Addressing Neurocognitive Disorders, Dementias, and Alzheimer’s Disease in Colonias of the Lower Rio Grande Valley: Establishing a Research Foundation Using Promotores

Several Texas communities along the Mexican border, including the Lower Rio Grande Valley (LRGV), are home to low-income Hispanic populations, many of whom live in underserved communities known as colonias. These areas have high incidences of neurocognitive disorders, dementia, and Alzheimer’s disease (AD); health care strategies that are culturally and linguistically appropriate for the area are needed. We aim to build capacity to reduce risk, facilitate treatment, and provide caregiver support for affected individuals. However, gaining trust of communities and presenting information about research studies in a way that is culturally appropriate is critical for engagement of underserved communities. This brief report examines our work with local community health workers (CHWs), promotores in Spanish, to establish contact with, engage, mobilize, and educate the Hispanic communities of the LGRV. Lessons from the successful experience of training promotores in autism spectrum disorder in the LRGV highlight the importance of specifically addressing outreach in health fairs, clinic vists and referral as well as adequate selection, training, management, and support of the promotores as critical aspects. To initiate and sustain recruitment of older adults and care partners in research studies of AD and other dementias in the RGV, we have incorporated these aspects as components of the promotores training and engagement model, which has been developed and implemented by researchers and their colleagues at the School of Medicine at the University of Texas Rio Grande Valley

Implementation of a Training Module on Alcohol Prevention for Promotoras on a Border Community in the Rio Grande Valley.

Background: Complications due to unhealthy alcohol use are widely spread, and there is a significant unmet need for prevention and treatment in the community. The South Texas-Mexico border region consists of over ninety percent of Hispanics and suffers from a significant shortage of physicians. Alcohol-related problems are highly unrecognized and untreated in this large Hispanic population due to the shortage of healthcare providers, low education levels, and limited trust in the health care system. Prevention efforts should be designed to prevent or reduce the risk of developing alcohol addiction. Methods: The proposed module focuses on enhancing the Promotoras or Community Health Worker (CHW) ability to screen and recognize unhealthy alcohol use and the need for referral for care. We use a survey to follow and record the experience of a subset of these Promotoras who will educate Hispanic families from their communities. Results: This module provides data that will significantly contribute to our understanding of the barriers in knowledge, access to services, and care for people with alcohol problems. The study consists of a train-the-trainer module designed by the Institute of Neuroscience at the University of Texas Rio Grande Valley (UTRGV) specifically for Promotoras. CHW aimed at increasing their knowledge concerning general health practices among ethnic minorities, specifically in terms of alcohol abuse prevention. The initial workshop trained 44 Promotoras from Cameron and Hidalgo counties. Each Promotora was assessed using pre-and post-test questionnaires. Conclusions: The research team assessed Promotora\u27s alcohol knowledge and prevention strategies with plotted data. In summary, the study provided a measurable unit of our training module in enhancing understanding of screening and the need for intervention for alcohol-related problems by Community Health Workers

Critical reflection in practice: Generating Knowledge from the Interactions with Promotores for Engagement in Neurocognitive Disorders

Background: Colonias are underserved areas along the Texas-Mexico border, with high incidences of neurocognitive disorders, dementia, and Alzheimer\u27s disease (AD). Our goal is to build capacity to reduce risk, facilitate treatment for affected individuals, and provide caregiver support. Our aim was to construct an approach that was reflective and would reveal the rich and diverse ways in which people make meaning of their experiences and interactions with scientists, faculty, staff and students. Methods: We examined our work with local community health workers. (CHWs), promotores in Spanish, to establish contact with, engage, mobilize, and educate the Hispanic communities of the Lower Rio Grande Valley (LRGV). Qualitative research methods were the principal way to approach this aim, including critical reflection. Results: We now have 347 certified promotores in LRGV: 174 in Cameron County, 169 in Hidalgo County, 3 in Starr County, and 1 in Willacy County. Most of the promotores in LRGV are female, Spanish-speakers (98%) although half of them are also fluent in English and more than half of the promotores have five years or more as a state-certified CHW. Assumptions about knowledge, power and reflexivity surfaced in the interactions with members of the academic world interacting with Colonia’s residents. Conclusions: Aspects of critical reflection, including deconstructing assumptions about knowledge, power and reflexivity, are useful to guide actions that facilitate capacity building in the Colonias, as well as action research methodology. The LRGV population’s characteristics make early detection of AD and dementia and support for patients and caregivers’ high priorities and clearly understanding the role of promotores as mediators is important

