AKI in Hospitalized Patients with COVID-19

BACKGROUND

Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described.

METHODS

This retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality.

RESULTS

Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up.

CONCLUSIONS

AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.

Views of women and clinicians on postpartum preparation and recovery

To explore important domains of women's postpartum experiences as perceived by postpartum mothers and obstetricians/midwives, and to investigate how postpartum care could enhance patient preparation for the postpartum period. Qualitative research study was conducted to explore women's and clinicians' perceptions of the postpartum experience. Four focus groups of postpartum women (n = 45) and two focus groups of obstetric clinicians (n = 13) were held at a large urban teaching hospital in New York City. All focus groups were audio recorded, transcribed, and analyzed using grounded theory. Four main themes were identified: lack of women's knowledge about postpartum health and lack of preparation for the postpartum experience, lack of continuity of care and absence of maternal care during the early postpartum period, disconnect between providers and postpartum mothers, and suggestions for improvement. Mothers did not expect many of the symptoms they experienced after childbirth and were disappointed with the lack of support by providers during this critical time in their recovery. Differences existed in the major postpartum concerns of mothers and clinicians. However, both mothers and clinicians agreed that preparation during the antepartum period could be beneficial for postpartum recovery. Results from this study indicate that many mothers do not feel prepared for the postpartum experience. Study findings raise the hypothesis that capturing patient-centered domains that define the postpartum experience and integrating these domains into patient care may enhance patient preparation for postpartum recovery and improve postpartum outcomes.

Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community

BACKGROUND

Randomized, controlled trials have shown that nurse-led disease management for patients with heart failure can reduce hospitalizations. Less is known about the cost-effectiveness of these interventions.

OBJECTIVE

To estimate the cost-effectiveness of a nurse-led disease management intervention over 12 months, implemented in a randomized, controlled effectiveness trial.

DESIGN

Cost-effectiveness analysis conducted alongside a randomized trial.

DATA SOURCES

Medical costs from administrative records, and self-reported quality of life and nonmedical costs from patient surveys.

PARTICIPANTS

Patients with systolic dysfunction recruited from ambulatory clinics in Harlem, New York.

TIME HORIZON

12 months.

PERSPECTIVE

Societal and payer.

INTERVENTION

12-month program that involved 1 face-to-face encounter with a nurse and regular telephone follow-up.

OUTCOME MEASURES

Quality of life as measured by the Health Utilities Index Mark 3 and EuroQol-5D and cost-effectiveness as measured by the incremental cost-effectiveness ratio (ICER).

RESULTS OF BASE-CASE ANALYSIS

Costs and quality of life were higher in the nurse-managed group than the usual care group. The ICERs over 12 months were $17,543 per EuroQol-5D-based quality-adjusted life-year (QALY) and $15,169 per Health Utilities Index Mark 3-based QALY (in 2001 U.S. dollars).

RESULTS OF SENSITIVITY ANALYSIS

From a payer perspective, the ICER ranged from $3673 to $4495 per QALY. Applying national prices in place of New York City prices yielded a societal ICER of $13,460 to $15,556 per QALY. Cost-effectiveness acceptability curves suggest that the intervention was most likely cost-effective for patients with less severe (New York Heart Association classes I to II) heart failure.

LIMITATION

The trial was conducted in an ethnically diverse, inner-city neighborhood; thus, results may not be generalizable to other communities.

CONCLUSION

Over 12 months, the nurse-led disease management program was a reasonably cost-effective way to reduce the burden of heart failure in this community.

Cardiovascular risk factor prevention in black schoolchildren: two-year results of the "Know Your Body" program

A five-year intervention study of the effectiveness of the "Know Your Body" program in reducing coronary heart disease risk factors among black students in the District of Columbia, who were in grades 4-6 at baseline, was begun in 1983. Nine schools were stratified on socioeconomic status and randomly assigned to control and intervention groups. The "Know Your Body" curriculum focuses on nutrition, fitness, and the prevention of cigarette smoking. At baseline, 1,234 students were eligible for the screening in which the following target risk factors were measured: systolic and diastolic blood pressures, ponderosity index, triceps skinfold thickness, postexercise pulse recovery rate, serum total and high density lipoprotein (HDL) cholesterol, and serum thiocyanate. After two years of intervention, results indicated that the program may have had a favorable impact on the following risk factors: systolic and diastolic pressures, HDL cholesterol, ratio of total to HDL cholesterol, fitness (postexercise pulse recovery rate), and smoking. Significant net changes in the favorable direction also were found for health knowledge and attitude toward smoking. Blood pressure reduction was associated with decreased ponderosity and improved fitness, and increased HDL cholesterol was associated with decreased ponderosity. These results are consistent with other evaluations of the "Know Your Body" program, suggesting that the program may be effective in reducing chronic disease risk in diverse school populations.

