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Jiménez DJ, Gomez O, Meraz R, Pollitt AM, Evans L, Lee N, Ignacio M, Garcia K, Redondo R, Redondo F, Williamson HJ, Oesterle S, Parthasarathy S, Sabo S. Community Engagement Alliance (CEAL) Against COVID-19 Disparities: Academic-community partnership to support workforce capacity building among Arizona community health workers. Front Public Health 2023; 11:1072808. [PMID: 36817902 PMCID: PMC9932528 DOI: 10.3389/fpubh.2023.1072808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic has both highlighted and worsened existing health inequities among communities of color and structurally vulnerable populations. Community Health Workers, inclusive of Community Health Representatives (CHW/Rs) have entered the spotlight as essential to COVID-19 prevention and control. To learn about community experiences and perspectives related to COVID-19 and inform CHW/R workforce capacity building efforts, a series of focus groups were conducted with CHW/Rs throughout Arizona at two time points in 2021. Throughout the data collection and analysis process, researchers and community partners engaged in ongoing and open dialogue about what CHW/Rs on the ground were reporting as priority community concerns, needs, and challenges. Thus, CHW/Rs informed the development of culturally and linguistically relevant health education messages, materials, and training for CHW/Rs. In this community case study, we detail the efforts of partnership between a statewide CHW professional association and an academic research team that facilitated rapid decision-making and knowledge sharing to create community-grounded tools and resources supportive of CHW/R workforce capacity building in the context of the COVID-19 pandemic.
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Affiliation(s)
- Dulce J. Jiménez
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States,*Correspondence: Dulce J. Jiménez ✉
| | - Omar Gomez
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Ruby Meraz
- Arizona Community Health Workers Association, Douglas, AZ, United States
| | - Amanda M. Pollitt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Linnea Evans
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Naomi Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, United States
| | - Matt Ignacio
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, United States
| | - Katherine Garcia
- Arizona Community Health Workers Association, Douglas, AZ, United States
| | - Richard Redondo
- Arizona Community Health Workers Association, Douglas, AZ, United States
| | - Floribella Redondo
- Arizona Community Health Workers Association, Douglas, AZ, United States
| | - Heather J. Williamson
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, United States
| | - Sairam Parthasarathy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
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Ingram M, Coulter K, Doubleday K, Espinoza C, Redondo F, Wilkinson-Lee AM, Lohr AM, Carvajal SC. An integrated mixed methods approach to clarifying delivery, receipt and potential benefits of CHW-facilitated social support in a health promotion intervention. BMC Health Serv Res 2021; 21:793. [PMID: 34380482 PMCID: PMC8359608 DOI: 10.1186/s12913-021-06778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Social support plays a critical role in physical and emotional health, making it an important component of community health worker (CHW) health promotion interventions. Different types of support operate in different ways, however, and the relationship between the nature of CHW support and the subsequent health benefit for their clients is not well understood. Methods This paper describes an integrated mixed methods study of the emotional, informational, appraisal and tangible support CHWs provided to Latinx community members residing in three US-Mexico border communities. Using a cohort (n = 159) from a CHW community-based intervention, we identify and describe four clusters of social support in which participants are characterized by life situations that informed the types of social support provided by the CHW. We examine the association between each cluster and client perceptions of social support over the 6-month intervention. Results CHWs provided emotional, appraisal, informational and tangible support depending on the needs of participants. Participants who received higher levels of emotional support from the CHW experienced the greatest post intervention increase in perceived social support. Conclusions Study findings suggest that CHWs may be adept at providing non-directive social support based on their interaction with a client rather than a health outcome objective. Health promotion interventions should allow CHWs the flexibility to tailor provision of social support based on their assessment of client needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06778-6.
