Effect of Clostridium difficile Prevalence in Hospitals and Nursing Homes on Risk of Infection.

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Effect of Clostridium difficile Prevalence in Hospitals and Nursing Homes on Risk of Infection. J Am Geriatr Soc. 2017 Jul;65(7):1527-1534 Authors: Joyce NR, Mylonakis E, Mor V Abstract OBJECTIVES: To assess the effect of facility Clostridium difficile infection (CDI) prevalence on risk of healthcare facility (HFC) acquired CDI. DESIGN: Retrospective cohort study. SETTING: Medicare fee-for-service (FFS) claims and skilled nursing facility (SNF) Minimum Data Set 3.0 assessments. PARTICIPANTS: Medicare beneficiaries with 90 days or more of no contact with a HCF before a hospital admission without a CDI diagnosis. Participants were separated into two cohorts: discharged to the community and discharged to a SNF. MEASUREMENTS: Risk of HCF-acquired CDI associated with CDI prevalence at the index facility measured according to 30-day rehospitalization with a discharge diagnosis of CDI or diagnosis in the SNF after admission. Hospital and SNF CDI prevalence were categorized into three groups: 0% and above and below the median value for facilities with greater than 0% prevalence. RESULTS: Of 817,900 eligible individuals, there were 553,423 admissions in the first cohort (discharged to the community) and 315,109 in the second (discharged to a SNF). In the first cohort, the risk of HCF-acquired CDI was higher for individuals admitted to hospitals with CDI prevalence less than the median (relative risk (RR) = 1.58, 95% confidence interval (CI) = 1.18-2.12) and greater than the median (RR = 2.56, 95% CI = 1.91-3.45) than for those with no CDI. In the second cohort, the risk of HCF-acquired CDI was greater for individuals admitted to a hospital (RR = 1.89, 95% CI = 1.49-2.39) and a SNF (RR = 1.48, 95% CI = 1.31-1.67) with CDI prevalence greater than the median. CONCLUSION: The risk of HCF-acquired CDI is greater for noninfected individuals admitted to hospitals and SNFs with a high prevalence of CDI. PMID: 28394408 [PubMed - indexed for MEDLINE]

From good health to illness with post-infectious fatigue syndrome: a qualitative study of adults’ experiences of the illness trajectory.

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From good health to illness with post-infectious fatigue syndrome: a qualitative study of adults' experiences of the illness trajectory. BMC Fam Pract. 2017 Mar 27;18(1):49 Authors: Stormorken E, Jason LA, Kirkevold M Abstract BACKGROUND: Municipal drinking water contaminated with the parasite Giardia lamblia in Bergen, Norway, in 2004 caused an outbreak of gastrointestinal infection in 2500 people, according to the Norwegian Prescription Database. In the aftermath a minor group subsequently developed post-infectious fatigue syndrome (PIFS). Persons in this minor group had laboratory-confirmed parasites in their stool samples, and their enteritis had been cured by one or more courses of antibiotic treatment. The study's purpose was to explore how the affected persons experienced the illness trajectory and various PIFS disabilities. METHODS: A qualitative design with in-depth interviews was used to obtain first-hand experiences of PIFS. To get an overall understanding of their perceived illness trajectory, the participants were asked to retrospectively rate their functional level at different points in time. A maximum variation sample of adults diagnosed with PIFS according to the international 1994 criteria was recruited from a cohort of persons diagnosed with PIFS at a tertiary Neurology Outpatient Clinic in Western Norway. The sample comprised 19 women and seven men (mean age 41 years, range 26-59). The interviews were fully transcribed and subjected to a qualitative content analysis. RESULTS: All participants had been living healthy lives pre-illness. The time to develop PIFS varied. Multiple disabilities in the physical, cognitive, emotional, neurological, sleep and intolerance domains were described. Everyone more or less dropped out from studies or work, and few needed to be taken care of during the worst period. The severity of these disabilities varied among the participants and during the illness phases. Despite individual variations, an overall pattern of illness trajectory emerged. Five phases were identified: prodromal, downward, turning, upward and chronic phase. All reached a nadir followed by varying degrees of improvement in their functional ability. None regained pre-illness health or personal and professional abilities. CONCLUSIONS: The needs of persons with this condition are not met. Early diagnosis and interdisciplinary rehabilitation could be beneficial in altering the downward trajectory at an earlier stage, avoiding the most severe disability and optimising improvement. Enhanced knowledge among health professionals, tailored treatment, rest as needed, financial support and practical help would likely improve prognosis. PMID: 28347294 [PubMed - indexed for MEDLINE]

Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review.

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Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review. Pediatrics. 2017 Sep;140(3): Authors: Zafack JG, De Serres G, Kiely M, Gariépy MC, Rouleau I, Top KA, Canadian Immunization Research Network Abstract CONTEXT: Reimmunizing patients who had an adverse event following immunization (AEFI) is sometimes a challenge because there are limited data on the risk and severity of AEFI recurrence. OBJECTIVE: To summarize the literature on the risk of AEFI recurrence. DATA SOURCES: PubMed, Embase, and Cochrane library. STUDY SELECTION: We included articles in English or French published before September 30, 2016. Articles were selected if they estimated the risk of AEFI recurrence in at least 5 individuals. Studies with experimental vaccines were excluded. DATA EXTRACTION: Data on study design, setting, population, vaccines, and AEFI recurrence were extracted. RESULTS: Twenty-nine articles were included. Among patients with a history of hypotonic hyporesponsive episode (n = 398), anaphylaxis (n = 133), or seizures (n = 60) who were reimmunized, events recurred in 0% to 0.8%. Allergic-like events recurred in 30 of 594 reimmunized patients. Fever recurred in 0% to 84% of 836 reimmunized patients, depending on the vaccine and dose number. Among children with extensive limb swelling after the fourth dose of diphtheria-tetanus-acellular pertussis vaccine, recurrence was higher when the fifth dose was given withthe full-antigen formulation (78%) compared with the reduced-antigen formulation (53%, P = .02) LIMITATIONS: Many studies, included few patients, and those with severe AEFIs were often not reimmunized. CONCLUSIONS: Despite vaccines being administered to millions of people annually, there are few studies in which researchers evaluated AEFI recurrence. Published studies suggest that reimmunization is usually safe. However in these studies, severe cases were often not reimmunized. PMID: 28847985 [PubMed - indexed for MEDLINE]

Tobacco packaging design for reducing tobacco use.

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Tobacco packaging design for reducing tobacco use. Cochrane Database Syst Rev. 2017 Apr 27;4:CD011244 Authors: McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J Abstract BACKGROUND: Tobacco use is the largest single preventable cause of death and disease worldwide. Standardised tobacco packaging is an intervention intended to reduce the promotional appeal of packs and can be defined as packaging with a uniform colour (and in some cases shape and size) with no logos or branding, apart from health warnings and other government-mandated information, and the brand name in a prescribed uniform font, colour and size. Australia was the first country to implement standardised tobacco packaging between October and December 2012, France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing, or intending to implement, standardised tobacco packaging. OBJECTIVES: To assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. SEARCH METHODS: We searched MEDLINE, Embase, PsycINFO and six other databases from 1980 to January 2016. We checked bibliographies and contacted study authors to identify additional peer-reviewed studies. SELECTION CRITERIA: Primary outcomes included changes in tobacco use prevalence incorporating tobacco use uptake, cessation, consumption and relapse prevention. Secondary outcomes covered intermediate outcomes that can be measured and are relevant to tobacco use uptake, cessation or reduction. We considered multiple study designs: randomised controlled trials, quasi-experimental and experimental studies, observational cross-sectional and cohort studies. The review focused on all populations and people of any age; to be included, studies had to be published in peer-reviewed journals. We examined studies that assessed the impact of changes in tobacco packaging such as colour, design, size and type of health warnings on the packs in relation to branded packaging. In experiments, the control condition was branded tobacco packaging but could include variations of standardised packaging. DATA COLLECTION AND ANALYSIS: Screening and data extraction followed standard Cochrane methods. We used different 'Risk of bias' domains for different study types. We have summarised findings narratively. MAIN RESULTS: Fifty-one studies met our inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between- and within-participant experimental studies, cohort and cross-sectional studies, and time-series analyses. Few studies assessed behavioural outcomes in youth and non-smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross-sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non-behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall we judged most studies to be at high or unclear risk of bias in at least one domain. The one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 percentage point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. Findings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. One national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post-implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye-tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non-behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. We found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse-tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. AUTHORS' CONCLUSIONS: The available evidence suggests that standardised packaging may reduce smoking prevalence. Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect. A reduction in smoking behaviour is supported by routinely collected data by the Australian government. Data on the effects of standardised packaging on non-behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence. As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake. We did not find any evidence suggesting standardised packaging may increase tobacco use. PMID: 28447363 [PubMed - indexed for MEDLINE]

Statin Prescriptions for High-Risk Patients Are Increased by Laboratory-Initiated Framingham Risk Scores: A Quality-Improvement Initiative.

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Statin Prescriptions for High-Risk Patients Are Increased by Laboratory-Initiated Framingham Risk Scores: A Quality-Improvement Initiative. Can J Cardiol. 2017 May;33(5):682-684 Authors: Naugler C, Cook C, Morrin L, Wesenberg J, Venner AA, Campbell N, Anderson T Abstract Low rates of cardiovascular preventive therapy with statin medications is a significant public health problem in Canada. There is a pressing need for public health interventions to increase the use of statin medications, especially among high-risk patients. In this article, we present the results of a quality assurance pilot program to provide laboratory-reported Framingham Risk Score (FRS) to physicians. This work was performed in a mixed urban and rural setting in southern Alberta. We provided FRSs and, for high-risk patients, statin treatment recommendations in conjunction with laboratory lipid panel requests. Adhesive labels were supplied to primary care physicians, and space was provided for information necessary for the calculation of the FRS by a laboratory information system. In total, 16 physicians from 4 different clinics participated in the pilot program. Data were collected from October 25, 2014-November 5, 2015, during which time 1266 patients had FRSs from the laboratory. Three hundred twenty-four individuals were identified as high risk for coronary heart disease (≥ 20% 10-year risk) and received a recommendation for treatment with a statin medication in the laboratory result report. These individuals had a 26% relative and a 6.4% absolute increase in statin prescriptions compared with before the pilot program. The laboratory-based provision of FRSs with statin treatment recommendations for high-risk individuals has the potential to significantly increase the use of statin drugs. PMID: 28449839 [PubMed - indexed for MEDLINE]

Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.

