Search

Introduction: Limited English proficiency (LEP) is linked to lower health care access and worse clinical outcomes. This study aims to explore the potential role of LEP on clinical outcomes of pediatric burn patients., Methods: We conducted a single-institution retrospective study of burn patients presenting at a tertiary pediatric burn referral program between January 2016 and December 2020. Patient demographics, burn mechanism, severity, interventions, and primary patient language were abstracted from the electronic health record. Clinical outcomes (length of stay [LOS], clinic follow-up, and 30-day readmission) of patients with LEP were compared to patients with English as primary language (EPL)., Results: Thirty-five (4.2%) patients with LEP were identified of 840 total patients. On univariate analysis, there was no difference in mean total body surface area (6.5% versus 6.1%), report of physical abuse (2.9% versus 8.9%), or need for grafting (14.3% versus 15.0%) comparing patients with LEP to those with EPL. Patients with LEP were more likely to have a scald burn (68.6% versus 48.9%, P = 0.025) and less likely to have a flame/fire burn (20.0% versus 37.6%, P = 0.047). On multivariate analysis, there was no difference between patients with LEP compared to patients with EPL for LOS (2.9 versus 3.5 d), 30-day readmissions (5.6% versus 5.7%), or clinic follow-up (80.6% versus 75.0%). In patients with >10% total body surface area, patients with LEP had a longer emergency department LOS (277 min versus 145 min, P = 0.06) but no difference in outcome measures., Conclusions: Pediatric patients with LEP were not found to have worse burn outcomes compared to EPL patients in our patient sample. However, a true association is difficult to determine given the small sample size of LEP patients and the potential underestimation of language discordancy as recorded in the electronic medical record. Further research is needed to better explore the role of primary language and health communication as a social determinant of health in pediatric burn patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Child physical abuse (CPA) is closely linked to social factors like insurance status with limited evaluation at a structural population-level. This study evaluates the role of social determinants of health within the built environment on CPA., Methods: A single-institution retrospective review of pediatric trauma patients was conducted between January 2016 and December 2020. Patient address was geocoded to the census-tract level. Socioeconomic metrics, including poverty rate, supermarket access and Social Vulnerability Index (SVI) were estimated from the Food Access Research Atlas. Univariate and multivariable regression analyses were conducted to compare demographics and outcomes., Results: Of 3,540 patients, 317 (9.0%) had concern for physical abuse reported in the registry. CPA patients were younger (7.5 vs 9.6 years, p<0.0001) and more often Black (37.0%, N = 117 vs 23.5%, N = 753; p<0.0001). CPA had higher injury severity scores (ISS) (7.9 vs 5.8, p<0.0001) and longer length of stay (5.3 vs 2.9 days, p<0.0001). CPA had higher Medicaid (73.0%, N = 232 vs 53.8%, N = 1748, p<0.0001) and SVI (0.65 vs 0.59, p<0.0001) with lower median income ($52,100 vs $56,100, p<0.0001) and more low-food access tracts (59.6% vs 53.6%, p = 0.06). Combined low-income and low-food access populations showed widened disparities (40.0% vs 28.9%, p = 0.0002). On multivariate analysis, CPA was associated with poverty (OR 2.3, 95% CI [0.979, 3.60], p = 0.0006), low-access Black share (OR 3.3, 95% CI [1.18, 5.47], p = 0.002) and urban designation (OR 1.5, 95% CI [1.13, 1.87], p = 0.004)., Conclusion: The built-environment and population-level social determinants of health are related to child physical abuse and should influence advocacy and prevention., Level of Evidence: Level III., Type of Study: Retrospective., Competing Interests: Conflict of Interest None to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Burn injury risk, severity, and outcomes have been associated with socioeconomic status. Limited data exist to evaluate health access-related influences at a structural population level. This study evaluated factors at the Census-tract level, specifically evaluating food access and social vulnerability in pediatric scald burns., Methods: A single-institution retrospective review using the trauma registry and electronic medical record was conducted of pediatric burns between 2016 and 2020. Home address was coded to the Census-tract level and bulk analyzed. Socioeconomic metrics of the home environment were evaluated from publicly available databases, the United States Food and Drug Administration Food Access Research Atlas, and the Centers for Disease