Can a Clinic-Based Community Health Worker Intervention Buffer the Negative Impact of the COVID-19 Pandemic on Health and Well-Being of Low-Income Families during Early Childhood

We examined changes in self-reported mental health, physical health, and emotional support among low-income parents with children ages 0-2 years old from pre-pandemic to pandemic periods and compared changes in parental health among parents who did versus did not have access to a clinic-based community health worker intervention supporting parents at early childhood preventive care visits. We utilized longitudinal parent survey data from pre-COVID-19 and COVID-19 time periods from both the intervention and control arms of an existing cohort of parents enrolled in a 10-clinic cluster randomized controlled trial (RCT). At enrollment (pre-pandemic) and 12-month follow-up (pandemic), participants reported on mental health, physical health, and emotional support using PROMIS measures (n = 401). During the pre-pandemic portion, control and intervention group parents had similar mean T-scores for mental health, physical health, and emotional support. At follow-up, mean T-scores for mental health, physical health, and emotional support decreased across both control and intervention groups, but intervention group parents had smaller declines in mental health T-scores (p = 0.005). Our findings indicate that low-income parents with young children suffered significant declines in mental and physical health and emotional support during the pandemic and that the decline in mental health may have been buffered by the community health worker intervention.

Environmental evidence of Valencia lagoon coastal barrier stabilization from 8500 BP to Present. Climate and eustatic variations

The Albufera de Valencia is one of the largest lagoon in the Spanish Mediterranean. Two continuous borehole cores reaching depths of 8 and 14 m in the northern part of the lagoon underwent sedimentological, micropaleontological and biological study. The organic content was also analysed, and ¹⁴C radiometric dating and amino acid racemization were performed. Study of the content of benthic foraminifera and n-alkanes and alkanoic acids in the lagoon sedimentary record identified several periods. The core records showed seven different environments: alluvial; freshwater marsh; brackish marsh; brackish lagoon; brackish lagoon with marine connection, backbarrier flat, and backshore. These environments changed due to eight phases associated with the transgression and regression of the barrier system, which caused the shift from exposed environments as the backshore with washover, to the typical low-energy lagoon and marsh deposition. The paleoenvironmental evolution described above is interpreted as a response to global climate changes. The shift from an alluvial setting to a brackish lagoon is probably related to the late of Early Holocene sea level rise ending at the Holocene Climate Optimum, when the highest sea level was reached. The persistence of the brackish lagoon, with no marine connection, is probably synchronous with dry conditions in the area (Booth et al., 2005) at the time of Bond event 3 (i.e., 4.2 ka) in the North Atlantic region (Bond et al., 2001). Finally, the arrival of large amounts of sediment triggered the accretion of the barrier, also enhancing coastal progradation until the present day. These results allow an evaluation of the impact of anthropic action on the Valencia lagoon, especially since the eighteenth century, and a short- and medium-term projection of the consequences of present-day climate change.

Geochemical evolution of amino acids in dentine of Pleistocene bears

A linear correlation was established between aspartic acid racemization ratio from cave bear dentine collagen and absolute dating. The high correlation coefficient obtained allowed age calculation through amino acid racemization. Aspartic acid and glutamic acid racemization kinetics have also been explored in dentine from a North American black bear (Ursus americanus Pallas). Three sample sets were prepared for kinetic heating experiments in nitrogen atmosphere: one water soaked, one with a water-saturated nitrogen atmosphere, and one without any moisture. It was possible to show that the presence of water is a factor controlling amino acid racemization rate. The aspartic acid in a heating experiment at 105 degrees C shows an "apparent kinetics reversal" which can be explained by a progressive hydrolysis of amino acid chains (proteins and polypeptides). Because of the low potential of collagen preservation over long periods of time, the apparent kinetics reversal phenomenon will not affect the dating of old material where no traces of collagen remain. An apparent kinetics reversal was not observed in glutamic acid, which racemizates more slowly.

Gastric colonization as a consequence of stress ulcer prophylaxis: a prospective, randomized trial

STUDY OBJECTIVE

To evaluate gastric alkalization and bacterial colonization in critically ill patients receiving stress ulcer prophylaxis with gastric tube feeds, sucralfate, intermittent intravenous cimetidine, or continuous intravenous cimetidine. DESIGN; Prospective, randomized, unblinded trial.

SETTING

Medical and surgical intensive care units of a large university-affiliated, tertiary care community hospital.

PATIENTS

Fifty-three evaluable critically ill patients with respiratory failure requiring mechanical ventilation.

INTERVENTIONS

Patients not receiving nasogastric tube feeds were randomized to sucralfate 1 g every 6 hours, cimetidine 300 mg by intravenous bolus every 8 hours, or cimetidine 900 mg by continuous intravenous infusion/24 hours. Gastric samples were obtained daily for pH and culture.

MEASUREMENTS AND MAIN RESULTS

Patients with respiratory failure and a high mortality rate had a mean gastric pH of 1.96 +/- 1.5 at study entry. There were no significant differences in gastric pH or gastric colonization among the three arms. Fourteen patients (26%) developed gastric colonization, which was statistically significant but poorly correlated with gastric alkalinity (r2=0.08, p<0.043).

CONCLUSION

Gastric luminal pH was unchanged regardless of which method was used for stress ulcer prophylaxis. Bacterial colonization was increasingly likely in patients with a persistent alkaline gastric environment.

Vascular complications of shotgun injury to the face

This is a case report of a 23-year-old female who received a gunshot wound to the face while working at a convenience store. Her injuries were: a large left facial entrance wound with a single sinus cavity that was converted from destruction of the paranasal sinuses, a right Collet-Sicard syndrome, and a right vertebral artery pseudoaneurysm at the C1 level. The successful treatment of her injuries is described, with an extensive discussion of the pseudoaneurysm, which was treated endovascularly, with permanent occlusion of the vertebral artery by use of a balloon catheter.

Toxic epidermal necrolysis-case report and review of the literature

A patient who developed toxic epidermal necrolysis secondary to a sulfonamide derivative is presented. Treatment consisted of fluid resuscitation and silver nitrate soaks to the affected areas. Silver nitrate was selected over silver sulfadiazine (Silvadene) and mafenide in view of the nature of the offending agent. Tissue biopsy helps in the differentiation of toxic epidermal necrolysis from staphylococcal scalded skin syndrome. A biopsy is especially useful if the offending agent is not known so that appropriate treatment can be started promptly. The mortality associated with toxic epidermal necrolysis is in the neighborhood of 30%. The priniciples of burn wound management are the key to treatment of this disease. The wound usually heals by epithelialization without the need of skin grafting.