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Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups. BMC Health Serv Res. 2017 Feb 16;17(1):141 Authors: Markle-Reid M, Dykeman C, Ploeg J, Kelly Stradiotto C, Andrews A, Bonomo S, Orr-Shaw S, Salker N Abstract BACKGROUND: Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact. METHODS: Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers. RESULTS: The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted. CONCLUSION: To align stakeholders working towards fall prevention for community-dwelling older adults and establish a foundation for collective impact, public health professionals employed practices that reflected a collaborative leadership style. Looking ahead, public health professionals will want to shift their focus to evaluating the effectiveness of their group work within communities. They will also need to assess outcomes and evaluate whether the anticipated reductions in fall rates among community-dwelling older adults is being achieved. PMID: 28209143 [PubMed - indexed for MEDLINE]

Impacts on Global Health from Nursing Research.

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Impacts on Global Health from Nursing Research. Am J Trop Med Hyg. 2017 Apr;96(4):765-766 Authors: Baltzell K, McLemore M, Shattell M, Rankin S Abstract AbstractInfectious disease continues to adversely affect populations in low- and middle-income countries. Investments in solutions often focus on technology, yet health-care workers remain in short supply. Nurses are the largest cadre of health-care workers and are largely responsible for patient care around the world. In fact, it is estimated that nurses care for nine out of every 10 patients seen. Importantly, sound nursing science contributes to solutions that directly impact patient care, especially those that pertain to infectious disease. Here we share several examples of nursing science that are improving care delivery in three global health areas: human immunodeficiency virus testing and prevention strategies in Malawi, family planning in Kenya, and response to Ebola virus disease. PMID: 28219991 [PubMed - indexed for MEDLINE]

Metabolically healthy obesity across the life course: epidemiology, determinants, and implications.

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Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann N Y Acad Sci. 2017 Mar;1391(1):85-100 Authors: Phillips CM Abstract In recent years, different subphenotypes of obesity have been described, including metabolically healthy obesity (MHO), in which a proportion of obese individuals, despite excess body fat, remain free of metabolic abnormalities and increased cardiometabolic risk. In the absence of a universally accepted set of criteria to classify MHO, the reported prevalence estimates vary widely. Our understanding of the determinants and stability of MHO over time and the associated cardiometabolic and mortality risks is improving, but many questions remain. For example, whether MHO is truly benign is debatable, and whether risk stratification of obese individuals on the basis of their metabolic health status may offer new opportunities for more personalized approaches in diagnosis, intervention, and treatment of diabetes remains speculative. Furthermore, as most of the research to date has focused on MHO in adults, little is known about childhood MHO. In this review, we focus on the epidemiology, determinants, stability, and health implications of MHO across the life course. PMID: 27723940 [PubMed - indexed for MEDLINE]

The management of infection with Mycobacterium tuberculosis in young children post-2015: an opportunity to close the policy-practice gap.

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The management of infection with Mycobacterium tuberculosis in young children post-2015: an opportunity to close the policy-practice gap. Expert Rev Respir Med. 2017 Jan;11(1):41-49 Authors: Graham SM Abstract INTRODUCTION: The treatment of infection with Mycobacterium tuberculosis in young children is supported by universal policy based on strong rationale and evidence of effectiveness, but has rarely been implemented in tuberculosis endemic countries. Areas covered: This review highlights a number of important recent developments that provide an unprecedented opportunity to close the policy-practice gap, as well as ongoing needs to facilitate implementation under programmatic conditions and scale-up. Expert commentary: The WHO's End TB Strategy and Stop TB Partnership's Plan to End TB provide ambitious targets for prevention at a time when National Tuberculosis Programs in tuberculosis endemic countries are increasing attention to the challenges of management and prevention of tuberculosis disease in children. This opportunity is greatly enhanced by recent evidence of the effectiveness of shorter, simpler and safer regimens to treat tuberculosis infection. The scale of the challenge for implementation will require a decentralized, integrated, community-based approach. An accurate and low-cost point-of-care test for tuberculous infection would be a major advance to support such implementation. Specific guidance for the treatment of infection in young child contacts of multidrug-resistant tuberculosis cases is a major current need while awaiting further evidence. PMID: 27910720 [PubMed - indexed for MEDLINE]

Interventions Using Social Media for Cancer Prevention and Management: A Systematic Review.

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Interventions Using Social Media for Cancer Prevention and Management: A Systematic Review. Cancer Nurs. 2017 Jul 27;: Authors: Han CJ, Lee YJ, Demiris G Abstract BACKGROUND: Regarding cancer awareness, social media effectively promotes health and supports self-management. Given the diverse study designs, methodologies, and approaches of social media interventions in oncology, it is difficult to determine the effects of social media on cancer prevention and management. OBJECTIVE: We aim to systematically review intervention studies using social media for cancer care. METHODS: A systematic search, using 7 electronic databases (PubMed, Web of Science, CINAHL, Cochrane Library, Scopus, EMBASE, and PsycINFO), was conducted to identify surveys and interventions using contemporary social media tools with a focus on cancer. RESULTS: Of the 18 selected studies, 7 were randomized controlled trials. Most studies were conducted for all types of cancer, and some were conducted for breast cancer in the United States, with mostly white female participants. Facebook was the most frequently used platform. Most studies targeted healthy participants providing cancer prevention education. With social media platforms as part of a larger intervention, or the main component of interventions, interventions were overall feasible and showed a significant improvement in cancer prevention and management. CONCLUSIONS: Social media tools have the potential to be effective in delivering interventions for cancer prevention and management. However, there was a dearth of studies with rigorous study methodologies to test social media effects on various cancer-related clinical outcomes. IMPLICATIONS FOR PRACTICE: Social media use in cancer care will facilitate improved communication and support among patients, caregivers, and clinicians and, ultimately, improved patient care. Clinicians need to carefully harness social media to enhance patient care and clinical outcomes. PMID: 28753192 [PubMed - as supplied by publisher]

Meningococcal Vaccination in Men Who Have Sex with Men.

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Meningococcal Vaccination in Men Who Have Sex with Men. Public Health Nurs. 2017 Mar;34(2):147-151 Authors: Blackwell CW Abstract Recent outbreaks of meningitis in men who have sex with men (MSM) in Los Angeles, Chicago, New York City, and other locations across the United States have heightened public health concerns regarding the increasing incidence of meningococcal infections in this vulnerable population. MSM have unique risk factors that result in greater threat from certain infectious diseases, including meningococcal infection. Men who have sex with men who are infected with HIV are at even higher risk. This article explores the increased risks among MSM in contracting and communicating meningococcal infection, use of vaccination as primary prevention, and outreach strategies that may help address this issue and lessen the disease burden associated with meningococcal infection in these sexual minorities. PMID: 27921318 [PubMed - indexed for MEDLINE]

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach.

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How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach. Int J Environ Res Public Health. 2017 Apr 04;14(4): Authors: Forberger S, Bammann K, Bauer J, Boll S, Bolte G, Brand T, Hein A, Koppelin F, Lippke S, Meyer J, Pischke CR, Voelcker-Rehage C, Zeeb H Abstract The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that thenetwork has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets. PMID: 28375177 [PubMed - indexed for MEDLINE]

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action.

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Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat Rev Nephrol. 2017 Jul;13(7):393-409 Authors: Vanholder R, Annemans L, Brown E, Gansevoort R, Gout-Zwart JJ, Lameire N, Morton RL, Oberbauer R, Postma MJ, Tonelli M, Biesen WV, Zoccali C, European Kidney Health Alliance Abstract The treatment of chronic kidney disease (CKD) and of end-stage renal disease (ESRD) imposes substantial societal costs. Expenditure is highest for renal replacement therapy (RRT), especially in-hospital haemodialysis. Redirection towards less expensive forms of RRT (peritoneal dialysis, home haemodialysis) or kidney transplantation should decrease financial pressure. However, costs for CKD are not limited to RRT, but also include nonrenal health-care costs, costs not related to health care, and costs for patients with CKD who are not yet receiving RRT. Even if patients with CKD or ESRD could be given the least expensive therapies, costs would decrease only marginally. We therefore propose a consistent and sustainable approach focusing on prevention. Before a preventive strategy is favoured, however, authorities should carefully analyse the cost to benefit ratio of each strategy. Primary prevention of CKD is more important than secondary prevention, as many other related chronic diseases, such as diabetes mellitus, hypertension, cardiovascular disease, liver disease, cancer, and pulmonary disorders could also be prevented. Primary prevention largely consists of lifestyle changes that will reduce global societal costs and, more importantly, result in a healthy, active, and long-lived population. Nephrologists need to collaborate closely with other sectors and governments, to reach these aims. PMID: 28555652 [PubMed - indexed for MEDLINE]

Lead Levels in Landfill Areas and Childhood Exposure: An Integrative Review.

