Perceived Quality of Care, Receipt of Preventive Care, and Usual Source of Health Care Among Undocumented and Other Latinos

Latinos are the largest minority group in the United States and experience persistent disparities in access to and quality of health care. (1) To determine the relationship between nativity/immigration status and self-reported quality of care and preventive care. (2) To assess the impact of a usual source of health care on receipt of preventive care among Latinos. Using cross-sectional data from the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative telephone survey of 4,013 Latino adults, we compared US-born Latinos with foreign-born Latino citizens, foreign-born Latino permanent residents and undocumented Latinos. We estimated odds ratios using separate multivariate ordered logistic models for five outcomes: blood pressure checked in the past 2 years, cholesterol checked in the past 5 years, perceived quality of medical care in the past year, perceived receipt of no health/health-care information from a doctor in the past year, and language concordance. Undocumented Latinos had the lowest percentages of insurance coverage (37% vs 77% US-born, P < 0.001), usual source of care (58% vs 79% US-born, P < 0.001), blood pressure checked (67% vs 87% US-born, P < 0.001), cholesterol checked (56% vs 83% US-born, P < 0.001), and reported excellent/good care in the past year (76% vs 80% US-born, P < 0.05). Undocumented Latinos also reported the highest percentage receiving no health/health-care information from their doctor (40% vs 20% US-born, P < 0.001) in the past year. Adjusted results showed that undocumented status was associated with lower likelihood of blood pressure checked in the previous 2 years (OR = 0.60; 95% CI, 0.43–0.84), cholesterol checked in the past 5 years (OR = 0.62; 95% CI, 0.39–0.99), and perceived receipt of excellent/good care in the past year (OR = 0.56; 95% CI, 0.39–0.77). Having a usual source of care increased the likelihood of a blood pressure check in the past 2 years and a cholesterol check in the past 5 years. In this national sample, undocumented Latinos were less likely to report receiving blood pressure and cholesterol level checks, less likely to report having received excellent/good quality of care, and more likely to receive no health/health-care information from doctors, even after adjusting for potential confounders. Our study shows that differences in nativity/immigration status should be taken into consideration when we discuss perceived quality of care among Latinos

Fungal colonization with Pneumocystis correlates to increasing chloride channel accessory 1 (hCLCA1) suggesting a pathway for up-regulation of airway mucus responses, in infant lungs

AbstractFungal colonization with Pneumocystis is associated with increased airway mucus in infants during their primary Pneumocystis infection, and to severity of COPD in adults. The pathogenic mechanisms are under investigation. Interestingly, increased levels of hCLCA1 – a member of the calcium-sensitive chloride conductance family of proteins that drives mucus hypersecretion – have been associated with increased mucus production in patients diagnosed with COPD and in immunocompetent rodents with Pneumocystis infection. Pneumocystis is highly prevalent in infants; therefore, the contribution of Pneumocystis to hCLCA1 expression was examined in autopsied infant lungs. Respiratory viruses that may potentially increase mucus, were also examined. hCLCA1 expression was measured using actin-normalized Western-blot, and the burden of Pneumocystis organisms was quantified by qPCR in 55 autopsied lungs from apparently healthy infants who died in the community. Respiratory viruses were diagnosed using RT-PCR for RSV, metapneumovirus, influenza, and parainfluenza viruses; and by PCR for adenovirus. hCLCA1 levels in virus positive samples were comparable to those in virus-negative samples. An association between Pneumocystis and increased hCLCA1 expression was documented (P=0.028). Additionally, increasing Pneumocystis burden correlated with increasing hCLCA1 protein expression levels (P=0.017). Results strengthen the evidence of Pneumocystis-associated up-regulation of mucus-related airway responses in infant lungs. Further characterization of this immunocompetent host-Pneumocystis-interaction, including assessment of potential clinical significance, is warranted

Las termas y el Suburbium marítimo de Baelo Claudia. Avance de un reciente descubrimiento