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Affiliation(s)
- Maia Ingram
- Health Promotion Sciences College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA.
| | - Kiera Coulter
- Health Promotion Sciences College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA
| | - Kevin Doubleday
- Health Promotion Sciences College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA
| | - Cynthia Espinoza
- Yuma County Health Services District, 2200 W 28th St #137, Yuma, AZ, 85364, USA
| | - Floribella Redondo
- Arizona Community Health Workers Association, 424 N Christine Ave, Douglas, AZ, 85607-354, USA
| | - Ada M Wilkinson-Lee
- Mexican American Studies, University of Arizona, 1110 James E. Rogers Way, Tucson, AZ, 85721, USA
| | - Abby M Lohr
- Health Promotion Sciences College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA
| | - Scott C Carvajal
- Health Promotion Sciences College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA
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Byrd-Williams C, Ewing M, Rosenthal EL, St. John JA, Menking P, Redondo F, Sieswerda S. Training Needs of Community Health Workers Facing the COVID-19 Pandemic in Texas: A Cross-Sectional Study. Front Public Health 2021; 9:689946. [PMID: 34195172 PMCID: PMC8236534 DOI: 10.3389/fpubh.2021.689946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has required the professional healthcare workforce not only to adjust methods of delivering care safely but also act as a trusted sources of information during a time of uncertainty and rapid research and discovery. The Community Health Worker COVID-19 Impact Survey is a cross-sectional study developed to better understand the impact of COVID-19 on this sector of the healthcare workforce, including training needs of those working through the pandemic. The survey was distributed in Texas, New Mexico, and Arizona. This study focuses on Texas, and the data presented (n = 693) is a sub-set of qualitative data from the larger survey. Results of the content analysis described in this paper are intended to inform current COVID-19-related CHW training curriculum, in addition to future infectious disease prevention and preparedness response trainings.
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Affiliation(s)
- Courtney Byrd-Williams
- Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - Mollie Ewing
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - E. Lee Rosenthal
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, United States
| | - Julie Ann St. John
- Julia Jones Matthews Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Paige Menking
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Stephanie Sieswerda
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
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Sabo S, Wexler N, O'Meara L, Dreifuss H, Soto Y, Redondo F, Carter H, Guernsey de Zapien J, Ingram M. Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study. Front Public Health 2021; 9:601908. [PMID: 34164362 PMCID: PMC8216650 DOI: 10.3389/fpubh.2021.601908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.
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Affiliation(s)
- Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Nancy Wexler
- The John A. Hartford Foundation, New York, NY, United States
| | - Louisa O'Meara
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Heather Dreifuss
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
| | - Yanitza Soto
- Arizona Department of Health and Human Services, Phoenix, AZ, United States
| | | | - Heather Carter
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
| | - Jill Guernsey de Zapien
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
| | - Maia Ingram
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
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Ingram M, Sabo S, Redondo F, Soto Y, Russell K, Carter H, Bender B, de Zapien JG. Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce. Hum Resour Health 2020; 18:46. [PMID: 32586328 PMCID: PMC7318497 DOI: 10.1186/s12960-020-00487-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.
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Affiliation(s)
- Maia Ingram
- University of Arizona College of Public Health, 1295 N. Martin Ave, Tucson, Arizona, 85724, United States of America.