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Lead Levels in Landfill Areas and Childhood Exposure: An Integrative Review. Public Health Nurs. 2017 Jan;34(1):87-97 Authors: Kim MA, Williams KA Abstract OBJECTIVE: Landfills are high-risk areas for environmental lead exposure for children living in poverty stricken areas in many countries. This review examines landfills and lead toxicity in children. The review discusses the effects of lead toxicity, provides evidenced based recommendations to reduce lead exposure, and identify gaps in the evidence. DESIGN AND SAMPLE: A database search was conducted of articles in English from 1985 to 2014. Ten articles met the inclusion criteria. The Whittemore and Knafl framework and the John Hopkins Research Evidence Appraisal Tool(©) were used for reviewing the data. RESULTS: Elevated blood lead levels (BLLs) of children living near landfills were related to increased soil lead levels. Toxic effects of lead included adverse outcomes such as encephalopathy or death for children. Different approaches to decrease lead level include environmental surveillance, BLL screening, and soil abatement which are costly. CONCLUSION: Increased BLL through environmental exposure is connected with poor health outcomes and death among children. Evidence-based prevention included monitoring and screening and costly soil abatement. It is recommended that future studies focus on community education for exposure avoidance for children living near landfill areas. PMID: 26879806 [PubMed - indexed for MEDLINE]

Risk of Active Tuberculosis among Index Case of Householders-A Long-Term Assessment after the Conventional Contacts Study.

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Risk of Active Tuberculosis among Index Case of Householders-A Long-Term Assessment after the Conventional Contacts Study. Public Health Nurs. 2017 Mar;34(2):112-117 Authors: Puma DV, Pérez-Quílez O, Roure S, Martínez-Cuevas O, Bocanegra C, Feijoo-Cid M, Valerio L Abstract OBJECTIVES: The aim of this study was to determine the incidence of active tuberculosis (TB) among household contacts of TB-index cases diagnosed during a 7-year period in a public Primary Care Center located in a high-incidence area. DESIGN AND SAMPLE: A retrospective cohort study was performed. Data collection was based on the capture-recapture method; the two main sources crossed information from TB-index and contact cases from the El Fondo Primary Care Center (Santa Coloma de Gramenet, Spain) and their reports to the National Epidemiologic Surveillance Service. MEASURES: Variables were divided into demographic and health data (result of the Mantoux test, chest X-ray, presence of risk factors, and indication for chemoprophylaxis). RESULTS: Community nurses identified 103 household contacts that underwent the conventional contact study. Overall, 60.19% were male; the mean age was 29.08 years. Only one case of secondary active TB was found, representing an incidence of 0.56% per TB-index case and year. CONCLUSION: The incidence of new secondary TB among household contacts with TB-index cases was of a case. Nevertheless, a long-term follow-up of these householders beyond the conventional contacts study should be considered in areas with higher incidences of TB or among specific high-risk populations. PMID: 27377204 [PubMed - indexed for MEDLINE]

A national patient and public colorectal research agenda: integration of consumer perspectives in bowel disease through early consultation.

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A national patient and public colorectal research agenda: integration of consumer perspectives in bowel disease through early consultation. Colorectal Dis. 2017 Jan;19(1):O75-O85 Authors: McNair AG, Heywood N, Tiernan J, Verjee A, Bach SP, Fearnhead NS, ORACLE Collaboration Abstract AIM: There is a recognized need to include the views of patients and the public in prioritizing health research. This study aimed: (i) to explore patients' views on colorectal research; and (ii) to prioritize research topics with patients and the public. METHOD: In phase 1, 12 charitable organizations and patient groups with an interest in bowel disease were invited to attend a consultation exercise. Participants were briefed on 25 colorectal research topics prioritized by members of the Association of Coloproctology of Great Britain and Ireland. Focus groups were conducted and discussions were recorded with field notes. Analysis was conducted using principles of thematic analysis. In phase 2, a free public consultation was undertaken. Participants were recruited from newspaper advertisements, were briefed on the same research topics and were asked to rate the importance of each on a five-point Likert scale. Descriptive statistics were used to rank the topics. Univariable linear regression compared recorded demographic details with mean topic scores. RESULTS: Focus groups were attended by 12 patients who highlighted the importance of patient-centred information for trial recruitment and when selecting outcome measures. Some 360 people attended the public consultation, of whom 277 (77%) were recruited. Participants rated 'What is the best way to treat early cancer in the back passage?' highest, with 227 (85%) scoring it 4 or 5. There was no correlation between participant demographics and mean topic scores. CONCLUSION: The present study prioritized a colorectal research agenda with the input of patients and the public. Further research is required to translate this agenda into real improvements in patient care. PMID: 27870254 [PubMed - indexed for MEDLINE]

The HIQA’s Health Technology Assessment of Breast Screening: Highlighting Some of the Challenges Posed by Evaluations of Screening Programs.

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The HIQA's Health Technology Assessment of Breast Screening: Highlighting Some of the Challenges Posed by Evaluations of Screening Programs. Value Health. 2017 Jul - Aug;20(7):1000-1002 Authors: Teljeur C, Moran P, Harrington P, Ryan M Abstract A review of the Health Information and Quality Authority's (HIQA) assessment of breast cancer surveillance cancer criticized how the results were presented and interpreted. The health technology assessment (HTA) investigated surveillance options for women aged less than 50 years who were at elevated risk of breast cancer. Surveillance strategies using digital mammography, magnetic resonance imaging, or a combination of the two modalities were modeled on the basis of diagnostic test accuracy. The HTA faced a number of issues, including the use of diagnostic test accuracy as a surrogate for long-term outcomes; modeling interventions that were not considered acceptable to clinicians; and extrapolating for screening intervals and age ranges not directly supported by available evidence. The evaluation of screening programs gives rise to challenges in terms of balancing an adequate exploration of the possible options while also being cognizant of what is appropriately supported by evidence. In this article, the authors of the HIQA report discuss the challenges posed by this particular HTA. PMID: 28712610 [PubMed - indexed for MEDLINE]

Abdominal obesity and its association with socioeconomic factors among adolescents from different living environments.

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Abdominal obesity and its association with socioeconomic factors among adolescents from different living environments. Pediatr Obes. 2017 Apr;12(2):110-119 Authors: Costa de Oliveira Forkert E, de Moraes AC, Carvalho HB, Kafatos A, Manios Y, Sjöström M, González-Gross M, Gottrand F, Beghin L, Censi L, Kersting M, Moreno LA Abstract BACKGROUND: Socioeconomic status has been associated with obesity in children and adolescents. This association may be dependent according with where adolescents lives. OBJECTIVE: The aim of this study was to evaluate the association between different socioeconomic indicators such as parental education and occupation and socioeconomic status with abdominal obesity in adolescents from two observational studies: the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (HELENA-CSS) and the Brazilian Cardiovascular Adolescent Health (BRACAH) study. METHODS: European (n = 3192, aged 12.5-17.5 years, with 53.1% girls from HELENA-CSS) and Brazilian (n = 991, aged 14-18 years, with 54.5% girls from BRACAH study) adolescents from two cross-sectional studies were included in this analysis. Complete data on waist circumference (WC), height, socioeconomic status indicators and several confounders were collected. Socioeconomic indicators were measured using a self-reported questionnaire in order to assess the family social status of the adolescents. Multilevel linear regression models were used to examine associations, and results were adjusted for potential confounders. RESULTS: Adjusted results showed inverse associations between mother's and father's education levels (p < 0.001) and father's occupation level (p < 0.001) with waist-to-height ratio (WHtR) and WC in HELENA-CSS girls. Similarly in European girls, socioeconomic indicators by socioeconomic status and maternal occupation level were associated with WHtR. In HELENA-CSS boys, the same significant association was found between WHtR and WC with maternal occupation level. Moreover, in European boys WHtR was also associated with parental education. In Brazilian adolescents, both indicators of abdominal obesity did not remain associated with the independents variables, after adjustment for potential confounders. CONCLUSIONS: Abdominal obesity was associated with socioeconomic indicators in higher-income countries, but this association was not observed in a lower-middle-income country. PMID: 26910497 [PubMed - indexed for MEDLINE]

Diagnosis of viral hepatitis.

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Diagnosis of viral hepatitis. Curr Opin HIV AIDS. 2017 May;12(3):302-314 Authors: Easterbrook PJ, Roberts T, Sands A, Peeling R Abstract PURPOSE OF REVIEW: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and HIV-HBV and HCV coinfection are major causes of chronic liver disease worldwide. Testing and diagnosis is the gateway for access to both treatment and prevention services, but there remains a large burden of undiagnosed infection globally. We review the global epidemiology, key challenges in the current hepatitis testing response, new tools to support the hepatitis global response (2016-2020 Global Hepatitis Health Sector strategy, and 2017 WHO guidelines on hepatitis testing) and future directions and innovations in hepatitis diagnostics. RECENT FINDINGS: Key challenges in the current hepatitis testing response include lack of quality-assured serological and low-cost virological in-vitro diagnostics, limited facilities for testing, inadequate data to guide country-specific hepatitis testing approaches, stigmatization of those with or at risk of viral hepatitis and lack of guidelines on hepatitis testing for resource-limited settings. The new Global Hepatitis Health Sector strategy sets out goals for elimination of viral hepatitis as a public health threat by 2030 and gives outcome targets for reductions in new infections and mortality, as well as service delivery targets that include testing, diagnosis and treatment. The 2017 WHO hepatitis testing guidelines for adults, adolescents and children in low-income and middle-income countries outline the public health approach to strengthen and expand current testing practices for viral hepatitis and addresses who to test (testing approaches), which serological and virological assays to use (testing strategies) as well as interventions to promote linkage to prevention and care. SUMMARY: Future directions and innovations in hepatitis testing include strategies to improve access such as through use of existing facility and community-based testing opportunities for hepatitis testing, near-patient or point-of-care assays for virological markers (nucleic acid testing and HCV core antigen), dried blood spot specimens used with different serological and nucleic acid test assays, multiplex and multi-disease platforms to enable testing for multiple analytes/pathogens and potential self-testing for viral hepatitis. PMID: 28306597 [PubMed - indexed for MEDLINE]

An individual-level meta-analysis assessing the impact of community-level sanitation access on child stunting, anemia, and diarrhea: Evidence from DHS and MICS surveys.

