In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.

The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.

This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.

From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).

Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.

To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.

The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.

These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.

Hispanics/Latinos in the United States are less aware of their cholesterol levels and have a higher burden of associated adverse cardiovascular and cerebrovascular outcomes than non-Latino whites. Investigations of the associations between cholesterol levels and cognition in this population have often occurred within the context of metabolic syndrome and are limited to select lipids despite the fact that triglycerides (TGs) may be more relevant to the health of Hispanics/Latinos.

Baseline data from the Hispanic Community Health Study/Study of Latinos, collected from 2008 to 2011, was used to investigate the associations of lipid levels (i.e., TG, total cholesterol, TC; low-density and high-density lipoprotein cholesterol, LDL-C and HDL-C) with cognition (i.e., learning, memory, verbal fluency, and digit symbol substitution, DSS), adjusting for relevant confounders.

In 7413 participants ages 45 to 74 years from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds, separate, fully adjusted linear regression models revealed that TG levels were inversely associated with DSS performance; however, this relationship was no longer significant once additional cardiovascular disease risk factors were added to the model (p = .06). TC and LDL-C levels (separately) were positively associated with learning and verbal fluency regardless of adjustments (p-values < .05). Separate analyses investigating the effect modification by background and sex revealed a particularly robust association between TC levels and DSS performance for Puerto Ricans and Central Americans (albeit in opposite directions) and an inverse relationship between TG levels and DSS performance for women (p-values < .02).

It is important to consider individual lipid levels and demographic characteristics when investigating associations between cholesterol levels and cognition in Hispanics/Latinos.

To determine the prevalence of low scores for two neuropsychological tests with five total scores that evaluate learning and memory functions.

N = 5402 healthy adults from 11 countries in Latin America and the commonwealth of Puerto Rico were administered the Rey–Osterrieth Complex Figure (ROCF) and the Hopkins Verbal Learning Test (HVLT-R). Two-thirds of the participants were women, and the average age was 53.5 ± 20.0 years. Z-scores were calculated for ROCF Copy and Memory scores and HVLT-R Total Recall, Delayed Recall, and Recognition scores, adjusting for age, age2, sex, education, and interaction variables if significant for the given country. Each Z-score was converted to a percentile for each of the five subtest scores. Each participant was categorized based on his/her number of low scoring tests in specific percentile cutoff groups (25th, 16th, 10th, 5th, and 2nd).

Between 57.3% (El Salvador) and 64.6% (Bolivia) of the sample scored below the 25th percentile on at least one of the five scores. Between 27.1% (El Salvador) and 33.9% (Puerto Rico) scored below the 10th percentile on at least one of the five subtests. Between 5.9% (Chile, El Salvador, Peru) and 10.3% (Argentina) scored below the 2nd percentile on at least one of the five scores.

Results are consistent with other studies that found that low scores are common when multiple neuropsychological outcomes are evaluated in healthy individuals. Clinicians should consider the higher probability of low scores when evaluating learning and memory using various sets of scores to reduce false-positive diagnoses of cognitive deficits.

Emergency physicians play a frontline role in hospital disaster responses and require appropriate training.

The aim of the current study was to pilot and compare the effectiveness of two emergency preparedness teaching interventions: the first employing traditional lecture-based instruction (LEC) and the second utilizing interactive simulation/game-based teaching (SIM).

A two-group randomized pre- and post-test design was implemented into the didactic curriculum of the Emergency Medicine (EM) Residency Training Program at the San Lucas Episcopal Hospital in Ponce, Puerto Rico. Residents (n=23) completed either a LEC (control) or SIM teaching module (single day, one to two hours) focusing on emergency preparedness concepts, disaster-related clinical decision-making, and physician responsibilities during hospital disaster protocols. Knowledge-based multiple-choice exams and scenario-based competency exams were administered at three different time points: one-week pre-intervention, immediately post-training, and two-weeks post-training. Test scores were compared between groups at each time point using the Mann-Whitney U test.

Following the teaching interventions, no significant differences were found between the LEC group versus the SIM group in knowledge-based exam performance (LEC 81.1%[9.4] vs. SIM 74.9%[12.1]; U=42.50, p=0.15) and scenario-based exam performance (LEC 80.0%[9.7] vs. SIM 80.2%[9.2]; U=62.00, p=0.83), suggesting both teaching methods were similarly effective. Indeed, knowledge-based exam scores improved two-fold and scenario-based exam scores improved by over 50% immediately following training relative to baseline exam scores. Two-weeks post-training, a significant decrease in scenario-based exam performance was found in the LEC group relative to the SIM group (LEC 63.1%[11.6] vs. SIM 75.4%[11.5]; U=91.50, p=0.036), suggesting residents who train with simulations show greater retention of scenario-based concepts compared to those who train with lecture-based training alone.

The current study highlights the potential dual value of incorporating simulation training in EM emergency preparedness curriculums in improving both knowledge and concept retention of physician disaster responsibilities.

Informal caregivers of individuals with Parkinson’s disease face a range of responsibilities that increase as the disease progresses. As a result of these stressors, caregivers are vulnerable to decreased health-related quality of life (HRQOL). Guided by the stress process model of caregiving, the present study examined the relations between family cohesion, perceived burden, and mental and physical HRQOL among Parkinson’s disease caregivers in Mexico. It was hypothesized that perceived burden would mediate the relations of family cohesion and mental and physical HRQOL.

Ninety-five family caregivers of individuals with Parkinson’s disease in Mexico City, Mexico, participated in the study. Multiple regression was utilized to conduct mediation analyses.

Results indicated that burden fully mediated the relation between family cohesion and mental HRQOL, and family cohesion was not associated with physical HRQOL.

Findings extend the stress process model cross-culturally and lend support for the importance of family cohesion and perceived burden in determining caregiver mental HRQOL. Clinical health promotion interventions should target perceived burden and family cohesion together to improve mental HRQOL among familial caregivers in Mexico.

To develop an educational video to reach elderly Latinos in order to improve understanding and encourage evaluation of cognitive changes by 1) using focus groups to identify dementia knowledge gaps, health communication preferences and trusted advisors for health concerns; 2) collaborating with elderly Latino community members to create a video; and 3) collecting survey data regarding community response to the video.

Grounded theory qualitative approach using focus groups; collaborative community based model to create the video and anonymous survey at community screenings.

Community senior centers in East Harlem, New York.

A team of low-income mono and bilingual elderly Latino community residents, researchers, clinicians, and a film professional.

Thematic analysis of focus group transcripts; three item survey.

A collaboratively produced video and initial assessment in 49 Latino elders that indicated the video had a positive effect on interest in obtaining a brief memory screening at outreach events (71%).

The project demonstrates the feasibility of this interdisciplinary partnership to create a culturally and linguistically sensitive video to promote service use concerning memory loss and cognitive evaluations among elderly Latinos. Initial survey results suggested a positive response and an increase in interest in memory screening.