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Background: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why.Objective: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users.Subjects: Data were collected from a random Puerto Rican community sample of caregiver-child dyads.Measures: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems.Statistical Methods: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care.Results: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis.Conclusion: : Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need. [ABSTRACT FROM AUTHOR]

Clinical records (also known as Electronic Medical Records or EMRs) have been considered as a collection of patients health information. Elettronic Citizen Helth Records store information regarding life style, activities, habits, environment (i.e. water sources or air quality), routine health screening like blood biological analysis. Patients and providers stand to benefit from Internet of Things (IoT) in healthcare. Some uses of healthcare IoT are mobile medical applications or wearable devices that allow patients to capture their health data. Smart personal devices as well as data generator devices (i.e., internet of things) allow to provide such kind of data which may be collected in unique (cloud) database. Such information can then be related to location data within a geographic context. We use clinical anonymized data extracted from a Biological Department of University Magna Graecia Hospital. We show how to include geographic operators to statistical methods and how to analyze environmental data and citizen habits to improve wellness. We report on developing and testing a geo-based system to analyze biological data. [ABSTRACT FROM AUTHOR]

The vestibular apparatus allows to perform audiological and equilibrium human functions and to capture movements with respect to gravity. Damages to the vestibular system causes diseases that can be measured by using Vestibular Evoked Myogenic Potentials (VEMPs) test. The test produces a lot of data that has to be collected and analyzed to allow a disease study and classification. We propose a framework that includes algorithms able to perform pathology distribution and classification. It has been tested on electronic patient records loaded from the University Hospital database. The software allows to manage the structure and framework and a blind application of one of the available classification techniques shows a relation among gender and vestibular apparatus disease. [ABSTRACT FROM AUTHOR]

Objective: We conducted a secondary analysis of randomized controlled trial data to determine if the Engagement and Counseling for Latinos (ECLA) intervention, a brief, evidence-based, and culturally adapted cognitive-behavioral intervention specifically designed for and effective at treating depression, also reduced co-occurring worry symptoms. We also explored whether delivery modality (telephone, face-to-face) and sociodemographic patient characteristics moderated treatment effectiveness. Method: Between May 2011 and September 2012, low-income Latino primary care patients (N = 257) with depression from Boston and San Juan were randomized to usual care (n = 86), face-to-face ECLA (n = 84), or telephone ECLA (n = 87) and completed a psychosocial assessment at baseline and 4 months after randomization. We used intention-to-treat analyses with linear regression models with change in worry (4 months from randomization) as the primary outcome and treatment condition as the primary predictor. Results: Patients in ECLA experienced significant reductions in worry at 4 months from randomization than those in usual care (PSWQA = -3.28, p < .05). Among patients receiving ECLA, those in the telephone condition exhibited greater worry reductions than those in the face-to-face condition (telephone: M = -7.83, SD = 11.45; face-to-face: M = -6.13, SD = 12.23; p < .05). Employment status was the only significant treatment moderator. Unemployed patients did not exhibit any changes in worry irrespective of condition, whereas employed patients exhibited the greatest worry reductions across conditions. Conclusions: Although worry was not a treatment target in ECLA, it also reduced worry among low-income Latinos, which suggests ECLA may have transdiagnostic clinical implications. Telephone-delivered ECLA might hold promise for increasing the uptake of mental health care among employed low-income Latinos. [ABSTRACT FROM AUTHOR]

The article focuses on the relevant history of electronic contracts of adhesion and the judicial approaches and opinions on the contract requirements define the current judicial conflict. It mentions that the requirements of notice and assent, which affects both the structure and content of sign-in-wrap contracts and rules for requirements of the contracts regardless of consumers' backgrounds. It also mentions that a court case Salameno v. Gogo Inc. on the validity of contract law.