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An individual-level meta-analysis assessing the impact of community-level sanitation access on child stunting, anemia, and diarrhea: Evidence from DHS and MICS surveys. PLoS Negl Trop Dis. 2017 Jun;11(6):e0005591 Authors: Larsen DA, Grisham T, Slawsky E, Narine L Abstract BACKGROUND: A lack of access to sanitation is an important risk factor child health, facilitating fecal-oral transmission of pathogens including soil-transmitted helminthes and various causes of diarrheal disease. We conducted a meta-analysis of cross-sectional surveys to determine the impact that community-level sanitation access has on child health for children with and without household sanitation access. METHODOLOGY/PRINCIPAL FINDINGS: Using 301 two-stage demographic health surveys and multiple indicator cluster surveys conducted between 1990 and 2015 we calculated the sanitation access in the community as the proportion of households in the sampled cluster that had household access to any type of sanitation facility. We then conducted exact matching of children based on various predictors of living in a community with high access to sanitation. Using logistic regression with the matched group as a random intercept we examined the association between the child health outcomes of stunted growth, any anemia, moderate or severe anemia, and diarrhea in the previous two weeks and the exposure of living in a community with varying degrees of community-level sanitation access. For children with household-level sanitation access, living in a community with 100% sanitation access was associated with lowered odds of stunting (adjusted odds ratio [AOR] = 0.97, 95%; confidence interval (CI) = 0.94-1.00; n = 14,153 matched groups, 1,175,167 children), any anemia (AOR = 0.73; 95% CI = 0.67-0.78; n = 5,319 matched groups, 299,033 children), moderate or severe anemia (AOR = 0.72, 95% CI = 0.68-0.77; n = 5,319 matched groups, 299,033 children) and diarrhea (AOR = 0.94; 95% CI = 0.91-0.97); n = 16,379 matched groups, 1,603,731 children) compared to living in a community with < 30% sanitation access. For children without household-level sanitation access, living in communities with 0% sanitation access was associated with higher odds of stunting (AOR = 1.04, 95% CI = 1.02-1.06; n = 14,153 matched groups, 1,175,167 children), any anemia (AOR = 1.05, 95% CI = 1.00-1.09; n = 5,319 matched groups, 299,033 children), moderate or severe anemia (AOR = 1.04, 95% CI = 1.00-1.09; n = 5,319 matched groups, 299,033 children) but not diarrhea (AOR = 1.00, 95% CI = 0.98-1.02; n = 16,379 matched groups, 1,603,731 children) compared to children without household-level sanitation access living in communities with 1-30% sanitation access. CONCLUSIONS/SIGNIFICANCE: Community-level sanitation access is associated with improved child health outcomes independent of household-level sanitation access. The proportion of children living in communities with 100% sanitation access throughout the world is appallingly low. Ensuring sanitation access to all by 2030 will greatly improve child health. PMID: 28594828 [PubMed - indexed for MEDLINE]

Integrating cervical cancer with HIV healthcare services: A systematic review.

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Integrating cervical cancer with HIV healthcare services: A systematic review. PLoS One. 2017;12(7):e0181156 Authors: Sigfrid L, Murphy G, Haldane V, Chuah FLH, Ong SE, Cervero-Liceras F, Watt N, Alvaro A, Otero-Garcia L, Balabanova D, Hogarth S, Maimaris W, Buse K, Mckee M, Piot P, Perel P, Legido-Quigley H Abstract BACKGROUND: Cervical cancer is a major public health problem. Even though readily preventable, it is the fourth leading cause of death in women globally. Women living with HIV are at increased risk of invasive cervical cancer, highlighting the need for access to screening and treatment for this population. Integration of services has been proposed as an effective way of improving access to cervical cancer screening especially in areas of high HIV prevalence as well as lower resourced settings. This paper presents the results of a systematic review of programs integrating cervical cancer and HIV services globally, including feasibility, acceptability, clinical outcomes and facilitators for service delivery. METHODS: This is part of a larger systematic review on integration of services for HIV and non-communicable diseases. To be considered for inclusion studies had to report on programs to integrate cervical cancer and HIV services at the level of service delivery. We searched multiple databases including Global Health, Medline and Embase from inception until December 2015. Articles were screened independently by two reviewers for inclusion and data were extracted and assessed for risk of bias. MAIN RESULTS: 11,057 records were identified initially. 7,616 articles were screened by title and abstract for inclusion. A total of 21 papers reporting interventions integrating cervical cancer care and HIV services met the criteria for inclusion. All but one study described integration of cervical cancer screening services into existing HIV services. Most programs also offered treatment of minor lesions, a 'screen-and-treat' approach, with some also offering treatment of larger lesions within the same visit. Three distinct models of integration were identified. One model described integration within the same clinic through training of existing staff. Another model described integration through co-location of services, with the third model describing programs of integration through complex coordination across the care pathway. The studies suggested that integration of cervical cancer services with HIV services using all models was feasible and acceptable to patients. However, several barriers were reported, including high loss to follow up for further treatment, limited human-resources, and logistical and chain management support. Using visual screening methods can facilitate screening and treatment of minor to larger lesions in a single 'screen-and-treat' visit. Complex integration in a single-visit was shown to reduce loss to follow up. The use of existing health infrastructure and funding together with comprehensive staff training and supervision, community engagement and digital technology were some of the many other facilitators for integration reported across models. CONCLUSIONS: This review shows that integration of cervical cancer screening and treatment with HIV services using different models of service delivery is feasible as well as acceptable to women living with HIV. However, the descriptive nature of most papers and lack of data on the effect on long-term outcomes for HIV or cervical cancer limits the inference on the effectiveness of the integrated programs. There is a need for strengthening of health systems across the care continuum and for high quality studies evaluating the effect of integration on HIV as well as on cervical cancer outcomes. PMID: 28732037 [PubMed - in process]

Exploring patient strategies in response to untoward healthcare encounters.

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Exploring patient strategies in response to untoward healthcare encounters. Nurs Ethics. 2017 Mar;24(2):190-197 Authors: Brüggemann AJ Abstract BACKGROUND: Increasing attention to patients' rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized. OBJECTIVE: To explore patients' potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient. RESEARCH DESIGN: The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient. Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient's story, but aims to be realistic and recognizable. FINDINGS AND CONCLUSION: Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients' responses to improve practice and find ways to prevent patients from untoward experiences in healthcare. PMID: 26174469 [PubMed - indexed for MEDLINE]

Tackling sepsis using an identification pathway.

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Tackling sepsis using an identification pathway. Nurs Child Young People. 2017 Mar 06;29(2):19 Authors: M Chapman S Abstract Background The risk of death from sepsis is reduced if it is identified early and treated promptly. Treatment can be delayed through a failure to recognise its signs and symptoms. PMID: 28262065 [PubMed - indexed for MEDLINE]

Evaluation of the National Health Service (NHS) Direct Pilot Telehealth Program: Cost-Effectiveness Analysis.

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Evaluation of the National Health Service (NHS) Direct Pilot Telehealth Program: Cost-Effectiveness Analysis. Telemed J E Health. 2017 Jul 18;: Authors: Clarke M, Fursse J, Connolly N, Sharma U, Jones R Abstract OBJECTIVE: To evaluate the cost-effectiveness of a pilot telehealth program applied to a wide population of patients with chronic obstructive pulmonary disease (COPD). DESIGN: Vital signs data were transmitted from the home of the patient on a daily basis using a patient monitoring system for review by community nurse to assist decisions on management. SETTING: Community services for patients diagnosed with COPD. PARTICIPANTS: Two Primary Care Trusts (PCTs) enrolled 321 patients diagnosed with COPD into the telehealth program. Two hundred twenty-seven (n = 227) patients having a complete baseline record of at least 88 days of continuous remote monitoring and meeting all inclusion criteria were included in the statistical analysis. INTERVENTION: Remote monitoring. METHODS: Resource and cost data associated with patient events (inpatient hospitalization, accident and emergency [A&E], and home visits) 12 months before, immediately before and during monitoring, equipment, start-up, and administration were collected and compared to determine cost-effectiveness of the program. MAIN OUTCOME MEASURES: Cost-effectiveness of program, impact on resource usage, and patterns of change in resource usage. RESULTS: Cost-effectiveness was determined for the two PCTs and the two periods before monitoring to provide four separate estimates. Cost-effectiveness had high variance both between the PCTs and between the comparison periods ranging from a saving of £140,800 ($176,000) to an increase of £9,600 ($12,000). The average saving was £1,023 ($1,280) per patient per year. The largest impact was on length of stay with a fall in the average length of inpatient care in PCT1 from 11.5 days in the period 12 months before monitoring to 6.5 days during monitoring, and similarly in PCT2 from 7.5 to 5.2 days. CONCLUSION: There was a wide discrepancy in the results from the two PCTs. This places doubt on outcomes and may indicate also why the literature on cost-effectiveness remains inconclusive. The wide variance on savings and the uncertainty of monitoring cost do not allow a definitive conclusion on the cost-effectiveness as an outcome of this study. It might well be that the average saving was £1,023 ($1,280) per patient per year, but the variance is too great to allow this to be statistically significant. Each locality-based clinical service provides a service to achieve the same clinical goal, but it does so in significantly different ways. The introduction of remote monitoring has a profound effect on team learning and clinical practice and thus distorts the cost-effectiveness evaluation of the use of the technology. Cost-effectiveness studies will continue to struggle to provide a definitive answer because outcome measurements are too dependent on factors other than the technology. PMID: 28723244 [PubMed - as supplied by publisher]

Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas.

