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1.
Cell ; 186(23): 5098-5113.e19, 2023 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-37918395

RESUMEN

Drug-resistant Pseudomonas aeruginosa (PA) poses an emerging threat to human health with urgent need for alternative therapeutic approaches. Here, we deciphered the B cell and antibody response to the virulence-associated type III secretion system (T3SS) in a cohort of patients chronically infected with PA. Single-cell analytics revealed a diverse B cell receptor repertoire directed against the T3SS needle-tip protein PcrV, enabling the production of monoclonal antibodies (mAbs) abrogating T3SS-mediated cytotoxicity. Mechanistic studies involving cryoelectron microscopy identified a surface-exposed C-terminal PcrV epitope as the target of highly neutralizing mAbs with broad activity against drug-resistant PA isolates. These anti-PcrV mAbs were as effective as treatment with conventional antibiotics in vivo. Our study reveals that chronically infected patients represent a source of neutralizing antibodies, which can be exploited as therapeutics against PA.


Asunto(s)
Anticuerpos Antibacterianos , Anticuerpos Neutralizantes , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Humanos , Anticuerpos Antibacterianos/farmacología , Microscopía por Crioelectrón , Inmunoglobulinas/metabolismo , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/fisiología , Infecciones por Pseudomonas/tratamiento farmacológico
2.
Infection ; 49(3): 437-445, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33140838

RESUMEN

BACKGROUND: With 1.5 million deaths worldwide in 2018, tuberculosis (TB) remains a major global public health problem. While pulmonary TB (PTB) is the most common manifestation, the proportion of extrapulmonary TB (EPTB) is increasing in low-burden countries. EPTB is a heterogeneous disease entity posing diagnostic and management challenges due to the lack of reliable biomarkers. In this study, we prospectively evaluated clinical data and treatment response which were correlated with different biomarkers. METHODS: The study was conducted at the University Hospital of Cologne. 20 patients with EPTB were enrolled. We analyzed plasma interferon-γ-inducible protein 10 (IP-10) levels in plasma by ELISA for up to 12 months of treatment. In addition, the QuantiFERON®-TB Gold Plus (QFT® Plus) test was performed during the course of treatment. Clinical data were assessed prospectively and correlated with QFT® Plus and IP-10 levels. RESULTS: Plasma IP-10 levels were found to be significantly increased (p < 0.001) in patients with extensive disease compared to patients with limited disease (cervical lymph node TB) or healthy controls. In patients with clinically confirmed paradoxical reaction (PR), a further increase of IP-10 was noted. IFN-γ measured by the QFT® Plus test did not decrease significantly during the course of treatment. Of note, in four EPTB patients (20%) without radiographic pulmonary involvement, sputum culture was positive for Mycobacterium tuberculosis. CONCLUSION: Our data demonstrate that IP-10 may be a valuable biomarker for estimation of disease severity in EPTB and monitoring of the disease course in extensive forms. However, IP-10 may be less suitable for diagnosis and monitoring of EPTB patients with limited disease. The QFT® Plus test does not appear to be a suitable marker for therapy monitoring. Sputum should be examined in EPTB patients even in case of normal diagnostic imaging of the chest.


Asunto(s)
Quimiocina CXCL10/sangre , Tuberculosis Ganglionar , Humanos , Ensayos de Liberación de Interferón gamma , Mycobacterium tuberculosis , Índice de Severidad de la Enfermedad , Tuberculosis Ganglionar/diagnóstico
3.
Occup Ther Health Care ; 35(4): 363-379, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34236951

RESUMEN

Equipoise, feasibility, and fidelity were studied for the control condition of an occupational therapy driving intervention in a randomized controlled trial. We ranked equipoise and feasibility of six traffic safety education methods and created an implementation fidelity competency checklist. Education method selection was informed using the proportion of concordant ranks analysis while literature and a peer review informed competency checklist development. A proctored-online course delivery had the highest rater agreement (equipoise = .96 [.87-1.00]; feasibility = .99 [.97-1.00]). Implementation fidelity was supported by a 19-component training and evaluation checklist. This study supports promoting the scientific rigor of the RCT via - equipoise, feasibility, and implementation fidelity.


