Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic.

PURPOSE: Methods for assessing the structural mechanisms of health inequity are not well established. This study applies a phased approach to modeling racial, occupational, and rural disparities on the county level. METHODS: Rural counties with disparately high rates of COVID-19 incidence or mortality were randomly paired with in-state control counties with the same rural-urban continuum code. Analysis was restricted to the first six months of the pandemic to represent the baseline structural reserves for each county and reduce biases related to the disruption of these reserves over time. Conditional logistic regression was applied in two phases-first, to examine the demographic distribution of disparities and then, to examine the relationships between these disparities and county-level social and structural reserves. RESULTS: In over 200 rural county pairs (205 for incidence, 209 for mortality), disparities were associated with structural variables representing economic factors, healthcare infrastructure, and local industry. Modeling results were sensitive to assumptions about the relationships between race and other social and structural variables measured at the county level, particularly in models intended to reflect effect modification or mediation. CONCLUSIONS: Multivariable modeling of health disparities should reflect the social and structural mechanisms of inequity and anticipate interventions that can advance equity.

Slow and steady hurts the crab: Effects of chronic and acute microplastic exposures on a filter feeder crab.

Microplastics are a widespread environmental contaminant. Although detrimental effects on aquatic organisms are well documented, little is known about the long-term effects of microplastic exposure to filter-feeding organisms at ecologically realistic levels. This study investigates the effects of environmentally relevant concentrations of polyethylene micro beads ranging in size from 3 to 30 µm, on the physiology and energetics of a coastal filter-feeding crab Petrolisthes laevigatus. We evaluated the impact of microplastics by exposing P. laevigatus to two different concentrations and exposure times: i) a chronic exposure for five months at 250 particles L-1, and ii) an acute exposure for 48 h at 20,800 particles L-1, ~80 times higher than the chronic exposure. The results showed that only chronic exposures elicited negative effects on the coastal crab in both, metabolic and physiological parameters. Our findings demonstrate a strong correlation between the ingestion rate and weight loss, even at low concentrations, the crabs exhibited severe nutritional damage as a result of long-term microplastic exposure. By contrast, acute exposure revealed no significant effects to the crabs, a possible explanation for this being short-term compensatory responses. These results suggest that environmentally relevant concentrations of microplastics are harmful to marine organisms, and they should be evaluated during realistic temporal scales, as their effects strongly dependent on the exposure time. Our results also suggest that the effects of microplastics have been likely underestimated to date, due to the dominance of short-term exposures (acute) reported in the current literature.

Office of Diversity, Equity, and Inclusion: Engagement and Leadership Opportunities for Trainees.

Introduction: To achieve a healthier future for all, improving diversity through efforts such as diversifying faculty and leadership in academic medicine is imperative. Therefore, medical trainees (medical students, residents, fellows) from groups underrepresented in medicine (UiM) are encouraged to pursue academic careers and have opportunities to gain faculty leadership skills during their training. Trainees also need exposure to the leadership positions within various offices of an academic institution such as the Office of Diversity, Equity, and Inclusion (DEI). The goal of this module is to expose UiM trainees to the Office of DEI and leadership competencies that can be obtained via service and leadership opportunities with it. Methods: The Kern model was used in the development, implementation, and evaluation of this 75-minute workshop. The workshop consisted of a PowerPoint presentation, reflection exercises, and case discussion to raise trainees' awareness of the Office of DEI and opportunities to become engaged with and develop faculty leadership competencies through the office. Results: Sixty-six diverse learners across three sites completed pre- and postworkshop surveys. Ninety-five percent of participants agreed or strongly agreed that the learning objectives of the workshop had been met. Discussion: Overall, this interactive workshop facilitated learners' awareness of the responsibilities of the Office of DEI and opportunities for learners to develop faculty leadership competencies through engagement. Although primarily evaluated among medical students, the module can be of use to learners and faculty of other health professions programs with an Office of DEI.

Beneficios del rol de enfermería en salud escolar, implementación a nivel internacional. Revisión sistemática / Benefits of the nursing role in school health, implementation at international level. Systematic review

La salud escolar en Chile se desarrolla a nivel de la Atención Primaria en salud a cargo de los profesionales de enfermería, quienes por su rol deben velar por el bienestar integral de la comunidad escolar, fortaleciendo conductas de autocuidado y hábitos saludables a través de la promoción y prevención e investigación en salud. OBJETIVO: Analizar los beneficios del rol de enfermería en salud escolar desde el punto de vista político y social en países en que ha sido legalmente implementada a nivel internacional. MÉTODOS: Se realizó una revisión sistemática de la literatura científica en bases de datos (Scielo, Pubmed, Scopus, Sciencedirect, Oxford, Web of Science). Se utilizó el flujograma PRISMA. La calidad metodológica consideró los criterios de alto, medio y bajo cumplimiento de 46 indicadores de una pauta de lectura crítica. RESULTADOS: Se identificaron 32 artículos en los últimos 5 años. Las líneas temáticas encontradas fueron las políticas públicas en salud escolar, destacando países como EEUU, España y México con regulación sobre la Enfermera escolar, en cambio en Latinoamérica, existe una regulación parcial o carencia como en Chile. Las competencias y acciones del profesional de enfermería en establecimientos educacionales tienen como prioridad la promoción de la salud y la educación a la comunidad escolar. Se evidencia que las consultas que atiende la enfermera escolar son de urgencia y son variables según la zona geográfica. CONCLUSIONES: La implementación legal del rol de enfermería escolar ofrece ventajas significativas para la mejora del sistema sanitario del país, incrementando la calidad asistencial y mejorando el acceso a salud.

