Community Stakeholder Perspectives Around the Strengths and Needs of Unaccompanied Immigrant Minors

Unaccompanied immigrant minors (UIM) are youth who lack lawful immigration status and who are without a parent or guardian in the U.S. who can provide custody and care. By all accounts, UIM experience stressful and traumatic circumstances before, during and postmigration. Most UIM left their home countries due to economic stagnation, poverty, crime and gang-related violence (Kandel et al., 2014); almost half described fleeing societal violence and one in five described experiencing domestic abuse (UNHCR, 2014). During migration, UIM are vulnerable to human trafficking, kidnapping, and other abuses (Kandel et al., 2014). Upon resettlement, UIM sometimes experience extended stays in detention centers, community violence exposure in resettlement areas, and an uncertain future in the U.S., all without family support to buffer these stressors (Alvarez & Alegria, 2016). Not surprisingly, UIM are at increased risk for mental health problems compared to accompanied immigrant youth (Derluyn & Broekaert, 2008; Huemer et al., 2009). Research on protective factors is emerging, but scarce.This presentation describes community stakeholder perspectives around the strengths and needs of UIM. Stakeholders include academic researchers with experience working with UIM; key decision makers in agencies serving UIM; professionals with insider knowledge (e.g., immigration attorneys, psychologists with expertise in asylum evaluations); and community members participating in immigrant-focused coalitions. Stakeholder interviews identified significant need for support for UIM. They noted that UIM need emotional support before, during and after legal interviews when youth must recount traumatic events. Families need support during periods of separations and reunions, which can lead to uncertainty and unanticipated conflict, and foster families sponsoring UIM need parenting support for raising children facing difficult circumstances. Stakeholders also noted role conflicts that arise when simultaneously addressing the legal and mental health needs of UIM and the emotional toll that this work takes on professionals serving UIM

Adaptación a los cambios ambientales y territoriales

En este libro se abordan temáticas que destacan la adaptación de los distintos sectores de población a los cambios ambientales y territoriales, la cual muestra las respuestas a la incidencia de los estímulos del entorno, económico, social y ambiental. Así, se destaca la exposición de la población a los efectos destructivos de las amenazas y peligros naturales, lo que ha despertado interés en conocer sus causas, prevenir y mitigar el daño. A través de la revisión de estudios se induce la aprehensión de un tema que adquiere importancia en el contexto de los impactos globales, regionales y locales que se producen como consecuencia de la vulnerabilidad estructural característica de los países en desarrollo.En este libro se proponen estrategias de prevención ante la ocurrencia periódica de inundación en San Mateo Atenco, Estado de México y se analizan los factores sociales que inciden en el deterioro del bosque templado en San Lorenzo Huitzitzilapan. También se exponen soluciones para que se mejoren la condición del bosque y la calidad de vida de la población.Proyecto realizado con financiamiento de la Secretaría de Educación Pública-Subsecretaría de Educación Superior-Dirección General de Educación Superior Universitaria. Número del convenio con la SEP: 2017-15-001-017

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Considering how the Acculturation Process Affects Family Relations and Child Mental Health Outcomes in Latino Families

The process of acculturation may affect how Latino families interact and respond to their children. Acculturation has been defined as the process of adaptation that occurs when an individual or groups come into contact with a different culture (Berry, 2003). Acculturating to the American culture has been associated with erosion of Latinx cultural values (Gil et al., 2000) as well as with acculturative stress (Cervantes & Cordova; 2011). Family models examining acculturation processes have found that parents tend to acculturate to the American culture at a slower pace than their children, often creating friction and increasing family conflict and reducing family unity or cohesion (Dumka, Roosa, & Jackson, 1997; Felix-Ortiz, Fernandez, & Newcomb, 1998; Szapocznik, Kurtines, & Fernandez, 1980). These factors, as a result, increase the risk for externalizing behavior problems in youth (Pasch et al., 2006). Other research suggests that parents experiencing acculturative stress may become more controlling of their children as a way to protect them from unfamiliar or possibly dangerous experiences (Luis et al, 2008). However, overcontrolling and overprotective parent behavior has been found to be associated with anxiety symptoms in youth (McLeod et al., 2003). Therefore, various family dynamics and parent behaviors have been implicated in poor mental health outcomes for Latinx youth. Understanding how cultural processes affect family processes is important for providing effective psychosocial and preventive interventions with Latinx populations

Acculturative Stress: What Role does it play in the Relationship between Threat Interpretation Bias and Anxiety?

Latino/a youth are at increased risk for developing anxiety and report a higher prevalence rate of anxiety symptoms when compared to other ethnic groups (Anderson & Mayes, 2010). Moreover, past research has shown that both cognitive factors, such as threat interpretation bias (the tendency to interpret ambiguous situations as threatening), and cultural factors, especially acculturative stress (the need to adjust to a difficult environmental change), are associated with anxiety symptoms (e.g., Chorpita, Albano, & Barlow, 1996; Suarez-Morales & Lopez, 2009). However, no study has examined the association between threat interpretation bias and anxiety in a primarily Latino/a sample. Moreover, it remains unclear what role acculturative stress plays in the association between threat interpretation bias and anxiety. The purpose of the current study was to determine whether acculturative stress mediates and/or moderates the association between threat interpretation bias and anxiety in Latino/a youth. Participants included 286 middle-school students recruited from two public middle schools in South Florida. Participants completed the Revised Children’s Anxiety and Depression Scale(Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000) to assess for anxiety symptoms, the Acculturative Stress Inventory for Children (Suarez-Morales, Dillon, & Szapocznik, 2007) to measure acculturative stress, and the Children’s Opinions of Everyday Life Events-Revised(Suarez-Morales & Bell, 2006) to asses for threat interpretation bias. The findings supported the positive association between threat interpretation bias and anxiety symptoms. Further, acculturative stress partially mediated (but, did not moderate) this relationship. Results indicated that there was a significant total (β = .46, SE = .05, p \u3c .001), direct (β = .25, SE = .05, p \u3c .001), and indirect effect such that acculturative stress partially mediated the association between threat interpretation bias and anxiety (β = .20, SE = .03, p \u3c .001). Thus, the tendency to interpret situations as threatening, which is associated with anxiety symptoms, is partly explained by negative and stressful experiences Latino youth encounter when adjusting to a new culture. The findings of this study support cognitive process theories, specifically social information-processing theory with Latino populations. Moreover, the mediation findings suggest that an anxious adolescent may have perceived threat in an ambiguous situation due to cultural stressors. Cognitive interventions focused on providing an opportunity for youth to develop a more flexible and neutral interpretation to situations may be a worthwhile endeavor