Asunto(s)
Conducción de Automóvil , Terapia Ocupacional , Veteranos , Humanos
4.
J Urban Health ; 97(4): 529-542, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32613496

RESUMEN

The availability of parks and urban green spaces has been associated with a number of benefits, including increased physical activity, improvements in mental health, increases in social interactions, improvements to the environment, and increases in property values. The installation of temporary pop-up parks in urban areas is one way for urban communities to obtain these benefits. In this mixed-methods study, quantitative and qualitative data were gathered by researchers, the city council, a local investment company, and community residents that informed the initiation, iteration, and incremental expansion of a series of temporary, summer pop-up parks in the downtown business district of the City of Los Altos in Northern California over a 4-year period (2013-2016). Results showed that the parks were visited by a large, multigenerational group of users who engaged in leisure-time physical activity, shopped at local stores, attended programed events, and socialized with others. Direct observation and survey data gathered in year 2014 also indicated that foot traffic into businesses directly fronting on a pop-up park (n = 8) was higher during a 4-day period when the park was in place, as compared to a similar 4-day period before the park was installed. The majority of downtown business owners/managers reported no decrease in sales compared to the month before the pop-up park was installed. City sales tax data indicated increases in year-on-year sales tax revenue in the summer quarter of 2014 and 2016 compared with the year (2015) when there was no downtown pop-up park. Perspectives of community residents collected before, during, and after the installation of the pop-up parks indicated that the pop-up park created a vibrant space in an otherwise underutilized area that was enjoyed by a variety of people in a host of ways (e.g., children playing, families relaxing, people shopping and eating at downtown stores and restaurants, people of all ages attending scheduled park events). These results informed a number of discussions and meetings between key stakeholders about the pop-up parks, culminating in a temporary park that was held in a new location in 2017 that was substantially larger in size, installed for a longer time period, cost more, and had more scheduled park events. Results from this prospective investigation of the initial impacts of pop-up parks in this urban location provide insights regarding the potential benefits and viability of such temporary parks for residents and businesses alike.


Asunto(s)
Parques Recreativos , California , Ciudades , Economía , Ejercicio Físico , Humanos , Parques Recreativos/organización & administración , Estudios Prospectivos , Investigación Cualitativa , Interacción Social
5.
BMC Public Health ; 19(1): 256, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30823917

RESUMEN

BACKGROUND: While promoting active commuting to school can positively affect children's daily physical activity levels, effectively engaging community members to maximize program impact remains challenging. We evaluated the initial utility of adding a technology-enabled citizen science engagement model, called Our Voice, to a standard Safe Routes to School (SRTS) program to enhance program engagement activities and student travel mode behavior. METHODS: In Investigation 1, a prospective controlled comparison design was used to compare the initial year of the Santa Clara County Public Health Department's SRTS program, with and without the Our Voice engagement model added, in two elementary schools in Gilroy, California, USA. School parents served as Our Voice citizen scientists in the SRTS + Our Voice school. In Investigation 2, the feasibility of the combined SRTS + Our Voice methods was evaluated in a middle school in the same district using students, rather than adults, as citizen scientists. Standard SRTS program engagement measures and student travel mode tallies were collected at the beginning and end of the school year for each school. RESULTS: In the elementary school investigation (Investigation 1), the SRTS + Our Voice elementary school held twice as many first-year SRTS planning/encouragement events compared to the SRTS-Alone elementary school, and between-school changes in walking/biking to school rates favored the SRTS + Our Voice school (increases of 24.5% vs. 2.6%, P < .001). The Investigation 2 results supported the feasibility of using students to conduct SRTS + Our Voice in a middle school-age population. CONCLUSIONS: The findings from this first-generation study indicated that adding a technology-enabled citizen science process to a standard elementary school SRTS program was associated with higher levels of community engagement and walking/biking to school compared to SRTS alone. The approach was also found to be acceptable and feasible in a middle school setting.


Asunto(s)
Seguridad , Instituciones Académicas , Transportes/métodos , Adulto , Ciclismo , California , Niño , Participación de la Comunidad , Femenino , Humanos , Masculino , Padres , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Estudiantes , Tecnología/métodos , Caminata
6.
J Urban Health ; 95(6): 913, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30039302

RESUMEN

There were two errors in this article as originally published: Coauthor Olga L. Sarmiento was listed with an affiliation-Children's Hospital of Eastern Ontario Research Institute-that does not apply to her (only "Universidad de los Andes Bogota, Colombia" is a correct affiliation for her).