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Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas. J Sch Nurs. 2017 Feb;33(1):8-17 Authors: DePriest K, Butz A Abstract Asthma disproportionately affects children who are non-White and of low socioeconomic status. One innovative approach to address these health disparities is to investigate the child's neighborhood environment and factors influencing asthma symptoms. The purpose of this integrative review is to critique research investigating the relationships between neighborhood-level factors and asthma morbidity in urban children. Three literature databases were searched using the terms "asthma," "child," "neighborhood," and "urban." The articles included were organized into six themes within the larger domains of prevalence, physical, and social factors. Literature tables provide in-depth analysis of each article and demonstrate a need for strengthening analysis methods. The current research points to the necessity for a multilevel study to analyze neighborhood-level factors that are associated with increased asthma morbidity in urban children. School nurse clinicians, working within children's neighborhoods, are uniquely positioned to assess modifiable neighborhood-level determinants of health in caring for children with asthma. PMID: 27756873 [PubMed - indexed for MEDLINE]

Density and Proximity of Licensed Tobacco Retailers and Adolescent Smoking.

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Density and Proximity of Licensed Tobacco Retailers and Adolescent Smoking. J Sch Nurs. 2017 Feb;33(1):18-29 Authors: Gwon SH, DeGuzman PB, Kulbok PA, Jeong S Abstract Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on tobacco retailer density and proximity in relation to adolescent smoking, published in peer-reviewed journals between 2004 and 2014. The tobacco retailer density and proximity were correlated with adolescent lifetime smoking, past 12-month smoking, past 30-day smoking, and susceptibility to smoking. School nurses or other school health professionals may need to include the density and proximity of tobacco retailer factors around schools in school-based tobacco-use prevention programs. Health policy makers may need to consider zoning or licensing restrictions of tobacco retailers around schools for adolescent smoking prevention. PMID: 27864341 [PubMed - indexed for MEDLINE]

A community virtual ward model to support older persons with complex health care and social care needs.

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A community virtual ward model to support older persons with complex health care and social care needs. Clin Interv Aging. 2017;12:985-993 Authors: Lewis C, Moore Z, Doyle F, Martin A, Patton D, Nugent LE Abstract BACKGROUND: Globally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline. METHODS: A quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann-Whitney test pre-and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman's ρ test. RESULTS: There was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0-1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations. CONCLUSION: Through an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions. PMID: 28721026 [PubMed - in process]

Medical Care for Undocumented Immigrants: National and International Issues.

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Medical Care for Undocumented Immigrants: National and International Issues. Prim Care. 2017 Mar;44(1):e1-e13 Authors: Beck TL, Le TK, Henry-Okafor Q, Shah MK Abstract The number of undocumented immigrants (UIs) varies worldwide, and most reside in the United States. With more than 12 million UIs in the United States, addressing the health care needs of this population presents unique challenges and opportunities. Most UIs are uninsured and rely on the safety-net health system for their care. Because of young age, this population is often considered to be healthier than the overall US population, but they have specific health conditions and risks. Adequate coverage is lacking; however, there are examples of how to better address the health care needs of UIs. PMID: 28164824 [PubMed - indexed for MEDLINE]

The One Health approach to identify knowledge, attitudes and practices that affect community involvement in the control of Rift Valley fever outbreaks.

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The One Health approach to identify knowledge, attitudes and practices that affect community involvement in the control of Rift Valley fever outbreaks. PLoS Negl Trop Dis. 2017 Feb;11(2):e0005383 Authors: Hassan OA, Affognon H, Rocklöv J, Mburu P, Sang R, Ahlm C, Evander M Abstract Rift Valley fever (RVF) is a viral mosquito-borne disease with the potential for global expansion, causes hemorrhagic fever, and has a high case fatality rate in young animals and in humans. Using a cross-sectional community-based study design, we investigated the knowledge, attitudes and practices of people living in small village in Sudan with respect to RVF outbreaks. A special One Health questionnaire was developed to compile data from 235 heads of household concerning their knowledge, attitudes, and practices with regard to controlling RVF. Although the 2007 RVF outbreak in Sudan had negatively affected the participants' food availability and livestock income, the participants did not fully understand how to identify RVF symptoms and risk factors for both humans and livestock. For example, the participants mistakenly believed that avoiding livestock that had suffered spontaneous abortions was the least important risk factor for RVF. Although the majority noticed an increase in mosquito population during the 2007 RVF outbreak, few used impregnated bed nets as preventive measures. The community was reluctant to notify the authorities about RVF suspicion in livestock, a sentinel for human RVF infection. Almost all the respondents stressed that they would not receive any compensation for their dead livestock if they notified the authorities. In addition, the participants believed that controlling RVF outbreaks was mainly the responsibility of human health authorities rather than veterinary authorities. The majority of the participants were aware that RVF could spread from one region to another within the country. Participants received most their information about RVF from social networks and the mass media, rather than the health system or veterinarians. Because the perceived role of the community in controlling RVF was fragmented, the probability of RVF spread increased. PMID: 28207905 [PubMed - indexed for MEDLINE]

DOT or SAT for Rifampicin-resistant tuberculosis? A non-randomized comparison in a high HIV-prevalence setting.

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DOT or SAT for Rifampicin-resistant tuberculosis? A non-randomized comparison in a high HIV-prevalence setting. PLoS One. 2017;12(5):e0178054 Authors: Mohr E, Daniels J, Beko B, Isaakidis P, Cox V, Steele SJ, Muller O, Snyman L, De Azevedo V, Shroufi A, Trivino Duran L, Hughes J Abstract BACKGROUND: Daily directly-observed therapy (DOT) is recommended for rifampicin-resistant tuberculosis (RR-TB) patients throughout treatment. We assessed the impact of self-administered treatment (SAT) in a South African township with high rates of RR-TB and HIV. METHODS: Community-supported SAT for patients who completed the intensive phase was piloted in five primary care clinics in Khayelitsha. We compared final treatment outcomes among RR-TB patients initiating treatment before (standard-of-care (SOC)-cohort, January 2010-July 2013) and after the implementation of the pilot (SAT-cohort, January 2012-December 2014). All patients with outcomes before January 1, 2017 were considered in the analysis of outcomes. RESULTS: One-hundred-eighteen patients in the SOC-cohort and 174 patients in the SAT-cohort had final RR-TB treatment outcomes; 70% and 73% were HIV-co-infected, respectively. The proportion of patients with a final outcome of loss to follow-up (LTFU) did not differ whether treated in the SOC (25/118, 21.2%) or SAT-cohort (31/174, 17.8%) (P = 0.47). There were no significant differences in the time to 24-month LTFU among HIV-infected and uninfected patients (HR 0.90, 95% CI: 0.51-1.6, P = 0.71), or among patients enrolled in the SOC-cohort versus the SAT-cohort (HR 0.83, 95% CI: 0.49-1.4, P = 0.50) who received at least 6-months of RR-TB treatment. CONCLUSION: The introduction of SAT during the continuation phase of RR-TB treatment does not adversely affect final RR-TB treatment outcomes in a high TB and HIV-burden setting. This differentiated, patient-centred model of care could be considered in RR-TB programmes to decrease the burden of DOT on patients and health facilities. PMID: 28542441 [PubMed - indexed for MEDLINE]

Racial and Geographic Differences in Breastfeeding – United States, 2011-2015.

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Racial and Geographic Differences in Breastfeeding - United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2017 Jul 14;66(27):723-727 Authors: Anstey EH, Chen J, Elam-Evans LD, Perrine CG Abstract Breastfeeding provides numerous health benefits for infants and mothers alike. The American Academy of Pediatrics recommends exclusive breastfeeding for approximately the first 6 months of life and continued breastfeeding with complementary foods through at least the first year (1). National estimates indicate substantial differences between non-Hispanic black (black) and non-Hispanic white (white) infants across breastfeeding indicators in the United States (2). CDC analyzed 2011-2015 National Immunization Survey (NIS) data for children born during 2010-2013 to describe breastfeeding initiation, exclusivity through 6 months and duration at 12 months among black and white infants. Among the 34 states (including the District of Columbia [DC]) with sufficient sample size (≥50 per group), initiation rates were significantly (p<0.05) lower among black infants than white infants in 23 states; in 14 of these states (primarily in the South and Midwest), the difference was at least 15 percentage points. A significant difference of at least 10 percentage points was identified in exclusive breastfeeding through 6 months in 12 states and in breastfeeding at 12 months in 22 states. Despite overall increases in breastfeeding rates for black and white infants over the last decade, racial disparities persist. Interventions specifically addressing barriers to breastfeeding for black women are needed. PMID: 28704352 [PubMed - indexed for MEDLINE]

Severe Mental Illness and Acute Stress: A Study of Service Utilization in a Conflict Zone.

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Severe Mental Illness and Acute Stress: A Study of Service Utilization in a Conflict Zone. Psychiatr Q. 2017 Mar;88(1):213-220 Authors: Halperin D, Levy T, Avissar S, Schreiber G Abstract Patients suffering from severe mental illness (SMI) are considered especially vulnerable to stress. In this study, their use of acute stress services in a military context affecting civilian populations was assessed, using naturally occurring data. The proportion of patients with a previously known SMI, defined as any chronic psychotic disorder or bipolar disorder, among all civilians examined at a center for treatment of stress during a military conflict versus at the ER in usual times, was compared, using the Chi square statistical test. Among 354 subjects examined at the center for treatment of stress, 12 had a SMI diagnosis. Among 404 subjects examined at the ER in usual times, 16 had a SMI diagnosis. Patients with SMI were under-represented, but not in a statistically significant manner, at the center for treatment of stress (χ(2) = 0.31, p = ns). Although these results may imply that patients with SMI are not more vulnerable to external stress than the general population, we believe that they may have difficulties in seeking immediate help in such traumatogenic contexts. In order to reduce the occurrence of PTSD and gain efficacy in the treatment of the primary disorder, psychiatric services should perhaps make a reaching out effort to identify and examine these patients in the community. . PMID: 27334286 [PubMed - indexed for MEDLINE]

Black carbon emission reduction strategies in healthcare industry for effective global climate change management.

