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INTRODUCTION: Cigarette smoking is highly prevalent among Asian American immigrant subgroups. Previously, Asian-language telephone Quitline services were only available in California. In 2012, the Centers for Disease Control and Prevention (CDC) funded the national Asian Smokers' Quitline (ASQ) to expand Asian-language Quitline services nationally. However, there are relatively few calls to the ASQ from outside California. AIMS AND METHODS: This pilot study assessed the feasibility of two proactive outreach interventions to connect Vietnamese-speaking participants who smoke to the ASQ. Both interventions, (1) proactive telephone outreach with a counselor trained in motivational interviewing (PRO-MI) and (2) proactive telephone outreach with interactive voice response (PRO-IVR), were adapted to be culturally and linguistically appropriate for Vietnamese-speaking participants. Participants were randomly assigned 2:1 to PRO-IVR versus PRO-MI. Assessments were conducted at baseline and 3 months post-enrollment. Feasibility indicators were the recruitment rate and initiation of ASQ treatment. RESULTS: Using the HealthPartners electronic health record, a large health system in Minnesota, we identified approximately 343 potentially eligible Vietnamese participants who were mailed invitation letters and baseline surveys with telephone follow-up. We enrolled 86 eligible participants (25% recruitment rate). In the PRO-IVR group 7/58 participants were directly transferred to the ASQ (12% initiation rate) and in the PRO-MI group 8/28 participants were warm transferred to the ASQ (29% initiation rate). CONCLUSIONS: This pilot study demonstrates the feasibility of our recruitment methods and of implementing proactive outreach interventions to promote the initiation of smoking cessation treatment with the ASQ. IMPLICATIONS: This pilot study contributes novel data on the uptake of Asian Smokers' Quitline (ASQ) services among Vietnamese-speaking people who smoke (PWS) with two proactive outreach interventions: (1) proactive telephone outreach with a counselor trained in motivational interviewing (PRO-MI) and (2) proactive telephone outreach with interactive voice response (PRO-IVR). We found that it is feasible to implement these proactive outreach interventions to promote the initiation of ASQ cessation treatment among Vietnamese-language speaking PWS. Future large trials are needed to rigorously compare PRO-MI and PRO-IVR and conduct budget impact analyses to understand the most efficient strategies for incorporation into health system settings.
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Fumar Cigarrillos , Emigrantes e Inmigrantes , Cese del Hábito de Fumar , Humanos , Asiático , Consejo/métodos , Estudios de Factibilidad , Lenguaje , Proyectos Piloto , Fumadores , CaliforniaRESUMEN
BACKGROUND/OBJECTIVE: InFLUenza Patient-reported Outcome (FLU-PRO Plus) is a 34-item patient-reported outcome instrument designed to capture the intensity and frequency of viral respiratory symptoms. This study evaluates whether FLU-PRO Plus responses could discriminate between symptoms of coronavirus disease 2019 (COVID-19) and influenza-like illness (ILI) with no COVID diagnosis, as well as forecast disease progression. METHODS: FLU-PRO Plus was administered daily for 14 days. Exploratory factor analysis was used to reduce the FLU-PRO Plus responses on the first day to 3 factors interpreted as "symptom clusters." The 3 clusters were used to predict COVID-19 versus ILI diagnosis in logistic regression. Correlation between the clusters and quality of life (QoL) measures was used to assess concurrent validity. The timing of self-reported return to usual health in the 14-day period was estimated as a function of the clusters within COVID-19 and ILI groups. RESULTS: Three hundred fourteen patients completed day 1 FLU-PRO Plus, of which 65% had a COVID-19 diagnosis. Exploratory factor analysis identified 3 symptom clusters: (1)general Body, (2) tracheal/bronchial, and (3) nasopharyngeal. Higher nasopharyngeal scores were associated with higher odds of COVID-19 compared with ILI diagnosis [adjusted odds ratio = 1.61 (1.21, 2.12)]. Higher tracheal/bronchial scores were associated with lower odds of COVID-19 [0.58 (0.44, 0.77)]. The 3 symptom clusters were correlated with multiple QoL measures ( r = 0.14-0.56). Higher scores on the general body and tracheal/bronchial symptom clusters were associated with prolonged time to return to usual health [adjusted hazard ratios: 0.76 (0.64, 0.91), 0.80 (0.67, 0.96)]. CONCLUSION: Three symptom clusters identified from FLU-PRO Plus responses successfully discriminated patients with COVID-19 from non-COVID ILI and were associated with QoL and predicted symptom duration.