| | - Samantha Sabo
- Northern Arizona University, Center for Health Equity Research, 1395 S. Knoles Dr, Flagstaff, AZ, 86011, United States of America
| | - Floribella Redondo
- Arizona Community Health Worker Association, 424 N. Christine Ave, Douglas, AZ, 85607, United States of America
| | - Yanitza Soto
- Arizona Department of Health Services, 150 N. 18th Ave, Phoenix, AZ, 85007, United States of America
| | - Kim Russell
- Arizona Advisory Council on Indian Health Care, 141 E Palm Ln, Suite #8, Phoenix, AZ, 85004, United States of America
| | - Heather Carter
- University of Arizona College of Public Health, 1295 N. Martin Ave, Tucson, Arizona, 85724, United States of America
| | - Brook Bender
- Hualapai Tribe, Hualapai Health-Education and Wellness, 488 Hualapai Way, Peach Springs, AZ, 86434, United States of America
| | - Jill Guernsey de Zapien
- University of Arizona College of Public Health, 1295 N. Martin Ave, Tucson, Arizona, 85724, United States of America
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Lohr AM, Ingram M, Carvajal SC, Doubleday K, Aceves B, Espinoza C, Redondo F, Coronado G, David C, Bell ML. Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border. BMC Public Health 2019; 19:399. [PMID: 30975126 PMCID: PMC6460798 DOI: 10.1186/s12889-019-6725-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/29/2019] [Indexed: 12/03/2022] Open
Abstract
Background Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. Methods The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. Discussion The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. Trial registration This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6725-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abby M Lohr
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
| | - Maia Ingram
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Scott C Carvajal
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Kevin Doubleday
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Benjamin Aceves
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Cynthia Espinoza
- Yuma County Health District, 2200 W 28th St # 137, Yuma, AZ, 85364, USA
| | - Floribella Redondo
- Arizona Community Health Outreach Workers Association, 1171 W Target Range Road, Nogales, AZ, 85621, USA
| | - Gloria Coronado
- Yuma County Health District, 2200 W 28th St # 137, Yuma, AZ, 85364, USA
| | - Cassalyn David
- Mariposa Community Health Center, 1710 N. Mastick Way, Nogales, AZ, 85621, USA
| | - Melanie L Bell
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
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Carvajal SC, Kibor C, McClelland DJ, Ingram M, de Zapien JG, Torres E, Redondo F, Rodriguez K, Rubio-Goldsmith R, Meister J, Rosales C. Stress and Sociocultural Factors Related to Health Status Among US–Mexico Border Farmworkers. J Immigr Minor Health 2013; 16:1176-82. [DOI: 10.1007/s10903-013-9853-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carvajal SC, Rosales C, Rubio-Goldsmith R, Sabo S, Ingram M, McClelland DJ, Redondo F, Torres E, Romero AJ, O'Leary AO, Sanchez Z, de Zapien JG. The border community and immigration stress scale: a preliminary examination of a community responsive measure in two Southwest samples. J Immigr Minor Health 2013; 15:427-36. [PMID: 22430894 PMCID: PMC4431619 DOI: 10.1007/s10903-012-9600-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-level health promotion efforts. This study presents descriptive findings on a new measure, the border community and immigration stress scale. The data were from two community surveys as part of community based participatory projects conducted in the Southwestern US border region. This scale includes stressful experiences reflected in extant measures, with new items reflecting heightened local migration pressures and health care barriers. Stressors representing each main domain, including novel ones, were reported with frequency and at high intensity in the predominantly Mexican-descent samples. Total stress was also significantly associated with mental and physical health indicators. The study suggests particularly high health burdens tied to the experience of stressors in the US border region. Further, many of the stressors are also likely relevant for other communities within developed nations also experiencing high levels of migration.
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Affiliation(s)
- Scott C Carvajal
- Department of Health Behavior Health Promotion, Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Drachman Hall A254, PO Box 245209, Tucson, AZ 85724, USA.
