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Introduction:Universal health coverage will be guaranteed to all individuals, safeguarding the rights of traditional communities, as in the quilombola population, respecting the dimensions of interculturality, gender and ethnicity.Objective:The aim of this study is to describe the conceptions of health and health care practices of Afro-Brazilian men from a quilombola community.Methods:This was a qualitative descriptive study conducted with Afro-Brazilian men from a quilombola community in Bahia, Brazil, where there is a significant concentration of black people and quilombola communities.Results:This group’s conceptions of health are based on the combination of the individual body with the body that is socially and culturally situated in the community. Health care practices are anchored in cultural knowledge and strengthened by the bonds with nature, friends and religious leaders.Conclusion:The black men from quilombola communities are in a state of vulnerability due to the lack of access to health services.

IntroductionMitral valve (MV) prolapse (MVP) is a primary valvular abnormality. We hypothesized that additionally there are concomitant abnormalities of the left ventricle (LV) and MV apparatus in this entity even in the absence of significant mitral regurgitation (MR).ObjectiveTo characterize MV and LV anatomic and functional features in MVP with preserved LV ejection fraction, with and without significant MR, using cardiovascular magnetic resonance (CMR).MethodsConsecutive MVP patients (n = 80, mean 52 years, 37% males) with preserved LV ejection fraction, and 44 controls (46 years, 52% males) by CMR were included, as well as 13 additional patients with “borderline” MVP. From cine images we quantified LV volumes, MV and LV anatomic measurements (including angle between diastolic and systolic annular planes, annular displacement, and basal inferolateral hypertrophy) and, using feature tracking, longitudinal and circumferential peak systolic strains.ResultsSignificant MR was found in 46 (56%) MVP patients. Compared with controls, MVP patients had LV enlargement, basal inferolateral hypertrophy, higher posterior annular excursion, and reduced shortening of the papillary muscles. LV basal strains were significantly increased, particularly in several basal segments. These differences remained significant in patients without significant MR, and many persisted in “borderline” MVP.ConclusionsIn patients with MVP and preserved LV ejection fraction there is LV dilatation, basal inferolateral hypertrophy, exaggerated posterior annular displacement and increased basal deformation, even in the absence of significant MR or overt MVP. These findings suggest that MVP is a disease not only of the MV but also of the adjacent myocardium.

ObjectivesTo evaluate an extended hybrid MR/PET imaging strategy in cardiac sarcoidosis (CS) employing qualitative and quantitative assessment of PET tracer uptake, and to evaluate its association with cardiac-related outcomes.BackgroundInvasive endomyocardial biopsy is the gold standard to diagnose CS, but it has poor sensitivity due to the patchy distribution of disease. Imaging with hybrid late gadolinium enhancement (LGE) MR and 18F-fluorodexyglucose (18F-FDG) PET allows simultaneous assessment of myocardial injury and disease activity and has shown promise for improved diagnosis of active CS based on the combined positive imaging outcome, MR(+)PET(+).Methods148 patients with suspected CS were enrolled for hybrid MR/PET imaging. Patients were classified based on presence/absence of LGE (MR+/MR-), presence/absence of 18F-FDG (PET+/PET-), and pattern of 18F-FDG uptake (focal/diffuse) into the following categories: MR(+)PET(+)FOCAL, MR(+)PET(+)DIFFUSE, MR(+)PET(-), MR(-)PET(+)FOCAL, MR(-)PET(+)DIFFUSE, MR(-)PET(-). Patients classified as MR(+)PET(+)FOCAL were designated as having active CS [aCS(+)], while all others were considered as having inactive or absent CS and designated aCS(-). Quantitative values of standard uptake value (SUVmax), target-to-background ratio (TBRmax), target-to-normal-myocardium ratio (TNMRmax) and T2 were measured. Occurrence of a cardiac-related clinical outcome was defined as any of the following during the 6-month period after imaging: cardiac arrest, ventricular arrhythmia, complete heart block, need for cardiac resynchronization/defibrillator/pacemaker/monitoring device (CRT-D, ICD/WCD, or ILR). MR/PET imaging results were compared to the presence of the composite clinical outcome.ResultsPatients designated aCS(+) had more than 4-fold increased odds of meeting the clinical endpoint compared to aCS(-) (unadjusted odds ratio 4.8; 95% CI 2.0-11.4; pConclusionsHybrid MR/PET imaging with an extended image-based classification of CS was statistically associated with clinical outcomes in CS. TNMRmax had high sensitivity and excellent specificity for quantifying the imaging-based classification of active CS.Condensed AbstractImaging with hybrid late gadolinium enhancement (LGE) MR and 18F-fluorodexyglucose (18F-FDG) PET allows simultaneous assessment of myocardial injury and disease activity and has shown promise for improved diagnosis of active cardiac sarcoidosis (CS). In this study, 148 patients with suspected CS were enrolled for hybrid MR/PET imaging. Patients were classified based on presence/absence of LGE (MR+/MR-), presence/absence of 18F-FDG (PET+/PET-), and pattern of 18F-FDG uptake (focal/diffuse). Patients classified as MR(+)PET(+)FOCAL were designated as having active CS and, compared to patients with any other imaging pattern, they had more than 4-fold increased odds of cardiac-related outcome at 6 months from imaging.

