Interprofessional education on complex patients in nursing homes: a focus group study

BACKGROUND

An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients' complex needs. This study describes graduate students' experiences of working practice based in interprofessional teams with complex patients' care needs in nursing homes.

METHOD

Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data.

RESULTS

Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified.

CONCLUSIONS

IPE in nursing homes facilitated the students' scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students' curricula. This could ensure that IPE is experienced more efficient by the students.

The influence of impaired processing speed on cognition in first-episode antipsychotic-naïve schizophrenic patients

Background:

Impaired cognition is a prominent feature of schizophrenia. To what extent the heterogeneous cognitive impairments can be accounted for by considering only a single underlying impairment or a small number of core impairments remains elusive. This study examined whether cognitive impairments in antipsychotic-naïve, first-episode schizophrenia patients may be determined by a relative slower speed of information processing.

Method:

Forty-eight antipsychotic-naïve patients with first-episode schizophrenia and 48 matched healthy controls were administered a comprehensive battery of neuropsychological tests to assess domains of cognitive impairments in schizophrenia. Composite scores were calculated, grouping tests into cognitive domains.

Results:

There were significant differences between patients and healthy controls on global cognition and all cognitive domains, including verbal intelligence, processing speed, sustained attention, working memory, reasoning and problem solving, verbal learning and memory, visual learning and memory, and reaction time. All these significant differences, except for verbal intelligence and global cognition, disappeared when processing speed was included as a covariate.

Conclusion:

At the first stage of illness, antipsychotic-naïve patients with schizophrenia display moderate/severe impairments in all the cognitive domains assessed. The results support the contention of a global cognitive dysfunction in schizophrenia that to some extent may be determined by impaired processing speed.

Enzymatic Determination of Free Glutamic Acid in Dried Soups and in Minced Sausages: NMKL1 Collaborative Study

An enzymatic method for the determination of free glutamic acid in meat products and dried soups was collaboratively studied in 11 laboratories. In the presence of the enzyme glutamate dehydrogenase, L-giutamic acid is oxidatively deaminated by nicotinamide adenine dinucleotide (NAD) to 2-oxoglutarate. In a reaction catalyzed by diaphorase, the NADH thus formed converts 2-(p-iodophenyl)-3-(p-nitrophenyl)-5-phenyltetrazolium chloride to a formazan, which is measured in the visible range at 492 nm. Fourteen samples (7 samples of minced sausage and 7 samples of dried cauliflower soup) with glutamate contents varying between 0.4 and 16 g/kg were included In the study. Materials were distributed to participants as blind duplicates and as split level pairs. The mean relative standard deviation (RSDR) for reproducibility for the dried soup material containing glutamate between 7 and 16 g/kg was 4.6%. RSDR values for samples of minced sausage containing glutamate at lower levels (0.4-1.3 g/kg) were between 12 and 16%.

Health impact of substituting red meat by fish: addressing variability in risk-benefit assessments

Background

Sufficient intake of fish and limited red meat intake is commonly encouraged by national dietary guidelines to prevent various lifestyle diseases. One way to fulfill these guidelines would be to substitute red meat by fish. However, quantitative evidence of the public health gain of such substitution is lacking. Moreover, contaminants in these foods may compromise nutritional benefits. We aimed to estimate the health impact of substituting red meat by fish in the Danish diet in a risk-benefit assessment (RBA). Our study can support policy makers in defining evidence-based public health strategies.

Methods

We quantified the health impact of substituting red meat by fish among Danish adults in terms of Disability-Adjusted Life Years (DALY) using data from a national dietary survey and food monitoring. We investigated the use of probabilistic methods to model variability in individual substitution behaviors and to assess health impact distributions in RBA of food.

Results

Health impact of the substitution varied largely by the type of fish consumed and by age and sex of the consumer. We estimated that 134 (95% uncertainty interval: 102; 169) DALYs/100,000 could be averted per year if a mix of lean and fatty fish is consumed in the Danish recommended amounts and intake of red meat decreased among Danish adults. The highest benefit was estimated for women in the childbearing age and for men above 50 years of age. However, a small fraction of women were assigned an overall health loss due to methylmercury exposure during pregnancy and the associated adverse effects in unborn children.

Conclusions

Our study estimated an overall health gain of substituting red meat by fish in the general Danish adult population, while providing insight in the variability in health impact at the level of individual consumers. Our approach can be applied in other RBAs and the results support the need for targeted public health strategies to ensure consumer health and safety.

Key messages

The health impact of substituting red meat by fish in Danish adults was quantified in terms of disability-adjusted life years (DALYs), while accounting for variability between individuals. We estimated that young women and men above 50 years of age will experience the largest health gain while a small fraction of the women were assigned a health loss due to chemical exposure.