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COVID-19 , Gripe Humana , Humanos , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Calidad de Vida , Estudios Prospectivos , Estudios de Cohortes , Prueba de COVID-19 , Síndrome , COVID-19/diagnóstico , COVID-19/epidemiología , Medición de Resultados Informados por el Paciente , Análisis FactorialRESUMEN
BACKGROUND: Melanoma survivors are at increased risk of developing a second primary melanoma; however, some report sub-optimal sun behaviors and sunburns. We tested the effectiveness of a wearable device with ultraviolet radiation (UVR)-sensing technology to improve sun behaviors and reduce sunburns in cutaneous melanoma survivors. MATERIALS AND METHODS: We conducted a randomized controlled trial using Shade 2, a commercially available wrist device that measures UVR. The intervention group received the device and mobile application notifications about their exposure and prompts to use sunscreen. The control group received the device and a separate research mobile application without information about their exposure or notifications. Participants wore the device for 12 weeks and self-reported sun behaviors before, during, and after the intervention. The primary outcome was a composite score of sun protection behaviors at week 12. RESULTS: 386 participants were randomized (186 control, 182 intervention). Most were female and 5+ years past their first melanoma diagnosis. The average age was 56 years. Most (93%) completed the study, though 40% experienced device issues. No meaningful differences were observed in self-reported sun protection behaviors at week 12 (controls 3.0±0.5 vs. intervention 2.9±0.5, p = 0.06), any sunburn during the intervention period (controls 14.4% vs. intervention 12.7%, p = 0.75), or average daily objective UVR exposure (controls median 87 vs. intervention 83 J/m2, p = 0.43). CONCLUSION: Wearing a device that measured and alerted melanoma survivors to UVR exposure did not result in different sun behaviors, exposure, or sunburns relative to controls. The technology needs refinement before further attempts to assess the effectiveness of self-monitoring UVR exposure. CLINICAL TRIALS REGISTRATION: NCT03927742.
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Supervivientes de Cáncer , Melanoma , Neoplasias Cutáneas , Quemadura Solar , Humanos , Femenino , Persona de Mediana Edad , Masculino , Melanoma/prevención & control , Melanoma/tratamiento farmacológico , Neoplasias Cutáneas/prevención & control , Neoplasias Cutáneas/tratamiento farmacológico , Rayos Ultravioleta/efectos adversos , Quemadura Solar/prevención & control , Luz Solar/efectos adversos , Protectores Solares/uso terapéuticoRESUMEN
BACKGROUND: Patient reported outcome measures (PROM) can improve patient care and be crucial for symptom tracking especially during disease outbreaks. FLU-PRO Plus is a validated PROM used to track viral respiratory symptoms. Our study aimed to evaluate the feasibility of using FLU-PRO© Plus, to track symptoms across three healthcare systems. METHODS: The prospective, longitudinal study recruited adults between February-May 2021 from HealthPartners Institute (HP), Kaiser Permanente Georgia (KPGA), and Kaiser Permanente Mid-Atlantic States (KPMAS). Adult members were eligible if they had a positive lab or diagnosis for either COVID-19 or influenza-like illness (ILI) or exhibited 2 + viral respiratory symptoms. Descriptive statistics were calculated to describe the patient characteristics for participants that were eligible for FLU-PRO Plus, successfully contacted, attempted to log in to the FLU-PRO Plus website, and participants who completed FLU-PRO Plus Day 1. Bivariable and multivariable logistic regression using PROC GLIMMIXX investigated the patient characteristics associated with (1) successful contact and (2) FLU-PRO Plus Day 1 completion. RESULTS: We identified a total of 15,650 eligible participants during the