Translating using RE-AIM of a falls behavior change program among an assisted living population

A Matter of Balance/Volunteer Lay Leader model is an evidence-based program to change behavior to adopt falls prevention strategies. The purpose was to translate this program to assisted living communities. A single-arm intervention study was designed to assess for falls-related and physical performance measures. Forty-one residents, with a mean age of 87 years, were eligible for participation. The Falls Management Scale (P = .02) and the Physical Component Summary Score (P = .01) significantly improved from baseline to 8 weeks. Gait speed (P = .059) was borderline significant from baseline to 6 months. We showed evidence for successful translation within the assisted living communities sampled.

Studying the association of microRNA-210 level with chronic hepatitis B progression

We studied the relationship between hypoxia and microRNA-210 (miR-210) levels, the miR-210 levels in patients with hepatitis B and the roles of miR-210 in liver inflammation. We used the concanavalin A (Con A) murine hepatitis model and inflammation, hypoxia and miR-210 levels were examined. In these patients, we studied serum miR-210 levels and clinical indexes related to hepatitis in 90 patients with different stages of chronic hepatitis B and 30 controls. Two functional assays of miR-210 in vitro under hypoxic condition were conducted. The animal experiments indicated that the liver and serum miR-210 levels significantly increased with liver hypoxia and inflammation. In humans, serum miR-210 levels enhanced with hepatitis severity and were related to serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB) and prothrombin activity (PTA) levels. The miR-210 functional assays showed that miR-210 elevation might be related to the decreases in HepG2.2.15 cell dehydrogenase activity and HBV replication under hypoxic conditions. Because the liver inflammation causes liver hypoxia which also results in liver and serum miR-210 level elevation, the serum miR-210 level may serve as a molecular biomarker for the severity of hepatitis and increases in liver miR-210 that we see may be a response of hepatocytes to hypoxia during hepatitis progression.

Feasibility testing of a web-based symptom self-management system for persons living with HIV

The purpose of this study was to explore the feasibility of using a Web-based tool to provide tailored symptom management strategies for persons living with HIV (PLWH) and to estimate the effect size of the tool for future studies. Testing the components of the Web-based system was done by incorporating a repeated-measures design measuring the outcomes of symptom frequency and intensity, use of symptom management strategies, and engagement with health care providers. We recruited 42 PLWH; participants were enrolled in the study for 12 weeks and were asked to use the system and complete the questionnaires every 2 weeks. Our results showed that participants who used the strategies were more likely to have a decrease in symptom frequency and intensity. Findings from this feasibility study provide preliminary evidence for the use of a Web-based HIV symptom management tool with self-management strategies for individuals living with HIV infection.

Atorvastatin suppresses Toll-like receptor 4 expression and NF-κB activation in rabbit atherosclerotic plaques

BACKGROUND

Toll-like receptor 4 (TLR4) plays an essential role in the pathogenesis and progression of atherosclerosis, which overexpresses in atherosclerotic lesions and mediates the production of inflammatory factors. The aim of this study was to investigate the effects of atorvastatin on TLR4 protein and mRNA expression and its downstream factor NF-κB activation in rabbit atherosclerotic plaques.

MATERIALS AND METHODS

Rabbits continuously fed with high-fat diet for 24 weeks were randomly divided into two groups, the drug-treated group orally administrated with atorvastatin (2 mg/kg/day) three weeks after high-fat diet feeding and the model group with no treatment. The expression of TLR4 protein and mRNA, the level of activated NF-κB (p65) were respectively detected by western blotting, quantitative RT-PCR, and ELISA.

RESULTS

The results showed that atorvastatin treatment reduced the expression of TLR4 protein and mRNA by 24.1% (p < 0.05) and 46.9% (p < 0.01), respectively, and also inhibited NF-κB activation by 76.0% (p < 0.001) in the atherosclerotic plaques.

CONCLUSIONS

Thus, it was suggested that atorvastatin could exert an anti-atherosclerotic activity besides inhibiting cholesterol biosynthesis.

Cognitive trio: relationship with major depression and clinical predictors in Han Chinese women

BACKGROUND

Previous studies support Beck's cognitive model of vulnerability to depression. However, the relationship between his cognitive triad and other clinical features and risk factors among those with major depression (MD) has rarely been systematically studied.

METHOD

The three key cognitive symptoms of worthlessness, hopelessness and helplessness were assessed during their lifetime worst episode in 1970 Han Chinese women with recurrent MD. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.

