Clinical and Sociodemographic Factors Associated with Telemedicine Engagement in an Urban Community Health Center Cohort During the COVID-19 Pandemic.

Objective: To examine chronic diseases, clinical factors, and sociodemographic characteristics associated with telemedicine utilization among a safety-net population. Materials and Methods: We conducted a retrospective cohort study of adults seeking care in an urban, multisite community health center in the Northeast United States. We included adults with ≥1 outpatient in-person visit during the pre-COVID-19 period (March 1, 2019-February 29, 2020) and ≥1 outpatient visit (in-person or telemedicine) during the COVID-19 period (March 1, 2020-February 29, 2021). Multivariable logistic regression models estimated associations between clinical and sociodemographic factors and telemedicine use, classified as "any" (≥1 visit) and "high" (≥3 visits). Results: Among 5,793 patients who met inclusion criteria, 4,687 (80.9%) had any (≥1) telemedicine visit and 1,053 (18.2%) had high (≥3) telemedicine visits during the COVID-19 period. Older age and Medicare coverage were associated with having any telemedicine use. Older and White patients were more likely to have high telemedicine use. Uninsured patients were less likely to have high telemedicine use. Patients with increased health care utilization in the pre-COVID-19 period and those with hypertension, diabetes, substance use disorders, and depression were more likely to have high telemedicine engagement. Discussion: Chronic conditions, older patients, and White patients compared with Latinx patients, were associated with high telemedicine engagement after adjusting for prior health care utilization. Conclusion: Equity-focused approaches to telemedicine clinical strategies are needed for safety-net populations. Community health centers can adopt disease-specific telemedicine strategies with high patient engagement.

Formación de almidón retrogradado relacionado a niveles de amilosa en el almidón de papa (Solanum tuberosum) y chuño / Retrograded starch formation dependent on amylose level of potatoe starch (Solanum tuberosum) and chuño

INTRODUCCIÓN: la papa es el tubérculo más importante producido a nivel mundial como producto alimenticio. Una de las formas ancestrales de conservación de la papa en los países andinos es la obtención de un producto llamado chuño, obtenido a partir de las denominadas papas amargas. Existen pocos datos respecto a la composición química y nutricional del chuño y sobre los cambios producidos en el almidón durante su elaboración en el proceso de congelado-secado en condiciones específicas de temperatura y exposición a rayos ultravioleta. OBJETIVO: el objetivo del trabajo fue realizar una revisión bibliográfica respecto a cambios producidos en la relación de amilosa y amilopectina, la composición de almidón aislado de papa y la modificación de las características de este almidón en el proceso de elaboración de chuño. METODOLOGÍA: La revisión bibliográfica se ha realizado con la recopilación de tres fuentes referenciales de estudios realizados sobre el chuño y su proceso de elaboración, artículos sobre la estructura del almidón de papa y otros tubérculos del mismo género, artículos de otros productos alimenticios del Altiplano boliviano y peruano, y finalmente la influencia de los cambios de la estructura del almidón en el incremento de la formación de almidón retrogradado. RESULTADOS: la revisión bibliográfica realizada, señala que el proceso de elaboración de chuño eleva el porcentaje de amilosa en el contenido total de almidón, lo cual está relacionado a procesos de exposición a radiación UV y a cambios de temperaturas muy drásticos, que van entre -13,5 ºC y 16 ºC. Este proceso llevaría a la activación de enzimas, como amilasas, para la catálisis de reacciones de ruptura de enlaces como principal ruta del proceso; sin embargo, se podrían evaluar otras causas. CONCLUSIONES: el mayor porcentaje de amilosa permitiría la obtención de altos porcentajes de almidón retrogradado.

INTRODUCTION: the potato is the most important tuber produced worldwide as a food product. One of the ancestral ways of preserving pootatoes in the Andean countries is a product called chuño (traditional Andean freeze and sun-dried potato), obtained from the so-called bitter potatoes. There are few data regarding the chemical and nutritional composition of chuño and the changes produced in the starch during its preparation in the freeze-drying process under specific conditions of temperature and exposure to ultraviolet rays. OBJECTIVE: the objective of this article was to do a bibliographic review regarding changes produced in the amylose and amylopectin ratio, the composition of isolated potato starch and the modification of the characteristics of this starch in the process of making chuño. METHODOLOGY: the literature review methodology has the compilation of three reference sources of studies carried out on chuño and its production process, articles about the structure of potato starch and other tubers, research on other food products from the Bolivian and Peruvian of Altiplano and finally the influence of the changes in starch structure in relation to the increasing of retrograde starch formation. RESULTS: the results show that the process of making chuño increases the percentage of amylose in the total starch content, which is related to the processes of exposure to UV radiation and very drastic temperature changes, ranging between -13, 5 ºC and 16 ºC. This process would lead to the activation of enzymes, such as amylases, for the catalysis of bond breaking reactions as the main route of the process; however, other causes could be evaluated. CONCLUSIONS: the higher percentage of amylose would allow the obtaining of high percentages of retrograded starch.