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Black carbon emission reduction strategies in healthcare industry for effective global climate change management. Waste Manag Res. 2017 Apr;35(4):416-425 Authors: Raila EM, Anderson DO Abstract Climate change remains one of the biggest threats to life on earth to date with black carbon (BC) emissions or smoke being the strongest cause after carbon dioxide (CO2). Surprisingly, scientific evidence about black carbon emissions reduction in healthcare settings is sparse. This paper presents new research findings on the reduction of black carbon emissions from an observational study conducted at the UN Peacekeeping Operations (MINUSTAH) in Haiti in 2014. Researchers observed 20 incineration cycles, 30 minutes for each cycle of plastic and cardboard sharps healthcare waste (HCW) containers ranged from 3 to 14.6 kg. The primary aim was to determine if black carbon emissions from healthcare waste incineration can be lowered by mainstreaming the use of cardboard sharps healthcare waste containers instead of plastic sharps healthcare waste containers. Similarly, the study looks into whether burning temperature was associated with the smoke levels for each case or not. Independent samples t-tests demonstrated significantly lower black carbon emissions during the incineration of cardboard sharps containers (6.81 ± 4.79% smoke) than in plastic containers (17.77 ± 8.38% smoke); a statistically significant increase of 10.96% smoke (95% Confidence Interval ( CI) [4.4 to 17.5% smoke], p = 0.003). Correspondingly, lower bottom burner temperatures occurred during the incineration of cardboard sharps containers than in plastic (95% Cl [16 to 126°C], p = 0.014). Finally, we expect the application of the new quantitative evidence to form the basis for policy formulation, mainstream the use of cardboard sharps containers and opt for non-incineration disposal technologies as urgent steps for going green in healthcare waste management. PMID: 27909212 [PubMed - indexed for MEDLINE]

Smoking cessation interventions for patients with coronary heart disease and comorbidities: an observational cross-sectional study in primary care.

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Smoking cessation interventions for patients with coronary heart disease and comorbidities: an observational cross-sectional study in primary care. Br J Gen Pract. 2017 Feb;67(655):e118-e129 Authors: Blane DN, Mackay D, Guthrie B, Mercer SW Abstract BACKGROUND: Little is known about how smoking cessation practices in primary care differ for patients with coronary heart disease (CHD) who have different comorbidities. AIM: To determine the association between different patterns of comorbidity and smoking rates and smoking cessation interventions in primary care for patients with CHD. DESIGN AND SETTING: Cross-sectional study of 81 456 adults with CHD in primary care in Scotland. METHOD: Details of eight concordant physical comorbidities, 23 discordant physical comorbidities, and eight mental health comorbidities were extracted from electronic health records between April 2006 and March 2007. Multilevel binary logistic regression models were constructed to determine the association between these patterns of comorbidity and smoking status, smoking cessation advice, and smoking cessation medication (nicotine replacement therapy) prescribed. RESULTS: The most deprived quintile had nearly three times higher odds of being current smokers than the least deprived (odds ratio [OR] 2.76; 95% confidence interval [CI] = 2.49 to 3.05). People with CHD and two or more mental health comorbidities had more than twice the odds of being current smokers than those with no mental health conditions (OR 2.11; 95% CI = 1.99 to 2.24). Despite this, those with two or more mental health comorbidities (OR 0.77; 95% CI = 0.61 to 0.98) were less likely to receive smoking cessation advice, but absolute differences were small. CONCLUSION: Patterns of comorbidity are associated with variation in smoking status and the delivery of smoking cessation advice among people with CHD in primary care. Those from the most deprived areas and those with mental health problems are considerably more likely to be current smokers and require additional smoking cessation support. PMID: 27919936 [PubMed - indexed for MEDLINE]

Primary care screening for peripheral arterial disease: a cross-sectional observational study.

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Primary care screening for peripheral arterial disease: a cross-sectional observational study. Br J Gen Pract. 2017 Feb;67(655):e103-e110 Authors: Davies JH, Richards J, Conway K, Kenkre JE, Lewis JE, Mark Williams E Abstract BACKGROUND: Early identification of peripheral arterial disease (PAD) and subsequent instigation of risk modification strategies could minimise disease progression and reduce overall risk of cardiovascular (CV) mortality. However, the feasibility and value of primary care PAD screening is uncertain. AIM: This study (the PIPETTE study - Peripheral arterial disease In Primary carE: Targeted screening and subsequenT managEment) aimed to determine the value of a proposed primary care PAD screening strategy. Outcomes assessed were: prevalence of PAD and agreement of ankle- brachial index (ABI)-defined PAD (ABI ≤0.9) with QRISK(®)2-defined high CV risk (≥20). DESIGN AND SETTING: A cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales. METHOD: In total, 1101 individuals with ≥2 pre-identified CV risk factors but no known CV disease or diabetes were invited to participate. Participants underwent ABI measurement and QRISK2 assessment, and completed Edinburgh Claudication Questionnaires. RESULTS: A total of 368 people participated in the study (participation rate: 33%). Prevalence of PAD was 3% (n = 12). The number needed to screen (NNS) to detect one new case of PAD was 31. Refining the study population to those aged ≥50 years with a smoking history reduced the NNS to 14, while still identifying 100% of PAD cases. Of participants with PAD, 33% reported severe lifestyle-limiting symptoms of intermittent claudication that warranted subsequent endovascular intervention, yet had not previously presented to their GP. The QRISK2 score predicted high CV risk in 92% of participants with PAD. CONCLUSION: The low PAD yield and the fact that QRISK2 was largely comparable to the ABI in predicting high CV risk suggests that routine PAD screening may be unwarranted. Instead, strategies to improve public awareness of PAD are needed. PMID: 28126882 [PubMed - indexed for MEDLINE]

Predicting Ebola Severity: A Clinical Prioritization Score for Ebola Virus Disease.

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Predicting Ebola Severity: A Clinical Prioritization Score for Ebola Virus Disease. PLoS Negl Trop Dis. 2017 Feb;11(2):e0005265 Authors: Hartley MA, Young A, Tran AM, Okoni-Williams HH, Suma M, Mancuso B, Al-Dikhari A, Faouzi M Abstract BACKGROUND: Despite the notoriety of Ebola virus disease (EVD) as one of the world's most deadly infections, EVD has a wide range of outcomes, where asymptomatic infection may be almost as common as fatality. With increasingly sensitive EVD diagnosis, there is a need for more accurate prognostic tools that objectively stratify clinical severity to better allocate limited resources and identify those most in need of intensive treatment. METHODS/PRINCIPAL FINDINGS: This retrospective cohort study analyses the clinical characteristics of 158 EVD(+) patients at the GOAL-Mathaska Ebola Treatment Centre, Sierra Leone. The prognostic potential of each characteristic was assessed and incorporated into a statistically weighted disease score. The mortality rate among EVD(+) patients was 60.8% and highest in those aged <5 or >25 years (p<0.05). Death was significantly associated with malaria co-infection (OR = 2.5, p = 0.01). However, this observation was abrogated after adjustment to Ebola viral load (p = 0.1), potentially indicating a pathologic synergy between the infections. Similarly, referral-time interacted with viral load, and adjustment revealed referral-time as a significant determinant of mortality, thus quantifying the benefits of early reporting as a 12% mortality risk reduction per day (p = 0.012). Disorientation was the strongest unadjusted predictor of death (OR = 13.1, p = 0.014) followed by hiccups, diarrhoea, conjunctivitis, dyspnoea and myalgia. Including these characteristics in multivariate prognostic scores, we obtained a 91% and 97% ability to discriminate death at or after triage respectively (area under ROC curve). CONCLUSIONS/SIGNIFICANCE: This study proposes highly predictive and easy-to-use prognostic tools, which stratify the risk of EVD mortality at or after EVD triage. PMID: 28151955 [PubMed - indexed for MEDLINE]

Clinical Recognition of Melanoma in Dermatologists and Nondermatologists.

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Clinical Recognition of Melanoma in Dermatologists and Nondermatologists. J Cutan Med Surg. 2016 Nov;20(6):532-535 Authors: Martinka MJ, Crawford RI, Humphrey S Abstract BACKGROUND: The incidence of melanoma is increasing annually in Canada. OBJECTIVES: This retrospective study was designed to assess the ability of physicians of different specialties to accurately recognize melanoma. METHODS: Pathology reports of biopsies submitted to Vancouver Coastal Health with clinical diagnoses of melanoma were reviewed (January to July 2013). The clinical diagnoses made by dermatologists, general practitioners and family physicians, and all other specialists were correlated with the final histopathologic diagnoses. RESULTS: The dermatologists, general practitioners and family physicians, and all other specialists achieved diagnostic accuracies of 24.75%, 3.52%, and 12.75%, respectively. CONCLUSIONS: Although the diagnostic accuracy of dermatologists was significantly better than that the other practitioners, the majority of patients with suspicious skin lesions present to family physicians or general practitioners first. Thus, there is considerable value in providing more training and education to nondermatologists, because it can have a meaningful impact on patient care. PMID: 26676952 [PubMed - indexed for MEDLINE]

Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients.