enrollment period: 9,582 from HP, 1,740 from KPGA, and 4,328 from KPMAS. Among the total of 409 eligible adults who attempted to participate in FLU-PRO Plus, 317 completed FLU-PRO Plus Day 1. Among the 317 individuals that completed FLU-PRO Plus Day 1, 205 (67.5%) were diagnosed with COVID-19; 112 adults diagnosed with COVID-19 completed FLU-PRO Plus Day 14. Among adults successfully contacted, adults aged 35-64 (OR = 1.40, 95% CI 1.05, 1.87), females (OR = 1.77, 95% CI 1.38, 2.27), and adults diagnosed with COVID-19 (OR = 1.66, 95% CI 1.27, 2.17) had higher odds of completing FLU-PRO Plus Day 1; Asian adults (OR = 0.38, 95% CI 0.19, 0.76) and Black and African American adults (OR = 0.33, 95% CI 0.19, 0.76) had lower odds compared to White adults. CONCLUSION: Our study reports on the feasibility of patients across three integrated healthcare systems utilizing FLU-PRO Plus to monitor their respiratory symptoms. Patient reported outcome measures (PROM) can improve patient care, quality of life, and reduce the strain of limited resources on healthcare systems. Future FLU-PRO Plus studies should develop an implementation strategy to fully integrate FLU-PRO Plus within clinical care and patient management.
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COVID-19 , Gripe Humana , Adulto , Femenino , Humanos , COVID-19/diagnóstico , COVID-19/epidemiología , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Estudios Longitudinales , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Calidad de Vida , Sistema Respiratorio , Síndrome , Atención Dirigida al PacienteRESUMEN
BACKGROUND: Concerns about research misbehavior in academic science have sparked interest in the factors that may explain research misbehavior. Often three clusters of factors are distinguished: individual factors, climate factors and publication factors. Our research question was: to what extent can individual, climate and publication factors explain the variance in frequently perceived research misbehaviors? METHODS: From May 2017 until July 2017, we conducted a survey study among academic researchers in Amsterdam. The survey included three measurement instruments that we previously reported individual results of and here we integrate these findings. RESULTS: One thousand two hundred ninety-eight researchers completed the survey (response rate: 17%). Results showed that individual, climate and publication factors combined explained 34% of variance in perceived frequency of research misbehavior. Individual factors explained 7%, climate factors explained 22% and publication factors 16%. CONCLUSIONS: Our results suggest that the perceptions of the research climate play a substantial role in explaining variance in research misbehavior. This suggests that efforts to improve departmental norms might have a salutary effect on behavior.
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BACKGROUND: Cardiovascular disease (CVD) risks are of concern among immigrants and refugees settling in affluent host countries. The prevalence of CVD and risk factors among Somali African immigrants to the U.S. has not been systematically studied. METHODS: In 2015-2016, we surveyed 1156 adult Somalis in a Midwestern metropolitan area using respondent-driven sampling to obtain anthropometric, interview, and laboratory data about CVD and associated risk factors, demographics, and social factors. RESULTS: The prevalence of diabetes and low physical activity among men and women was high. Overweight, obesity, and dyslipidemia were also particularly prevalent. Levels of calculated CVD risk across the community were greater for men than women. CONCLUSION: Though CVD risk is lower among Somalis than the general U.S. population, our results suggest significant prevalence of risk factors among Somali immigrants. Comparison with prior research suggests that CVD risks may be increasing, necessitating thoughtful intervention to prevent adverse population outcomes.