Background Stress cardiomyopathy (SCM) is a transient ventricular dysfunction frequently precipitated by acute emotional or physical stress. According to ventricular contractile pattern there are four SCM variants, being apical (80%) and midventricular (15%) the most frequents. Our aim is to describe the differences between these two SCM variants. Methods We performed an observational study of patients who were diagnosed with SCM in our centre from February 2010 to January 2020. We registered demographic information, medical history, clinical, echocardiographic and analytical data of our patients and we performed a digital analysis of the 12-lead electrocardiogram (ECG) recorded in the first 48 hours after the onset of symptoms. Patients were divided into two groups, those with apical LV ballooning and patients with midventricular SCM. Results We included 86 patients; baseline characteristics of the population are described in the table. The median age was 77 (IQR: 67.7–82.9), and 91.9% were female. Fifty-six patients (65.1%) had apical variant whereas thirty patients (34.9%) showed midventricular one. The most frequent antecedent trigger was an emotional stressor (36.3%) follow by physical stressor (identified in 23.8%). Chest pain was the most frequent clinical presentation (54.7%). Median LVEF was 35% (IQR 30.0–45.0) and mean basal septal thickness was 9.50 (IQR 9.0–11.0). Median peak of troponin level was 1.71 (IQR 0.6–3.4). Comparing apical and midventricular variants of SCM median age was 80.2 (IQR 68.9–84.5) in apical group and 71.6 (IQR 59.64–78.0) in midventricular variant (P=0.001). There were no other differences in the medical history, clinical, echocardiographic and analytical data between both groups (table). After comparative analysis of ECG we found differences in negatives T wave location and QT duration. Apical variant present more negative-T waves in leads II, III, AVF, V4, V5, V6, while in midventricular variant they are more present in AVR and AVL (figure 1). Mean QT duration was 508.0ms (IQR 470.0–552.0) in apical variant and 470.5ms (IQR 423.7–524.2) in midventricular group (p=0.026). There were no differences in Q waves between both groups. Conclusions In our group of patients, apical and midventricular stress cardiomyopathy variants exhibit clinical and electrocardiographic differences. Patient with apical stress cardiomyopathy are older. They present more negative T waves in inferior and precordial leads, and longer QT interval. These results suggest that the pathophysiology of both entities could be different. Funding Acknowledgement Type of funding sources: None. Negative T-Waves comparationPopulation characteristics.