7.
J Urban Health ; 95(6): 899-912, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29948785

RESUMEN

Physical inactivity is estimated to be the fourth leading cause of global mortality. Strategies to increase physical activity (PA) increasingly emphasize environmental and policy changes including the modification of neighborhood environments to promote walking and other forms of healthy activity. Open Streets (OS) initiatives, an important and growing strategy to modify neighborhood environments for PA, create temporary parks for recreational activity by closing streets to motor vehicle traffic, thereby offering health and community building benefits. We used the Stanford Neighborhood Discovery Tool (DT)-photo/voice software on a tablet-to train neighborhood residents to act as "citizen scientist" observers of the local built environment on a non-event day and during an OS initiative. The purposes of this project were as follows: (1) to assess adult residents' perceptions of neighborhood characteristics of the OS initiative in three socioeconomically diverse sites and (2) to test the DT for use in three international urban settings with OS initiatives; Bogota, Colombia; San Francisco, USA; and Temuco, Chile, among a multigenerational, multiethnic sample of adults including, for the first time, a vulnerable population of homeless adults (Bogota). Using the DT, participants walked an OS route taking photos and recording reasons for the photos, then completed a 25-item demographic/environmental observation survey and a 16-item Reflection Survey on perceived environmental changes. A total of 18 themes were reported by participants with areas of overlapping themes (e.g., Community and Social Connectedness) and areas where a single site reported a theme (e.g., Social Isolation in Older Adults). Ten of the 18 themes were identified by at least two sites including "Bike Resources" and "Services", indicating the value of programming at OS initiatives. The themes of "Festive Environment" and "Family Friendly Environment" reflect the quality of the overall environment for participants. Four themes (Community and Social Connectedness, Family Friendly Environment, PA, and Safety) were reported by all sites. Three of the four unifying themes were also ranked among the highest reported categories of "seemed better" on the Reflection Survey (Ease of Walking, Overall Safety of Neighborhood, and Friendliness of Environment), providing additional confirmation of the shared experience of social, health, and psychological benefits from OS initiatives. OS initiatives offer a global strategy for increasing neighborhood opportunities for PA and a potential site for training citizen scientists to document environmental influences on PA.


Asunto(s)
Ciclismo/psicología , Ciclismo/estadística & datos numéricos , Planificación Ambiental/estadística & datos numéricos , Ejercicio Físico/psicología , Características de la Residencia/estadística & datos numéricos , Caminata/psicología , Caminata/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , América Latina , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos , Población Urbana/estadística & datos numéricos , Adulto Joven
8.
Int J Behav Nutr Phys Act ; 14(1): 133, 2017 09 29.
Artículo en Inglés | MEDLINE | ID: mdl-28962580

RESUMEN

BACKGROUND: Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting. OBJECTIVES: We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact. DISCUSSION: Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol. CONCLUSIONS: We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.


Asunto(s)
Participación de la Comunidad/métodos , Ambiente , Ejercicio Físico , Promoción de la Salud/métodos , Proyectos de Investigación , Humanos , Salud Pública/métodos , Investigación , Planificación Social
9.
J Urban Health ; 94(2): 180-189, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28247054

RESUMEN

Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods.


Asunto(s)
Dieta Saludable/métodos , Ambiente , Promoción de la Salud/métodos , Poder Psicológico , Salud Urbana , Anciano , Anciano de 80 o más Años , California , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Pobreza , Proyectos de Investigación , Características de la Residencia , Medio Social , Estados Unidos
10.
J Urban Health ; 94(4): 470-481, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28646369

RESUMEN

Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face.


Asunto(s)
Ejercicio Físico , Promoción de la Salud/métodos , Parques Recreativos/estadística & datos numéricos , Características de la Residencia , Adolescente , Adulto , Factores de Edad , Anciano , California , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducta Sedentaria , Factores Socioeconómicos , Factores de Tiempo , Población Urbana , Caminata , Adulto Joven
11.
J Aging Phys Act ; 25(3): 420-431, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27992252

RESUMEN

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.