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OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is associated with elevated cardiovascular morbidity and mortality. Considering that oxidative stress is involved in endothelial dysfunction and atherosclerosis development, our aim was to examine lipid peroxidation and protein oxidation, two parameters of oxidative status, in a group of subjects with OSAS. PATIENTS AND METHODS: We consecutively enrolled 48 patients (36 men and 12 women; mean age 49.7±14.6 yrs) with OSAS, subsequently subdivided according to the apnea/hypopnea index (AHI) value in two subgroups: Low (L= 21 subjects with AHI<30) and High (H= 27 subjects with AHI>30). We examined lipid peroxidation, expressed as TBARS, and protein oxidation, measured as carbonyl groups in plasma samples from fasting venous blood. RESULTS: We observed that TBARS and carbonyl groups were significantly higher in subjects with AHI > 30 in comparison with the L subgroup and the whole group of OSAS subjects. In addition, we found that these parameters were positively correlated with neck and waist circumference, with the AHI value and with the oxygen desaturation index, and negatively correlated with the mean oxygen saturation. CONCLUSIONS: Lipid peroxidation and protein oxidation in OSAS patients are significantly correlated with the severity of the disease. [ABSTRACT FROM AUTHOR]

Aims Our purpose was to examine the total antioxidant status (TAS) in subjects with metabolic syndrome (MS) subdivided according to the presence or not of diabetes mellitus. Methods We enrolled 106 subjects (45 women, 61 men) with MS subsequently subdivided in diabetics (14 women, 29 men) and nondiabetics (31 women, 29 men). TAS was obtained using an Assay kit which relies on the ability of plasma antioxidant substances to inhibit the oxidation of 2,2′-azino-bis(3-ethylbenzthiazoline sulfonic acid) to the radical ABTS +. Results In the group of MS subjects a significant decrease in TAS ( p < 0.05) in comparison with normal controls was evident. This difference was present between normal subjects and nondiabetic subjects with MS ( p < 0.001) but not between normal and diabetic subjects with MS. Examining the linear regression among TAS, age, anthropometric profile, blood pressure values and glycometabolic pattern, conflicting data were found. Conclusions Although we know that TAS includes several enzymatic and non enzymatic antioxidants, we retain that the difference observed in the two subgroups of subjects with MS must be looked in particular into two pathophysiological aspects regarding bilirubin and uric acid. [ABSTRACT FROM AUTHOR]

Abstract: Indium tin oxide (ITO) thin films were deposited by magnetron sputtering from a ceramic target, and annealed at temperatures up to 1000°C in N2 atmosphere. Some samples were capped in a-Si:H or spin-on glass to prevent residual oxygen contamination from the annealing ambient, and annihilation of oxygen vacancies. The electrical and optical properties were measured before and after annealing. It is found that the protecting layer effectively limits the ITO degradation up to 900°C, whereas high transparency is preserved in all cases. The results indicate the applicability of the procedure to high temperature devices, and opens the way to the application of a variety of nanostructured materials in advanced photovoltaic devices. [Copyright &y& Elsevier]

Abstract: Aims: To examine the protein oxidation, marker of the oxidative stress, in metabolic syndrome (MS). Methods: We enrolled 106 subjects (45 women and 61 men) with MS of which 43 (14 women and 27 men) were with diabetes mellitus and 63 (31 women and 32 men) were without diabetes mellitus, and 54 subjects (19 women and 35 men) as control group. The protein oxidation, expressed as carbonyl groups, was measured by an enzyme-like immunosorbent assay (ELISA) kit (BioCell PC test kit, Enzo Life Sciences AG, Switzerland). Results: In the whole group of MS subjects, in comparison with control group, a significant increase in carbonyl groups was present. The same datum was also evident between control group and diabetic subjects with MS and between control group and nondiabetic subjects with MS. No difference was observed between the two subgroups (diabetic and nondiabetic subjects with MS) about NOx. Few information were obtained examining the linear regression among carbonyl groups, age, BMI, waist circumference, blood pressure values and metabolic pattern of MS subjects. Conclusions: In MS subject we observed an increase of protein oxidation not influenced by diabetes mellitus. Several strategies may be employed to reduce this parameter. [Copyright &y& Elsevier]