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Enfermedades Cardiovasculares , Emigrantes e Inmigrantes , Refugiados , Adulto , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , SomaliaRESUMEN
BACKGROUND: Individuals who have been diagnosed with melanoma have more than a 9-fold increased risk of developing another melanoma. Ultraviolet radiation (UVR) exposure following a melanoma diagnosis can be modified to reduce risk of a new melanoma diagnosis. Yet research shows that many melanoma survivors do not report optimal sun protection practices. The objective of this study is to evaluate the effectiveness of a UVR-sensor wearable device to improve sun protection behaviors and reduce sunburns in a randomized controlled trial (RCT) in melanoma survivors. METHODS: We will conduct an RCT among 368 melanoma survivors in two waves (Summer 2020, Summer 2021). This approach allows for adequate recruitment of the required sample and potential improvements to recruitment, compliance, and retention strategies between waves. The intervention includes an informational brochure about sun protection behaviors and a commercially available UVR-sensor wearable device (Shade), which accurately measures UVR. The device, along with its associated mobile application, measures and stores UVR exposure. As UVR exposure accumulates, the device provides notifications to increase sun protection action. Survivors in the control group receive the device and a separate mobile application that does not provide notifications or summary UVR exposure data. Participants will be asked to wear the device for 12 weeks. They will complete surveys about their sun behaviors at study entry, every 4 weeks during the intervention, and 1 year later. At the end of the intervention period, intervention and control groups will be compared for differences in a summary measure of sun protection habits and experience of a sunburn. We will also measure self-reported physical activity, depression, and anxiety to examine potential unintended negative consequences of the intervention. DISCUSSION: The study intervention will be completed Fall 2021, with anticipated results available in 2022. If this intervention improves sun protection behaviors in melanoma survivors, these findings would support expanding the use of this technology with other populations at high risk for melanoma. TRIAL REGISTRATION: ClinicalTrials.gov NCT03927742 . Registered on April 15, 2019.
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Melanoma , Neoplasias Cutáneas , Quemadura Solar , Dispositivos Electrónicos Vestibles , Humanos , Melanoma/diagnóstico , Melanoma/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/prevención & control , Quemadura Solar/tratamiento farmacológico , Quemadura Solar/prevención & control , Protectores Solares/uso terapéutico , SobrevivientesRESUMEN
BACKGROUND: Long-term opioid therapy for chronic pain arose amid limited availability and awareness of other pain therapies. Although many complementary and integrative health (CIH) and nondrug therapies are effective for chronic pain, little is known about CIH/nondrug therapy use patterns among people prescribed opioid analgesics. OBJECTIVE: The objective of this study was to estimate patterns and predictors of self-reported CIH/nondrug therapy use for chronic pain within a representative national sample of US military veterans prescribed long-term opioids for chronic pain. RESEARCH DESIGN: National two-stage stratified random sample survey combined with electronic medical record data. Data were analyzed using logistic regressions and latent class analysis. SUBJECTS: US military veterans in Veterans Affairs (VA) primary care who received ≥6 months of opioid analgesics. MEASURES: Self-reported use of each of 10 CIH/nondrug therapies to treat or cope with chronic pain in the past year: meditation/mindfulness, relaxation, psychotherapy, yoga, t'ai chi, aerobic exercise, stretching/strengthening, acupuncture, chiropractic, massage; Brief Pain Inventory-Interference (BPI-I) scale as a measure of pain-related function. RESULTS: In total, 8891 (65%) of 13,660 invitees completed the questionnaire. Eighty percent of veterans reported past-year use of at least 1 nondrug therapy for pain. Younger age and female sex were associated with the use of most nondrug therapies. Higher pain interference was associated with lower use of exercise/movement therapies. Nondrug therapy use patterns reflected functional categories (psychological/behavioral, exercise/movement, manual). CONCLUSIONS: Use of CIH/nondrug therapies for pain was common among patients receiving long-term opioids. Future analyses will examine nondrug therapy use in relation to pain and quality of life outcomes over time.
