Rotavirus is a leading cause of acute diarrhea in children worldwide. Costa Rica recently started universal rotavirus vaccinations for infants with a two-dose schedule in February 2019. We aimed to study the seasonality of rotavirus during the pre-vaccination era. We retrospectively studied a six-year period of hospital admissions due to rotavirus gastroenteritis. We estimated seasonal peak timing and relative intensities using trend-adjusted negative binomial regression models with the δ-method. We assessed the relationship between rotavirus cases and weather characteristics and estimated their effects for the current month, one-month prior and two months prior, by using Pearson correlation coefficients. A total of 798 cases were analyzed. Rotavirus cases predominated in the first five months of the year. On average, the peak of admissions occurred between late-February and early-March. During the seasonal peaks, the monthly count tended to increase 2.5–2.75 times above the seasonal nadir. We found the strongest negative association of monthly hospitalizations and joint percentiles of precipitation and minimal temperature at a lag of two months (R = −0.265, p = 0.027) and we detected correlations of −0.218, −0.223, and −0.226 (p < 0.05 for all three estimates) between monthly cases and the percentile of precipitation at lags 0, 1, and 2 months. In the warm tropical climate of Costa Rica, the increase in rotavirus hospitalizations coincided with dry and cold weather conditions with a two-month lag. The findings serve as the base for predictive modeling and estimation of the impact of a nation-wide vaccination campaign on pediatric rotaviral infection morbidity.

Introduction/Objectives: Physical activity (PA) improves quality of life and prevents chronic disease, but many adults are inactive. Planning with a health care provider in the form of an exercise “prescription” or referral may increase PA, but determinants of referral utilization are not well understood among underserved populations. This study examined sociodemographic and theory-based psychosocial determinants of exercise referral program utilization. Methods: Patients at a large, federally qualified health center with an on-site exercise facility (ie, “Wellness Center”) referral were eligible to exercise with a personal fitness advisor. Self-reported PA behavior, self-efficacy, and self-regulation strategies were measured via survey and merged with electronic health records and attendance data. Negative binomial regression was used to estimate the rate of Wellness Center utilization. Results: Patients with exercise referrals (n = 1136) were, on average, 45.6 ± 14.6 years, 78.8% female, and 78.0% Hispanic/Latino or non-Hispanic Black. Approximately half (593/1136; 52.2%) initiated exercise at the Wellness Center; initiators completed 8.8 ± 12.4 visits during follow-up. Older age was associated with higher utilization ( P < .001) and patients meeting PA recommendations had lower utilization than patients not meeting recommendations (incident rate ratio = 0.72, 95% CI 0.53-0.97; P = .03). Baseline self-efficacy ( P < .001) and self-regulation strategies ( P = .03) were significantly associated with follow-up PA, even after adjusting for baseline PA. Conclusions: In this racially/ethnically diverse patient population, older and less active patients at baseline had higher program utilization. Patients with higher self-efficacy and self-regulation strategies reported higher PA over time. Community health centers have a unique opportunity to support PA through exercise referral programs to public health priority populations.

Background Shared genetic and environmental factors suggest that family relationships are important predictors of obesity-related behaviors, yet little is known about how siblings influence physical activity and sedentary behaviors. This study examined physical activity and sedentary behavior between sibling dyads across summer and fall time points and determined if birth order and gender modify the relationship between sibling behaviors. Methods Mexican-heritage families residing in colonias along the United States-Mexico border were recruited using promotoras de salud to participate in summer and school year surveys. Eighty-seven sibling dyads had complete data for the physical activity sub-study: 21 older brother-younger brother, 21 older brother-younger sister, 23 older sister-younger brother, and 22 older sister-younger sister dyads. Physical activity and sedentary behavior were measured using a validated 7-day recall instrument to create summary measures of weekly active, moderate-to-vigorous physical activity (MVPA) metabolic equivalents (MET), sitting, and screen time minutes. We used linear regression analyses to examine changes over time and the association between older and younger sibling behavior. Results During summer, older siblings (mean age = 11.2 years) reported 1069 active minutes and 1244 sitting minutes per week; younger siblings (mean age = 8.3 years) reported 1201 active minutes and 1368 sitting minutes per week. Younger brothers reported fewer active minutes (mean = − 459.6; p = 0.01) and fewer MVPA MET-minutes (mean = − 2261.7; p = 0.02) of physical activity during the fall. Within all 87 dyads, older sibling physical activity was significantly associated with younger sibling active minutes (B = 0.45; p = 0.004) and MET-minutes (B = 0.45; p = 0.003) during summer but not fall; older sibling sedentary behavior was significantly associated with younger sibling sitting (B = 0.23; p = 0.01) and screen time minutes (B = 0.23;p = 0.004) during fall but not summer. After stratifying by gender dyad groups, younger brother behavior was strongly associated with older brother behavior at both time points. Conclusion Younger siblings appear to emulate the physical activity behaviors of their older siblings during non-school summer months and sedentary behaviors of older siblings during school-time fall months, especially older brother-younger brother dyads. Family-based interventions to increase physical activity and decrease sedentary behavior are growing in popularity, but more work is needed to understand the role of sibling influences.

