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It is estimated that more than 50 million Latinos live in the United States. This is projected to more than double by 2050. InHealth Issues in Latino Malesexperts from public health, medicine, and sociology examine the issues affecting Latino men's health and recommend policies to overcome inequities and better serve this population. The book addresses sexual and reproductive health; alcohol, tobacco, and drug use; mental and physical health among those in the juvenile justice or prison systems; chronic diseases; HIV/AIDS; Alzheimer's and dementia; and health issues among war veterans. It discusses utilization, insurance coverage, and research programs, and includes an extensive appendix charting epidemiological data on Latino health.

Young people with chronic health conditions and disabilities rely on the healthcare system to maintain their best possible health. The appropriate delivery and utilization of healthcare services are key to improve their autonomy, self-efficacy and employment outcomes. The research question of our study is directed toward investigating if poor availability and accessibility of healthcare services in general, as identified by unmet needs in healthcare, are associated with dissatisfaction with healthcare. Within a European multicenter observational study, 357 young adults with cerebral palsy aged 19-28 were included. We assessed special healthcare needs, utilization of healthcare services, and satisfaction with healthcare applying the short-form of the YHC-SUN-SF, environmental and social variables (EAEQ) as well as indicators for severity of condition and functionality (e.g., GMFCS) of these participants based on a self-, assisted self- or proxy-reports. We used correlation analyses to explore associations between satisfaction with healthcare and respective indicators related to availability and accessibility of healthcare services as well as severity of the condition. In addition, we included reference values for satisfaction with heath care from young adults with various chronic conditions assessed within population-based surveys from some of the European countries included in the study. We identified several unmet healthcare needs, especially for widely used and established services (e.g., physical therapy). Satisfaction with healthcare (YHC-SUN-SF general and subscale scores) was moderate to high and almost consistently better for the sample of young adults with cerebral palsy as compared to reference values for young adults with various chronic conditions assessed within general population surveys). Correlation coefficients between satisfaction with healthcare and utilization of services and (unmet) healthcare needs were low, also with different indicators for severity of the condition or functionality. Young adults with cerebral palsy reports of unmet healthcare needs varied largely but showed substantial deficits in some aspects. This seems to have no impact on the satisfaction with healthcare those patients currently receive. We conclude that these are two different constructs and somewhat independent indicators to evaluate the quality of healthcare. Clinicians and other practitioners should consider this distinction when monitoring patient needs in their daily practice.

This study explored the variation in emerging adults’ communication with gastroenterologists around the management of inflammatory bowel disease (IBD).Nineteen emerging adults with IBD aged 18–25 and seven gastroenterologists participated in the study. Outpatient specialist consultations of consenting participants were audio-recorded and transcribed. Transcribed consultations were analysed in terms of the linguistic structure of the consultations and the gastroenterologist-patient role relationship.Variations in the emerging adults’ communication with their gastroenterologists stem partly from variation in their ability, opportunity, or need to contribute to the different phases of the consultation and partly from variations in the gastroenterologists’ style of communication. Gastroenterologists differed in the construction of their role relationship with the patient, resulting in variations in employing empowering strategies including eliciting, exploring, and clarifying the patient’s concerns, sharing clinical reasoning, and validating the patient experience. Variations were also observed in the length of appointments and the gastroenterologists’ assessment and addressing of adherence issues. Techniques used by the gastroenterologist varied (1) from simply confirming adherence, to a comprehensive assessment of the patient’s understanding of their management plan and their feedback, and (2) from use of persuasion to values calibration.Evidence-based consumer interventions and communication guidelines for clinicians are needed to address the identified variations in providing care to emerging adults living with chronic conditions.