RESULTS

Compared to patients who did not endorse the cognitive trio, those who did had a greater number of DSM-IV A criteria, more individual depressive symptoms, an earlier age at onset, a greater number of episodes, and were more likely to meet diagnostic criteria for melancholia, postnatal depression, dysthymia and anxiety disorders. Hopelessness was highly related to all the suicidal symptomatology, with ORs ranging from 5.92 to 6.51. Neuroticism, stressful life events (SLEs) and a protective parental rearing style were associated with these cognitive symptoms.

CONCLUSIONS

During the worst episode of MD in Han Chinese women, the endorsement of the cognitive trio was associated with a worse course of depression and an increased risk of suicide. Individuals with high levels of neuroticism, many SLEs and high parental protectiveness were at increased risk for these cognitive depressive symptoms. As in Western populations, symptoms of the cognitive trio appear to play a central role in the psychopathology of MD in Chinese women.

First Report of Bipolaris papendorfii Causing Corn Leaf Spot in China

Corn is the most important cereal crop in China, with over 34.94 million ha being cultivated in the country annually. However, fungal diseases are a major limiting factor in corn production. In August 2012, 20 ha of corn fields in Anhui Province were found to be heavily infected by fungi. The margin of the lesion was achlorotic, and the middle was yellowish white or off-white, which was similar to the corn Curvalaria leaf spot. The oval lesions were approximately 5 to 7 mm. Lesion tissue was removed from the border between symptomatic and healthy tissue. The surface was sterilized in 75% ethanol for 30 s and 0.1% HgCl₂ for 1 min, after which the sample was washed three times in sterile distilled water. The isolate was purified and subcultured on potato dextrose agar (PDA) at 25 ± 2°C. The initial color of the colony was light brown, turning dark brown after being cultured for 7 days. The conidia were boat-shaped or inverted pear-shaped and were clearly bent to one side. The cells of both ends were slightly lighter and respectively ranged from 34.5 to 44.0 μm and 12.0 to 21.0 μm away from the base, with the second cell as the widest. The majority conidia had three or four false septates; isolates produced light brown to medium brown conidiophore, scattered or clustered, often branching, and exhibited bending. These morphological characteristics matched with the description of Bipolaris papendorfii reported by Zhang (3). A pathogenicity test was conducted with the two isolates on each of the 36 corns by spraying 2 ml spore suspension (10⁶ conidia/ml). For the control treatment, 36 corns were inoculated with an equal volume of sterilized water. Inoculated plants were placed in a greenhouse from 29 to 33°C and 95% relative humidity. The typical 5 to 7 mm oval lesions were observed 7 days after inoculation, except on the control samples. Three replications of 36 corns were used for each treatment. The isolate was consistently 100% reisolated from the diseased tissue according to Koch's postulate. The isolate was found to be morphologically similar to B. papendorfii. Preliminary morphological identification of the fungus was confirmed by PCR assay using genomic DNA extracted from the mycelium of a 7-day-old culture on PDA at 25 ± 2°C. A 550-bp amplified region of the internal transcribed spacer (ITS) of rDNA was generated using ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3') universal primers (1). The ITS region (GenBank Accession No. KC592365) was then sequenced by Sangon Biotech (Shanghai, China), and displayed 99% nucleotide similarity with the rDNA-ITS of B. papendorfii (JQ753972.1) separately after BLASTn research in GenBank. Based on the symptoms, fungal morphology, ITS sequence, and pathogenicity testing, this fungus was identified as B. papendorfii. The pathogen could reportedly infect tobacco and cotton (2). To our knowledge, this is the first study to report that B. papendorfii can infect corn in China. This report will establish a foundation for the further study of B. papendorfii to address the disease effectively. Further studies will be conducted to determine the incidence of the disease and the severity of damage caused by B. papendorfii as well as determine a possible mode for controlling the spread of the disease. References: (1) Y. J. Cao et al. Chin. J. Trop. Crops 31:1098, 2010. (2) H. Deng et al. Mycosystema 21:327, 2002. (3) T. Y. Zhang. Chin. Fungi Chi. 30:21, 2010.

Surgical site infections and bloodstream infections in infants after cardiac surgery

OBJECTIVE

Few recent studies have assessed the epidemiology of and risk factors for surgical site infections (SSIs) and bloodstream infections (BSIs) in infants after cardiac surgery. We hypothesized that infants younger than 30 days old and those with higher Risk Adjustment in Congenital Heart Surgery-1 scores would have an increased risk of SSIs, but not an increased risk of BSIs after surgery.