Entre los años 2010 y 2012, la Universidad de Cádiz y la Junta de Andalucía han desarrollado investigaciones arqueológicas en la zona extramuros de la ciudad hispanorromana, en el marco del Proyecto General de Investigación “La economía marítima y las actividades haliéuticas en Baelo Claudia”. Se presentan en esta sede los primeros resultados, que han permitido identificar la existencia de un suburbium occidental en la ciudad, entre el cauce del arroyo de las Villas, la playa y la necrópolis oeste, cuya existencia se ha podido confirmar por datos geofísicos y arqueológicos. En él han podido ser excavadas parcialmente unas estructuras que se han identificado con unas termas suburbanas, activas entre el s. II y el V d.C., habiéndose excavado una piscina del frigidarium y algunas estancias calefactadas, con hallazgos muy significativos como parte de la decoración marmórea y escultórica del complejo, que en época tardorromana fue amortizado intencionalmente por motivos posiblemente religiosos. Estos hallazgos son de gran interés, pues además de verificar la existencia de un segundo complejo balneario público en la ciudad plantean la importancia del poblamiento periurbano, una línea de investigación totalmente inédita hasta la fechaBetween the year 2010 and 2012, the University of Cadiz and the Regional Government (Junta de Andalucía) have developed archaeological activities in the zone outside the hispano-roman city, in the frame of the General Project of Research titled “The maritime economy and the halieutic activities in Baelo Claudia”. We are presenting in this paper the first results, which have allowed to identify the existence of a western suburbium outside the city, between the riverbed of the so called “arroyo de las Villas”, the beach and the western necropolis, whose remains have been confirmed by geophysical and archaeological techniques. Inside this area a few structures have been excavated, identified as a Roman baths complex, active from the 2nd up to the 5th century a.D. A big pool, part of the frigidarium and some heated rooms have been unearthed, with very significant findings as part of the marmoreal and sculptural decoration of the complex, which in late roman times was intentionally broken into pieces possibly by religious motives. These findings are of great interest, since beside confirming the existence of the second public thermae of the city they raise the importance of the peri-urban buildings, a new line of research up to dat

Evidencias arqueológicas de desplomes paramentales traumáticos en las Termas Marítimas de Baelo Claudia. Reflexiones arqueosismológicas

Durante los años 2011 a 2013 se han localizado, identificado y excavado parcialmente los restos de un nuevo complejo termal en la ciudad hispanorromana de Baelo Claudia (Tarifa, Cádiz), situado en el suburbium occidental de la ciudad, junto a la línea de costa. Denominadas Termas Marítimas, construidas en la primera mitad del s. II d.C. y abandonadas en época de Diocleciano/Constantino han sido excavadas estratigráficamente con detalle, habiéndose detectado la existencia de fases anteriores (que se remontan al s. II a.C.) y una continuidad de uso del ambiente en época tardorromana y moderna, vinculada con la explotación de los recursos marinos. Especialmente singular ha sido la constatación del desplome traumático de parte de los paramentos de las habitaciones del edificio en dos momentos concretos: por un lado en la Antigüedad Tardía (500 d.C. circa), ya que una unidad muraria de una de las habitaciones (H-3), anexa a la natatio, se localizó completamente derrumbada sobre el suelo, conexionada; y por otro, el desplome del muro oeste de la natatio y el oriental de la cisterna, estructuras de más de seis metros de longitud y cuatro de altura mínima conservada, desplomadas sobre los niveles de abandono del asentamiento en época bajomedieval o moderna (ss. XIV-XV d.C.). Se trata en ambas ocasiones de colapsos estructurales no habituales en circunstancias normales en los procesos de sedimentación arqueológica, por lo que es muy probable que su desplome se pueda vincular con eventos sísmicos u otras causas naturales similare

Factores de riesgo asociados a la recurrencia de preeclampsia en gestantes del servicio de alto riesgo obstétrico del Hospital Nacional Guillermo Almenara Irigoyen en el 2017 - 2018