Smartphone ownership and perspectives on health apps among a vulnerable population in East Harlem, New York

BACKGROUND

Individuals from low-income and racial/ethnic minority backgrounds have traditionally had less access to mobile health (mHealth) technologies, but there is evidence that this gap has been rapidly narrowing. Given the increase in access to mobile technologies recently seen in vulnerable populations, mHealth has been championed as a strategy for improving population health and reducing health disparities. However, members of low-income and racial/ethnic minority populations have had a limited role in the development and implementation of mHealth interventions designed to impact them.

METHODS

We used community-based participatory research (CBPR), a research approach that is frequently employed to help reach communities that are disproportionately affected by illness but are difficult to engage. Our community-academic collaboration, the East Harlem Partnership for Diabetes Prevention, sought to create a mobile technology platform that would allow adults in East Harlem, New York to improve their own health and promote the health of the broader community. As a first step, we developed and conducted a survey of community residents to better understand access to, usage of, and attitudes towards mobile technologies among diverse, low-income adults. We administered the cross-sectional survey to a convenience sample of adults who utilized a variety of community-based organizations in East Harlem. We examined frequencies for each survey item and then used chi-square tests (or Fisher's exact tests) and multivariate logistic regression to evaluate relationships between these outcomes and sociodemographic factors.

RESULTS

We approached 154 people, of whom 104 (68%) agreed to participate. The majority of respondents were of Black and/or Hispanic/Latino descent with a mean age of 37 years. Our sample displayed a high percentage of smartphone ownership (82% of the participants reported that they owned a cell phone, and 88% of owners reported that their cell phone was a smartphone). We found lower rates of ownership among individuals who were older, self-identified as Latino, insured by Medicare, and had a household income of less than $30,000 per year. Multivariate logistic regression showed that after adjusting for age, gender and race, those with at least a high school education were seven times more likely to use health apps than those with less than a high school education (OR 6.8, 95% CI: 1.7-27.1). Participants expressed interest in health promoting apps that provide interactive, individualized diet, exercise and weight loss tools and offer information about local health resources and events.

CONCLUSIONS

Despite some notable disparities, our study results suggest that the digital divide is narrowing in the East Harlem community with relatively high rates of smartphone ownership and use, even among individuals from low-income, low education backgrounds and those without health insurance. Based on study results, our partnership developed an app supporting healthy lifestyle and diabetes prevention tailored to the East Harlem community.

Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records

OBJECTIVE

To assess association of clinical features on COVID-19 patient outcomes.

DESIGN

Retrospective observational study using electronic medical record data.

SETTING

Five member hospitals from the Mount Sinai Health System in New York City (NYC).

PARTICIPANTS

28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.

MAIN OUTCOMES AND MEASURES

Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.

RESULTS

Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray's T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.

CONCLUSIONS

While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.

Telemedicine Impact on the Patient-Provider Relationship in Primary Care During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care requiring both patients and providers to learn how to navigate care remotely. This change can impact the patient-provider relationship that often defines care, especially in primary care.

OBJECTIVE

This study aims to provide insight into the experiences of patients and providers with telemedicine during the pandemic, and the impact it had on their relationship.

RESEARCH DESIGN

A qualitative study using thematic analysis of semistructured interviews.

SUBJECTS

Primary care providers (n=21) and adult patients (n=65) with chronic disease across primary care practices in 3 National Patient-centered Clinical Research Network sites in New York City, North Carolina, and Florida.

MEASURES

Experiences with telemedicine during the COVID-19 pandemic in primary care. Codes related to the patient-provider relationship were analyzed for this study.

RESULTS

A recurrent theme was the challenge telemedicine posed on rapport building and alliance. Patients felt that telemedicine affected provider's attentiveness in varying ways, whereas providers appreciated that telemedicine provided unique insight into patients' lives and living situations. Finally, both patients and providers described communication challenges.