Health Effects of 12 Weeks of Team-Sport Training and Fitness Training in a Community Health Centre for Sedentary Men with Lifestyle Diseases

This study compares the effects of team-sport training, for sedentary men with lifestyle diseases, with fitness training in a pragmatic set-up in a community health centre (CHC). Thirty-two men in the fitness group (FiG) and 36 men in the team-sport group (TsG) completed the training and trained for 60-90 min, two times/week for 12-16 weeks. In FiG and TsG, mean heart rate (HR) during training was 73.2% and 74.5% of HRmax, respectively. Percentage of training time above 90%HRmax was 6 ± 9% and 10 ± 15% and the percentage of participants who spent > 10% of total training time with HR > 90%HRmax was 20% and 41%, in FiG and TsG, respectively. In FiG, total fat mass was reduced by 3.5%  (P < 0.01), while performance in the 6 min walking test (6MWT) increased by 11%  (P < 0.001). In TsG, total fat mass was reduced by 2.2%  (P < 0.01), while 6MWT performance improved by 5%  (P < 0.05). Between-group differences were observed for systolic BP (P = 0.041) and mean arterial pressure (P = 0.050) in favour of TsG and for sit-to-stand test (P = 0.031) in favour of FiG. In conclusion, small-sided team sport is a worthy alternative to fitness training since the overall health effects are comparable, for example, improved balance and reduced fat mass. Team sport elicits high heart rates and improves cardiovascular health by reducing blood pressure, while fitness training improves sit-to-stand test performance related to activity of daily living.

Computed VS. Film-Screen Magnification Radiography of Fingers in Hyperparathyroidism

One hundred randomly selected patients with suspected or known hyperparathyroidism were examined in a prospective study of the 2nd and 3rd fingers with film-screen and digital luminescence radiographs using magnification technique. The digital images were displayed on a work-station and printed as hard-copies. Two radiologists evaluated the film-screen images regarding subperiosteal and intracortical resorption and their results were defined as “gold standard” regarding the absence or presence of these changes. Four radiologists evaluated these changes in the 3 image forms and an ROC analysis was performed. Comparing the areas under the ROC curves no significant difference was found between the film-screen images and the 2 digital display forms. These results suggest that currently available digital systems provide adequate diagnostic accuracy for evaluation of subtle skeletal changes.

Individual- and Neighborhood-Level Determinants of Fear of Violent Crime Among Adolescents

Fear of violent crime is common among adolescents in urban settings; however, little is known about individual- and neighborhood-level determinants of fear. A generalized ordered logit model was used to analyze individual- and neighborhood-level variables among 2474 adolescents. Seeing violence significantly reduced the probability of feeling unafraid, as did higher levels of social disorder. The more block faces where police were visible, the higher the probability of feeling unafraid and lower the probability of feeling very afraid. Reducing fear could affect more people than just reducing crime. Fear-reduction strategies should target those most at risk of becoming fearful.

Association of body fat and vitamin D status and the effect of body fat on the response to vitamin D supplementation in Pakistani immigrants in Denmark

Vitamin D deficiency and obesity are both prevalent conditions in the northern countries, especially among immigrants. The aims were to assess the possible relationship between body fat and vitamin D status, and to investigate the effect of body fat on the response to oral vitamin D supplementation in Pakistani immigrants in Denmark. Data were obtained from a 1-year double-blind randomised controlled trial with oral vitamin D supplementation. A total of 122 women and men received either vitamin D3 supplementation (10 or 20 μg/day) or placebo. No association was found between body fat percentage and vitamin D status in a multiple linear regression model (P<0.001). No effect of body fat was seen on the vitamin D status response following the intervention with vitamin D. In conclusion, there was no baseline association between body fat percentage and vitamin D status, and body fat percentage had no effect on the response to vitamin D supplementation.

Change in sleep duration and proposed dietary risk factors for obesity in Danish school children

BACKGROUND

Recent cross-sectional studies found higher consumption of energy-dense foods among children with short sleep duration; however, longitudinal studies examining changes in sleep and diet over time are needed.

OBJECTIVE

This study aimed to investigate prospective associations between changes in objectively measured sleep duration and alterations in proposed dietary risk factors for obesity in 8-11-year-old Danish children.

METHODS

Four hundred forty-one children recorded dietary intake during seven consecutive days, along with accelerometer measurements estimating sleep duration at baseline and after ∼200 days.