Chilean school health is developed at the level of Primary Health Care in charge of nursing professionals, who for their role must ensure the comprehensive well-being of the school community, strengthening self-care behaviors and healthy habits through promotion and prevention and health research. OBJECTIVE: To analyze the benefits of the nursing role in school health from the political and social point of view in countries where it has been legally implemented internationally. METHODS: A systematic review of the scientific literature in databases (Scielo, Pubmed, Scopus, Sciencedirect, Oxford, Web of Science) was carried out. The PRISMA flow chart was used. The methodological quality considered the criteria of high, medium and low compliance with 46 indicators of a critical reading pattern. RESULTS: 32 articles were identified in the last 5 years. The thematic lines found were public policies in school health, highlighting countries such as the US, Spain and Mexico with regulations on school nurses, on the other hand in Latin America, there is a partial regulation or lack as in Chile. The competences and actions of the nursing professional in educational establishments have as a priority the promotion of health and education to the school community. It is evident that the consultations attended by the school nurse are urgent and vary according to the geographical area. CONCLUSIONS: The legal implementation of the role of school nursing offers significant advantages for the improvement of the country's health system, increasing the quality of care and improving access to health.

Age dependent physiological tolerances explain population dynamics and distribution in the intertidal zone: A study with porcelain crabs.

Population dynamics and their response to environmental stressors have been widely studied in intertidal organisms. However, how these dynamics and responses change with animal age have been largely ignored to date. Traditionally, it is assumed that younger organisms are more sensitive than adults to environmental stressors; under this perspective it could be predicted that fully grown organisms should be able to occupy the harsh upper limit of their intertidal habitat. However, in some intertidal Porcelain crabs the opposite distribution has been observed. Using Petrolisthes laevigatus, we tested the physiological tolerance of crabs of different sizes (i.e. age) and evaluated how this trait shapes population dynamics (distribution and small-scale migrations under different weather conditions). We determined the abundance and size distribution of P. laevigatus at the middle and upper intertidal levels during sunny and rainy days, finding that abundances decreased drastically and size distribution shifted to smaller individuals on rainy days. In the laboratory, survival and behavioural responses of individuals in water at 5, 10, 15 and 33 PSU salinities were evaluated. Young crabs were found in higher proportion in the upper intertidal while fully grown crabs (i.e. adults) mainly occupied the middle intertidal zone. Young crabs had a higher osmoregulatory capacity than adults, as they were better at regulating passive water uptake when challenged with diluted seawater. This was also correlated with a lower lethal salinity LC50 in young crabs compared to adults. Behavioural trials showed that young crabs performed better escaping in both water and air, at intermediate and reduced salinities than adults. Therefore, weather influences small scale migrations from the upper to the lower intertidal zone, and this migration is also age-dependent, with younger crabs being more tolerant to low salinities and therefore allowing them to remain in the upper intertidal zone during raniny days.

Ocean acidification and pathogen exposure modulate the immune response of the edible mussel Mytilus chilensis.

Ocean acidification (OA) is one of the main consequences of increasing atmospheric carbon dioxide (CO2), impacting key biological processes of marine organisms such as development, growth and immune response. However, there are scarce studies on the influence of OA on marine invertebrates' ability to cope with pathogens. This study evaluated the single and combined effects of OA and bacterial infection on the transcription expression of genes related to antioxidant system, antimicrobial peptides and pattern recognition receptors in the edible mussel Mytilus chilensis. Individuals of M. chilensis were exposed during 60 days at two concentrations of pCO2 (550 and 1200 µatm) representing respectively current and future scenario of OA and were then injected with the pathogenic bacterium Vibrio anguillarum. Results evidenced an immunomodulation following the OA exposure with an up-regulation of C-type Lectin and Mytilin B and a down-regulation of Myticin A and PGRP. This immunomodulation pattern is partially counteracted after challenge with V. anguillarum with a down-regulation of the C-type lectin and Mytilin B and the up-regulation of Myticin A. In turn, these results evidence that pCO2-driven OA scenarios might triggers specific immune-related genes at early stages of infection, promoting the transcription of antimicrobial peptides and patterns recognition receptors. This study provides new evidence of how the immune response of bivalves is modulated by higher CO2 conditions in the ocean, as well one factor for the resilience of marine population upon global change scenarios.

Iron homeostasis during risperidone treatment in children and adolescents.

