Cardiovascular Risk Factors and Dehydroepiandrosterone Sulfate Among Latinos in the Boston Puerto Rican Health Study.

Low blood dehydroepiandrosterone sulfate (DHEAS) levels have strong positive associations with stroke and coronary heart disease. However, it is unclear whether DHEAS is independently associated with cardiovascular risk factors. Therefore, we examined the association between cardiovascular risk factors and DHEAS concentration among a high-risk population of Latinos (Puerto Ricans aged 45 to 75 years at baseline) in a cross-sectional analysis of the Boston Puerto Rican Health Study. Of eligible participants, 72% completed baseline interviews and provided blood samples. Complete data were available for 1355 participants. Associations between cardiovascular risk factors (age, sex, total cholesterol, high-density lipid cholesterol, triglycerides, and glucose) and log-transformed DHEAS (μg/dL) were assessed. In robust multivariable regression analyses, DHEAS was significantly inversely associated with age (β = -12.4; 95% CI: -15.2, -9.7; per 5 years), being female (vs. male) (β = -46; 95% CI: -55.3, -36.6), and plasma triglyceride concentration (β = -0.2; 95% CI: -0.3, -0.1; per 10 mg/dL) and was positively associated with total cholesterol and plasma glucose levels (β = 1.8; 95% CI: 0.6, 3 and β = 0.2; 95% CI: 0.04, 0.3, respectively, per 10 mg/dL) after adjustment for smoking, alcohol, and physical activity and for postmenopausal hormone use in women. Estimates were unchanged after adjustment for measures of chronic disease and inflammation. Women exhibited a stronger age-related decline in DHEAS and a positive association with glucose in contrast to findings among men (P interaction < 0.05). In conclusion, in this large study of Latinos with a heavy cardiovascular risk factor burden, we observed significant associations between cardiovascular disease (CVD) risk factors and DHEAS, with variations by sex. These findings improve our understanding of the role DHEAS may play in CVD etiology

Comparación entre perfil epidemiológico, clínico y costos hospitalarios de pacientes con manejo médico y quirúrgico por embarazo ectópico tubárico no roto, en el Hospital Nacional de la Mujer "Dra. María Isabel Rodríguez", Junio 2012-Junio 2017.

El embarazo ectópico es la implantación de un óvulo fecundado fuera de la cavidad uterina, el cual tiene un abordaje quirúrgico y otro médico, que en ocasiones puede generar inseguridad o temor en los médicos tratantes optar por este último; pero ya existen criterios establecidos para este, los cuales incluye: tamaño de saco gestacional ectópico, concentración sérica de B-hCG y estabilidad hemodinámica; representando un menor costo hospitalario. El Metotrexato es un antagonista del ácido fólico que inhibe síntesis de Novo de purinas y pirimidinas, también interfiere con síntesis de ADN y proliferación celular

County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality.

Background Hispanics are the fastest growing ethnic group in the United States, and little is known about how Hispanic ethnic population density impacts cardiovascular disease ( CVD ) mortality. Methods and Results We examined county-level deaths for Hispanics and non-Hispanic whites from 2003 to 2012 using data from the National Center for Health Statistics' Multiple Cause of Death mortality files. Counties with more than 20 Hispanic deaths (n=715) were included in the analyses. CVD deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10), I00 to I78, and population estimates were calculated using linear interpolation from 2000 and 2010 census data. Multivariate linear regression was used to examine the association of Hispanic ethnic density with Hispanic and non-Hispanic white age-adjusted CVD mortality rates. County-level age-adjusted CVD mortality rates were adjusted for county-level demographic, socioeconomic, and healthcare factors. There were a total of 4 769 040 deaths among Hispanics (n=382 416) and non-Hispanic whites (n=4 386 624). Overall, cardiovascular age-adjusted mortality rates were higher among non-Hispanic whites compared with Hispanics (244.8 versus 189.0 per 100 000). Hispanic density ranged from 1% to 96% in each county. Counties in the highest compared with lowest category of Hispanic density had 60% higher Hispanic mortality (215.3 versus 134.2 per 100 000 population). In linear regression models, after adjusting for county-level demographic, socioeconomic, and healthcare factors, increasing Hispanic ethnic density remained strongly associated with mortality for Hispanics but not for non-Hispanic whites. Conclusions CVD mortality is higher in counties with higher Hispanic ethnic density. County-level characteristics do not fully explain the higher CVD mortality among Hispanics in ethnically concentrated counties

Association of acculturation with cardiac structure and function among Hispanics/Latinos: a cross-sectional analysis of the echocardiographic study of Latinos.