Control's Social Vulnerability Index., Results: There were 840 patients that met inclusion criteria (49.8% scald, N = 418). The mean total body surface area for scalds was 6.6% with an age of 10.2 years; 76% (n = 317) of scalds had Medicaid, and 15% (n = 63) were due to hot noodles. Scalds occurred more in females (45.7%, N = 191 vs 28.0%, N = 118; P &lt; .0001), non-White race (62.7%, N = 262 vs 29.1%, N = 123; P &lt; .0001), and low-income and low-food access populations (39.8%, N = 147 vs 30.4%, N = 116; P = .007). Low-food access Black populations showed increased scald injury (18% [interquartile range 6-35] vs 10% [interquartile range 4-25]), whereas all other populations showed no association. The patients with scalds had a higher overall social vulnerability index (0.67 vs 0.62, P = .008)., Conclusion: Often related to poverty, health access, and health equity, population-level social determinants of health like social vulnerability and food access have significant impact on health care and should influence health outreach and systems improvement., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: The heterogeneity of street-involved youth was examined using a person-centered approach. Youth were classified based on patterns of street involvement and the identified profiles compared to identify theoretically coherent and practically significant differences., Methods: Participants were 111 street-involved youth aged 9 to 18 (M age = 14.15 years; 81.1% male, 91.1% non-white) from three Brazilian cities. Youth completed a life history interview and structured assessment. Latent class analysis was used to identify three profiles of youth based on reasons for going to the street and connections to major developmental contexts (street, family, institutions). Profile comparisons on psychosocial variables (e.g., age, life events) and adjustment indicators (e.g., drug use, life satisfaction) were conducted using multinomial logistic regression., Results: The largest profile (48.6%) included youth drawn to the street by drug use or trafficking, who had moderate connections to street and family. Another group (40.5%) went to the street to escape family dysfunction, and the street represented their primary developmental context. These groups differed on some psychosocial indicators but had similar patterns of adjustment. The third group of youth (10.8%) had families with a history of street involvement and maintained strong ties to all three developmental contexts. These youth had generally better adjustment than their peers (e.g., less drug use, higher life satisfaction) but had higher levels of sexual risk related to the overrepresentation of girls., Conclusions: Street involvement is a multidetermined phenomenon that may expose young people to distinct conditions of vulnerability. Findings have implications for research, practice, and policy., (Copyright © 2021 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background and Purpose: Delirium is an acute and fluctuating impairment of attention, cognition, and behavior. Although common in stroke, studies that associate the clinical subtypes of delirium with functional outcome and death are lacking. We aimed to evaluate the influence of delirium occurrence and its different motor subtypes over stroke patients' prognosis., Methods: Prospective cohort of stroke patients with symptom onset within 72 hours before research admission. Delirium was diagnosed by Confusion Assessment Method for the Intensive Care Unit, and its motor subtypes were defined according to the Richmond Agitation-Sedation Scale. The main outcome was functional dependence or death (modified Rankin Scale>2) at 90 days comparing: delirium versus no delirium patients; and between motor subtypes. Secondary outcomes included modified Rankin Scale score >2 at 30 days and 90-day-mortality., Results: Two hundred twenty-seven patients were enrolled. Delirium occurred in 71 patients (31.3%), with the hypoactive subtype as the most frequent, in 41 subjects (57.8%). Delirium was associated with increased risk of death and functional dependence at 30 and 90 days and higher 90-day mortality. Multivariate analysis showed delirium (odds ratio, 3.28 [95% CI, 1.17-9.22]) as independent predictor of modified Rankin Scale >2 at 90 days., Conclusions: Delirium is frequent in stroke patients in the acute phase. Its occurrence-specifically in mixed and hypoactive subtypes-seems to predict worse outcomes in this population. To our knowledge, this is the first study to prospectively investigate differences between delirium motor subtypes over functional outcome three months poststroke. Larger studies are needed to elucidate the relationship between motor subtypes of delirium and functional outcomes in the context of acute stroke.