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Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. AIDS Care. 2017 Jun;29(6):751-758 Authors: Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR Abstract HIV pre-exposure prophylaxis (PrEP) presents new opportunities for HIV prevention. While women comprise approximately 20% of new HIV infections in the US, significant questions remain about how to most effectively facilitate PrEP uptake for this population. Family planning clinics are a dominant source of health care for young women and support an estimated 4.5 million women annually. We explore characteristics associated with HIV risk perception and PrEP acceptability among young adult women seeking reproductive health services in a high-prevalence setting. A cross-sectional, clinic-based survey was conducted with women ages 18-35 (n = 146) seeking health care at two family planning clinics in the greater Baltimore, Maryland area, from January to April 2014. An estimated 22% of women reported being worried about HIV risk, and 60% reported they would consider taking a pill daily to prevent HIV. In adjusted models, HIV-related worry was associated with having no college education, being single or dating more than one person, practicing consistent condom use during vaginal sex, and having ever traded sex. PrEP acceptability was significantly associated with being Black (71% vs. 49%, AOR 2.23, CI: 1.89-2.64) and having ever traded sex (83% vs. 58%, AOR 4.94, CI: 2.00-12.22). For women with a history of intimate partner violence (IPV), PrEP acceptability was significantly lower (57% vs. 62%, AOR .71, CI: .59-.85) relative to their non-abused counterparts. Results suggest that family planning clinics may be a natural setting for PrEP discussion and roll-out. They should be considered in the context of integrating HIV prevention with reproductive health services. Women with a trauma history may need additional support for implementing HIV prevention in the form of PrEP. PMID: 27680304 [PubMed - indexed for MEDLINE]

Reductions in Medication-Related Hospitalizations in Older Adults with Medication Management by Hospital and Community Pharmacists: A Quasi-Experimental Study.

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Reductions in Medication-Related Hospitalizations in Older Adults with Medication Management by Hospital and Community Pharmacists: A Quasi-Experimental Study. J Am Geriatr Soc. 2017 Jan;65(1):212-219 Authors: Pellegrin KL, Krenk L, Oakes SJ, Ciarleglio A, Lynn J, McInnis T, Bairos AW, Gomez L, McCrary MB, Hanlon AL, Miyamura J Abstract OBJECTIVES: To evaluate the association between a system of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm) and rates and costs of medication-related hospitalization in older adults. DESIGN: Quasi-experimental interrupted time series design comparing intervention and nonintervention hospitals using a mixed-effects analysis that modeled the intervention as a time-dependent variable. SETTING: Sequential implementation of Pharm2Pharm at six general nonfederal acute care hospitals in Hawaii with more than 50 beds in 2013 and 2014. All five other such hospitals served as a contemporaneous comparison group. PARTICIPANTS: Adult inpatients who met criteria for being at risk for medication problems (N = 2,083), 62% of whom were aged 65 or older. INTERVENTION: A state-wide system of medication management services provided by specially trained hospital and community pharmacists serving high-risk individuals from hospitalization through transition to home and for up to 1 year after discharge. MEASUREMENTS: Medication-related hospitalization rate per 1,000 admissions of individuals aged 65 and older, adjusted for case mix; estimate of costs of hospitalizations and actual costs of pharmacist services. RESULTS: The predicted, case mix-adjusted medication-related hospitalization rate of individuals aged 65 and older was 36.5% lower in the Pharm2Pharm hospitals after implementation than in the nonintervention hospitals (P = .01). The estimated annualized cost of avoided admissions was $6.6 million. The annual cost of the pharmacist services for all Pharm2Pharm participants was $1.8 million. CONCLUSION: The Pharm2Pharm model was associated with an estimated 36% reduction in the medication-related hospitalization rate for older adults and a 2.6:1 return on investment, highlighting the value of pharmacists as drug therapy experts in geriatric care. PMID: 27714762 [PubMed - indexed for MEDLINE]

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations.

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Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations. J Natl Cancer Inst. 2017 Apr;109(4): Authors: Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, Kutner J, Patrick D, Zimmerman L, Xiao C, Matocha M, Marden S Abstract An overview of proceedings, findings, and recommendations from the workshop on "Advancing Symptom Science Through Symptom Cluster Research" sponsored by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, is presented. This workshop engaged an expert panel in an evidenced-based discussion regarding the state of the science of symptom clusters in chronic conditions including cancer and other rare diseases. An interdisciplinary working group from the extramural research community representing nursing, medicine, oncology, psychology, and bioinformatics was convened at the National Institutes of Health. Based on expertise, members were divided into teams to address key areas: defining characteristics of symptom clusters, priority symptom clusters and underlying mechanisms, measurement issues, targeted interventions, and new analytic strategies. For each area, the evidence was synthesized, limitations and gaps identified, and recommendations for future research delineated. The majority of findings in each area were from studies of oncology patients. However, increasing evidence suggests that symptom clusters occur in patients with other chronic conditions (eg, pulmonary, cardiac, and end-stage renal disease). Nonetheless, symptom cluster research is extremely limited and scientists are just beginning to understand how to investigate symptom clusters by developing frameworks and new methods and approaches. With a focus on personalized care, an understanding of individual susceptibility to symptoms and whether a "driving" symptom exists that triggers other symptoms in the cluster is needed. Also, research aimed at identifying the mechanisms that underlie symptom clusters is essential to developing targeted interventions. PMID: 28119347 [PubMed - indexed for MEDLINE]

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health.

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Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health. Am J Public Health. 2017 May;107(S1):S56-S60 Authors: Simmer-Beck M, Wellever A, Kelly P Abstract We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion. PMID: 28661808 [PubMed - indexed for MEDLINE]

Unanswered clinical questions: a survey of specialists and primary care providers.

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Unanswered clinical questions: a survey of specialists and primary care providers. J Med Libr Assoc. 2017 Jan;105(1):4-11 Authors: Brassil E, Gunn B, Shenoy AM, Blanchard R Abstract OBJECTIVE: With the myriad of cases presented to clinicians every day at our integrated academic health system, clinical questions are bound to arise. Clinicians need to recognize these knowledge gaps and act on them. However, for many reasons, clinicians might not seek answers to these questions. Our goal was to investigate the rationale and process behind these unanswered clinical questions. Subsequently, we explored the use of biomedical information resources among specialists and primary care providers and identified ways to promote more informed clinical decision making. METHODS: We conducted a survey to assess how practitioners identify and respond to information gaps, their background knowledge of search tools and strategies, and their usage of and comfort level with technology. RESULTS: Most of the 292 respondents encountered clinical questions at least a few times per week. While the vast majority often or always pursued answers, time was the biggest barrier for not following through on questions. Most respondents did not have any formal training in searching databases, were unaware of many digital resources, and indicated a need for resources and services that could be provided at the point of care. CONCLUSIONS: While the reasons for unanswered clinical questions varied, thoughtful review of the responses suggested that a combination of educational strategies, embedded librarian services, and technology applications could help providers pursue answers to their clinical questions, enhance patient safety, and contribute to patient-based, self-directed learning. PMID: 28096740 [PubMed - indexed for MEDLINE]

Utility of Surveillance Research to Inform Physical Activity Policy: An Exemplar From Canada.

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Utility of Surveillance Research to Inform Physical Activity Policy: An Exemplar From Canada. J Phys Act Health. 2017 Mar;14(3):229-239 Authors: Craig CL, Cameron CA, Bauman A Abstract BACKGROUND: There are several well-known risk factor monitoring systems, but few examples of comprehensive surveillance systems designed specifically to inform physical activity (PA) policy. This paper examines the utility of Canada`s Physical Activity and Sport Monitoring System in guiding policy and practice. METHODS: Indicators were determined in conjunction with government, nongovernmental associations and academics. Serial measures were collected from representative population (telephone interviews, n = 4000 to 11,000) and setting-based (postal surveys, n = 1425 to 4304) surveys. RESULTS: Adult PA was higher in 2014 (47%) than 1998 (37%). The prevalence of knowledge about sufficient PA to meet national guidelines increased (31% to 57%). Most adults (66%) reported having many safe places to walk locally. Having policies to encourage walking and cycling when redeveloping communities increased by community size (5% to 37%). PA promotion was available in 10% to 15% of workplaces. Most parents (64%) provided transportation to support their child's PA. The prevalence of policies mandating daily PE increased 2001 to 2011 (36% to 55%), as did having no policy to hire qualified PE teachers (25% to 34%). CONCLUSIONS: Canada's surveillance system has provided information for guiding policy planning, resource allocation, setting and tracking national goals, assessing changes in PA determinants, and evaluating national campaigns, naturally occurring experiments, and innovative policies. PMID: 27918686 [PubMed - indexed for MEDLINE]

Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia.

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Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia. BMC Psychiatry. 2017 Feb 17;17(1):72 Authors: Girard V, Tinland A, Bonin JP, Olive F, Poule J, Lancon C, Apostolidis T, Rowe M, Greacen T, Simeoni MC Abstract BACKGROUND: Increasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless. METHODS: In a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument. RESULTS: Although the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets. CONCLUSIONS: Less intrusive questions, more readily understandable vocabulary and greater relevance to subjects' living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward. PMID: 28212630 [PubMed - indexed for MEDLINE]

A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP).

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A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP). J Epidemiol Community Health. 2017 Jul 05;: Authors: Oneka G, Vahid Shahidi F, Muntaner C, Bayoumi AM, Mahabir DF, Freiler A, O'Campo P, Shankardass K Abstract Health in All Policies (HiAP) is a strategy that seeks to integrate health considerations into the development, implementation and evaluation of policies across various non-health sectors of the government. Over the past 15 years, there has been an increase in the uptake of HiAP by local, regional and national governments. Despite the growing popularity of this approach, most existing literature on HiAP implementation remains descriptive rather than explanatory in its orientation. Moreover, prior research has focused on the more technical aspects of the implementation process. Thus, studies that aim to 'build capacity to promote, implement and evaluate HiAP' abound. Conversely, there is little emphasis on the political aspects of HiAP implementation. Neglecting the role of politics in shaping the use of HiAP is problematic, since health and the strategies by which it is promoted are partially political.This glossary addresses the politics gap in the existing literature by drawing on theoretical concepts from political, policy, and public health sciences to articulate a framework for studying how political mechanisms influence HiAP implementation. To this end, the glossary forms part of an on-going multiple explanatory case study of HiAP implementation, HARMONICS (HiAP Analysis using Realist Methods on International Case Studies, harmonics-hiap.ca), and is meant to expand on a previously published glossary addressing the topic of HiAP implementation more broadly. Collectively, these glossaries offer a conceptual toolkit for understanding how politics explains implementation outcomes of HiAP. PMID: 28679539 [PubMed - as supplied by publisher]

Knowledge, Attitude and Practice Tools for Health Education Among Diabetic Patients.