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González P, Massardo T, Coll C, Redondo F, Yovanovich J, Jofré J, Chamorro H, Humeres P, Sierralta P, Ramírez A, Kunstmann S, López H, Aramburú I, Brugère S. An assessment of wall motion, perfusion and glucose metabolism in recent myocardial infarction: a comparison in patients with and without revascularization. Nucl Med Commun 2003; 24:1155-65. [PMID: 14569170 DOI: 10.1097/00006231-200311000-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to compare the extent and severity of wall motion abnormalities, perfusion and glucose metabolism, in recent myocardial infarction in patients with and without revascularization. Forty-nine patients were studied (82% men; mean age 58 years) by using echocardiography, 201Tl single photon emission computed tomography (SPECT) rest and redistribution, and 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) SPECT at a mean of 9.2 days (range, 1-24 days) after myocardial infarction. Twenty-seven of the 49 patients underwent revascularization while the other 22 received medical therapy before echocardiography and studies using radionuclides. A contrast angiogram was obtained for each patient. A follow-up echocardiogram at 3 months was obtained for 44 patients. Images were read blindly, using a 17 segment model, with semi-quantitative analysis. In the whole group, the extent of hypokinesia was 15%+/-14 (mean+/-SD); the extent of mild defects was determined as 5%+/-6 by using 201Tl at rest, 6%+/-9 by using 201Tl redistribution, and 4%+/-6 by using 18F-FDG (P<0.0005, echocardiogram/radionuclides). Echocardiography showed that the extent of akinesia-dyskinesia was 16%+/-18 in revascularized patients and 28%+/-18 in non-revascularized patients (P=0.017). With regard to moderate and severe defects, 201Tl rest showed 19%+/-16 and 28%+/-17, respectively (P=0.047); 201Tl redistribution 17%+/-15 and 26%+/-15, respectively (P=0.043); and 18F-FDG 17%+/-13 and 24%+/-15, respectively (NS). In echocardiography, the extent of hypokinetic segments decreased from 16%+/-15 at baseline to 10%+/-11 at 3 months (P=0.045), in revascularized patients. It is concluded that, in recent myocardial infarction, hypokinesia extent on echocardiogram is greater than mild perfusion or metabolic defect extent, reflecting stunning and so the use of radionuclide techniques appear more accurate for defining the extent of myocardial infarction. Non-revascularized patients showed a significantly greater extent of akinesia-dyskinesia and moderate-severe perfusion defects than did revascularized patients, which can be considered a result of therapy. It is suggested that 201Tl rest perfusion be used for the assessment of myocardial infarction soon after revascularization.
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Affiliation(s)
- P González
- Nuclear Medicine and Cardiovascular Centers, University of Chile Clinical Hospital and Clinica Santa Maria, Santiago.
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Bravo Blanco AM, de la Peña F, García M, Redondo F, Barreiro R, Fernández O, Pradas G. [Isolated pulmonary valve endocarditis in a healthy heart]. An Med Interna 2003; 20:334-5. [PMID: 12848612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Torres Larrosa T, Alvarez-Argüelles H, Herreros V, Pérez L, Castro C, Redondo F, Díaz-Flores L, Reig F. [Inflammatory pseudotumor of the maxillary sinus: report of a new case and review of the literature]. Acta Otorrinolaringol Esp 2000; 51:163-6. [PMID: 10804120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A new case of inflammatory pseudotumor (IPT) of the maxillary sinus is presented. The clinical and histological features of this rare entity are discussed. Immunohistochemical studies support a possible myofibroblastic origin. Early diagnosis is important to prevent IPT, classified as a benign disease, from becoming a progressive destructive lesion.
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Affiliation(s)
- T Torres Larrosa
- Servicio de ORL, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Tenerife, España
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Torres Larrosa T, Pérez L, Guerrero M, Redondo F, López Aguado D. [High-frequency audiometry: variations in auditory thresholds in the premenstrual period]. Acta Otorrinolaringol Esp 1999; 50:603-6. [PMID: 10619894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The hormonal changes that occur during the premenstrual period have been implicated as a causative factor for many psychological and physical symptoms. The present work was undertaken to determine the effect of these hormonal changes on audition. We studied 60 ears from 30 women (20-30 years old) with regular menstrual cycles and no middle/inner ear pathology. We performed audiometries one week before menstruation and one week after it, testing the range of frequencies from 250 to 16,000 Hz. After calculating the mean pre and postmenstrual threshold the results were compared using the paired <<t>>-Student test. We found statistical significant differences in the frequencies 9,000, 10,000 and 11,200 Hz.