OBJECTIVE: Previous cross-sectional evidence has linked antipsychotic-related weight gain to reduced body iron concentration. Using longitudinal data, we examined the association between changes in weight following risperidone initiation or discontinuation and ferritin concentration. METHOD: Study 1: Between April 2004 and September 2007, participants were enrolled from outpatient settings in a prospective randomized clinical trial comparing the efficacy of risperidone monotherapy to the combination of risperidone and behavior therapy in targeting disruptive behavior in 4- to 13-year-old children with DSM-IV-TR-based autism spectrum disorder. Study 2: Medically healthy 7- to 17-year-old participants in long-term open-label risperidone treatment at study entry returned for follow-up 1.5 years later, between July 2007 and July 2011. Available blood samples were used to measure ferritin. Linear multivariable regression analysis tested the association between ferritin concentration and change in age-sex-specific body mass index (BMI) z score between study entry and endpoint, adjusting for relevant confounders. RESULTS: Study 1 sample consisted of 73 participants (85% males, mean age: 7.7 ± 2.4 years). After 18.0 ± 2.0 weeks on risperidone, their BMI z score increased by 0.93 ± 0.70 points and ferritin concentration declined by 6.8 ± 13.3 µg/L. After adjusting for age and sex, change in BMI z score was inversely correlated with percent change in ferritin concentration (ß = -18.3, P < .003). Study 2 participants had all been receiving risperidone at study entry. At follow-up, 1.5 ± 0.3 years later, risperidone was discontinued in 26 of the 96 who were included in the analysis. Neither change in BMI z score nor in ferritin concentration was different between those who continued versus discontinued risperidone. However, a reduction in BMI z score between study entry and follow-up was associated with higher ferritin concentration at follow-up in participants who discontinued risperidone compared to those who continued it (P = .01). CONCLUSIONS: Risperidone-related weight gain is associated with a reduction in body iron reserves, which appears to improve with weight loss following risperidone discontinuation. Preliminary evidence suggests that risperidone may also directly inhibit iron absorption. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00080145.

Frecuencia de DNA-HPV-HR por método automatizado PCR (COBAS®) en muestras cervicouterinas de una población en Proboquilla-Cartagena, Colombia / COBAS® automated PCR – based detection of HR-HPV DNA in cervix samples collected among a population in Proboquilla-Cartagena, Colombia

Determinar ADN-HPV-HR por método automatizado PCR (cobas®) en muestras cervicouterinas de una población en Proboquilla, Cartagena, Colombia. Métodos: serie de casos de mujeres que asistieron a la campaña donde se tomó citología convencional y una segunda muestra en un vial para determinar DNA del HPV-HR mediante la reacción en cadena de la polimerasa (PCR). Resultados: se recolectaron 31 muestras de citología cérvico-uterina, la prueba PCR fue positiva en seis; 4 casos con infección simple y 2 con infección múltiple. Una de estas últimas fue positiva para los tres grupos (HR-HPV, HPV-16, HPV-18)y la otra para dos (HR-HPV y HPV-18). Conclusión: se detectó un grupo de mujeres infectadas por HPVs clasificados de alto riesgo, con infección simple y múltiple, que fueron remitidas a ginecología. Se confirmó la infección por HPV-HR en 5:7 resultados de citología clasificados como ASC-US...

To determine HR-HPV DNA detection using the Cobas® PCR automated method in cervix samples collectedamong women of Proboquilla, Cartagena, Colombia. Methods: case series based on conventional cytology and second samples, in a vial, through polymerase chain reaction (PCR) testing for HR-HPV DNA detection, among women who attended the campaign. Results: we collected 31 cervix cytology samples, PCR test was positive in six; 4 cases had asimple infection and 2 a multiple infection. One of the latter was positive for the three types (HR-HPV, HPV-16, HPV-18) and the other for two (HR-HPV and HPV-18). Conclusion: high risk HPV infection as well as simple and multipleinfections were identified in a group of women and were referred to the gynecology department. HR-HPV infectionwas confirmed in 5:7 ASC-US cytology results...

759C/T Variants of the Serotonin (5-HT2C) Receptor Gene and Weight Gain in Children and Adolescents in Long-Term Risperidone Treatment.

BACKGROUND: Great inter-individual variability exists in the susceptibility to gain weight during antipsychotic treatment. Thus, we examined whether the -759C/T variants in the promoter region of the 5HT2C receptor gene were differentially associated with weight gain in children and adolescents in long-term risperidone treatment. METHODS: Medically healthy 7 to 17 year-olds, treated with risperidone for ≥ six months, were enrolled. Anthropometric measurements, laboratory tests, and treatment history were obtained upon enrollment and from medical records. The effect of the genotype on the trajectory of age-sex-adjusted weight and body mass index (BMI) z scores before and after the onset of risperidone treatment was investigated. RESULTS: In 124 subjects (90% males, mean age: 11.8 years) treated with risperidone for a mean of 2.8 years, weight and BMI z scores significantly increased after starting risperidone. This change was similar across the two genotype groups as were changes in several cardiometabolic variables. CONCLUSION: In contrast to other reports, the T allele failed to confer protection against excessive weight gain or cardiometabolic abnormalities in this group of children and adolescents chronically treated with risperidone.