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Analgésicos Opioides/uso terapéutico , Dolor Crónico/terapia , Terapias Complementarias/estadística & datos numéricos , Medicina Integrativa/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Dolor Crónico/tratamiento farmacológico , Terapias Complementarias/métodos , Femenino , Estado de Salud , Humanos , Medicina Integrativa/métodos , Masculino , Persona de Mediana Edad , Manejo del Dolor , Percepción del Dolor , Calidad de Vida , Factores Sexuales , Factores Socioeconómicos , Estados Unidos , United States Department of Veterans Affairs , Salud de los VeteranosRESUMEN
In the United States (US), long-term opioid therapy has been commonly prescribed for chronic pain. Since recognition of the opioid overdose epidemic, clinical practice guidelines have recommended tapering long-term opioids to reduced doses or discontinuation. The Effects of Prescription Opioid Changes for veterans (EPOCH) study is a national population-based prospective observational study of US Veterans Health Administration primary care patients designed to assess effects of evolving opioid prescribing practice on patients treated with long-term opioids for chronic pain. A stratified random sampling design was used to identify a survey sample from the target population of patients treated with opioid analgesics for ≥ 6 months. Demographic, diagnostic, visit, and pharmacy dispensing data were extracted from existing datasets. A 2016 mixed-mode mail and telephone survey collected patient-reported data, including the main patient-reported outcomes of pain-related function (Brief Pain Inventory interference; BPI-I scores 0-10, higher scores = worse) and health-related quality of life. Data on survey participants and non-participants were analyzed to assess potential nonresponse bias. Weights were used to account for design. Linear regression models were used to assess cross-sectional associations of opioid treatment with patient-reported measures. Of 14,160 patients contacted, 9253 (65.4%) completed the survey. Participants were older than non-participants (63.9 ± 10.6 vs. 59.6 ± 13.0 years). The mean number of bothersome pain locations was 6.8 (SE 0.04). Effectiveness of pain treatment and quality of pain care were rated fair or poor by 56.1% and 45.3%, respectively. The opioid daily dosage range was 1.6 to 1038.2 mg, with mean = 50.6 mg (SE 1.1) and median = 30.9 mg (IQR 40.7). Among the 73.2% of patients who did not receive long-acting opioids, the mean daily dosage was 30.4 mg (SE 0.6) and mean BPI-I was 6.4 (SE 00.4). Among patients who received long-acting opioids, the mean daily dosage was 106.2 mg (SE 2.8) and mean BPI-I was 6.8 (SE 0.07). Higher daily dosage was associated with worse pain-related function and quality of life among patients without long-acting opioids, but not among patients with long-acting opioids. Future analyses will use follow-up data to examine effects of opioid dose reduction and discontinuation on patient outcomes.
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Analgésicos Opioides , Prescripciones de Medicamentos/estadística & datos numéricos , Encuestas y Cuestionarios , Veteranos/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , AutoinformeRESUMEN
This study investigated the influence of gut microbiome composition in modulating susceptibility to Mycoplasma hyopneumoniae in pigs. Thirty-two conventional M. hyopneumoniae free piglets were randomly selected from six different litters at 3 weeks of age and were experimentally inoculated with M. hyopneumoniae at 8 weeks of age. Lung lesion scores (LS) were recorded 4 weeks post-inoculation (12 weeks of age) from piglet lungs at necropsy. Fecal bacterial community composition of piglets at 3, 8 and 12 weeks of age were targeted by amplifying the V3-V4 region of the 16S rRNA gene. The LS ranged from 0.3 to 43% with an evident clustering of the scores observed in piglets within litters. There were significant differences in species richness and alpha diversity in fecal microbiomes among piglets within litters at different time points (p < 0.05). The dissimilarity matrices indicated that at 3 weeks of age, the fecal microbiota of piglets was more dissimilar compared to those from 8 to 12 weeks of age. Specific groups of bacteria in the gut that might predict the decreased severity of M. hyopneumoniae associated lesions were identified. The microbial shift at 3 weeks of age was observed to be driven by the increase in abundance of the indicator family, Ruminococcaceae in piglets with low LS (p < 0.05). The taxa, Ruminococcus_2 having the highest richness scores, correlated significantly between litters showing stronger associations with the lowest LS (r = -0.49, p = 0.005). These findings suggest that early life gut microbiota can be a potential determinant for M. hyopneumoniae susceptibility in pigs.