METHODS

We performed a retrospective cohort study of infants younger than 1 year of age undergoing cardiac surgery from January 2010 to December 2011 to determine the rates of SSIs and BSIs occurring within 3 months of surgery, risk factors associated with these infections, and causative pathogens. Multivariable associations using Cox proportional hazard modeling assessed potential risk factors for BSIs or SSIs.

RESULTS

Overall, 8.7% (48 of 552) of surgical procedures were complicated by SSIs (n = 19) or BSIs (n = 29). Thus, SSIs and BSIs occurred after 3.4% and 5.3% of procedures, respectively. Multivariate models found age younger than 30 days, incorrect timing of preoperative antibiotics, and excessive bleeding within 24 hours of surgery to be significant predictors for SSIs, and duration of use of arterial lines to be a significant predictor for BSIs. Gram-positive bacteria caused 75% of SSIs and BSIs and methicillin-susceptible Staphylococcus aureus caused 63% of SSIs.

DISCUSSION

We identified some potential strategies to reduce risk, including closer monitoring of timing of preoperative antimicrobial prophylaxis and enhanced efforts to achieve intraoperative hemostasis and earlier removal of arterial lines.

CONCLUSIONS

SSIs and BSIs remain important complications after cardiac surgery in infants.

Prevalence of high-risk human papilloma virus among women with hepatitis C virus before liver transplantation

BACKGROUND

We sought to assess the prevalence and risk factors for high-risk human papillomavirus (HPV) infection among female liver transplant (LT) candidates. Traditional health screening before LT listing has included Pap smear and is typically carried out by the patient's local provider. The prevalence of high-risk HPV in this population has not been studied.

METHODS

With Institutional Review Board approval, 62 LT candidates received a liquid-based Pap smear with high-risk HPV testing as part of their pre-transplant evaluation by a single provider. Clinical variables included age, ethnicity, insurance status, prior Pap smear, and HPV results, HPV risk factors including age of first intercourse, number of lifetime partners, last sexual activity, smoking, birth control pill use, history of sexually transmitted infections, human immunodeficiency virus status, immunosuppressive medication, medical diagnoses, prescribed medications, and history of hepatitis A, B, C, or D.

RESULTS

The 62 women had a median age of 56 years, and 39% had high-risk behavior known to be associated with HPV. Ten of 62 patients (16.1%) had high-risk HPV at baseline screening, 5 of whom had atypical cytology. All of the patients who were positive for high-risk HPV had an etiology of hepatitis C virus (HCV) as the underlying cause of liver disease, with the majority (90%) having no history of high-risk behavior for HPV. In contrast, all patients with high-risk behavior who were HCV negative were HPV negative. Fisher's exact test demonstrated a statistically significant relationship between HPV and HCV; odds ratio = 24.4, 95% confidence interval, 1.4, 438.7, P-value = 0.0013. None of the other potential risk factors were associated with HPV in this cohort.

CONCLUSIONS

In this study, we provide evidence of a strong association between HCV and HPV in LT candidates, which has not been previously reported. HPV positivity was observed in non-sexually active women, suggesting a reactivation of dormant HPV. An association between hepatitis C and high-risk HPV could involve impairment of T-cell function by hepatitis C. These data support close surveillance in women's health screening for LT candidates. Further studies to characterize immune responses in these patients will be in order.

Impact of the 2009 influenza A (H1N1) pandemic on healthcare workers at a tertiary care center in New York City

BACKGROUND AND OBJECTIVE

Assessing the impact of 2009 influenza A (H1N1) on healthcare workers (HCWs) is important for pandemic planning.

METHODS

We retrospectively analyzed employee health records of HCWs at a tertiary care center in New York City with influenza-like illnesses (ILI) and confirmed influenza from March 31, 2009, to February 28, 2010. We evaluated HCWs' clinical presentations during the first and second wave of the pandemic, staff absenteeism, exposures among HCWs, and association between high-risk occupational exposures to respiratory secretions and infection.

RESULTS

During the pandemic, 40% (141/352) of HCWs with ILI tested positive for influenza, representing a 1% attack rate among our 13,066 employees. HCWs with influenza were more likely to have fever, cough, and tachycardia. When compared with the second wave, cases in the first wave were sicker and at higher risk of exposure to patients' respiratory secretions (P=.049). HCWs with ILI--with and without confirmed influenza--missed on average 4.7 and 2.7 work days, respectively (P=.001). Among HCWs asked about working while ill, 65% (153/235) reported they did so (mean, 2 days).

CONCLUSIONS

HCWs in the first wave had more severe ILI than those in the second wave and were more likely to be exposed to patients' respiratory secretions. HCWs with ILI often worked while ill. Timely strategies to educate and support HCWs were critical to managing this population during the pandemic.