RESULTS

Baseline sleep duration did not predict changes in dietary intake or vice versa (all P ≥ 0.69). However, 1-h lower sleep duration was associated with higher intake of added sugar (1.59 E%; P = 0.001) and sugar-sweetened beverages (0.90 E%; P = 0.002) after 200 days with no change in energy density of the diet (P = 0.78).

CONCLUSION

Our results suggest that a negative change in sleep duration is associated with higher intakes of sugar containing foods/beverages.

Barriers to drug use behavior change among primary care patients in urban United States community health centers

In 2011 and 2012, 147 patients in urban United States Community Health Centers who misused drugs, but did not meet criteria for drug dependence, received a brief intervention as part of a National Institute on Drug Abuse-funded clinical trial of a screening and brief intervention protocol. Potential study participants were identified using the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test. Data gathered during brief interventions were analyzed using grounded theory strategies to identify barriers patients believed inhibited drug use behavior change. Numerous perceived barriers to drug use behavior change were identified. Study implications and limitations are discussed.

Genetics of steroid-resistant nephrotic syndrome: a review of mutation spectrum and suggested approach for genetic testing

Identification of genes, associated mutations and genotype-phenotype correlations in steroid-resistant nephrotic syndrome (SRNS) is being translated to clinical practice through genetic testing. This review provides an update on the genes and mutations associated with SRNS along with a suggested approach for genetic testing in patients with SRNS.

CONCLUSION

The number of indentified genes associated with SRNS is increasing along with our understanding of their impact on treatment response and risk of recurrence. A systematic approach to genetic testing in patients with SRNS might aid the physician in selecting appropriate treatment.

Short sleep duration and large variability in sleep duration are independently associated with dietary risk factors for obesity in Danish school children

BACKGROUND

Lack of sleep and increased consumption of energy-dense foods and sugar-sweetened beverages (SSBs) have all been suggested as factors contributing to the increased prevalence of overweight and obesity.

OBJECTIVE

To evaluate whether objectively measured sleep duration (average and day-to-day variability) as well as parent-reported sleep problems are independently associated with proposed dietary risk factors for overweight and obesity in 8-11-year-old children.

DESIGN

In this cross-sectional study, data on sleep duration and day-to-day variability in sleep duration were measured in 676 Danish, apparently healthy children by an objective measure (actigraphy) for 8 nights, and the Children's Sleep Habits Questionnaire (CSHQ) was filled out by the parents. Diet was recorded using a web-based food record for 7 consecutive days. Fasting blood samples were obtained for measurements of plasma leptin and ghrelin levels.

RESULTS

Sleep duration (h per night) was negatively associated with energy density (ED) of the diet (β = -0.32 kJ g(-1)), added sugar (β = -1.50 E%) and SSBs (β = -1.07 E%) (all P ≤ 0.003). Furthermore, variability in sleep duration (10-min per night) was positively associated with SSBs (β = 0.20 E%, P = 0.03), independent of sleep duration, and CSHQ score was positively associated with ED (β = 0.16 kJ g(-1), P = 0.04). All of these associations were independent of potential confounders (age, sex, pubertal status, height, weight, screen time, moderate-to-vigorous physical activity and parental education and ethnicity).

CONCLUSION

Our study suggests that short sleep duration, high sleep duration variability and experiencing sleep problems are all associated with a poor, obesity-promoting diet in children.

Objectively measured physical activity and C-reactive protein: National Health and Nutrition Examination Survey 2003-2004

The association between physical activity (PA) and C-reactive protein (CRP) is inconsistent, with nearly all studies using self-report measures of PA. The purpose of this study was to examine the association between objectively measured PA and CRP in US adults and children. Adults (N=2912) and children (N=1643) with valid accelerometer data and CRP data were included in the analyses. Logistic regression analysis was used to assess the odds of meeting PA guidelines across CRP quartiles for children and among adults with low, average, and high CRP levels. For adults, after adjustments for age, gender, race, body mass index, smoking, diabetes, and high-density lipoprotein cholesterol (HDL-C), compared with those with low CRP levels, odds ratios were 0.59 (CI=0.45-0.77) and 0.46 (CI=0.28-0.76) for participants with average and high CRP levels, respectively. For children, after adjustments for age, gender, race, weight status, and HDL-C, compared with those in CRP quartile 1, odds ratios were 0.96 (CI=0.5-1.84), 1.23 (CI=0.71-2.12), and 0.79 (CI=0.33-1.88) for participants in quartiles 2, 3, and 4, respectively. Objectively measured PA is inversely associated with CRP in adults, with PA not related to CRP in children.