CONCLUSIONS

Telemedicine has altered structure and process aspects of primary health care such as the physical spaces of encounters, creating a new setting to which both patients and providers must adjust. It is important to recognize the opportunities and limits that this new technology has to help providers maintain the type of one-on-one attention that patients expect and that contributes to relationship building.

Limited impact of a multicenter intervention to improve the quality and efficiency of pneumonia care

STUDY OBJECTIVES

To evaluate the impact of a multifactorial intervention to improve the quality, efficiency, and patient understanding of care for community-acquired pneumonia.

DESIGN

Times series cohort study.

SETTING

Four academic health centers in the New York City metropolitan area.

PATIENTS OR PARTICIPANTS

All consecutive adults hospitalized for pneumonia during a 5-month period before (n = 1,013) and after (n = 1,081) implementation of an inpatient quality improvement (QI) initiative.

INTERVENTIONS

A multidisciplinary team of opinion leaders developed evidence-based treatment guidelines and critical pathways, conducted educational sessions with physicians, distributed pocket reminder cards, promoted standardized orders, and developed bilingual patient education materials.

MEASUREMENTS AND RESULTS

The average age was 71.4 years, and 44.1% of cases were low risk, 36.8% were moderate risk, and 19.2% were high risk. The preintervention and postintervention groups were well matched on age, sex, race, nursing home residence, pneumonia severity, initial presentation, and most major comorbidities. The intervention increased the use of guideline-recommended antimicrobial therapy from 78.1 to 83.4% (p = 0.003). There was also a borderline decrease in the proportion of patients being discharged prior to becoming clinically stable, from 27.0 to 23.5% (p = 0.06). However, there were no improvements in the other targeted indicators, including time to first dose of antibiotics, proportion receiving antibiotics within 8 h, timely switch to oral antibiotics, timely discharge, length of stay, or patient education outcomes.

CONCLUSIONS

This real-world QI program was able to improve modestly on some quality indicators, but not effect resource use or patient knowledge of their disease. Changing physician and organizational behavior in academic health centers will require the development and implementation of more intensive, system-oriented strategies.

Acute Kidney Injury in Hospitalized Patients with COVID-19

IMPORTANCE

Preliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID)-19 patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described.

OBJECTIVE

To provide information about frequency, outcomes and recovery associated with AKI and dialysis in hospitalized COVID-19 patients.

DESIGN

Observational, retrospective study.

SETTING

Admitted to hospital between February 27 and April 15, 2020.

PARTICIPANTS

Patients aged ≥18 years with laboratory confirmed COVID-19 Exposures: AKI (peak serum creatinine increase of 0.3 mg/dL or 50% above baseline). Main Outcomes and Measures: Frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) with mortality. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation.

RESULTS

A total of 3,235 hospitalized patients were diagnosed with COVID-19. AKI occurred in 1406 (46%) patients overall and 280 (20%) with AKI required renal replacement therapy. The incidence of AKI (admission plus new cases) in patients admitted to the intensive care unit was 68% (553 of 815). In the entire cohort, the proportion with stages 1, 2, and 3 AKI were 35%, 20%, 45%, respectively. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41% overall and 52% in intensive care. The aOR for mortality associated with AKI was 9.6 (95% CI 7.4-12.3) overall and 20.9 (95% CI 11.7-37.3) in patients receiving intensive care. 56% of patients with AKI who were discharged alive recovered kidney function back to baseline. The area under the curve (AUC) for the machine learned predictive model using baseline features for dialysis requirement was 0.79 in a validation test.

CONCLUSIONS AND RELEVANCE

AKI is common in patients hospitalized with COVID-19, associated with worse mortality, and the majority of patients that survive do not recover kidney function. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation.

Prenatal induction of sucrase activity in rat jejunum

Daily application of cortisone acetate (10mg/100g body wt.) or L-tri-iodothyronine (20 microng/100g body wt.) to female rats in the last (third) week of pregnancy elicits a precocious appearance of jejunal sucrase in their foetuses.

Physical activity, fruit and vegetable intake, and health-related quality of life among older Chinese, Hispanics, and Blacks in New York City

OBJECTIVES

We explored the relationship between health-related quality of life (HRQOL) and adequate physical activity (PA) and fruit and vegetable (F&V) intake among racial/ethnic minority groups aged 60 years or older living in New York City (NYC).