PURPOSE: Vaccine requirements are effective population-based strategies to increase vaccination rates. In 2018, Puerto Rico’s DOH announced that the HPV vaccine would be required for school entrance. This study explored arguments in favor of and against the HPV vaccine school-entry requirement in PR. METHODS: We conducted a content analysis of two Puerto Rican newspapers. Articles (n = 286) published between 1/1/2015 and 7/31/2018 containing the Spanish terms for “HPV” and “human papillomavirus” were included. Data were summarized using descriptive statistics. Articles that mentioned the HPV vaccine school-entry requirement (n = 33) were reviewed qualitatively using applied thematic analysis. RESULTS: The top five primary focus areas were education about HPV and the HPV vaccine, advertisements promoting the HPV vaccine, general vaccine information, cervical cancer and screening information, and the HPV vaccine school-entry requirement. Of the 33 articles that mentioned the requirement, 61% presented arguments in favor, 15% presented arguments against, 12% presented both arguments, and 12% only mentioned the existence of the requirement or were the DOH announcement. Arguments in favor centered on cancer prevention, high rates of HPV-associated cancers, and population wellness. Arguments against included worries about sexual transmission of HPV, HPV vaccine’s side effects, issues related to the policy (e.g., mandatory), and lack of education. CONCLUSION: Understanding reasons people support or oppose an HPV vaccine school-entry requirement is important for the policy processes to be successful. Education efforts must continue to change the HPV vaccine narrative. Messages should be crafted to educate and gain support among parents and stakeholders towards this population-based cancer prevention strategy.

Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico’s HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews ( n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations’ leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza’s case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.

Additional file 4. Left ventricle peak systolic longitudinal strain. Table including individual LV segments peak systolic longitudinal strain measurements.

Additional file 3. Late gadolinium enhancement in patients with mitral valve prolapse. Examples of 4 patients with MVP and typical examples of intramyocardial LGE (asterisks) in the basal inferolateral (A and B), basal inferior (C) and basal anterolateral (D) segments. An example of papillary muscle LGE is also shown in C (arrow).

Additional file 6. Geometric and myocardial strain comparison between mitral valve prolapse patients with phase contrast in the ascending aorta and controls. Table showing the comparison between controls, MVP patients, and MVP without significant MR corroborated by phase contrast.

Additional file 5. Left ventricle peak systolic circumferential strain. Table including individual LV segments peak systolic circumferential strain measurements.

Introduction Cardiac resynchronization therapy with defrilator (CRT-D) has been shown to reduce mortality in HFrEF. The width and morphology of the QRS are essential when deciding on the implantation of these devices. QRS fragmentation (fQRS) has been shown to be a good predictor of cardiovascular events in certain patients, but its role in patients with CRT-D has not been studied. The aim of this study is to determine whether the presence of a fQRS at the time of CRT-D implantation can predict clinical events. Methods All patients who underwent CRT-D implantation from 2010 to 2017 were included. Patients' ECG were evaluated at the time of implantation, and the incidence of clinical events during follow-up was also assessed. fQRS was defined as the presence of an RSR' pattern with a notch in the R wave or in the ascending or descending branch of the S wave in two continuous leads on the ECG. Results We studied 131 patients (mean age 73 years, 76.5% male). The mean follow-up period was 37±26 months. No difference in baseline characteristics was found (Table 1); the proportion of fQRS was 48.9%. 25 patients (19.1%) had hospital admissions secondary to cardiovascular causes (heart failure, arrhythmic events, acute coronary syndrome, and death from other causes). We performed a multivariate logistic regression analysis aiming at an association between the presence of fQRS and the increased risk of hospital admissions due to cardiovascular causes OR 2.92 (95% CI: 1.04–8.21, P=0.04). Conclusion The presence of a fQRS at the time of implantation of a CRT-D is an independent predictor of hospital admissions due to cardiovascular causes. Therefore this could be a useful marker to identify the population at high risk of cardiovascular events, for this we consider necessary to conduct future studies and thus assess the value of the fQRS for the selection of patients requiring closer monitoring thus avoiding further hospital admissions. Funding Acknowledgement Type of funding source: None

Introducción: La atención en las unidades de cuidado intensivo neonatal (UCIN) ha sido centrada en diversos equipos tecnológicos que han dejado a un lado la parte humana y el acercamiento de los padres en esta etapa vulnerable, es por ello que las iniciativas de cuidados humanos en neonatología se consideran como un método que permite humanizar el cuidado de estos bebés constituyéndose como la herramienta más apropiada los avances tecnológicos, en armonía con el contacto del entorno familiar. Materiales y métodos: Estudio descriptivo que con la aplicación de instrumento tipo CAP y una guía de observación determinó los conocimientos, actitudes y prácticas de los enfermeros sobre las iniciativas de cuidados humanos en neonatología en las UCIN en Valledupar. Resultados: La mayor parte de la población se ubica en edades entre 18- 30 años, femeninas en su totalidad, con experiencia laboral entre 1- 5 años y formación avanzada a nivel de diplomado en el área. El 100% de las enfermeras conocen las iniciativas de practicarlas. Solo el 16% interviene en el protocolo de mínima manipulación neonatal, y fomenta el neurodesarrollo del recién nacido