Time lag for posting transmission-based isolation precaution signs

BACKGROUND

Rapid identification and isolation of patients colonized or infected with virulent pathogens is essential to minimize risk of exposure to other patients, visitors, and health care workers.

OBJECTIVE

Our objective was to determine the time lag between when a patient is identified as requiring isolation precautions and when an isolation sign is posted outside of their room.

METHODS

Patients requiring assessment of isolation precautions because of a new positive culture, readmission, or transfers within the institution were identified through an electronic surveillance system. Observers recorded the presence of isolation signs at the patient's door at time (T) 0hr, T2hr, T4hr, T24hr, and T48hr or until an isolation sign was posted.

RESULTS

The majority of patients was adults in nonintensive care units. Isolation signs were present for 79.0% of the patients at T0hr and increased to 83.8% by T48hr. No difference was seen between the unit type or indications for isolation. The most common organisms for which isolation was indicated were influenza and resistant enterococci, Staphylococcus aureus; isolation sign postings at T0hr were 87.9%, 85.7%, and 80.7%, respectively. There was a significant difference seen in compliance among the adult (82.8%) and pediatrics (66.7%) sites (P = .0268).

CONCLUSION

Isolation precautions are indicated to prevent transmission of virulent pathogens; however, their implementation in a timely manner can be challenging. In this study, approximately 20% of patients for whom isolation was needed had no sign posted within the first 24 hours, and there were only minimal increases thereafter. Simple processes are needed for early identification of patients, communication of the protective equipment needed, and continuous monitoring of adherence to guidelines.

Clinicians' knowledge, attitudes, and practices regarding infections with multidrug-resistant gram-negative bacilli in intensive care units

OBJECTIVE

To assess how healthcare professionals caring for patients in intensive care units (ICUs) understand and use antimicrobial susceptibility testing (AST) for multidrug-resistant gram-negative bacilli (MDR-GNB).

DESIGN

A knowledge, attitude, and practice survey assessed ICU clinicians' knowledge of antimicrobial resistance, confidence interpreting AST results, and beliefs regarding the impact of AST on patient outcomes.

SETTING

Sixteen ICUs affiliated with NewYork-Presbyterian Hospital.

PARTICIPANTS

Attending physicians and subspecialty residents with primary clinical responsibilities in adult or pediatric ICUs as well as infectious diseases subspecialists and clinical pharmacists.

METHODS

Participants completed an anonymous electronic survey. Responses included 4-level Likert scales dichotomized for analysis. Multivariate analyses were performed using generalized estimating equation logistic regression to account for correlation of respondents from the same ICU.

RESULTS

The response rate was 51% (178 of 349 eligible participants); of the respondents, 120 (67%) were ICU physicians. Those caring for adult patients were more knowledgeable about antimicrobial activity and were more familiar with MDR-GNB infections. Only 33% and 12% of ICU physicians were familiar with standardized and specialized AST methods, respectively, but more than 95% believed that AST improved patient outcomes. After adjustment for demographic and healthcare provider characteristics, those familiar with treatment of MDR-GNB bloodstream infections, those aware of resistance mechanisms, and those aware of AST methods were more confident that they could interpret AST results and/or request additional in vitro testing.

CONCLUSIONS

Our study uncovered knowledge gaps and educational needs that could serve as the foundation for future interventions. Familiarity with MDR-GNB increased overall knowledge, and familiarity with AST increased confidence interpreting the results.

Quality-adjusted life expectancy (QALE) loss due to smoking in the United States

PURPOSE

Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S.

METHODS

Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population.

RESULTS

In 2009, an 18-year-old smoker was expected to have 43.5 (SE = 0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE = 0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE = 0.2) years of QALE loss for smokers and 4.1 years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18.

CONCLUSIONS

This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE--especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL.

The effects of diabetes, hypertension, asthma, heart disease, and stroke on quality-adjusted life expectancy

OBJECTIVE

Quality-adjusted life expectancy (QALE) is a summary measure that combines mortality and health-related quality of life across different stages of life. The objective of this study was to estimate QALE loss due to five chronic diseases-diabetes mellitus, hypertension, asthma, heart disease, and stroke.

METHODS

Health-related quality of life scores were from the 1993-2009 Behavioral Risk Factor Surveillance System. Using age-specific deaths from the Compressed Mortality File, this study constructed life tables to calculate losses in life expectancy and QALE due to each of the five diseases from 1993 through 2009 and for 50 US states and the District of Columbia.