METHODS

Survey data from 2009 to 2012 targeted minority groups in NYC ethnic enclaves; we analyzed 3594 individuals (Blacks, Hispanics, and Chinese) aged 60 years or older. Descriptive statistics were run; unadjusted and adjusted logistic regression evaluated the relationship of HRQOL with PA and F&V intake.

RESULTS

Hispanics were most likely to engage in sufficient PA and eat recommended F&Vs and had significantly worse HRQOL. After multivariable adjustment, significant associations were found between PA and self-reported health, activity limitation and physical health days for all groups, and PA and mental health days for Hispanics. Significant associations were found between F&V intake and physical health days for Hispanics and F&V intake and self-reported health for Chinese.

CONCLUSIONS

Findings indicated variations between HRQOL and PA by racial/ethnic subgroup. Despite being highly insured, recommendations for PA and F&V intake were not met. There is a need to promote healthy living behaviors among aging NYC racial/ethnic populations.

Effect of cortisone or L-triiodothyronine administration to pregnant rats on the activity of fetal intestinal disaccharidases and lysosomal acid beta-galactosidase

Activities of maltase, sucrase, lactase and acid-beta-galactosidase were studied in jejunum and ileum of term rat fetuses obtained by cesarian section. Female rats were either untreated or injected daily in the last (3rd) week of pregnancy with cortisone acetate (10 or 50 mg/100 g body weight) or L-triiodothyronine (20 or 50 microgram/100 g body weight). Two other control groups were injected with appropriate solvents. Cortisone or T3 treatment to mothers increased sucrase and maltase activity in jejunum and ileum of the offspring. Generally, higher doses of hormone were more effective. Lactase activity was increased by 25% in the jejunum by the higher dose of cortisone. Both doses of cortisone increased ileal lactase. Jejunal acid-beta-galactosidase activity was decreased in fetuses of T3-treated mothers.

Esperanza y Vida: a culturally and linguistically customized breast and cervical education program for diverse Latinas at three different United States sites

Breast cancer is the most common cause of cancer and the leading cause of cancer death among Latinas in the United States. In addition, Latinas experience a disproportionate burden of cervical cancer incidence, morbidity, and mortality compared with non-Hispanic White women. Lower use of breast and cervical cancer screening services may contribute to these disparities. To address the underutilization of breast and cervical cancer screening among diverse subgroups of Latinas, a peer-led education program called Esperanza y Vida ("Hope and Life") was developed and administered at 3 sites (2 in New York and 1 in Arkansas). Immigrant Latina women and their partners were educated about the importance of breast and cervical cancer screening, with the goals of increasing their knowledge about these cancers and their screening behavior. An analysis of the intervention's findings at baseline among female participants demonstrated significant sociodemographic, interpersonal, cultural, health care system, and program variability in 3 distinct geographic regions in the United States. These data indicate the need for and feasibility of customizing cancer outreach and educational programs for diverse Latina subgroups living in various U.S. regions, with implications for informing the expansion and replication of the program in other regions of the country.

Cardiovascular risk factors among black schoolchildren: comparisons among four Know Your Body studies

Baseline cardiovascular risk factor variables were obtained from 1,041 black District of Columbia children in Grades 4-6 as part of a Know Your Body evaluation project. Screening included height, weight, triceps skinfold measurements, systolic and diastolic blood pressures, step-test for fitness, serum cholesterol, high-density lipoprotein cholesterol and thiocyanate. Results were compared with those in three other Know Your Body studies, Bronx, New York, Westchester, New York, and Los Angeles, and indicated that District of Columbia black children are more likely to have high cholesterol levels and to fail the fitness test than black children in the other studies. In the District of Columbia, obese children had significantly higher total serum cholesterol, systolic, diastolic, and high-density lipoprotein levels, and were less fit than other District of Columbia children; almost three-fourths of all of the children had one or more risk factors. Socioeconomic status was negatively correlated with diastolic blood pressure, skinfold thickness, and cholesterol levels and was positively correlated with high-density lipoprotein cholesterol. Rates of obesity and diastolic blood pressure were consistent with Bronx and Westchester comparisons suggesting that socioeconomic status interacts with ethnicity to determine risk factor levels. The existence of children with multiple risk factors in all of the Know Your Body studies supports the need for early intervention.

Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya

BACKGROUND

Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs.

METHODS

We created a Design Team of health professionals, patients, microfinance officers, community health workers, and village leaders. Over 6 weeks, the Design Team utilized a four-step approach of synthesis, idea generation, prototyping, and creation to develop an integrated microfinance-group medical visit model for NCD. We tested the intervention with a 6-month pilot and conducted a feasibility evaluation using focus group discussions with pilot participants and community members.