OBJECTIVE:Hispanics/Latinos, the largest immigrant population in the USA, undergo the process of acculturation and have a large burden of heart failure risk. Few studies have examined the association of acculturation on cardiac structure and function. DESIGN:Cross-sectional. SETTING:The Echocardiographic Study of Latinos. PARTICIPANTS:1818 Hispanic adult participants with baseline echocardiographic assessment and acculturation measured by the Short Acculturation Scale, nativity, age at immigration, length of US residence, generational status and language. PRIMARY AND SECONDARY OUTCOME MEASURES:Echocardiographic assessment of left atrial volume index (LAVI), left ventricular mass index (LVMI), early diastolic transmitral inflow and mitral annular velocities. RESULTS:The study population was predominantly Spanish-speaking and foreign-born with mean residence in the US of 22.7 years, mean age of 56.4 years; 50% had hypertension, 28% had diabetes and 44% had a body mass index &gt;30 kg/m2. Multivariable analyses demonstrated higher LAVI with increasing years of US residence. Foreign-born and first-generation participants had higher E/e' but lower LAVI and e' velocities compared with the second generation. Higher acculturation and income &gt;20K were associated with higher LVMI, LAVI and E/e' but lower e' velocities. Preferential Spanish-speakers with an income <20K had a higher E/e'. CONCLUSIONS:Acculturation was associated with abnormal cardiac structure and function, with some effect modification by socioeconomic status

Improving transgender health by building safe clinical environments that promote existing resilience: Results from a qualitative analysis of providers

Background: Transgender (TG) individuals experience discordance between their sex at birth and their gender identity. To better understand the health care needs and characteristics of TG youth that contribute to resilience, we conducted a qualitative study with clinical and non-clinical providers. Methods: In-depth interviews were conducted of providers (n = 11) of TG youth (ages 13–21). Convenience and purposive sampling were used to recruit participants in the Boston area. All interviews were audio-recorded and transcribed verbatim. An interview guide of 14 open-ended questions was used to guide the discussion. A grounded theory approach was utilized to code and analyze the data, including double-coding to address issues of inter-rater reliability. Results: Five primary themes emerged: 1) resilience of TG youth 2) lack of access to services that influence health, 3) the critical role of social support, 4) challenges in navigating the health care system, and 5) the need for trans-affirming competency training for providers and frontline staff. Conclusion: The findings of this study show that providers recognize multiple barriers and challenges in the care of TG youth. However, they also identify the resilience exhibited by many youth. We propose that providers can further enhance the resilience of TG youth and help them flourish by offering them necessary resources via the creation of safe and welcoming clinical environments

Limited English Proficient Patients and Time Spent in Therapeutic Range in a Warfarin Anticoagulation Clinic

Background: While anticoagulation clinics have been shown to deliver tailored, high‐quality care to patients receiving warfarin therapy, communication barriers with limited English proficient (LEP) patients may lead to disparities in anticoagulation outcomes. Methods and Results: We analyzed data on 3770 patients receiving care from the Massachusetts General Hospital Anticoagulation Management Service (AMS) from 2009 to 2010. This included data on international normalized ratio (INR) tests and patient characteristics, including language and whether AMS used a surrogate for primary communication. We calculated percent time in therapeutic range (TTR for INR between 2.0 and 3.0) and time in danger range (TDR for INR 3.5) using the standard Rosendaal interpolation method. There were 241 LEP patients; LEP patients, compared with non‐LEP patients, had a higher number of comorbidities (3.2 versus 2.9 comorbidities, P=0.004), were more frequently uninsured (17.0% versus 4.3%, P<0.001), and less educated (47.7% versus 6.0% ≤high school education, P<0.001). LEP patients compared with non‐LEP patients spent less TTR (71.6% versus 74.0%, P=0.007) and more TDR (12.9% versus 11.3%, P=0.018). In adjusted analyses, LEP patients had lower TTR as compared with non‐LEP patients (OR 1.5, 95% CI [1.1, 2.2]). LEP patients who used a communication surrogate spent less TTR and more TDR. Conclusion: Even within a large anticoagulation clinic with a high average TTR, a small but significant decrease in TTR was observed for LEP patients compared with English speakers. Future studies are warranted to explore how the use of professional interpreters impact TTR for LEP patients

Young Hispanic Women Experience Higher In-Hospital Mortality Following an Acute Myocardial Infarction

Background: Although mortality rates for acute myocardial infarction (AMI) have declined for men and women, prior studies have reported a sex gap in mortality such that younger women were most likely to die after an AMI. Methods and Results: We sought to explore the impact of race and ethnicity on the sex gap in AMI patterns of care and mortality for younger women in a contemporary patient cohort. We constructed multivariable hierarchical logistic regression models to examine trends in AMI hospitalizations, procedures, and in-hospital mortality by sex, age (<65 and ≥65 years), and race/ethnicity (white, black, and Hispanic). Analyses were derived from 194 071 patients who were hospitalized for an AMI with available race and ethnicity data from the 2009–2010 National Inpatient Sample. Hospitalization rates, procedures (coronary angiography, percutaneous coronary interventions, and cardiac bypass surgery), and inpatient mortality were analyzed across age, sex, and race/ethnic groups. There was significant variation in hospitalization rates by age and race/ethnicity. All racial/ethnic groups were less likely to undergo invasive procedures compared with white men (P<0.001). After adjustment for comorbidities, younger Hispanic women experienced higher in-hospital mortality compared with younger white men, with an odds ratio of 1.5 (95% CI 1.2 to 1.9), adjusted for age and comorbidities. Conclusion: We found significant racial and sex disparities in AMI hospitalizations, care patterns, and mortality, with higher in-hospital mortality experienced by younger Hispanic women. Future studies are necessary to explore determinants of these significant racial and sex disparities in outcomes for AMI