Invasive pathogens threaten wildlife health and biodiversity. Physiological responses of species highly susceptible to pathogen infections following invasion are well described. However, the responses of less susceptible species (relative to highly susceptible species) are not well known. Latitudinal gradients, which can influence body condition via Bergmann's rule and/or reflect the time it takes for an introduced pathogen to spread geographically, add an additional layer for how mammalian species respond to pathogen exposure. Our goal was to understand how hosts less susceptible to pathogen infections respond to long‐term pathogen exposure across a broad latitudinal gradient. We examined changes in body mass throughout pathogen exposure time across the eastern United States (latitude ranging 30.5° N–44.8° N) in Eptesicus fuscus, a bat species classified as less susceptible to infection (relative to highly susceptible species) by the invasive fungal pathogen that causes white‐nose syndrome, Pseudogymnoascus destructans (Pd). Using 30 years of spring through fall adult capture records, we created linear mixed‐effects models for female and male bats to determine how mass or mass variation changed across the eastern United States from pre‐Pd invasion years through Pd invasion (0–1 years with Pd), epidemic (2–4 years with Pd), and established years (5+ years with Pd). By Pd establishment, all female and male bats decreased body mass with increasing latitude across a spatial threshold at 39.6° N. Differences in bat mass north and south of the spatial threshold progressively increased over Pd exposure time‐steps such that body mass was lower in northern latitudes compared to southern latitudes by Pd establishment. Results indicated that the progressive differences in E. fuscus body mass with latitude across the eastern United States are due to long‐term pathogen exposure; however, other environmental and ecological pressures may contribute to decreases in E. fuscus body mass with latitude and long‐term pathogen exposure. As pathogen introductions and emerging infectious diseases become more prevalent on the landscape, it is imperative that we understand how less susceptible species directly and indirectly respond to long‐term pathogen exposure in order to maintain population health in surviving species.

Purpose The purpose of this integrative review was to evaluate and synthesize studies that incorporated biological measures and examined their associations with chronic stress and anxiety in adolescents and emerging adults with chronic health conditions. Design An integrative literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement to identify studies published between 2005 and 2015. Methods Using key terms, three databases (PubMed/Medline, PsycInfo and the Cumulative Index to Nursing and Allied Health Literature) were searched by a research librarian. Additional publications with relevance to the topic were identified from citing and cited literature. The full text of 61 publications was reviewed. The final group of articles analyzed for this review included 36 peer‐reviewed publications and meeting s. Findings Studies varied considerably in characteristics, theoretical frameworks, phenotypes of interest, and study measures. Few studies evaluated genomic variants; those that did often examined small samples and a limited number of biological factors. Conclusions Studies of chronic stress and anxiety in adolescents and emerging adults with chronic health conditions are currently limited in scope and impact. A more comprehensive approach will facilitate translation into practice to improve short‐ and long‐term health outcomes. Clinical Relevance Precision and genomic healthcare initiatives support the relevance of this work for nurses in all areas of clinical practice. Genomic testing is expanding to include individuals in all age groups, with and without diagnosed conditions. As psychological and behavioral phenotypes may influence self‐management outcomes of adolescents and emerging adults with chronic health conditions, further research in this area is warranted.

Chloroquine and hydroxychloroquine are aminoquinolines used in the treatment of endemic diseases in Latin America such as malaria and non-endemic with wide prevalence such as rheumatoid arthritis and lupus erythematosus. Described as persistent, bioaccumulative, and dangerous for aquatic biota, chloroquine and hydroxychloroquine are considered emerging pollutants intensified by the COVID-19 pandemic, occurring in low concentrations that are not totally removed in wastewater treatment plants and are not covered by legislation. This article presents a theoretical approach based on literature review following a semi-systematic methodology covering detection strategies of the chloroquine and hydroxychloroquine drugs in effluent and receiving water bodies; estimates of environmental concentrations during the pandemic; methods that use degradation and removal of compounds from water; and toxic effects on aquatic biota. Concentrations previously detected and estimated in the aquatic environment can lead to significant changes in animal physiology analyzed from biomarker changes, behavior and mortality in studies with native and non-native species. Studies are necessary to reproduce and understand possible environmental scenarios adopting the indiscriminate use of drugs to serve as standards for environmentally safe concentrations when there is no specific legislation. Keywords: COVID-19, emerging pollutants, toxicity.

