RESUMEN
BACKGROUND: The COVID-19 pandemic has exacerbated disparities in poverty and illness for people in vulnerable circumstances in ethnocultural communities. We sought to understand the evolving impacts of COVID-19 on ethnocultural communities to inform intersectoral advocacy and community action. METHODS: The Illuminate Project used participatory action research, with cultural health brokers as peer researchers, from Sept. 21 to Dec. 31, 2020, in Edmonton, Alberta. Twenty-one peer researchers collected narratives from members of ethnocultural communities and self-interpreted them as they entered the narratives into the SenseMaker platform, a mixed-method data collection tool. The entire research team analyzed real-time, aggregate, quantitative and qualitative data to identify emerging thematic domains, then visualized these domains with social network analysis. RESULTS: Brokers serving diverse communities collected 773 narratives. Identified domains illuminate the evolving and entangled impacts of COVID-19 including the following: COVID-19 prevention and management; care of acute, chronic and serious illnesses other than COVID-19; maternal care; mental health and triggers of past trauma; financial insecurity; impact on children and youth and seniors; and legal concerns. We identified that community social capital and cultural brokering are key assets that facilitate access to formal health and social system supports. INTERPRETATION: The Illuminate Project has illustrated the entangled, systemic issues that result in poor health among vulnerable members of ethnocultural communities, and the exacerbating effects of COVID-19, which also increased barriers to mitigation. Cultural brokering and community social capital are key supports for people during the COVID-19 pandemic. These findings can inform policy to reduce harm and support community resiliency.
Asunto(s)
COVID-19/etnología , Servicios de Salud Comunitaria/organización & administración , Pandemias , Poblaciones Vulnerables/etnología , Alberta/epidemiología , COVID-19/prevención & control , COVID-19/terapia , Información de Salud al Consumidor , Femenino , Estrés Financiero , Investigación sobre Servicios de Salud , Disparidades en Atención de Salud , Humanos , Masculino , Pobreza , SARS-CoV-2 , Capital Social , Análisis de Redes Sociales , Apoyo SocialRESUMEN
We assessed the impact of a structured lower-limb aerobic exercise training intervention during pregnancy on brachial artery endothelial function, shear rate and patterns, and forearm blood flow and reactive hyperemia. Twenty-seven pregnant women were recruited and randomized into either a control group (n = 11; 31.0 ± 0.7 years), or an exercise intervention group (n = 16; 32.6 ± 0.9 years). The exercise group completed 40 minutes of aerobic exercise (50-70% heart rate reserve) 3-4 times per week, between the second and third trimester of pregnancy. Endothelial function was assessed using flow-mediated dilation (FMD, normalized for shear stress) at pre- (16-20 weeks) and post-intervention (34-36 weeks). The exercise training group experienced an attenuated increase in mean arterial pressure (MAP) relative to the control group (ΔMAP exercise: +2 ± 2 mm Hg vs. control: +7 ± 3 mm Hg; p = 0.044) from pre- to post-intervention. % FMD change corrected for shear stress was not different between groups (p = 0.460); however, the post-occlusion mean flow rate (exercise: 437 ± 32 mL/min vs. control: 364 ± 35 mL/min; p = 0.001) and post-occlusion anterograde flow rate (exercise: 438 ± 32 mL/min vs. control: 364 ± 46 mL/min; p = 0.001) were larger for the exercise training group compared with controls, post-intervention. Although endothelial function was not different between groups, we observed an increase in microcirculatory dilatory capacity, as suggested by the augmented reactive hyperemia in the exercise training group. Registered at ClinicalTrials.gov: NCT02948439. Novelty: Endothelial function was not altered with exercise training during pregnancy. Exercise training did contribute to improved cardiovascular outcomes, which may have been associated with augmented reactive hyperemia, indicative of increased microcirculatory dilatory capacity.
Asunto(s)
Endotelio Vascular/fisiología , Ejercicio Físico/fisiología , Atención Prenatal/métodos , Resistencia Vascular/fisiología , Vasodilatación/fisiología , Adulto , Velocidad del Flujo Sanguíneo , Presión Sanguínea/fisiología , Arteria Braquial/fisiología , Femenino , Antebrazo/irrigación sanguínea , Humanos , Hiperemia/fisiopatología , Extremidad Inferior/fisiología , Microcirculación/fisiología , EmbarazoRESUMEN
PURPOSE: To determine the role of moderate-to-vigorous physical activity (MVPA) and sedentary behavior in flow-mediated dilation (FMD) and glucose metabolism during late pregnancy. METHODS: Seventy normotensive, euglycemic pregnant women (31.6 ± 2.9 yr) in their third trimester (28-39 wk) were recruited. After a fasted blood sample; FMD was measured (brachial artery Doppler ultrasonography, normalized for the shear stimulus [area under the curve]). Anterograde and retrograde shear rate were estimated. Physical activity (MVPA) and sedentary behavior were assessed via accelerometry for seven consecutive days (Actigraph wGT3X-BT). We categorized the women as active (>150 min·wk) or inactive (<150 min·wk) according to their accelerometry data. Data were corrected for age and gestational age. RESULTS: On average, women were sedentary 67.1% ± 8.2% of their waking hours. Active pregnant women (>150 min·wk MVPA, n = 32) engaged in 266.7 ± 99.3 min·wk MVPA, whereas inactive pregnant women (<150 min·wk MVPA, n = 38) engaged in 76.1 ± 42.5 min·wk MVPA. The FMD response (normalized to the magnitude of shear stress stimulus) was greater in active compared with inactive pregnant women (6.5 ± 4.4 a.u. vs 3.9 ± 3.5 a.u.; F = 4.619; P = 0.005). The MVPA in active pregnant women was inversely correlated with insulin concentrations (r = -0.556; P = 0.03). In inactive pregnant women, higher amounts of sedentary behavior were associated with lower amounts of retrograde shear rate (r = 0.504; P = 0.02), retrograde blood flow (r = 0.499; P = 0.02), and retrograde velocity (r = 0.508; P = 0.02) during baseline, but not correlated with the FMD response. CONCLUSIONS: Engaging in MVPA during pregnancy is associated with improved FMD and a lower insulin concentration. Sedentary behavior was not associated with FMD responses.