Human resources and innovation practices in SMEs for tourist accommodation in Machala, Ecuador: An exploratory study

La complejidad y alto nivel de incertidumbre que generan los cambios que enfrentan las PyMEs de alojamiento para el turismo, exigen cambios en su gestión, donde el capital humano pasa a desempeñar un rol fundamental. El presente estudio centra su interés en analizar las prácticas en la gestión del capital humano como factor estratégico para el desempeño de estas organizaciones. Al efecto se realizó un estudio analítico de carácter transversal que incluyó PyMES de alojamiento para el turismo del Cantón Machala de la Provincia El Oro en Ecuador. Se utilizaron métodos teóricos como el analítico sintético y el histórico lógico; del nivel empírico el análisis de documentos, observación, entrevista y la encuesta. Se concluye que es insuficiente la utilización de las prácticas de recursos humanos en los alojamientos turísticos, lo cual impacta en el nivel de competitividad de las PyMES del Cantón Machala de la Provincia de El Oro, Ecuador.The complexity and high level of uncertainty generated by the changes faced by tourism accommodation SMEs require that their management practices be modified to give priority to human resources. The present study focuses on an analysis of the present practices in human resource management as a strategic factor for the successful performance of these organizations. To this effect, a cross‑sectional analytical study was carried out that included SMEs for tourism accommodation in Canton Machala in the province of El Oro in Ecuador. Theoretical methods such as synthetic, analytical and historical logic were used together with empirical analysis of documents plus observation studies,interviews and surveys. The results show that the present use and management of human resources is insufficientI, impacting negatively on the competitiveness of tourism accommodation SMEs in Canton Machala in the province of El Oro, Ecuador

Programa de estrategias psicopedagógicas para elevar el nivel de autoestima de las estudiantes del cuarto grado de la institución educativa "Santa Magdalena Sofía" del distrito de Chiclayo

Diversos estudios han demostrado que el nivel de autoestima es un factor determinante de los éxitos y fracasos escolares. La elevada autoestima, vinculada a un concepto positivo de sí mismo, potenciará la capacidad de la persona para desarrollar sus habilidades y aumentará el nivel de seguridad personal, mientras que un bajo nivel de autoestima conduce a la persona a la derrota y al fracaso; situación que se viene dando en las estudiantes de cuarto grado de la Institución Educativa “Santa Magdalena Sofía”, del distrito de Chiclayo, durante el presente año, entendiéndose la autoestima como la capacidad que tiene la persona de valorarse, amarse, apreciarse y aceptarse a sí mismo, mientras mejor se encuentre emocionalmente la persona, tendrá un mejor desarrollo de sí misma. Para afirmar lo escrito anteriormente se aplicó el inventario de autoestima de Stanley Coopersmith, llegando a identificar que las estudiantes de la muestra, en su mayoría se encuentran en un nivel de autoestima de nivel medio hacia abajo, se sienten infelices, obtienen bajo rendimiento académico, no controlan adecuadamente sus emociones y deficientes relaciones con sus familiares más directos. Los resultados obtenidos muestran que existe un considerable grupo de estudiantes del cuarto grado de la Institución Educativa “Santa Magdalena Sofía", del distrito de Chiclayo, que presentan un nivel bajo de autoestima, es por ello que se diseñó y aplicó el programa de estrategias psicopedagógicas, donde las estudiantes aprendieron a medir su auto conocimiento y auto valoración, mejorar su confianza en sí mismas y hacia los demás y su nivel de autonomía e independencia, lo cual nos llevó a elevar el nivel de autoestima de las estudiantes, cuya eficacia fue comprobada al comparar los resultados del grupo control con el experimental, quedando demostrado que sí es posible mejorar el nivel de autoestima de las personas

FORMACIÓN DEL CIUDADANO AMBIENTAL A PARTIR DE HERRAMIENTAS EDUCATIVAS

La educación ambiental se encuentra contemplada como una de las principales preocupaciones de la sociedad, esto se evidencia desde la legislación constitucional hasta en las normativas de las instituciones educativas y en diversos escenarios sociales. Es preciso establecer las relaciones entre la educación cívica y educación ambiental que provean herramientas prácticas para conciliar el comportamiento proambiental con la necesidad de intervenir positivamente en el medio ambiente.Este proyecto pretende establecer las relaciones entre estas dos variables educativas y articularlas a través del diseño de material educativo que permita ejercer una práctica específica encaminada a conservar y cuidar el medio que los rodea