Systemic markers of inflammation are associated with cardiac allograft vasculopathy and an increased intimal inflammatory component

We evaluated an extensive profile of clinical variables and immune markers to assess the inflammatory milieu associated with cardiac allograft vasculopathy (CAV) assessed by intravascular ultrasound (IVUS) and virtual histology (VH). In total, 101 heart transplant (HTx) recipients were included and underwent IVUS/VH examination and measurement of plasma C-reactive protein (CRP), soluble tumor necrosis factor receptor-1, interleukin-6, osteoprotegerin, soluble gp130, von Willebrand factor, vascular cell adhesion molecule-1 (VCAM-1) and neopterin. Mean Maximal Intimal Thickness (MIT) was 0.61 +/- 0.19 mm and mean fibrotic, fibrofatty, dense calcified and necrotic core components were 55 +/- 15, 14 +/- 10, 15 +/- 13 and 17 +/- 9%, respectively. In multivariate analysis, CRP > 1.5 mg/L (OR 4.6, p < 0.01), VCAM-1 > 391 ng/mL (adjusted OR 3.2, p = 0.04) and neopterin > 7.7 nmol/L (OR 3.8, p = 0.02) were independently associated with MIT > 0.5 mm. Similarly, CRP > 1.5 mg/L (OR 3.7, p < 0.01) and VCAM-1 > 391 (OR 2.7, p = 0.04) were independently associated with an increased intimal inflammatory component (dense calcified/necrotic core component > 30%). Advanced CAV is associated with elevated CRP, VCAM-1 and neopterin and the two former biomarkers are also associated with an increased intimal inflammatory component. Forthcoming studies should clarify if routine measurements of these markers can accurately identify HTx recipients at risk of developing advanced CAV and vulnerable lesions.

Habitat and roe deer fawn vulnerability to red fox predation

1. Notwithstanding the growing amount of literature emphasizing the link between habitat, life-history traits and behaviour, few empirical studies investigated the combined effect of these parameters on individual predation risk. We investigated direct and indirect consequences of habitat composition at multiple spatial scales on predation risk by red foxes on 151 radio-monitored roe deer fawns. We hypothesized that the higher resource availability in fragmented agricultural areas increased predation risk because of: (i) shorter prey movements, which may increase predictability; (ii) larger litter size and faster growth rates, which may increase detectability in species adopting a hiding neonatal anti-predator strategy. The sharing of risky habitat among littermates was expected to promote whole-litter losses as a result of predation. 2. The landscape-scale availability of agricultural areas negatively affected pre-weaning movements, but did not influence growth rates or litter size. Predation risk was best described by the interplay between movements and fine-scale habitat fragmentation: a higher mobility increased the encounter rate and predation risk in highly fragmented home ranges, while it reduced predation risk in forest-dominated areas with clumped resources because of decreased predictability. This is one of the first demonstrations that movement patterns can be an efficient anti-predator strategy when adjusted to local conditions. 3. In accordance with previous studies documenting the existence of family effects (i.e. non-independence among siblings) in survival, littermates survived or died together more often than expected by chance. In addition, our study specifically demonstrated the occurrence of behaviourally mediated family effects in predation risk: after a fox killed one fawn the probability of a sibling being killed within a few days rose from 20% to 47%, likely because of the win-stay strategy (i.e. return to a previously rewarding site) adopted by the predator. Hence, the predator's hunting strategy has the potential to raise fawn mortality disproportionately to predator abundance. 4. There is increasing evidence that fawns inhabiting highly productive predator-free habitats are granted lifetime fitness benefits; these potential advantages, however, can be cancelled out when predation risk increases in the very same high-productivity areas, which might thus turn into attractive sinks.

Hospitalizations among homeless women: are there ethnic and drug abuse disparities?

This paper explores associations among the vulnerabilities of being female, being a member of a minority group, and being a drug abuser in homeless women's hospitalizations. It uses a 1997 probability survey of 974 homeless females age 15-44 in Los Angeles. In unadjusted analyses, whites were more likely than other ethnic minority groups to be hospitalized, and drug abusers were more likely to be hospitalized than non-drug abusers. Multiple logistic regression analyses indicated that factors associated with hospitalization differed considerably among the ethnic and drug-abuse subgroups. For example, ethnic disparities in inpatient health care were found for drug-abusing women, but not for those who did not abuse drugs. Pregnancy was the only important determinant of hospitalization in all subgroups (OR, 2.9-17.4). Preventing unintended pregnancy appears to be the most inclusive means of reducing hospitalization and attendant costs among homeless women.