Women's preferences for and experiences with prenatal genetic testing decision making: Sociodemographic disparities in preference-concordant decision making.

OBJECTIVE: To investigate women's preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience. METHODS: We conducted a secondary analysis of data from two randomized trials conducted between 2007-2012. Survey items assessed participants' preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes. RESULTS: 56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors. CONCLUSION: Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making. PRACTICE IMPLICATIONS: Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient's backgrounds and desires.

Impacto de la rehabilitación neurológica a través de la terapia de restricción inducida modificada en la mejora del apoyo social en usuarios con ataque cerebro vascular / Impact of neurological rehabilitation through modified constraint induced therapy in improving social support patients with stroke

Introduction: Access to rehabilitation in stroke patients is critical, considering the physical and psychological disabilities and generates social impact involved. Purpose: Evaluate the effectiveness of neurorehabilitation in collective mode, compared to the individual mode, in improving social support among patients with stroke, after application of the constraint induced of movement therapy. Methods: A randomized controlled trial of 36 patients who had a stroke were divided into two intervention groups. The independent variable was the implementation of collective or individual therapy for 3 hours for 10 consecutive days and the dependent variable was social perception evaluated by the Medical Outcomes Study-Social Support Survey (MOS-SSS) at baseline (pre-test) and end (post-test). Results: After controlling the pre-test scores, analysis of covariance revealed significant differences in favor of the collective mode in all post-test social support dimensions. Conclusions: Compared with the individual mode, the collective mode significantly improves several aspects of the patient’s perceived social support, thus providing evidence of its clinical and practical effectiveness.

Introducción: El acceso a rehabilitación en usuarios con ataque cerebro vascular es fundamental, considerando las discapacidades físicas y psicológicas que genera y el impacto social que conlleva. Objetivo: Evaluar la efectividad de la neurorehabilitación en modalidad colectiva, comparada con la modalidad individual, en la mejora del apoyo social en usuarios con ACV, después de la aplicación de la terapia de restricción inducida de movimiento. Método: Se realizó un ensayo clínico aleatorizado con 36 usuarios con ACV divididos en dos grupos de intervención. La variable independiente fue la implementación de la terapia en modalidad colectiva o individual por 3 horas diarias durante 10 días consecutivos y la variable dependiente fue el apoyo social percibido evaluado mediante la Medical Outcomes Study-Social Support Survey (MOS-SSS) antes (pretest) y después (post-test) de la intervención. Resultados: Controlando los puntajes pre-test, análisis de covarianza revelaron diferencias significativas a favor de la modalidad colectiva en todas las dimensiones post-test del apoyo social. Conclusiones: La rehabilitación en modalidad colectiva, en comparación con la modalidad individual, mejora significativamente diversos aspectos del apoyo social percibido del usuario, apoyando así su efectividad clínica y práctica.

Estudio de seguimiento del desgaste profesional en relación con factores organizativos en el personal de enfermería de medicina interna / A survey of the professional weakening in relation with organizational factors in the nursing staff of the internal medicine deparment

El personal de enfermería es uno de los grupos profesionales más afectados por el Síndrome de burnout, debido a la gran cantidad de estresores diarios, inherentes a su profesión, que debe afrontar.El objetivo de este estudio fue analizar comparativamente el grado de estrés profesional y satisfacción laboral en un grupo de profesionales de enfermería de Medicina Interna en el año 1998 y 2005, e intentar analizar si existía relación con factores organizativos de la Institución.En ambos años se distribuyen 107 cuestionarios que incluían el Inventario de Burnout de Maslach (MBI) para medir la incidencia de Burnout y el Cuestionario de Satisfacción Laboral de Warr, Cook y Hall (1979).Se objetivó un descenso del grado de agotamiento emocional y un aumento del grado de realización personal. El grado de satisfacción laboral de los profesionales en ambos años objeto de estudio fue de moderadamente satisfecho.El hecho de disminuir la sobrecarga laboral y mejorar la seguridad en el puesto de trabajo podría influir positivamente en la reducción de la sobrecarga emocional (AU)

Nursing staff is one of the most affected professional groups the burnout syndrome due to the great quantity of everyday stressful factors which are attached to their profession which nurses have to face up to.The aim of this survey was to analyze comparatively the professional stress and labour self-satisfaction in a professional nursing staff of the internal medicine department between 1998 and 200 and to try to analyze if there was any relationship with organizational factors of the institution.107 questionnaires were given out in both years the questionnaires included burnout inventory of Maslach to measure the incidence of burnout and the questionary of laboral self-satisfaction.The result of the survey was a falling-of the emotional exhaustion degree and an increase of the personal fulfilment degree.The degree of personal self-satisfaction of the nursing staff during these two years was moderately satisfied.The fact of decreasing the labour overload and the fact of improving the security in their job could positively have an influence on the lessening of the emotional overload (AU)