RESULTS

In 2009, the individual-level QALE loss for diabetic people, compared with nondiabetic people, was 11.1 years; for those with hypertension, 6.3 years; for those with asthma, 7.0 years; for those with heart disease, 10.3 years; and for those with stroke, 12.4 years. At the population level, diabetes, hypertension, asthma, heart disease, and stroke contributed 1.9, 2.2, 0.8, 1.2, and 0.8 years of population QALE loss at age 18 years, respectively.

CONCLUSIONS

Persons with each of the five diseases had significantly lower life expectancy and QALE. Because the prevalence of diabetes and hypertension has increased significantly in the United States in the last two decades, the burdens of these two conditions, measured by population QALE losses, had increased 83% and 29% from 1993 to 2009, respectively. Also, by examining changes in population QALE loss at different ages, policymakers can identify age groups most affected by particular diseases and develop the most cost-effective interventions by focusing on these groups.

On the role of length of stay in healthcare-associated bloodstream infection

DESIGN

We conducted a retrospective cohort study to examine the role played by length of hospital stay in the risk of healthcare-associated bloodstream infection (BSI), independent of demographic and clinical risk factors for BSI.

PATIENTS

We employed data from 113,893 admissions from inpatients discharged between 2006 and 2008.

SETTING

Large tertiary healthcare center in New York City.

METHODS

We estimated the crude and adjusted hazard of BSI by conducting logistic regression using a person-day data structure. The covariates included in the fully adjusted model included age, sex, Charlson score of comorbidity, renal failure, and malignancy as static variables and central venous catheterization, mechanical ventilation, and intensive care unit stay as time-varying variables.

RESULTS

In the crude model, we observed a nonlinear increasing hazard of BSI with increasing hospital stay. This trend was reduced to a constant hazard when fully adjusted for demographic and clinical risk factors for BSI.

CONCLUSION

The association between longer length of hospital stay and increased risk of infection can largely be explained by the increased duration of stay among those who have underlying morbidity and require invasive procedures. We should take caution in attributing the association between length of stay and BSI to a direct negative impact of the healthcare environment.

Lack of significant variability among different methods for calculating antimicrobial days of therapy

Days of therapy (DOTs) are an important measure to quantify antimicrobial use but may not reflect patients' true antimicrobial exposure. Three methods of calculating DOTs were compared to determine whether including "exposure days," when antimicrobials are given less frequently than daily due to renal dysfunction, makes a difference.

Targeted therapy via oral administration of attenuated Salmonella expression plasmid-vectored Stat3-shRNA cures orthotopically transplanted mouse HCC

The development of RNA interference-based cancer gene therapies has been delayed due to the lack of effective tumor-targeting delivery systems. Attenuated Salmonella enterica serovar Typhimurium (S. Typhimurium) has a natural tropism for solid tumors. We report here the use of attenuated S. Typhimurium as a vector to deliver shRNA directly into tumor cells. Constitutively activated signal transducer and activator of transcription 3 (Stat3) is a key transcription factor involved in both hepatocellular carcinoma (HCC) growth and metastasis. In this study, attenuated S. Typhimurium was capable of delivering shRNA-expressing vectors to the targeted cancer cells and inducing RNA interference in vivo. More importantly, a single oral dose of attenuated S. Typhimurium carrying shRNA-expressing vectors targeting Stat3 induced remarkably delayed and reduced HCC (in 70% of mice). Cancer in these cured mice did not recur over 2 years following treatment. These data demonstrated that RNA interference combined with Salmonella as a delivery system may offer a novel clinical approach for cancer gene therapy.

Diabetes care practice patterns of recent pharmacy graduates

PURPOSE

The objective of this project was to determine the amount and type of clinical skills and diabetes education provided by recent pharmacy school graduates.

METHODS

Six hundred and one graduates were e-mailed a link to an online survey. Subjects were asked to report how frequently they either educate patients on diabetes self-care activities or perform diabetes-related patient care skills and to rate their ability to do so as poor, fair, good, or excellent.

RESULTS

Data from 155 (25.8%) respondents were analyzed. The most commonly reported clinical activity was changing medication, followed by interpreting blood glucose patterns, medication management therapy, and interpreting laboratory results. Subjects reported educating patients more on the signs and symptoms of hypoglycemia, blood glucose monitoring, and diet information relative to other topics. The majority of subjects rated their skills as good or excellent.

CONCLUSION

Pharmacists reported the most commonly performed diabetes-related clinical skill was changing medication and they most often educate patients about hypoglycemia and blood glucose monitoring. Subjects, who rated themselves poor/fair in these skills, preferred active learning strategies to enhance their ability.