Modèles de conception et d'exécution pour la médiation et l'intégration de services

Les systèmes logiciels s'orientent vers des environnements de plus en plus hétérogènes et dynamiques. Cette évolution est induite par différents facteurs : explosion des dispositifs embarqués avec de fortes capacités de calcul, adoption rapide des services distants fournis par des tiers, mobilité des usagers et évolution du contexte associé, etc. Ces facteurs ouvrent de grandes possibilités pour la construction de nouveaux services numériques dans des domaines aussi divers que la santé, le divertissement, la domotique, ou encore le transport. Ces nouveaux domaines d'applications demandent la mise en œuvre des opérations d'intégration dans des contextes dynamiques et hétérogènes. Il est aujourd'hui admis que les approches à services facilitent l'intégration logicielle par la définition de protocoles standard de découverte et de liaison. La problématique d'intégration, au sens médiation, reste néanmoins entière. Le problème principal abordé par cette thèse est l'intégration de services dans des contextes hétérogènes et dynamiques. Plus précisément, nous avons conçu un modèle à composant spécifique à l'intégration logicielle, nommé CILIA. Ce modèle repose sur des composants, appelés médiateurs, et sur un langage d'assemblage de ces médiateurs. CILIA reprend les grands principes du Génie Logiciel tels que l'abstraction, la séparation de préoccupations et la modularité, et s'appuie sur des patrons d'intégration bien connus (Enterprise Integration Patterns). CILIA est implanté sous la forme d'un framework dynamique qui permet la mise à jour à l'exécution des solutions d'intégration. Ce framework CILIA est pleinement opérationnel et disponible en open source. Il est utilisé dans plusieurs projets collaboratifs.Software systems are moving toward highly dynamic and heterogeneous environments. This dynamism is derived by several factors: the massive arrival of embedded devices with computing capabilities, the rapid adoption of newer distributed services provided by third parties, the user mobility and the constantly changing context, etc. These factors open up great opportunities for the construction of new and innovative services on several application domains, such as health-care systems, entertainment systems, home automation systems, transportation or traceability systems. These new application areas require the implementation of integration operations in dynamic and heterogeneous environments. It is well known that service-oriented computing eases the implementation of integrating systems by defining standard protocols to perform the discovery and the binding. However, some interoperability concerns, such as mediating, have been still unresolved. In this work we address the integration concern of service integration in dynamic and highly evolving environments. Specifically, we have developed an integration-specific component model called CILIA. This model is based on components, called mediators, and its assembly language. CILIA respects software engineering principles such as abstraction, separation of concerns, modularity, and anticipation of change and also it is influenced by the well-known enterprise integration patterns (EIP). CILIA has been developed as a dynamic framework that allows us to perform dynamic modifications at run-time on the integrated solutions. This framework is entirely developed and operational. It is available as an open source project and has been used by several collaborative projects.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF

An innovative model using Promotores or Community Health Workers for home based dementia care

Background: Health disparities and issues with trust building and relationship building are prominent in Hispanic and underserved populations in south Texas. Community health workers can play a bridging role with underserved communities and may be essential in improving the quality and value of health care. The Texas Health and Human Services Commission certifies the training Community Health Workers under the label of “promotores”. Method: Community health workers were integrated into the primary health care team to serve as a bridge between patient/caregiver dyads and the health care team. Result: Community health workers (CHWs) connected patients to social determinants of health resources such as transportation, food pantries and/or social benefits, Medicaid services, and home care provider services. Caregiver education and resources for respite care, caregiver support in person and virtually. Additionally, CHW\u27s provided education on dementia care resources, caregiver support, recruiting and engaging Hispanic underserve participants in research. Our team was able to increase home visits by 229% to homebound patients throughout several underserved zip codes in Bexar County. This is a success as our team was able to increase health care access to persons with dementia that are homebound that may have not been seen by a healthcare provider until they required emergency care. In fact, we saw roughly 11% decrease of inpatient admissions between 2021 and 2022. Conclusion: Trust and familiarity allows the promotores to easily communicate interventions with cultural sensitivity and experiential knowledge of community values, leading to foster rapport with patients and families. The rapport and trust developed with the patients also helped to engage, and recruit Hispanic and underserved participants for research in dementia