Asunto(s)
Ejercicio Físico , Vida Independiente/psicología , Caminata , Anciano , Accesibilidad Arquitectónica/métodos , Accesibilidad Arquitectónica/normas , Planificación Ambiental/normas , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia , Percepción Social , Estadística como Asunto , Caminata/fisiología , Caminata/psicología
12.
J Urban Health ; 93(6): 953-973, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27752825

RESUMEN

Middle- and low-income countries bear 80 % of the global chronic disease burden. Population-level, multi-sectoral approaches to promoting healthful lifestyles that take into local physical, socioeconomic, and sociocultural characteristics of both the environment and the population are needed. The "Nuestra Voz (Our Voice)" is one such approach that involves neighborhood residents acting as "citizen scientists" to systematically gather information on the barriers and facilitators of physical activity in their neighborhoods and then use their data to collectively advocate for local environmental- and policy-level changes to support active living. We pilot tested this approach in Cuernavaca, Mexico with adults and adolescents. This community-engaged and participatory approach is driven by residents, who utilize a GPS-enabled electronic tablet-based application with simple audio-based instructions to take photographs and record audio narratives of facets of their neighborhood that promote or hinder active living. After collecting these data, the citizen scientists come together in a community meeting and use their data to prioritize realistic, multi-level changes for promoting active living in their neighborhoods. A survey assessed participants' acceptability of the approach. Participating citizen scientists included 32 adults and 9 adolescents. The citizen scientists rated the acceptability of five of the nine acceptability survey items with an average of 4.0 or higher out of 5.0, indicating they thought it was "fun," were comfortable carrying the tablet, were likely to use it again, and would recommend it to friends and family. Items with average scores of less than 4 were all related to safety concerns. The most common barriers reported by citizen scientists using the tablet were poor sidewalk quality, presence of trash, negative characteristics of the streets, unpleasant aesthetics (e.g., graffiti), and presence of parks and recreational facilities. The Our Voice citizen scientist approach using the Discovery Tool has high potential for assisting communities in diverse settings to begin to identify both local barriers to active living as well as potentially useful strategies for promoting physical activity in culturally congruent ways that are appropriate and feasible in the local context.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Ejercicio Físico , Pobreza , Características de la Residencia , Adolescente , Adulto , Ambiente , Femenino , Estado de Salud , Humanos , Masculino , México
13.
Public Health Nutr ; 18(6): 994-1000, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24956064

RESUMEN

OBJECTIVE: To understand factors which enhance or detract from farmers' market shopper experiences to inform targeted interventions to increase farmers' market utilization, community-building and social marketing strategies. DESIGN: A consumer-intercept study using the Stanford Healthy Neighborhood Discovery Tool to capture real-time perceptions via photographs and audio narratives. SETTING: An urban farmers' market in a large metropolitan US city. PARTICIPANTS: Thirty-eight farmers' market shoppers, who recorded 748 unique coded elements through community-based participatory research methods. RESULTS: Shoppers were primarily women (65 %), 18-35 years of age (54 %), non-Hispanic (81 %) and white (73 %). Shoppers captured 291 photographs (7·9 (sd 6·3) per shopper), 171 audio narratives (5·3 (sd 4·7) per shopper), and ninety-one linked photograph + audio narrative pairs (3·8 (sd 2·8) per shopper). A systematic content analysis of the photographs and audio narratives was conducted by eight independent coders. In total, nine common elements emerged from the data that enhanced the farmers' market experience (61·8 %), detracted from the experience (5·7 %) or were neutral (32·4 %). The most frequently noted elements were freshness/abundance of produce (23·3 %), product presentation (12·8 %), social interactions (12·4 %) and farmers' market attractions (e.g. live entertainment, dining offerings; 10·3 %). CONCLUSIONS: While produce quality (i.e. freshness/abundance) was of primary importance, other contextual factors also appeared important to the shoppers' experiences. These results may inform social marketing strategies to increase farmers' market utilization and community-building efforts that target market venues.


Asunto(s)
Comportamiento del Consumidor , Abastecimiento de Alimentos , Características de la Residencia , Adolescente , Adulto , Actitud Frente a la Salud , California , Investigación Participativa Basada en la Comunidad , Computadoras de Mano , Femenino , Calidad de los Alimentos , Abastecimiento de Alimentos/economía , Frutas/química , Frutas/economía , Humanos , Relaciones Interpersonales , Masculino , Aplicaciones Móviles , Investigación Cualitativa , Población Urbana , Verduras/química , Verduras/economía , Adulto Joven
14.
Prev Chronic Dis ; 12: E102, 2015 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-26133645

RESUMEN

INTRODUCTION: A community's built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement. METHODS: Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change. RESULTS: Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use. CONCLUSION: An electronic tablet-based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.