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Susceptibilidad a Enfermedades/veterinaria , Microbioma Gastrointestinal/fisiología , Pulmón/patología , Mycoplasma hyopneumoniae/fisiología , Neumonía Porcina por Mycoplasma/patología , Animales , Susceptibilidad a Enfermedades/microbiología , Susceptibilidad a Enfermedades/patología , Neumonía Porcina por Mycoplasma/microbiología , ARN Bacteriano/análisis , ARN Ribosómico 16S/análisis , PorcinosRESUMEN
[This corrects the article DOI: 10.1186/s41073-016-0024-5.].
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Mycoplasma hyorhinis (Mhr) is a pathogen of pigs causing polyserositis and polyarthritis. The most susceptible population are nursery pigs of approximately 7 weeks of age, although we have shown that clinical signs can persist into finishing aged animals after a late-nursery infection. We have previously demonstrated the efficacy of a novel inactivated Mhr vaccine for the reduction of lameness and polyserositis in caesarian-derived colostrum-deprived (CDCD) pigs vaccinated at 3 weeks and challenged with Mhr at 6 weeks of age. Here we evaluated the duration of immunity (DOI) of the same vaccine. Vaccine or placebo was administered to CDCD pigs at 3 weeks of age. Pigs were challenged with Mhr at either 10 weeks of age (=7 week DOI) or 13 weeks of age (=10 week DOI). In the 7 week DOI, vaccination provided significant reductions in lameness (p = 0.0018), arthritis (p = 0.0002), and pericarditis (p = 0.0312) versus the placebo control. In the 10 week DOI, a significant reduction in arthritis (p = 0.0320) was observed in the vaccine group as compared to the placebo group. Both vaccine groups showed a significant increase (p < 0.0001) in the post-challenge average daily gain (ADG), gaining 0.2 kg/day more than their respective placebo groups.
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Artritis/veterinaria , Vacunas Bacterianas/inmunología , Infecciones por Mycoplasma/veterinaria , Mycoplasma hyorhinis/inmunología , Pericarditis/veterinaria , Enfermedades de los Porcinos/prevención & control , Animales , Artritis/prevención & control , Vacunas Bacterianas/administración & dosificación , Femenino , Pulmón/inmunología , Pulmón/microbiología , Masculino , Infecciones por Mycoplasma/inmunología , Infecciones por Mycoplasma/prevención & control , Pericarditis/prevención & control , Porcinos/inmunología , Porcinos/microbiología , Enfermedades de los Porcinos/inmunología , Vacunación , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunologíaRESUMEN
Breaches of research integrity have shocked the academic community. Initially explanations were sought at the level of individual researchers but over time increased recognition emerged of the important role that the research integrity climate may play in influencing researchers' (mis)behavior. In this study we aim to assess whether researchers from different academic ranks and disciplinary fields experience the research integrity climate differently. We sent an online questionnaire to academic researchers in Amsterdam using the Survey of Organizational Research Climate. Bonferroni corrected mean differences showed that junior researchers (PhD students, postdocs and assistant professors) perceive the research integrity climate more negatively than senior researchers (associate and full professors). Junior researchers note that their supervisors are less committed to talk about key research integrity principles compared to senior researchers (MD = -.39, CI = -.55, -.24). PhD students perceive more competition and suspicion among colleagues (MD = -.19, CI = -.35, -.05) than associate and full professors. We found that researchers from the natural sciences overall express a more positive perception of the research integrity climate. Researchers from social sciences as well as from the humanities perceive less fairness of their departments' expectations in terms of publishing and acquiring funding compared to natural sciences and biomedical sciences (MD = -.44, CI = -.74, -.15; MD = -.36, CI = -.61, -.11). Results suggest that department leaders in the humanities and social sciences should do more to set fairer expectations for their researchers and that senior scientists should ensure junior researchers are socialized into research integrity practices and foster a climate in their group where suspicion among colleagues has no place.