Objective: To determine the risk factors associated with the recurrence of preeclampsia in the HNGAI of 2017-2018.Methods: This is an observational, retrospective, analytical case-control study where descriptive and cross tables were used for the OR.  Results: After the univariate analysis of the risk factors, the highest prevalence of pregnant women between 20 and 35 years of age was seen, with a figure of 59.4%. After bivariate analysis, an association was observed between the variable overweight or obesity and the recurrence of preeclampsia with a p value of 0.031 and an OR of 1.94 (1.05 - 3.56) with 95% CI. An association was also seen between housewife and recurrence of preeclampsia with a p value of 0.030 and an OR of 1.95 (1.06 - 3.58) with a 95% CI. Finally, in the multivariate analysis, the factors studied maintained obesity with a p value of 0.036 and an adjusted OR of 1.99 (1.04- 3.79) at the 95% CI and the occupation variable a p of 0.023 and an adjusted OR of 2.07 (1.10 - 3.90) with a 95% CI. Conclusions: It is concluded that the variables overweight or obesity and occupation, in this case being housewives, is associated with recurrence of preeclampsia.Objetivo: Determinar los factores de riesgo asociados a la recurrencia de preeclampsia en el Hospital Nacional Guillermo Almenara I. (HNGAI) en el 2017-2018. Métodos: Se trata de un estudio observacional, retrospectivo, analítico tipo casos y controles donde se utilizaron tablas descriptivas y cruzadas para el OR. Resultados: Luego del análisis univariado de los factores de riesgo se vio la mayor prevalencia de gestantes de entre 20 a 35 años con una cifra de 59.4%. Después del análisis bivariado se observó una asociación entre la variable sobrepeso u obesidad y la recurrencia de preeclampsia con un p valor de 0.031 y un OR de 1.94 (1.05 – 3.56) con IC al 95%. También se vio asociación entre la ser ama de casa con la recurrencia de preeclampsia con un p valor de 0.030 y un OR de 1.95 (1.06 – 3.58) con un IC de 95%. Por último, en el análisis multivariado los factores estudiados mantuvieron la significancia la obesidad con un p valor de 0.036 y un OR ajustado de 1.99 (1.04- 3.79) al IC de 95% y la variable ocupación un p de 0.023 y un OR ajustado de 2.07 (1.10 – 3.90) con un IC al 95%. Conclusiones: Se concluye que las variables sobrepeso u obesidad y ocupación, en este caso ser ama de casa está asociado a recurrencia de preeclampsia

Heterogeneity in Health Insurance Coverage Among US Latino Adults

We sought to determine the differences in observed and unobserved factors affecting rates of health insurance coverage between US Latino adults and US Latino adults of Mexican ancestry. Our hypothesis was that Latinos of Mexican ancestry have worse health insurance coverage than their non-Mexican Latino counterparts. The National Health Interview Survey (NHIS) database from 1999–2007 consists of 33,847 Latinos. We compared Latinos of Mexican ancestry to non-Mexican Latinos in the initial descriptive analysis of health insurance coverage. Disparities in health insurance coverage across Latino categories were later analyzed in a multivariable logistic regression framework, which adjusts for confounding variables. The Blinder-Oaxaca technique was applied to parse out differences in health insurance coverage into observed and unobserved components. US Latinos of Mexican ancestry consistently had lower rates of health insurance coverage than did US non-Mexican Latinos. Approximately 65% of these disparities can be attributed to differences in observed characteristics of the Mexican ancestry population in the US (e.g., age, sex, income, employment status, education, citizenship, language and health condition). The remaining disparities may be attributed to unobserved heterogeneity that may include unobserved employment-related information (e.g., type of employment and firm size) and behavioral and idiosyncratic factors (e.g., risk aversion and cultural differences). This study confirmed that Latinos of Mexican ancestry were less likely to have health insurance than were non-Mexican Latinos. Moreover, while differences in observed socioeconomic and demographic factors accounted for most of these disparities, the share of unobserved heterogeneity accounted for 35% of these differences

Negative Modulation of Macroautophagy by Stabilized HERPUD1 is Counteracted by an Increased ER-Lysosomal Network With Impact in Drug-Induced Stress Cell Survival

