Community Health Development

Dupilumab is the first US FDA-approved biologic for moderate to severe atopic dermatitis (AD) in adults and children of age more than six months. It is a fully monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signal transmission. The initial product monograph mentioned major side effects like hypersensitivity reactions and eye problems like conjunctivitis, dry eye, and keratitis. Persistent facial redness with dupilumab administration has been reported in the past, and itraconazole proved to be effective for its treatment. We report a case of adult AD, on treatment with dupilumab, experiencing dupilumabfacial redness (DFR), giving a positive response to itraconazole. DFR is a recognized complication of dupilumab therapy for AD. Clinicians should maintain a high index of suspicion for DFR, especially in patients presenting with new-onset facial symptoms during dupilumab treatment. Itraconazole can be considered a standard therapy for DFR, given its efficacy and tolerability profile in this context.

Frailty is a significant predictor of a range of adverse outcomes in surgical patients, including increased mechanical ventilation time, longer hospital stays, unplanned readmissions, stroke, delirium, and death. However, accessible tools for screening in clinical settings are limited. Computed tomography of the psoas muscle is the current standard imaging device for measuring frailty, but it is expensive, time-consuming, and exposes the patient to ionizing radiation. Recently, the use of point-of-care ultrasound (POCUS) has emerged as a potential tool to determine the presence of frailty and has been shown to accurately predict frailty and postoperative outcomes. In this article, we will describe the image acquisition of the quadriceps muscles and explain how they can be used to determine frailty and predict postoperative adverse events. We will present information on probe selection, patient positioning, and troubleshooting. Images from a demonstration will be used to present the POCUS technique and example results. The article will culminate in a discussion of the use of these images in medical decision-making and potential limitations.

Abstract Background Previous studies have associated health literacy and social support with medication adherence in hypertension. However, limited evidence exists regarding the mechanisms between the factors and medication adherence. Purpose To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai. Methods A community-based cross-sectional study was conducted containing 1697 participants with hypertension. We collected the characteristics of sociodemographic and clinical, the profiles of health literature and social support, and medication adherence using questionnaires and examined interactions among the factors using a structural equation model. Results The participants contained 654 (38.54%) with low medication adherence, and 1043 (61.46%) with medium/high adherence. Social support influenced adherence directly (β = 0.165, P < 0.001) and indirectly through health literacy (β = 0.087, P < 0.001). Health literacy directly influenced adherence (β = 0.291, P < 0.001). Education indirectly affected adherence through social support (β = 0.048, P < 0.001) and health literature (β = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literature on the association between education and adherence (β = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit. Conclusions Medication adherence of hypertensive patients needs to improve. Health literacy and social support had direct and/or indirect effects on adherence, which should be more consider as the measures of improving adherence.

This paper focuses on the role of Sister Connection organization in improving the living conditions of Burundian widows. Specifically, it shows how received assistance has contributed to improving the living conditions of widows. It also shows different constraints that Sister Connection is facing in its effort of supporting widows. It further allowed us to know the suggestions that widows and the management of Sister Connection have. We opted for qualitative approaches with the use of the interview guide, and quantitative approaches with the use of a questionnaire administrated indirectly to the widows sponsored by Sister Connection. 96 widows have been selected using Bouchard’s technique. An interview protocol was conducted by the National Director and a questionnaire was administered to the 96 widows. Data findings were analyzed using the Statistical Package for the Social Sciences (SPSS). The “family systems theory” was chosen and it allowed us to understand how the solidarity that naturally characterizes Burundian families is broken at the death of a spouse and how other family members react to widows in Burundian society. Results showed that living conditions have been improved by the financial and spiritual assistance that the widows received from Sister Connection. Furthermore, the majority of widows have benefited shelter from Sister Connection. Despite all this effort, a significant number of widows assisted by Sister Connection are illiterate, and this presents a challenge to communicate with them whether it’s through written communications or simply explaining certain things or communicating ideas. Training or teaching them becomes a challenge as they don’t easily pick up on things or understand as fast as they could. Widows live far from each other. In fact, some live in isolated areas which make it difficult to reach them and know their needs on a regular basis.