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Affiliation(s)
- T Torres Larrosa
- Hospital Universitario de Canarias, La Laguna, Tenerife, Santa Cruz de Tenerife, España
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Abstract
A new cardiac transplantation technique that preserves the shape of the left atrium and leaves the right atrium intact has been introduced. To compare the new and the standard techniques, we studied cardiac physiology with Doppler echocardiography and catheterization in 26 patients who underwent operation with the standard technique (group A) and I1 who underwent operation with the new technique (group B). Right atrial dimensions were significantly lower in group B (right atrial area index 8.4 +/- 1.5 vs 14.5 +/- 1.9 cm2/m2, p < 0.001), whereas left atrial dimensions were slightly lower (left atrial area index 10.8 +/- 2.0 vs 16.4 +/- 7.0 cm2/m2, p = 0.07). Right atrial contraction, as reflected by peak late tricuspid velocity, was greater in group B (37 +/- 15 vs 30 +/- 10 cm/sec, p < 0.05). The subsequent systolic vena caval flow-velocity integral was also greater in group B at all respiratory phases (inspiration 10.0 +/- 4.0 vs 5.2 +/- 4.0 cm, p < 0.001; expiration 4.8 +/- 1.9 vs 2.9 +/- 1.4 cm, p < 0.001; apnea 5.3 +/- 2.0 vs 2.9 +/- 1.9 cm, p < 0.001) suggesting better atrial relaxation. Filling pressures on the right side of the heart were lower in group B (mean right atrial pressure 5.5 +/- 2.4 vs 6.6 +/- 2.8 mm Hg, p = 0.1; right atrial A wave 6.0 +/- 3.1 vs 8.3 +/- 3.2 mm Hg, p < 0.01; right atrial V wave 6.8 +/- 3.1 vs 9.2 +/- 3.2 mm Hg, p < 0.01; right ventricular end-diastolic pressure 5.6 +/- 3.2 vs 7.3 +/- 2.9 mm Hg, p < 0.05); however, no significant differences were found in left ventricular end-diastolic pressure or cardiac index. We conclude that patients undergoing the new technique exhibit cardiac physiologic improvements. Follow-up study is indicated to ascertain whether this finding implies improved long-term prognosis.
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Affiliation(s)
- J Peteiro
- Department of Cardiology, Hospital Juan Canalejo, La Coruña, Spain
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Peteiro J, Calviño R, Redondo F, Castro A. Unreliability of echocardiographic and Doppler indexes in the diagnosis of heart transplant acute rejection. Rev Port Cardiol 1996; 15:575-81, 548. [PMID: 8858904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate the value of Doppler echocardiography to diagnose heart transplant acute rejection in both patients submitted to the standard surgical technique (Group A), and to a new technique that preserves the size of the left atrium and leaves the right atrium intact (Group B). METHODS 122 Doppler echocardiographic studies and endomyocardial biopsies were performed on 27 group A and 11 group B patients. Systolic measurements included left ventricular shortening fraction, left ventricular endsystolic stress and tricuspid ring systolic displacement. Diastolic indexes investigated were left and right ventricle filling and superior vena caval flow parameters. RESULTS As expected, right atrium was smaller in group B(p < 0.01). In group A, peak early to late mitral flow velocity increased, as did the rejection grade; whereas in group B it decreased. Pericardial effusion was seen more frequently in group B rejectors (> or = 3) than non-rejectors (63% vs 27%, p < 0.01). Right heart pressures (right ventricular end-diastolic and right atrial mean) were slightly higher for group A and B rejector patients (p < 0.05 when comparing right ventricular end-diastolic pressure in rejector to non-rejector group B patients). Left ventricular isovolumic relaxation time was reduced during subsequent rejection episodes in the same patient, but sensitivity of 15% left ventricular isovolumetric relaxation time reduction for rejection > or = 3 diagnosis was only 22% with a specificity of 73%. No significant intrapatient changes were found in other Doppler-derived systolic or diastolic indexes. CONCLUSION Doppler echocardiography does not diagnose heart transplant acute rejection with enough reliability to avoid endomyocardial biopsies.
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Affiliation(s)
- J Peteiro
- Department of Cardiology and Cardiovascular Surgery, Hospital Juan Canalejo, A Coruña, Spain
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15
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Robledo A, Fonseca A, Peteiro C, Redondo F, Calviño S, Vázquez H. [Acute neutrophilic dermatosis]. Actas Dermosifiliogr 1981; 72:49-50. [PMID: 7020360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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16
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Fonseca A, Taboada M, Redondo F, Calviño S, Vázquez H, Robledo A. [Hailey-Hailey disease]. Actas Dermosifiliogr 1981; 72:37-8. [PMID: 7257898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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