Current measures of unintended pregnancy underestimate the co-occurring, complex set of social, cultural, economic and structural factors that influence how women interpret unintended pregnancy. The purpose of this study was to prospectively explore young adult US-born Latinas’ thoughts, feelings and beliefs about pregnancy, specifically unintended pregnancies and the sociocultural factors identified as contributors to those beliefs. In-depth interviews (n=20) were conducted with US born, English-speaking Latinas aged 18-25 years in south Florida. Seventeen participants did not intend to get pregnant, while the remaining participants (n=3) reported that their intentions kept changing. Participants’ beliefs regarding their unintended pregnancy were influenced by social and economic hardship and cultural factors such as fatalism and familismo. Ideas and the meaning of pregnancy differed based on the woman’s pregnancy resolution decision. Many women felt the term ‘unintended pregnancy’ placed blame on women and was stigmatising. When discussing pregnancy planning, most participants felt that women should not plan their pregnancies and doing so was going against fate. Findings suggest that salient influences such as culture and the social determinants related to unintended pregnancy should be incorporated into measurements examining unintended pregnancy.

Objective To compare the prevalence of demographic characteristics and sexual behaviours across age groups and to estimate their significance in predicting sexual risk factors by age cohort. Methods This cohort study examined sexually transmitted infection (STI) prevalence among heterosexual men in Brazil, Mexico and the USA ( N =3047). Participants completed a sexual risk factor questionnaire and were tested for chlamydia, gonorrhoea, syphilis and genital herpes. We examined sexual risk in the study population through a composite measure of STI positivity by age cohort (young: 18–30 years; middle-aged: 31–44 years; older: 45–70 years). Multivariable logistic regression models were used to generate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results We found that STI positivity varied significantly by age group among heterosexual men by a number of covariates. In younger men, having more advanced education had a protective effect (16 years: AOR=0.37, 95% CI 0.15– 0.92), whereas higher numbers of sexual partners elevated the risk for STIs (20–49 partners: AOR=2.06, 95% CI 1.04–4.06; ≥50 partners: AOR=4.33, 95% CI 1.74–10.76). Middle-aged men who were black (AOR=1.64, 95% CI 1.10–2.42) and divorced/separated/widowed (AOR=1.91, 95% CI 1.21–3.02) had an increased risk for a positive STI test. Among older men, a younger age at first vaginal sexual encounter (AOR=3.75, 95% CI 1.45–9.74) and a history of exchanging sex for money or drugs heightened STI risk (AOR=2.30, 95% CI 1.0–5.04). Conclusions These findings demonstrate that age-related life experiences among heterosexual men influence sexual risk and STI transmission. This topic warrants further investigation to support the development and implementation of targeted interventions that may potentially reduce adverse sexual health outcomes.

A 42-year-old man without a past cardiovascular history arrived in the emergency department reporting progressive chest pain, abdominal discomfort, dyspnea at rest, and orthopnea of 4 days duration. An abdominal ultrasound revealed significant pericardial and bilateral pleural effusion, with hepatomegaly and ascites of a probable congestive nature. A transthoracic echocardiogram showed severe pericardial effusion with data of hemodynamic compromise, and a right retroauricular mass anchored to the posterior atrial wall (Figures 1A and 2; Movies I and II in the online-only Data Supplement). Figure 1. A , Apical 4-chamber view transthoracic echocardiogram showing concentric severe pericardial effusion (PE), right (RV) and left (LV) ventricle, and tumor (arrow). B , CT scan showing tumor mass (arrow) attached to the right atrium (RA). C , Apical 4-chamber view with color flow Doppler demonstrating in the right chambers flow acceleration (arrow) secondary to extrinsic tumor compression. D , CT scan …