Nitrite and nitrate content in meat products and estimated intake in Denmark from 1998 to 2006

The content of nitrite and nitrate in cured meat products has been monitored in Denmark seven times between 1995 and 2006. The maximum permitted added amounts of sodium nitrite in Denmark (60 mg kg(-1) for most products up to 150 mg kg(-1) for special products) have not been exceeded, except for a few samples back in 2002. The intake, mean and intake distribution of sodium nitrite have been calculated from 1998 to 2006 with data from the Danish dietary survey conducted in 2000-02 on Danes from four to 75 years of age. The amounts used by industry have been relatively stable through the whole period with levels varying between 6 and 20 mg sodium nitrite kg(-1) with sausages, meat for open sandwiches and salami-type sausages being the greatest contributors. The mean intake of sodium nitrate was around 1 mg day(-1), which is very low compared with the total intake of 61 mg day(-1). The mean intake of sodium nitrite was 0.017 and 0.014, 0.009 and 0.008, and 0.007 and 0.003 mg kg(-1) body weight day(-1) for men and women in the age groups 4-5, 6-14 and 15-75 years, respectively, which was much lower than the acceptable daily intake (ADI) of 0.09 mg kg(-1) body weight day(-1). The 99th percentile for the group of 4-year-olds was 0.107 and 0.123 mg kg(-1) body weight day(-1) for boys and girls, respectively, and the 95th percentile was 0.057 and 0.073 mg kg(-1) body weight day(-1) for boys and girls, respectively, highest for the girls. With fewer than 100 boys and girls in the 4-5-year age group, only very few persons were responsible for the high intake. The conversion of nitrate to nitrite in the saliva and the degradation of nitrite during production and storage must also be considered when evaluating the intake of nitrite.

Ethnic differences in the correlates of mental distress among homeless women

BACKGROUND

Homeless women experience high rates of mental distress. We sought to determine whether ethnic differences exist in the relationship between the predisposing and enabling domains of the Gelberg-Andersen Behavioral Model for Vulnerable Populations and mental distress.

METHODS

We selected 821 homeless women in the Los Angeles area using a representative probability sampling design and invited them to participate in face-to-face interviews. The sample was 67% African American, 17% Hispanic, and 16% White.

RESULTS

We identified a number of ethnic differences in the correlates of mental distress. Being partnered or married was associated with greater distress among African American and White women, and experiencing competing needs was predictive of distress for African Americans and Hispanics.

CONCLUSION

A variety of factors contribute to mental distress among different ethnic groups of homeless women; these differences should be considered in the development of culturally appropriate services designed to address mental health problems among homeless populations.

When a generalist becomes a specialist: patterns of red fox predation on roe deer fawns under contrasting conditions

The red fox ( Vulpes vulpes (L., 1758)) functional response to roe deer ( Capreolus capreolus (L., 1758) fawn density was investigated in two Norwegian study areas characterized by a 26-fold difference in prey density and contrasting habitat characteristics. In the southern area, characterized by a fragmented agricultural landscape and high prey density, red fox consumption rates were closer to the specialist end in the specialist–generalist continuum of feeding habits. Conversely, in the northern area, dominated by boreal forest and with low prey density, the foxes displayed a type-III functional response typical of archetypal generalist predators. We suggest that differences in the predators’ feeding habits reflect differences in prey profitability, which was much higher in the southern area owing to higher prey density and to the openness of the landscape that both favour the hunting of roe deer fawns. Different functional responses produced different predation rates (25% for the southern area and 13% for the northern area) and different temporal patterns (highest predation risk for fawns born at the beginning or at the end of the birth season). Even though the understanding of a predator’s functional response is crucial for interpreting predation rates and patterns, much remains to be understood regarding its plasticity in different ecological settings. In the fawn–fox system, this might be the key factor in addressing unsolved questions regarding the adaptive value of reproductive synchrony as an antipredator strategy. Given the flexibility of the functional response and the resulting different impacts of predation with respect to birth synchrony, we suggest that reproductive synchrony evolved primarily in response to habitat seasonality and not as an antipredator strategy. Finally, our results contribute to the debate on the additive or compensatory nature of neonatal predation.

Applying the Gelberg-Andersen behavioral model for vulnerable populations to health services utilization in homeless women

We applied the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict health services utilization (HSU) in 875 homeless US women. Structural models assessed the impact of predisposing (demographics, psychological distress, alcohol/drug problems, homelessness severity), enabling (health insurance, source of care, barriers) and need (illness) variables on HSU (preventive care, outpatient visits, hospitalizations). Homelessness severity predicted illness, barriers and less insurance. Distress predicted more barriers, illness and less outpatient HSU. Drug problems predicted hospitalizations. Barriers predicted more illness and less outpatient HSU. Health and homelessness indicators were worse for White women. Better housing, access to care and insurance would encourage appropriate HSU.