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Knowledge, Attitude and Practice Tools for Health Education Among Diabetic Patients. Stud Health Technol Inform. 2017;238:250-252 Authors: Ismaile S, Alhosban F, Almoajel A, Albarrak A, Househ M Abstract Health education is an integral part of self-management programs and an important element for the control and effective management of any chronic disease including diabetes. Patient Knowledge, Awareness, and Practices (KAP) are considered to be the most important factors for assessing the results of health education in patients with diabetes. In order to develop such health education models, it is important to have a validated and reliable tools which asses a diabetic patient's knowledge, attitude and practice. The aim of this study is to systematically review the literature on KAP assessment tools regarding health education among diabetic patients. The researchers conducted a systematic literature review using MEDLINE database from 1980 up to 2016. A developed search strategy was conducted by the researchers for MEDLINE and EBESCO. Of the 94 articles identified only 16 articles fully met the inclusion criteria. This review identifies useful assessment tools of KAP regarding health education for diabetic patients which will help to improve strategies in regards to assessing KAP for diabetic patients worldwide. The KAP assessment tools should be: carefully developed, user friendly, evidence-based, valid and reliable. PMID: 28679936 [PubMed - in process]

A genome-wide investigation into parent-of-origin effects in autism spectrum disorder identifies previously associated genes including SHANK3.

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A genome-wide investigation into parent-of-origin effects in autism spectrum disorder identifies previously associated genes including SHANK3. Eur J Hum Genet. 2017 Feb;25(2):234-239 Authors: Connolly S, Anney R, Gallagher L, Heron EA Abstract Autism spectrum disorder (ASD) is known to be a heritable neurodevelopmental disorder affecting more than 1% of the population but in the majority of ASD cases, the genetic cause has not been identified. Parent-of-origin effects have been highlighted as an important mechanism in the pathology of neurodevelopmental disorders such as Prader-Willi and Angelman syndrome, with individuals with these syndromes often exhibiting ASD symptoms. Consequently, systematic investigation of these effects in ASD is clearly an important line of investigation in elucidating the underlying genetic mechanisms. Using estimation of maternal, imprinting and interaction effects using multinomial modelling (EMIM), we simultaneously investigated imprinting, maternal genetic effects and associations in the Autism Genome Project and Simons Simplex Consortium genome-wide association data sets. To avoid using the overly stringent genome-wide association study significance level, we used a Bayesian threshold that takes into account the sample size, allele frequency and any available prior knowledge. Between the two data sets, we identified a total of 18 imprinting effects and 68 maternal genetic effects that met this Bayesian threshold criteria, but none met the threshold in both data sets. We identified imprinting and maternal genetic effects for regions that have previously shown evidence for parent-of-origin effects in ASD. Together with these findings, we have identified maternal genetic effects not previously identified in ASD at a locus in SHANK3 on chromosome 22 and a locus in WBSCR17 on chromosome 7 (associated with Williams syndrome). Both genes have previously been associated with ASD. PMID: 27876814 [PubMed - indexed for MEDLINE]

‘IRDiRC Recognized Resources': a new mechanism to support scientists to conduct efficient, high-quality research for rare diseases.

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'IRDiRC Recognized Resources': a new mechanism to support scientists to conduct efficient, high-quality research for rare diseases. Eur J Hum Genet. 2017 Feb;25(2):162-165 Authors: Lochmüller H, Le Cam Y, Jonker AH, Lau LP, Baynam G, Kaufmann P, Lasko P, Dawkins HJ, Austin CP, Boycott KM Abstract The International Rare Diseases Research Consortium (IRDiRC) has created a quality label, 'IRDiRC Recognized Resources', formerly known as 'IRDiRC Recommended'. It is a peer-reviewed quality indicator process established based on the IRDiRC Policies and Guidelines to designate resources (ie, standards, guidelines, tools, and platforms) designed to accelerate the pace of discoveries and translation into clinical applications for the rare disease (RD) research community. In its first year of implementation, 13 resources successfully applied for this designation, each focused on key areas essential to IRDiRC objectives and to the field of RD research more broadly. These included data sharing for discovery, knowledge organisation and ontologies, networking patient registries, and therapeutic development. 'IRDiRC Recognized Resources' is a mechanism aimed to provide community-approved contributions to RD research higher visibility, and encourage researchers to adopt recognised standards, guidelines, tools, and platforms that facilitate research advances guided by the principles of interoperability and sharing. PMID: 27782107 [PubMed - indexed for MEDLINE]

Vitamin D metabolite concentrations in umbilical cord blood serum and associations with clinical characteristics in a large prospective mother-infant cohort in Ireland.

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Vitamin D metabolite concentrations in umbilical cord blood serum and associations with clinical characteristics in a large prospective mother-infant cohort in Ireland. J Steroid Biochem Mol Biol. 2017 Mar;167:162-168 Authors: Kiely M, O'Donovan SM, Kenny LC, Hourihane JO, Irvine AD, Murray DM Abstract Vitamin D deficiency is widespread among mothers and neonates and quality clinical and analytical data are lacking. We used a CDC-accredited LC-MS/MS method to analyze vitamin D metabolites in cord sera from 1050 maternal-infant dyads in the prospective SCOPE Ireland Pregnancy and BASELINE Birth cohort studies, based in Cork, Ireland. The mean±SD total 25(OH)D was 34.9±18.1nmol/L; 35% of cords (50% during winter) had 25(OH)D <25nmol/L, 46% were <30nmol/L and 80% were <50nmol/L. In this predominantly white cohort, the main predictor of cord 25(OH)D [adj. mean difference in nmol/L (95% CI)] was summer delivery [19.2 (17.4, 20.9), P<0.0001]. Maternal smoking during pregnancy (9% prevalence) was negatively associated (P<0.002) with cord 25(OH)D [-4.83 (-7.9, -1.5) nmol/L]. There were no associations between cord 25(OH)D and birth weight or any anthropometric measures at birth. Despite the high prevalence of vitamin D deficiency at birth, there were no documented musculoskeletal complications during infancy, which was likely due to widespread supplementation with vitamin D. The mean±SD concentration of 3-epi-25(OH)D3, detectable in 99.4% of cord samples, was 3.3±1.9nmol/L. The proportion of 25(OH)D as 3-epi-25(OH)D3 was 11.2%. Cord 3-epi-25(OH)D3 concentrations were positively predicted by cord 25(OH)D3 [0.101 (0.099, 0.103) nmol/L, P<0.0001] and negatively by gestational age [-0.104 (-0.131, -0.076) nmol/L, P<0.0001] and maternal age [-0.010 (-0.019, -0.001) nmol/L, P<0.05]. 25(OH)D2 was detected in 98% of cord sera (mean±SD; 2.2±1.9nmol/L) despite low antenatal consumption of vitamin D2 supplements. In conclusion, these first CDC-accredited data of vitamin D metabolites in umbilical cord blood emphasise the high risk of very low vitamin D status in infants born to un-supplemented mothers. Experimental data to define maternal vitamin D requirements for prevention of neonatal deficiency at high latitude are required. PMID: 28007533 [PubMed - indexed for MEDLINE]

Regional differences in mortality, hospital discharges and primary care contacts for cardiovascular disease.

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Regional differences in mortality, hospital discharges and primary care contacts for cardiovascular disease. Scand J Public Health. 2017 May;45(3):260-268 Authors: Haraldsdottir S, Gudmundsson S, Thorgeirsson G, Lund SH, Valdimarsdottir UA Abstract AIMS: Surveillance of geographical variations in cardiovascular health is important in order to achieve the objectives of reducing regional health disparities. We aimed to explore differences in cardiovascular disease (CVD) mortality and prevalence of CVD diagnoses made in primary and in-patient care, as well as risk factor distribution by geographic regions (urban/rural) in Iceland. METHODS: From nationwide health registers, we obtained data on CVD mortalities ( N = 7113), primary healthcare CVD contacts ( N = 58,246) and hospital CVD discharges ( N = 14,039), as well as data on CVD risk factors from a national health survey ( N = 5909; response rate 60.3%). Age-standardised annual mortality, primary healthcare contact and hospital discharge rates due to CVD were calculated per 100,000 population inside (urban) and outside (rural) the Capital Area (CA). Logistic regression was used to explore regional differences in CVD risk factors. RESULTS: We observed slightly higher total CVD mortality rates among women outside compared to inside the CA (Standardised Rate Ratio (SRR) 1.06 (95% confidence interval (CI) 1.05-1.07)), particularly due to atrial fibrillation (SRR 1.47 (95% CI 1.46-1.48)), heart failure (SRR 1.29 (95% CI 1.27-1.31)) and ischemic heart disease (SRR 1.11 (95% CI 1.10-1.12)), while reduced mortality risk for cerebrovascular disease (SRR 0.81 (95% CI 0.80-0.83)). The rates of hospital discharges and primary care contacts for these diseases, as well as prevalence of several modifiable risk factors, were generally higher outside the CA, particularly among women. CONCLUSIONS: The higher prevalence of modifiable risk factors and CVD in rural areas, especially among women, calls for refined treatment and health-promoting efforts in rural areas. PMID: 28078921 [PubMed - indexed for MEDLINE]