A simple, inexpensive and mild one-pot methodology for the synthesis of novel 4-aryl-3-methyl-1,2,3,4-tetrahydroquinolines derivatives using aqueous HCl as catalyst has been developed. The key step involves the formal inverse-electron-demand [4π+ + 2π] cycloaddition reaction of in situ-generated cationic 2-azadienes with arylpropenes (isoeugenol and trans-anethole). Iminium ion intermediates are generated through the condensation between N-benzylanilines and formalin. The products are obtained with good to excellent yields and high trans-diastereoselectivity. Further catalytic hydrogenation (Pd/C) allowed debenzylation to successfully obtain the respective 4-aryl-3-methyl-N-H-tetrahydroquinolines of interest. Recent reports suggest that these compounds could serve as interesting models in pharmacological studies against parasites that cause the most common tropical diseases.

Artículo de reflexión con el objetivo de señalar el valor de la intersectorialidad, la interdisciplinariedad y la educación en salud como pilares para desarrollar un modelo de responsabilidad social universitario cimentado en la conciencia social y cultura del valor de la otredad y de la alteridad. Surge de los resultados obtenidos de la investigación sobre percepción de riesgos que asumen los habitantes de mayor vulnerabilidad del área urbana de Valledupar con unos estilos de vida que pueden ser modelizados en bienestar saludable y a través del empoderamiento para desarrollar capacidad de autogestión para mejorar las condiciones de vida. El trabajo permite concluir es necesaria una mayor presencia institucional que de manera coordinada potencie los esfuerzos estatales y privados, en donde la universidad tiene un gran compromiso para promover proyectos con pertinencia y conciencia social. The objective of this article of reflection was to point out the value of the intersectorality, interdisciplinarity and health education as pillars to develop a University social responsibility model founded on social awareness and culture of the value of otherness. It comes from the results of the research made about the perception of risks the inhabitants of greater vulnerability of the urban area of Valledupar take who have life styles that can be modelled through empowerment and healthy well-being to develop the capacity for self-management to improve living conditions. It can be concluded that it is required to have a greater institutional presence that enhances State and private efforts, where the University has a strong commitment to promote projects with relevance and social awareness.

Traditional medicine is the main, and often the only, source of medical care for a great proportion of the population of the developing world. Systems of traditional medicine are usually rooted in long-standing cultural traditions, take a holistic approach to health, and are community based. The World Health Organization has long recognized the central role traditional systems of care can play in efforts to provide primary health care, especially in rural areas. This article provides an overview of national policies adopted by African governments following World Health Organization recommendations for the incorporation of traditional and allopathic systems of care.

Medical mistrust is associated with disparities in a variety of health outcomes. The human papillomavirus (HPV) vaccine has the potential to decrease disparities in cervical cancer by preventing infection with the virus that causes these malignancies. No study has examined associations between medical mistrust and preventative health behaviors including the HPV vaccine among young minority women. Self-reported racial/ethnic minority students completed a web-based survey in fall of 2011. Wilcoxon and Kruskal-Wallis were used to test differences in medical mistrust scores by demographics and health behaviors. Medical mistrust varied significantly by race with Black women reporting the highest scores. Women with no regular health-care provider (HCP) or who had difficulty talking to their provider had higher mistrust. Higher medical mistrust was associated with a preference to receive HPV vaccine recommendation from a HCP of the same race or ethnicity among unvaccinated women. Black and Asian women who had not received the HPV vaccine had higher mistrust scores than vaccinated women. Perceived difficulty in talking to a HCP was associated with ever having a Pap smear. Awareness of medical mistrust and the influence on health behaviors may aid in increasing delivery of quality health services for racial and ethnic minority populations. Further research among different populations is needed to elucidate impacts of medical mistrust and provider communication on preventative health behaviors.

This paper describes the involvement of young female tourists who visit rural Costa Rica with gringueros (i.e., local men who actively seek relationships with foreign women), and explores the implications of these relations, which gringueros see as outlets for sexual adventure, for sexual behaviors that could contribute to the spread of HIV/AIDS. The findings highlight the need to use tourism-related locales to implement HIV/AIDS awareness strategies targeted at women tourists, gringueros, and other local youth.