Trajectories of adjustment were examined in a sample of street-involved youth across a 1-year period. Participants (N = 113; M age  = 14.18 years; 80.5% male, 91% non-White) were recruited in three Brazilian cities. Interviews conducted at three time points included six measures of physical and psychological adjustment. Unconditional growth models revealed linear declines over time (i.e., improved adjustment) on three indicators: health symptoms, sexual risk behaviors, and negative affect. There were no linear changes in drug use, positive affect, or life satisfaction. Conditional growth models revealed few significant effects for age or gender, but ratings of stressful life events moderated longitudinal changes in health symptoms, drug use, and negative affect. Implications for practice, policy, and theory are discussed., (© 2019 Society for Research in Child Development.)

This work deals with the development of a nonlinear Periodic Event-Triggered Control strategy employed to the consensus of a multi-vehicle autonomous system based on (3,0) mobile robots. First, the existence of the Control Lyapunov Function (CLF) applicable to the consensus problem is proven. This is subsequently used to develop event and feedback functions. The Periodic Event-Triggered Control ensures trajectories boundedness and convergence to consensus while a specific sampling period is provided. Also, the formation problem is addressed as an extension of the presented work. Experimental results show the performance of the proposed control strategy which reduces 99.78% the number of control updates compared to a continuous control law, resulting in energy saving for the information transfer from central control to the mobile robots., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 ISA. Published by Elsevier Ltd. All rights reserved.)

The development of implicit and explicit racial attitudes were investigated in 542 White, Pardo, and Black Brazilian children and adolescents (aged 6 to 14) from 2 different regional contexts that vary dramatically in their racial diversity, Bahia (BA) and Rio Grande do Sul (RS). Results revealed the pervasive presence of race biases favoring higher status groups across multiple measures of implicit and explicit attitude. Contextual differences were also apparent, particularly in measures of group identification: Children from the more diverse context (BA), including Black children, identified themselves more strongly with lighter skin tones, particularly with Whites. Implicit attitudes were stable with age, whereas explicit attitudes generally showed less bias as a function of age. Implicit and explicit racial preference were related in younger but not older children, providing evidence of increasing divergence across early development. Differences between our findings and those reported from other regions underscores the need for greater diversity in our research efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Most research on adverse childhood experiences (ACEs) has been conducted in high-income countries in the global North. The current longitudinal study examined the prevalence, overlap, and impact of ACEs in a sample of Brazilian children and adolescents who use city streets as spaces for socialization and survival (i.e., street-involved youth). Participants (N = 113; M age = 14.18 years) were recruited in three cities following standardized procedures. Most youth were male (80.5%) and non-White (91%). Lifetime exposure to ACEs was assessed at the first study time point; six indicators of psychological, behavioral, and physical adjustment were assessed 6 months later. Analyses addressed three research goals. First, the prevalence of seven ACEs was examined. Youth reported an average of 4.8 ACEs (SD = 1.25); no significant age or gender differences were found in ACEs exposure (all ps > .05). Second, the overlap between different ACEs was explored. Family dysfunction was correlated with family disruption and physical abuse; poverty and physical abuse were related (ps < .05). Third, prospective associations between ACEs and adjustment were tested. Total number of ACEs was not significantly correlated with any outcome, but several associations emerged for specific ACEs. For example, death of a close friend or family member was prospectively associated with negative affect; sexual abuse was associated with illicit drug use and physical health symptoms (ps < .05). Findings highlight the prevalence of ACEs in this vulnerable population and underscore the value of extending research on ACEs into novel populations and contexts., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

This essay stresses the importance of undertaking a critical analysis of international cooperation for health based upon reflections on diplomacy, acknowledging the ethical limits and possibilities of cooperation within this context. It emphasizes the importance of adopting an historical perspective, highlighting the circumstances surrounding the consolidation of the current international system, whereby, after two world wars, the victorious countries created the United Nations Organization, which today brings together all the world's nations, notwithstanding the fact that the majority of countries are in favor of significant changes to its institutional framework. It also stresses the importance of the bioethics dimension, despite the systematic disregard of principles adopted in relevant UN documents, especially in view of inequalities pari passu with asymmetries of knowledge and enjoyment of innovations that separate nations. This reflection also suggests that South-South cooperation is fundamental to the analysis of the inequality and dependence that demarcate North-South and East-West bipolarity. These reflections are, in short, important guiding elements for deepening analysis and resolutions in the arena of international cooperation for health, leaving aside catastrophic visions and idealistic illusions.

Until now, the consumption of leaves by bats has been considered rare or sporadic, even among the herbivorous families Pteropodidae and Phyllostomidae. Among the phyllostomids there are reports of folivory in the genera Artibeus and Platyrrhinus, based on opportunistic observations. Here, we conducted behavioural sampling using camera-trapping in the roost of a colony of Platyrrhinus lineatus already known to consume leaves during the dry and wet seasons, in order to investigate the frequency of leaf consumption, as well as eventual seasonal differences. We observed feeding activity in 80.5% of sampling nights, where fruit was present in 90.3% and leaves at 80.6%, with no significant differences between the consumption of items. When analyzing video recordings, we observed feeding activity in 22.2% of the samples, in which the consumption of fruits was significantly more frequent than the consumption of leaves. We also observed seasonal variation, with the consumption of leaves being significantly higher than that of fruits during the dry season, whereas in the rainy season, fruits were consumed significantly more frequently. Fruits and leaves were consumed in equal proportions during the night, with no differences between the early and late night. Our findings show that the consumption of leaves by herbivorous bats may be more widespread than previously thought. Leaves may often be a regular food item rather than a fallback., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Event-triggered control (ETC) is a sampling strategy that updates the control value only when some events related to the state of the system occurs. It therefore relaxes the periodicity of control updates without deteriorating the closed-loop performance. This paper develops a nonlinear ETC for the stabilization of a (3,0) mobile robot. The construction of an event function and a feedback function is carried out based on the existence of a stabilizing control law and a Control Lyapunov Function (CLF). The event function is dependent on the time derivative of the CLF and the feedback function results from the extension of Sontag's formula, which ensures asymptotic stability, smoothness everywhere and continuity at the equilibrium. Experimental results, compared with a computed torque control, validate the theoretical analysis., (Copyright © 2015 ISA. Published by Elsevier Ltd. All rights reserved.)