Background This research offers two exploratory frameworks, one for medical regimen compliance and one for medical immediacy. The first classifies compliance awareness, compliance mitigation, and financial limitation for those patients that exhibit nonadherence with a medical regimen. The second classifies medical immediacy and characterizes avoidable utilization. Methods Representative sampling of adult patients presenting at an emergency department (62,000/ppy) triaged as low acuity; emergency department physician assessment of noncompliance with medical regimen for those patients with a complaint related to a chronic condition; and emergency department physician assessment of medical immediacy and avoidable utilization. Results Physicians report 48.3% (95% confidence interval (CI) 43.5% to 53.1%) of patients with at least a single chronic condition are presenting with symptoms or complaint related to a chronic condition, and 39.6% (CI 31.7% to 47.4%) of these exhibit noncompliance with the medical regimen associated with that chronic condition. 16.4% (CI 6.6% to 26.1%) of the patients exhibit pseudo compliance, a belief that the medical regimen is in compliance when in fact it is not. If the patient had been in compliance, 85.9% (CI 77.0% to 94.8%) of the presenting conditions may have been mitigated. Noncompliance cases (34.5% (CI 22.0% to 47.1%)) are partly attributable to financial constraints. Further, 19.1% (CI 15.7% to 22.5%) are assessed as requiring no medical intervention and 3.4% (CI 1.8% to 4.9%) require immediate stabilization. Conclusions A large portion of low-acuity presentations are related to a chronic condition and noncompliance with the associated medical regimen contributes to the need to seek medical services. Interventions addressing literacy and financial constraints may increase compliance and decrease utilization.

With the aim to identify at-risk individuals among a cohort of international travellers, 3442 individuals who sought advice at Marseille travel health centre in 2009 were prospectively included. Demographics, travel characteristics, chronic medical conditions, vaccinations and antimalarial chemoprophylaxis were documented. Chronic medical conditions were reported by 11% of individuals, including hypertension (39%), asthma (20%), thyroid disease (15%) and depression (13%). 4% reported taking a daily medication, and psychotropic and cardiovascular medications were the most commonly used. Older travellers (≥60 years) accounted for 10% of the travellers and the prevalence of chronic medical conditions was 27% in this group. Individuals aged 15 years or less accounted for 13% of the travellers. Age, last minute travel (17%) and neurological and psychiatric diseases were the most frequent factors that influenced Yellow fever vaccination and malaria chemoprophylaxis, with more than one tenth of the travellers reporting at least one risk factor for which adjusted advice may be necessary. Migrants visiting their relatives in their origin country accounted for 14% of travellers and 73% of this group travelled with their family including young children. We demonstrate that a significant proportion of travellers are at-risk (43%) because of their travel conditions (VFR), their age, or their health status, and should be targeted for risk reduction strategies.

Technological innovation is transforming the prevalence and functional impact of child disability, the scale of social disparities in child disability, and perhaps the essential meaning of disability in an increasingly technology-dominated world. In this article, Paul Wise investigates several specific facets of this transformation. He begins by showing how technological change influences the definition of disability, noting that all technology attempts to address some deficiency in human capacity or in the human condition. Wise then looks at the impact of technology on childhood disabilities. Technical improvements in the physical environment, such as better housing, safer roads, and poison-prevention packaging, have significantly reduced childhood injury and disability. Other technological breakthroughs, such as those that identify genetic disorders that may lead to pregnancy termination, raise difficult moral and ethical issues. Technologies that identify potential health risks are also problematic in the absence of any efficient treatment. Wise stresses the imbalance in the existing health care delivery system, which is geared toward treating childhood physical illnesses that are declining in prevalence at a time when mental and emotional conditions, many of which are not yet well understood, are on the rise. This mismatch, Wise says, poses complex challenges to caring for disabled children, particularly in providing them with highly coordinated and integrated systems of care. Technology can also widen social disparities in health care for people, including children with disabilities. As Wise observes, efficacy—the ability of a technology to change health outcomes—is key to understanding the relationship of technology to social disparities. As technological innovation enhances efficacy, access to that technology becomes more important. Health outcomes may improve for those who can afford the technology, for example, but not for others. Hence, as efficacy grows, so too does the burden on society to provide access to technology equitably to all those in need. Without such access, technological innovation will likely expand disparities in child outcomes rather than reduce them.

This chapter contains sections titled: Introduction A need to be productive The service Socio‐political context of the service Applying an occupational perspective Initiating change The project The experience The future: vocational rehabilitation The future: personal practice Conclusion References