Summary: Background & aims: Street food (SF) is defined as out-of-home food consumption, and generally consists of energy dense meals rich in saturated fats, and poor in fibers, vitamins and anti-oxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with endothelial function has not been considered. Methods: Participants were recruited among those who took part in a previous study of ours, done in Palermo, Italy, which investigated the association between consumption of SF and health in 1002 people. In that study, a score of SF consumption was obtained by categorizing each of ten foods consumed less than or more than once a month (0 = never consumed, 1 = once a month or less, 2 = more than once a month; thus, the sum of single scores could range from 0 to 20). Based on the interquartile values of SF score distribution, in the present study we included low SF consumers, defined on the basis of the first interquartile SF score range (range: 0–1), and high SF consumers, who were those in the forth interquartile range of the SF score (range: 7–20). The group of low SF consumers had 12 participants (median value of SF score: 1; range: 0–1), that of high SF consumers had 13 (median value of SF score: 11; range: 10–16). The brachial artery flow-mediated dilatation (FMD), a measure of endothelial function, and other cardiovascular biomarkers were investigated. Results: High SF consumers had higher BMI (P = 0.026), larger waist circumference (P = 0.041), higher levels of cholesterol (P = 0.013) and uric acid serum concentrations (P = 0.002) compared with low SF consumers. The high SF consumers had a significantly lower FMD (5.4 ± 2.1 versus 8.8 ± 2.8%; ANCOVA with BMI and waist circumpherence as covariates: P = 0.025) than the high consumers. Other cardiovascular biomarkers did not significantly differ between the two groups. Conclusions: This study suggests that high SF consumption in Palermo may be associated with endothelial dysfunction in healthy people, probably indicating that this category of foods should be limited, especially in people at high cardiovascular risk. [Copyright &y& Elsevier]

Summary: Background: Noninvasive ventilation (NIV) may improve quality of sleep but patient-ventilator asynchronies (PVA) may affect sleep structure. Possible changes in ventilation quality after hospital discharge are poorly known. Objective: To analyse the impact of different kinds of PVA on sleep disruption in chronically ventilated neuromuscular patients after in-hospital optimization of ventilator setting with nocturnal polygraphy, and to compare home and hospital PVA occurrence. Methods: Eighteen patients were included in the study. PVA during hospital polygraphic monitoring and during successive home polysomnography were analysed. The relationships between PVA and air leaks, sleep stages, and arousals or awakenings recorded during polysomnography were investigated. Results: Overall, PVA had a low rate of occurrence (4.32 events/h, IQR 1.75–6.25), but their number was higher during home polysomnographies than in hospital (p = 0.0039): their increase was correlated to an increase in air leaks with respect to hospital monitorings (p = 0.020). Autotriggerings were the most common asynchronies, followed by ineffective efforts (IE) and prolonged insufflations (PI). All asynchronies occurred more often in NREM than in REM sleep. Autotriggerings and IE were more often associated with arousals than PI (p < 0.05). PVA rate was correlated with arousals and awakenings rate (r = 0.49, p = 0.03), but, due to the low PVA rate, only 12.69% of arousals and awakenings were associated with PVA. Conclusions: Most kinds of PVA are often associated with arousals. Polygraphic monitoring may help to improve ventilator setting. However, air leaks and autotriggerings may increase in unassisted environments. Therefore, it may be useful to extend control of NIV effects at home. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate the concentration of metabolites (NO2 −, NO3 −) of nitric oxide (NO) in metabolic syndrome (MS). Materials and methods: We enrolled 106 subjects (45 women and 61 men) with MS of which 43 (14 women and 27 men) with diabetes mellitus and 63 (31 women and 32 men) without diabetes mellitus, and 54 subjects (19 women and 35 men) as control group. The nitric oxide metabolites (nitrite+nitrate=NOx) were evaluated employing the Griess reagent. Results: In the whole group of MS subjects was evident, in comparison with control group, a significant increase in NOx. The same finding was also present between control group and diabetic subjects with MS and between control group and nondiabetic subjects with MS. No difference was observed between the two subgroups (diabetic and nondiabetic subjects with MS) about NOx. Contrasting information were obtained examining the linear regression among NOx, age, anthropometric profile, blood pressure values and glycometabolic pattern of subjects with MS. Conclusions: In MS subjects we found a significant increase in NOx not influenced by diabetes mellitus. The NOx is a parameter that must be considered in MS keeping in mind that its behavior is related to chronic inflammation that accompanies this clinical condition. [Copyright &y& Elsevier]

The report “Healthy people” from the US Department of Health and Human Services defines health literacy (HL) as follows: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” The same report identifies asthma as a public health problem of high priority. Unfortunately, impaired HL is prevalent in our society, and patients with low HL and asthma face multiple challenges as they attempt to manage their disease. Indeed, the National Asthma Education and Prevention Program''s current guidelines require patients to have considerable HL and self-management skills. Numerous studies have linked inadequate literacy with poor health outcomes. Unlike many sociodemographic variables, HL can potentially be addressed in the health care setting. The purpose of this review is to raise awareness of the problem, summarize the current evidence linking HL and asthma, and offer strategies to strengthen the communication between patients and health care providers to decrease asthma health disparities. In addition, we discuss potential future directions for research in this field. [Copyright &y& Elsevier]

Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared with non-Latino white subjects. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex, and interrelated sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Several strategies that could be applied in clinical settings to reduce asthma disparities are described, including the need for routine assessment of the patient''s beliefs, financial barriers to disease management, and health literacy and the provision of cultural competence training and communication skills to health care provider groups. [Copyright &y& Elsevier]

Background: Island and mainland Puerto Rican children have the highest rates of asthma and asthma morbidity of any ethnic group in the United States. Objective: We evaluated the effectiveness of a culturally adapted family asthma management intervention called CALMA (an acronym of the Spanish for “Take Control, Empower Yourself and Achieve Management of Asthma”) in reducing asthma morbidity in poor Puerto Rican children with asthma. Methods: Low-income children with persistent asthma were selected from a national health plan insurance claims database by using a computerized algorithm. After baseline, families were randomly assigned to either the intervention or a control group. Results: No significant differences between control and intervention group were found for the primary outcome of symptom-free days. However, children in the CALMA intervention group had 6.5% more symptom-free nights, were 3 times more likely to have their asthma under control, and were less likely to visit the emergency department and be hospitalized as compared to the control group. Caregivers receiving CALMA were significantly less likely to feel helpless, frustrated, or upset because of their child''s asthma and more likely to feel confident to manage their child''s asthma. Conclusion: A home-based asthma intervention program tailored to the cultural needs of low income Puerto Rican families is a promising intervention for reducing asthma morbidity. [Copyright &y& Elsevier]

Abstract: Objective: We examined the prevalence of smoking behaviors and their association with specific psychiatric disorders in a representative sample of youth from behavioral health clinics in Puerto Rico. Method: A complex sampling design was used to select the sample, and analyses were conducted to account for the unequal selection probability, stratification, and clustering. All analyses were weighted back to the clinical population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0. Results: More than one third of the sample reported experience with cigarette smoking, and approximately one quarter reported smoking at least once per week (23.4%). As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. These were the only disorders that remained significantly associated with nicotine dependence after controlling for comorbidity. Conclusions: Our findings confirm the need for screening of smoking behavior and nicotine dependence in treatment settings and the integration of psychiatric/substance use treatments with smoking cessation. [Copyright &y& Elsevier]

Given that veterinary care involves both animal patients and human clients, it becomes necessary to find ways to improve not only one’s veterinary medical skills, but also one’s interpersonal abilities. Literature that discusses the communication and interpersonal aspects of veterinary medicine is neither widely available nor current; therefore, this article draws parallels from the systemic field of marriage and family therapy (particularly, emotionally focused therapy) to provide updated recommendations to improve the professional relationship between the veterinary behavior team and their human clients. An introduction with background information about the veterinary behavior team and of marriage and family therapists is included. Additionally, the similarities between the 2 fields regarding the mechanisms of the change process (i.e., of creating positive associations), the methodology of obtaining information from clients, the challenges and barriers with human clientele, and the common presenting problems are examined, with examples from both fields provided. [Copyright &y& Elsevier]

OBJECTIVE: Previous research documents an association of poor parental mental health with asthma in children. This study aims to determine whether the associations between parental mental health problems and childhood asthma attacks persist after controlling for childhood anxiety and depression and other confounding factors. DESIGN/METHODS: A community household sample of youth ages 4 to 17 years and their primary caregivers from the US Commonwealth of Puerto Rico was studied to determine the associations between parental mental health and childhood asthma attacks. Regression models that predicted asthma attacks in youth controlled for parental mental health problems, childhood anxiety and depression, zone of residence, and parents' age, education, and perception of poverty. RESULTS: After adjusting for children's depressive and anxiety disorders as well as other important confounders, associations between parental depression, suicide attempts, ataque de nervios, and history of mental health treatment and asthma attacks in offspring, by parental report, persisted. Additionally, the frequency of parental mental health problems was associated with children's asthma attacks. CONCLUSION: Parents with mental health problems were more likely to report histories of asthma attacks in their children compared with parents without mental health problems in Puerto Rico. These associations were not attributable to internalizing disorders in youth but persisted independent of childhood psychopathology and other confounding factors. Clinicians and researchers should recognize the relations between poor parental mental health and childhood asthma and explore the potential role of family psychosocial and behavioral factors related to the manifestation of the disease. [ABSTRACT FROM AUTHOR]