Intel l’a conçu et Google l’utilise pour son personnel. Comment ce système d’objectifs et de résultats clés, mieux connu sous l’acronyme OKR, peut-il aider les nouvelles entreprises à forte croissance à mieux se structurer ?

This paper evaluates the effectiveness of community health workers/promotores (CHWs) in promoting cancer preventive behaviors in the 2011-2013 Education to Promote Improved Cancer Outcomes (ÉPICO) project. The ÉPICO project utilized CHWs to disseminate cancer education to predominately Spanish-speaking Hispanics living in colonias in the Lower Rio Grande Valley of Texas. The CHWs received training to become Texas-certified CHW instructors and specialized training in message tailoring, and they delivered more than 5000 units of resident education on cancer prevention/detection, treatment, and survivorship for breast, cervical, and colorectal cancer. Using panel data to examine overtime changes in cancer knowledge among Lower Rio Grande Valley residents, the evaluation found significant changes from baseline to both times 1 and 2. Additional individual-level analysis indicated that the increase in resident cancer knowledge was predicted by residents' perceptions of CHW credibility and intention to change their lifestyles. Multilevel analysis also showed that the increase in cancer prevention knowledge among residents was predicted by attributes of the CHWs who taught them. In particular, CHWs with higher education levels had the most impact on residents' increased knowledge over time. Unexpectedly, CHWs with more years of experience were less effective teachers than their early-career counterparts.

Sleep problems are commonly encountered in children with a prevalence of 20-42 %. Sleep problem usually entails a sleep pattern that is unsatisfactory or cause of concern to the parent, child or physician. Children present to primary care physicians or pediatricians with mainly three types of sleep related problems-first group has disorders of initiating and maintaining sleep (dyssomnias); second category (hypersomnias) is characterized by excessive sleepiness and third section represents abnormal activity or behavior during sleep, also classified as parasomnias. Evaluation of a child with sleep problem involves a comprehensive sleep history followed by detailed medical, developmental and behavioral history. One simple sleep screening tool used for evaluation of sleep in children-BEARS (B is bed time problems, E is excessive day time sleepiness, A is awakenings during the night, R is regularity as well as duration of sleep, and S is snoring) has been discussed. This article discusses common sleep problems observed in different age groups starting right from neonatal to the adolescent period followed by management strategies to optimize outcome of sleep in children.

Polymorphisms of Helicobacter pylori cagA and vacA genes do exist and may contribute to differences in H. pylori infection and gastroduodenal diseases among races in the Malaysian population. This study was conducted to characterize the polymorphisms in H. pylori cagA and vacA in Malaysian population. A total of 110 H. pylori isolates were genotyped by PCR and sequenced for cagA and PCR-RFLP for vacA. East Asian cagA was predominantly detected (64.5%), whereas vacA s1m1 and s1m2 alleles were detected in 60.9 and 37.3% of strains, respectively. A statistical association between cagA type with patients' ethnicity (p < .0001) and age group >50 years old (p = .027) was identified. vacA alleles showed significant association with age group >50 years old (p = .017) and increased neutrophil activity in gastric mucosa (p = .028 and p = .016 for moderate and marked activity, respectively). Further identification of vacA polymorphism revealed that 84% of strains from Malays and Indians showed one RFLP pattern (RFLP-1), whereas more than one RFLP patterns (RFLP-2, 3, 4, 5, 6, and 8) were predominantly observed in strains from Chinese (82%) (p < .0001). Increasing severity of gastric inflammation was observed in gastric mucosa infected with strains carrying RFLP-2, 3, 4, 5, and 6 (p = .037). About 86.6% of H. pylori strains with East Asian cagA were vacA RFLP-2, 3, 4, 5, 6, and 8, and 88% of Western cagA strains were vacA RFLP-1 (p < .0001). Chinese and Indians are susceptible to different virulence genotypes of H. pylori, whereas Malays showed a mixed virulence genotypes. Marked differences in the polymorphisms of cagA and vacA were observed among strains in Malaysian population. This provides a new insight into the pathogenicity of H. pylori in multiracial population.