RESUMENObjetivo: Conocer las características clínico-epidemiológicas de los pacientes usuarios de drogas ingresados.Método: Estudio descriptivo-retrospectivo. Resultados: 123 pacientes (155 ingresos), 84,5% ingresaron por urgencias; edad media 33 ± 6. 65,9% hombres. 90,2% utilizó la vía parenteral; edad media de consumo 21 años (12-36). Años de adicción entre 1 y 30, (69 consumieron durante 10 años o más). 102 eran portadores crónicos de la hepatitis C, 13 de la B, 50 tenían algún marcador positivo de la B; 65 eran VIH (+) (todos UDVP) y 61 estaban coinfectados por el virus de la hepatitis C. 34 tenían sida. La patología infecciosa originó 105 ingresos. El destino mayoritario fue alta (134), 11 pacientes fallecieron.Conclusiones: La mayoría son varones. Los ingresos se deben, sobretodo, a procesos infecciosos. Las patologías asociadas más observadas son: ser VIH(+) y ser portador crónico de hepatitis C. El destino mayoritario fue alta y todos los fallecidos eran VIH(+).PALABRAS CLAVE: Usuarios de drogas. Ingresos. Infecciones. ABSTRACTAim: To know the clinical and epidemiological characteristics of drug users admitted to a hospital.Method: A descriptive-retrospective study. Results: Of the 123 patients admitted to the hospital (a total of 155 admissions), 84,5% of them were admitted through the Emergency Department. Their main age was 33 ± 6 and the 65,9% were male. The 90,2% were injecting drug users (IDU). The main age of initiation in the use of drugs was 21 years; and the time of addiction ranged from I to 30 years (69 patients remained addicted to drugs for 10 years or more). There were 102 HCV infections and 13 HBV infections, and 50 patients tested positive for at least I serological marker of hepatitis B infection; 65 were HIV positive (all ofthem were IDU) and 61 were coinfected with HCV. 34 patients had AIDS. Infectious diseases were responsible for 105 of the 155 admissions to hospital. In 134 occasions the patients were discharged and 11 died.Conclusions: Most of the patients were male. The admissions to hospital were mostly due to infectious diseases. The most commonly associated pathologies seen were to be HIV positive and to carry HCV. The outcome of patients was mainly the discharge from hospital, and those who died were all HIV positive.

No abstract

La sociedad moderna ha cambiado la orientación de la vida y la muerte hacia una perspectiva dominada por los valores científicos. El proceso de morir ha sufrido cambios desplazándose progresivamente desde el hogar y la familia hacia el médico y los centros hospitalarios (1). Sin embargo los hospitales modernos, con todo su dispositivo técnico, están orientados hacia un objetivo principal que es el restablecimiento de la salud, y ante un paciente terminal, o se cae en la tentación de prolongar la vida por todos los medios posibles, o prevalece un sentimiento de fracaso ("no hay nada más que hacer") (2). Parece por tanto registrarse una cierta tendencia a acudir a fallecer en el hospital, generando exploraciones y pruebas diagnósticas muchas veces innecesarias, que fortalecen la creencia popular de que siempre se puede "hacer algo más" y condicionando que estos pacientes mueran solos en un medio extraño y sin el apoyo de sus familias.