Macroautophagy and the ubiquitin proteasome system work as an interconnected network in the maintenance of cellular homeostasis. Indeed, efficient activation of macroautophagy upon nutritional deprivation is sustained by degradation of preexisting proteins by the proteasome. However, the specific substrates that are degraded by the proteasome in order to activate macroautophagy are currently unknown. By quantitative proteomic analysis we identified several proteins downregulated in response to starvation independently of ATG5 expression. Among them, the most significant was HERPUD1, an ER membrane protein with low expression and known to be degraded by the proteasome under normal conditions. Contrary, under ER stress, levels of HERPUD1 increased rapidly due to a blockage in its proteasomal degradation. Thus, we explored whether HERPUD1 stability could work as a negative regulator of autophagy. In this work, we expressed a version of HERPUD1 with its ubiquitin-like domain (UBL) deleted, which is known to be crucial for its proteasome degradation. In comparison to HERPUD1-WT, we found the UBL-deleted version caused a negative role on basal and induced macroautophagy. Unexpectedly, we found stabilized HERPUD1 promotes ER remodeling independent of unfolded protein response activation observing an increase in stacked-tubular structures resembling previously described tubular ER rearrangements. Importantly, a phosphomimetic S59D mutation within the UBL mimics the phenotype observed with the UBL-deleted version including an increase in HERPUD1 stability and ER remodeling together with a negative role on autophagy. Moreover, we found UBL-deleted version and HERPUD1-S59D trigger an increase in cellular size, whereas HERPUD1-S59D also causes an increased in nuclear size. Interestingly, ER remodeling by the deletion of the UBL and the phosphomimetic S59D version led to an increase in the number and function of lysosomes. In addition, the UBL-deleted version and phosphomimetic S59D version established a tight ER-lysosomal network with the presence of extended patches of ER-lysosomal membrane-contact sites condition that reveals an increase of cell survival under stress conditions. Altogether, we propose stabilized HERPUD1 downregulates macroautophagy favoring instead a closed interplay between the ER and lysosomes with consequences in drug-cell stress survival

No silver bullet for digital soil mapping: country-specific soil organic carbon estimates across Latin America.

Country-specific soil organic carbon (SOC) estimates are the baseline for the Global SOC Map of the Global Soil Partnership (GSOCmap-GSP). This endeavor is key to explaining the uncertainty of global SOC estimates but requires harmonizing heterogeneous datasets and building country-specific capacities for digital soil mapping (DSM).We identified country-specific predictors for SOC and tested the performance of five predictive algorithms for mapping SOC across Latin America. The algorithms included support vector machines (SVMs), random forest (RF), kernel-weighted nearest neighbors (KK), partial least squares regression (PL), and regression kriging based on stepwise multiple linear models (RK). Country-specific training data and SOC predictors (5 x 5 km pixel resolution) were obtained from ISRIC - World Soil Information. Temperature, soil type, vegetation indices, and topographic constraints were the best predictors for SOC, but country-specific predictors and their respective weights varied across Latin America. We compared a large diversity of country-specific datasets and models, and were able to explain SOC variability in a range between ~ 1 and ~ 60 %, with no universal predictive algorithm among countries. A regional (n = 11 268 SOC estimates) ensemble of these five algorithms was able to explain ~ 39% of SOC variability from repeated 5-fold cross-validation.We report a combined SOC stock of 77.8 +- 43.6 Pg (uncertainty represented by the full conditional response of independent model residuals) across Latin America. SOC stocks were higher in tropical forests (30 +- 16.5 Pg) and croplands (13 +- 8.1 Pg). Country-specific and regional ensembles revealed spatial discrepancies across geopolitical borders, higher elevations, and coastal plains, but provided similar regional stocks (77.8 +- 42.2 and 76.8 +- 45.1 Pg, respectively). These results are conservative compared to global estimates (e.g., SoilGrids250m 185.8 Pg, the Harmonized World Soil Database 138.4 Pg, or the GSOCmap-GSP 99.7 Pg). Countries with large area (i.e., Brazil, Bolivia, Mexico, Peru) and large spatial SOC heterogeneity had lower SOC stocks per unit area and larger uncertainty in their predictions. We highlight that expert opinion is needed to set boundary prediction limits to avoid unrealistically high modeling estimates. For maximizing explained variance while minimizing prediction bias, the selection of predictive algorithms for SOC mapping should consider density of available data and variability of country-specific environmental gradients. This study highlights the large degree of spatial uncertainty in SOC estimates across Latin America. We provide a framework for improving country-specific mapping efforts and reducing current discrepancy of global, regional, and country-specific SOC estimates

Estimating the Effects of Immigration Status on Mental Health Care Utilizations in the United States

Immigration status is a likely deterrent of mental health care utilization in the United States. Using the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006, multivariable logistic regressions were used to estimate the effects of immigration status on mental health care utilization among patients with depression or anxiety disorders. Multivariate regressions showed that immigrants were significantly less likely to take any prescription drugs, but not significantly less likely to have any physician visits compared to US-born citizens. Results also showed that improving immigrants’ health care access and health insurance coverage could potentially reduce disparities between US-born citizens and immigrants by 14–29% and 9–28% respectively. Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization. Targeted interventions should also focus on addressing immigrants’ language barriers, and providing culturally appropriate services