This study considers the scenario of international relations in the transition to the twenty-first century as a backdrop for reflection on the bioethical perspective of international cooperation in health. It presents an exploratory analysis of the interdisciplinary scientific production in bioethics and public health in the international context, revealing that the focus and confluence of both issues has scant coverage in terms of diplomatic relations. It describes the methodology used to select publications cataloged in this interdisciplinary area from two bibliographic sources available on the web (93 articles in BVS/BIREME and 161 in PubMed), pointing to difficulties in locating this literature. The potential of the epistemological approach that flourished in Latin America under the guise of the Bioethics of Intervention in addressing the challenges that confront the international cooperation system, identified as the benchmark for analysis of South-South cooperation in health, is recommended. It concludes by proposing systematization and broadening of knowledge at the intersection of bioethics, public health and diplomacy, whose projection in the political and institutional field can contribute to reducing inequalities in health conditions among nations.

The article contextualizes the emergence of an international policy for the Brazilian Unified Health System as the common agenda of the Pan American Health Organization (PAHO) and the Brazilian Ministry of Health. For this purpose, two contextual axes were explored throughout the work. The first discusses the explicit relationship between the development-cooperation-health triad from an international perspective. The second examines the recent evolution of Brazilian foreign policy, particularly with respect to the role it is playing in South-South cooperation on health matters. The contextual framework that defines Brazilian international cooperation with PAHO is emphasized, above all with regard to the implementation of a specific cooperation agreement. The article concludes that this agreement, within the framework of South-South cooperation, is one of the principal institutional mechanisms established to bring about technical cooperation in health in the current setting.

This paper analyzes whether south-south cooperation is legitimately a recent practice or merely an improved version of previous regional integration processes in Latin America and the Caribbean. The authors reviewed and systematized the historic development of subregional integration processes in Latin America and the Caribbean and focused on health cooperation in the following contexts: the Central American Integration System, the Andean Community of Nations, the Caribbean Community, the Amazon Cooperation Treaty Organization, the Southern Common Market, and the Union of South American Nations. The study concludes that the conceptual and methodologic foundations of south-south cooperation in health were born from and nurtured by the processes of regional integration in Latin America and the Caribbean. This paper posits that regional political and economic integration initiatives bring potential benefits to the health sector and act as an important mechanism to develop south-south cooperation in this domain. The study recommends furthering this type of research to provide information that will allow national and multilateral agencies, or other stakeholders, to formulate and implement better policies for international health cooperation that target reducing inequities and promoting health and well-being for all people.

This article presents a brief overview of the meaning of technical cooperation within the United Nations, underscoring the political dimension, i.e. the relationship among States. It also emphasizes the importance of health in this context, using the Americas and Brazil as a benchmark. It illustrates the new paradigm called South-South Cooperation by analyzing an experience in the health field, stressing the triangulation of an intergovernmental agency. In conclusion, it summarizes the arguments that place a given process of international cooperation within the framework of this paradigm.

The authors utilized two groups of adult male rats to study the effect of chronic-uremic toxemia on the synthesis of thyroid hormones. The control group was sham operated, while the other group had about 70--80% of the left kidney tissue surgically excised and a total right nephrectomy performed 10 days later. At the 90th day after the second operation, 8 muCi of 131I were injected intraperitoneally and 24 h later the thyroid was excised and hydrolyzed enzymatically for a period of 14 h at 37 degrees C. The percentages of iodinated components were then calculated after radiochromatographic separation on paper. The group of experimental rats by this time showed significant increases of plasma urea and creatinine, and an absence of acidosis. The results suggest that monoidotyrosine concentration is increased and diiodothyronine decreased in the experimental group of rats with renal failure. This might indicate a toxic metabolic blockage in the transformation of monoiodotyrosine to diiodothyronine.