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Investigación Biomédica/ética , Investigación Interdisciplinaria/ética , Percepción , Investigadores/estadística & datos numéricos , Encuestas y Cuestionarios , Femenino , Humanos , Masculino , Países Bajos , Análisis de RegresiónRESUMEN
BACKGROUND: Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans. METHOD: MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation. RESULTS: We screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence). DISCUSSION: Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
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Determinantes Sociales de la Salud , Salud de los Veteranos/estadística & datos numéricos , Medicina Basada en la Evidencia/métodos , Conductas Relacionadas con la Salud , Disparidades en el Estado de Salud , Humanos , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud Rural/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Factores Socioeconómicos , Estados Unidos/epidemiología , Veteranos , Poblaciones Vulnerables , Heridas y Lesiones/epidemiologíaRESUMEN
Mycoplasma hyorhinis (MHR) causes polyserositis and lameness in grower pigs. While herd-specific vaccines for this bacterium are being marketed, there are currently no licensed, commercially available vaccines for MHR. The objective of this study was to develop a challenge model in cesarean-derived, colostrum-deprived (CDCD) pigs using cell-associated MHR that results in both severe pericarditis and lameness, in order to evaluate suitable vaccine candidates. We investigated administering MHR to 7-week-old pigs over 3 d using 3 different routes compared to administering MHR on a single day using 1 of 3 routes. Pigs were monitored for 21 d for signs of lameness and well-being. At the end of the study, pigs were examined for evidence of polyserositis and arthritis associated with Mycoplasma. Results indicate that clinical manifestation of disease depended more on the route of administration than on the total dose given. A single intravenous (IV) administration of MHR resulted in extensive polyserositis, while a single intranasal (IN) administration showed little to no signs of disease. A single intraperitoneal (IP) administration did not induce the same level of polyserositis as observed in the IV group, but did result in an increased incidence of lameness. Furthermore, pigs administered MHR by IP (Day 0), IV (Day 1), and IN (Day 2) on 3 consecutive days showed a more robust disease manifestation, which resulted in both polyserositis and lameness. Optimization of this group showed that elimination of the 3rd-day IN challenge had no detrimental effect on clinical outcomes. The consecutive day administration of cell-associated MHR will allow polyserositis and lameness to be simultaneously evaluated in future vaccine trials.
Mycoplasma hyorhinis (MHR) cause une polysérosite et de la boiterie chez les porcs en croissance. Alors que pour ce microorganisme des vaccins spécifiques de troupeaux sont disponibles, il n'y a actuellement aucun vaccin homologué commercialement disponible pour MHR. L'objectif de la présente étude était de développer un modèle d'infection chez des porcs obtenus par césarienne et privés de colostrum en utilisant du MHR associé à des cellules qui causait une péricardite sévère et de la boiterie, afin d'évaluer des vaccins candidats appropriés. Nous avons évalué l'administration de MHR à des porcs âgés de 7 semaines sur 3 jours en utilisant trois voies d'administration différentes comparativement à l'administration de MHR en une seule journée en utilisant une des trois routes. Les porcs ont été suivis pendant 21 jours pour des signes de boiterie et de bien-être. À la fin de l'étude, les porcs ont été examinés pour des évidences de polysérosite et d'arthrite associées avec Mycoplasma. Les résultats indiquaient que la manifestation clinique de la maladie était plus dépendante de la voie d'administration que du nombre total de doses administré. L'administration intraveineuse (IV) d'une dose unique de MHR a résulté en une polysérosite généralisée, alors qu'une dose unique par voie intranasale (IN) ne causa que peu ou pas de signes de maladie. L'administration d'une dose unique par voie intrapéritonéale (IP) n'a pas induit le même degré de polysérosite que celui observé dans le groupe IV, mais on nota une augmentation de l'incidence de boiterie. De plus, les porcs auxquels on administra MHR par voie IP (Jour 0), IV (Jour 1), et IN (Jour 2) pendant 3 jours consécutifs ont montré des manifestations plus fortes de la maladie, ce qui résultat en polysérosite et boiterie. L'optimisation pour ce groupe a démontré que l'élimination de l'inoculation IN au troisième jour n'avait aucun effet délétère sur les résultats cliniques. L'administration de MHR associé à des cellules pendant des jours consécutifs permettra d'évaluer simultanément la polysérosite et la boiterie lors d'essais futurs de vaccins.(Traduit par Docteur Serge Messier).
