLUSION: A university-based research team implementation and dissemination approach seemed to be more effective than a train-the-trainers implementation method in improving dietary intake patterns. This finding suggests that CCCs may need robust educational support beyond their existing internal resources for long-term positive dietary intake pattern changes.

Utilizing the RE-AIM framework to determine effectiveness of a preschool intervention program on social-emotional outcomes.

Social-emotional issues in preschoolers continue to be an area of concern across the nation. Models to determine effective implementation practices are needed. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework is one model that can be used to evaluate program implementation in preschool settings. The Jump Start program provided short-term intervention to children in low-income preschools from multiethnic backgrounds. The goal was to promote prosocial behaviors while minimizing problem behaviors. Various evidenced-based practices (i.e., I Can Problem Solve, play therapy, Pyramid Model) were utilized. 305 children from 73 childcare centers participated in the program. The majority of participants were from ethnic minority backgrounds and resided in high-poverty areas of the county. The RE-AIM framework was utilized to determine program outcomes. Results showed successes on each level of RE-AIM with an at-risk population. The Jump Start program significantly increased positive behaviors and decreased challenging behaviors in preschool-aged children. Results indicated medium to large effect sizes. One year following program participation, the majority of children who participated in the program were at decreased risk of special education services and expulsion.

Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies.

OBJECTIVE: Despite the high prevalence of obesity among preschool-aged children, most states lack childcare center (CCC) nutrition and physical activity policies. The Healthy Caregivers, Healthy Children (HC) Phase 2 project is examining the relationship between the CCC nutrition and physical activity environment and child dietary intake/physical activity patterns and body mass index (BMI). PARTICIPANTS: A total of 24 "Quality Counts" (Miami Dade County, Florida's Quality Rating Improvement System [QRIS)]) CCCs serving low resource families with ≥50 2-to-5year olds attending have been randomized to either intervention (n=12) or control (n=12). INTERVENTION: The HC2 intervention arm CCCs receive implementation of a daily curricula for (1) teachers/parents; (2) children; (3) snack, beverage, physical activity, and screen time policies; and (4) technical assistance with menu modifications. Control arm schools receive an attention control safety curriculum. HC2 is delivered once a month in year 1, quarterly in year 2 and will be disseminated throughout the Quality Counts network in year 3. MAIN OUTCOME MEASURES: Primary outcome measures include the Environment and Policy Assessment and Observation tool (EPAO), standardized dietary intake and physical activity patterns surveys, and child BMI. The 'Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)' framework will guide the interpretation of outcome measures. CONCLUSIONS: CCCs are in need of evidence-based standardized nutrition and physical activity policies. The intersection of RE-AIM and early childhood obesity prevention in the childcare setting could generate robust and new information to the field about potential barriers, facilitators, adoption, and sustainability in this setting.

Cultural Competence

In this editorial the author describes the essential nature and characteristics of cultural competence (AU)

En esta editorial la autora describe la naturaleza esencial y las características de la competencia cultural (AU)

Neste editorial, o autor descreve a natureza e as características da competência cultural essencial (AU)

The physical, social and psychological impact of priapism on adult males with sickle cell disorder.

Priapism is defined as prolonged and painful penile erection that does not subside on orgasm. It is considered to be a urological emergency. However, patients do not always seek prompt medical help. The incidence of priapism is increased by sickle cell disease, where it is a complication of the characteristic sickling of the red blood cells. Little is known about the psychological or social implications of this complication or the strategies that sickle cell patients use to manage it. A qualitative study was carried out in order to investigate these topics. Semi-structured interviews were carried out with adult male patients of the Sickle Cell and Thalassaemia Centre in Birmingham in the UK who experienced priapism. These were subsequently analysed using grounded theory. Ten themes were elicited: first occurrence of priapism, pain, precipitants, emotional consequences, self-management, experience of hospital, impact on work and social life, impact on sexual relationships, erectile dysfunction, and disclosure. The dominant experiences were ones of despair, embarrassment, and isolation. Participants described finding it difficult to disclose priapism, with the result that it was often unreported until late in its course. Attempts to manage priapism at home varied, with there being little consensus on their efficacy. The results are discussed with respect to the healthcare services that cater for these patients.

Cultural Diversity in Health and Illness.

The purpose of this article is to describe the theoretical models that underlie the book Cultural Diversity in Health and Illness. The book's internal structure; functional structure; conceptual relationships; scope; knowledge antecedents; applications to theory, research, and practice; and areas for further development are discussed.