RESULTS

Using human-centered design methodology, we designed a model for NCD delivery that consisted of microfinance coupled with monthly group medical visits led by a community health educator and a rural clinician. Benefits of the intervention included medication availability, financial resources, peer support, and reduced caregiver burden. Critical concerns elicited through iterative feedback informed subsequent modifications that resulted in an intervention model tailored to the local context.

CONCLUSIONS

Contextualized interventions are important in settings with multiple barriers to care. We demonstrate the use of HCD to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya. HCD can be used as a framework to engage local stakeholders to optimize intervention design and implementation. This approach can facilitate the development of contextually relevant interventions in other low-resource settings.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015.

Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers

OBJECTIVES

To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination.

DESIGN

Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers.

SETTING

Two large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine.

PARTICIPANTS

1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff.

PRIMARY OUTCOME MEASURES

The primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers.

RESULTS

Among 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients.

CONCLUSIONS

Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers' decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.

Community capacity building: a collaborative approach to designing a training and education model

BACKGROUND

Successful community-academic research partnerships require building the capacity of both community-based organizations (CBOs) and academics to conduct collaborative research of mutual interest and benefit. Yet, information about the needs and goals of research-interested CBOs is lacking. Our partnership aimed to conduct a community research needs assessment and to use results to develop future capacity-building programs for CBOs.

METHODS

Based on our review of the literature, informal interviews with research-interested CBOs and community-engaged research groups locally and nationally, we developed a needs assessment survey. Key domains of this survey included history and experience with research collaboration, interest in specific research topics, and preference for learning format and structure. We trained community health workers (CHWs) to recruit senior leaders from CBOs in New York City (NYC) and encourage them to complete an on-line survey.

RESULTS

Fully 54% (33/61) of CBOs completed the needs assessment. Most (69%) reported involvement with research or evaluation in the last 2 years and 33% had some funding for research. Although 75% had collaborated with academic institutions in the past, 58% did not rate this experience well. The four areas respondents prioritized for skills building were program evaluation, developing needs assessments, building surveys, and understanding statistical analyses. They were less interested in learning to build collaborations with academics.

CONCLUSIONS

A formal needs assessment of research training and educational needs of CBOs revealed that most had experience, albeit negative, with academic collaborations. CBO leaders wanted to build skills to conduct and analyze assessments and program evaluations. Our community-academic partnership is using these findings to develop a research capacity-building course. Other partnerships should consider conducting such assessments to transform the capacity of CBOs to be active research partners and leaders.

Stress eating and sleep disturbance as mediators in the relationship between depression and obesity in low-income, minority women

The purpose of this study was to explore potential mediators of the relationship between depression and obesity in a sample of low-income, minority women. Data were extracted from a sample of 535 women enrolled in a weight loss intervention for the prevention of type 2 diabetes. Using a non-parametric bootstrapping procedure, the potential mediation effects of stress eating and sleep disturbance on the relationship between depression and obesity were tested. Results of a single mediation model indicated that depressive symptomatology was significantly associated with obesity (β=0.800, SE=0.290, p=0.006), and that stress eating (β=0.166, 95% CI [0.046, 0.328]) and sleep disturbance (β=1.032, 95% CI [0.612, 1.427]) were significant independent mediators of this relationship. Sleep disturbance remained a significant mediator in a combined mediation model (β=1.009, 95% CI [0.653, 1.399]). Findings add to the growing literature on the psychosocial factors implicated in the link between depression and obesity, particularly among disadvantaged populations. Future longitudinal research should aim to establish causal pathways between obesity, stress eating, sleep disturbance, and depression.

Effect of triiodothyronine injection on levels of triiodothyronine and thyroid-stimulating hormone in sera and milk of lactating rats and in sera of their sucklings; precocious development of jejunal alpha-disaccharidases in the sucklings

Administration of high doses of triiodothyronine (T3) for 4 days to lactating rats evokes an increase in T3 levels in their sera and milk, as well as in the sera of pups suckled by them. Thyroid-stimulating hormone levels in sera of mothers and sucklings are decreased. Suckling rats of T3-treated mothers exhibit a precocious increase in the activity of jejunal sucrase and maltase as well as in activity of several liver acid beta-glycosidases.