Asunto(s)
Infecciones por Mycoplasma/veterinaria , Mycoplasma hyorhinis , Enfermedades de los Porcinos/microbiología , Animales , Calostro/inmunología , Modelos Animales de Enfermedad , Susceptibilidad a Enfermedades/microbiología , Susceptibilidad a Enfermedades/veterinaria , Femenino , Fibrosis , Pulmón/patología , Masculino , Infecciones por Mycoplasma/microbiología , Miocardio/patología , Pleuresia/patología , Pleuresia/veterinaria , Distribución Aleatoria , Reacción en Cadena en Tiempo Real de la Polimerasa , Organismos Libres de Patógenos Específicos , PorcinosRESUMEN
Lameness and polyserositis in pigs caused by Mycoplasma hyorhinis are generally treated with antibiotics and may require multiple doses. The costs of these antibiotics combined with economic losses from culling and reduced feed conversion due to lameness are hardships to the swine producer. In this study we have demonstrated efficacy of an inactivated M. hyorhinis vaccine administered to three-week old caesarian-derived colostrum-deprived piglets. Three doses of vaccine (high, medium, and low) were evaluated and compared to a placebo control. Mycoplasma hyorhinis challenge occurred three weeks after vaccination. Pigs were observed for lameness and respiratory distress for three weeks following challenge. Pigs were then euthanized and a gross pathological evaluation for polyserositis and arthritis was performed. A minimum immunizing dose of vaccine was defined as containing at least 7.41â¯×â¯107 CCU of M. hyorhinis per 2.0â¯mL dose as represented by the medium dose vaccine. This vaccine provided significant reductions in lameness and pericarditis with preventive fractions of 0.76 (95% CI [0.26, 0.92]) and 0.58 (95% CI [0.31, 0.74]), respectively, compared to the placebo control group. A significant increase in post-challenge weight gain (Pâ¯<â¯.0001) was also achieved with this vaccine, with an average daily gain (ADG) of 0.92â¯lbs/day compared to 0.57â¯lbs/day in the placebo group.
Asunto(s)
Vacunas Bacterianas/inmunología , Cojera Animal/prevención & control , Infecciones por Mycoplasma/veterinaria , Mycoplasma hyorhinis/inmunología , Serositis/veterinaria , Enfermedades de los Porcinos/prevención & control , Animales , Vacunas Bacterianas/administración & dosificación , Peso Corporal , Infecciones por Mycoplasma/prevención & control , Placebos/administración & dosificación , Serositis/prevención & control , Porcinos , Enfermedades de los Porcinos/microbiología , Resultado del Tratamiento , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunologíaRESUMEN
Mycoplasma hyorhinis (MHR) is a major cause of lameness, arthritis, and polyserositis among growing pigs. Reduced performance and culling due to MHR infection result in economic losses in swine production. We have previously developed an MHR challenge model in seven week-old CDCD pigs using cell-associated challenge material which results in both severe pericarditis and lameness. In this study we sequentially challenged CDCD pigs at seven, ten, thirteen, and sixteen weeks of age. Lameness was observed in >60% of the animals in the first three age groups but only 33% in the oldest age group. The number of animals with arthritis declined from 100% at seven weeks, to 56% at ten weeks and approximately 25% at both thirteen and sixteen weeks of age. Pericarditis was observed in 87% of the seven week challenge group, 28% in the ten week challenge group, 8% in the thirteen week challenge group and 4% in the sixteen week challenge group. All challenged groups showed a reduced average daily gain (ADG) compared to their age-matched non-challenged control groups. The largest disparity in ADG (1.2 lbs/day difference) was noted at thirteen weeks of age. Results of this study demonstrate that these animals were susceptible to MHR-associated lameness through sixteen weeks of age while susceptibility to MHR-associated polyserositis appeared to peak at seven weeks of age.