Understanding the resources, barriers, facilitators and interests about aging and dementia research of community members from the Rio Grande Valley

Background: One of ten people aged 65 develops Alzheimer’s Disease and it is one of the sixth-leading cause of death in the United States. The Rio Grande Valley (RGV) is mostly constituted by Hispanic/Latinos (93%), a population that has a 1.5X increased risk of AD onset. Nevertheless, there are not enough resources to support people living with dementia and their care partners. This study will leverage research efforts deployed by the RGV Alzheimer’s Disease Resource Center for Minority Aging Research to understand the social representations about the resources, barriers, facilitators, and interests of the RGV community about dementia and Alzheimer’s Disease research. Methods: Four focus groups were conducted online via Zoom on April 2022 with a total of 15 participants (people living with dementia, caregivers, and community leaders from the RGV). Interactions occurred at their preferred language, mostly in Spanish and the discussion was based on six semi-structured questions about aging and dementia research. Focus groups were translated to English and analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Community health workers (promotoras) are one of the most important resources and facilitators in the Valley due to their deep knowledge of the dynamics of the community. The main barrier for dementia and aging research is the lack of information, which leads to fear, and stigmas and ultimately keeping target communities away from the resources. Focus groups served also as a channel of communication. After conducting the focus groups, some of the participants went from being unaware of the presence of Alzheimer’s disease and dementia research in the Valley to deciding about acting toward their prevention and participating in the research. Conclusions: The information collected during the focus groups will be used to strengthen community engagement strategies and to support the design and implementation of health disparities frameworks to facilitate tailoring of our strategies to maximize the impact of the resources developed to be used in the communities of the RGV

Alzheimer’s Disease Studies in the Tex-Mex Border: Dissecting a Complex Multifactorial Problem

Purpose: Alzheimer’s Disease (ALZ) is the leading cause of dementia in the aging population, and Latinos have \u3e3 times higher risk to develop dementia than the overall US population. Although several studies have examined for possible causes of this increased risk, lack of comprehensive information plus a reduced number of Latino samples available in each study have hindered the answers. Description: The University of Texas Rio Grande Valley has joined two large studies looking for multiple biomarkers associated with ALZ: The South Texas Alzheimer’s Center Clinical Data Repository and Biobank (STAC) and the Texas Alzheimer’s Research and Care Consortium (TARCC). We are now collecting clinical data along with neuroimaging and lab biomarkers from each individual enrolled in these studies, with the aim to enroll a large majority of Latinos in our site sample, which will help to elucidate the differences and risk factors inherent to our population in the border. We are also analyzing data from different Latin-American studies to study specific genetic risks, environmental factors, and their interactions. Partners: UTRGV has partnered with UTHSCSA for the STAC study and with many other academic research institutions at TARCC. We aim to provide experiences of clinical training to our psychology students and residents of medical specialties, as well as analysis opportunities and opening postdoctoral positions related to the development of this field at UTRGV. Looking Ahead: We expect to generate substantial contributions to the knowledge of cognitive decline in underserved populations, which can lead to improved treatments and better clinical care. Postdoctoral positions will be opening soon at the Institute of Neuroscience

Architectural Features of Streetscapes and Aging in Cameron County, Texas: Preliminary Results

The impact of architectural features in urban settings reveals priorities for its residents and the integration of social and natural environments. It has been estimated that 23% of global deaths to the environments in which people live. We aim to characterize the most prevalent architectural features of Cameron County, Texas streetscapes and analyze their role in health promotion and healthy aging

The 2022 symposium on dementia and brain aging in low‐ and middle‐income countries: Highlights on research, diagnosis, care, and impact

Two of every three persons living with dementia reside in low‐ and middle‐income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high‐income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC‐focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. Highlights: Two‐thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs

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