Asunto(s)
Computadoras de Mano/estadística & datos numéricos , Servicios de Alimentación , Conductas Relacionadas con la Salud , Actividad Motora , Población Rural , Actividades Cotidianas/psicología , Adulto , Anciano , Accesibilidad Arquitectónica , Enfermedad Crónica/prevención & control , Investigación Participativa Basada en la Comunidad , Planificación Ambiental/normas , Femenino , Grupos Focales , Estudios de Seguimiento , Servicios de Alimentación/economía , Servicios de Alimentación/normas , Sistemas de Información Geográfica , Conductas Relacionadas con la Salud/etnología , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , New York , Evaluación de Resultado en la Atención de Salud , Fotograbar , Investigación Cualitativa , Características de la Residencia , Factores Socioeconómicos , Caminata/psicología
15.
OTJR (Thorofare N J) ; 35(1): 42-52, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26623476

RESUMEN

We employed item response theory (IRT), specifically using Rasch modeling, to determine the measurement precision of the Fitness-to-Drive Screening Measure (FTDS), a tool that can be used by caregivers and occupational therapists to help detect at-risk drivers. We examined unidimensionality through the factor structure (how items contribute to the central construct of fitness to drive), rating scale (use of the categories of the rating scale), item/person-level separation (distinguishing between items with different difficulty levels or persons with different ability levels) and reliability, item hierarchy (easier driving items advancing to more difficult driving items), rater reliability, rater effects (severity vs. leniency of a rater), and criterion validity of the FTDS to an on-road assessment, via three rater groups (n = 200 older drivers; n = 200 caregivers; n = 2 evaluators). The FTDS is unidimensional, the rating scale performed well, has good person (> 3.07) and item (> 5.43) separation, good person (> 0.90) and item reliability (> 0.97), with < 10% misfitting items for two rater groups (caregivers and drivers). The intraclass correlation (ICC) coefficient among the three rater groups was significant (.253, p < .001) and the evaluators were the most severe raters. When comparing the caregivers' FTDS rating with the drivers' on-road assessment, the areas under the curve (index of discriminability; caregivers .726, p < .001) suggested concurrent validity between the FTDS and the on-road assessment. Despite limitations, the FTDS is a reliable and accurate screening measure for caregivers to help identify at-risk older drivers and for occupational therapy practitioners to start conversations about driving.


Asunto(s)
Examen de Aptitud para la Conducción de Vehículos , Conducción de Automóvil , Tamizaje Masivo/métodos , Terapia Ocupacional/métodos , Psicometría , Anciano , Cuidadores/psicología , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Ontario , Estudios Prospectivos , Reproducibilidad de los Resultados , Seguridad
18.
OTJR (Thorofare N J) ; 34(4): 177-82, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25347755

RESUMEN

Polytrauma, including mild traumatic brain injury, posttraumatic stress disorder, and orthopedic conditions, is common among combat veterans (CVs) from Operations Enduring Freedom and Iraqi Freedom. Medical conditions, coupled with deployment-related training, may affect CVs' fitness to drive and contribute to post-deployment crash and injury risks. However, empirical interventions are lacking. Therefore, the study purpose was to examine the efficacy of an occupational therapy driving intervention (OT-DI) with pre and post testing of CVs. Using a DriveSafety 250 simulator, Occupational Therapy-Driver Rehabilitation Specialists recorded driving errors. Eight CVs (mean age = 39.83, SD = 7.80) received three OT-DI sessions, which incorporated strategies to address driving errors and visual search retraining. We determined baseline driving errors (mean = 31.63, SD = 8.96) were double the number of posttest errors (mean = 15.38, SD = 9.71). At posttesting, a significant (p < 0.05) decrease was noted for total errors and lane maintenance. Despite study constraints, preliminary data support the efficacy of the OT-DI.


Asunto(s)
Conducción de Automóvil , Lesiones Encefálicas/rehabilitación , Traumatismo Múltiple/rehabilitación , Sistema Musculoesquelético/lesiones , Terapia Ocupacional/métodos , Trastornos por Estrés Postraumático/rehabilitación , Veteranos , Accidentes de Tránsito/prevención & control , Actividades Cotidianas , Adulto , Campaña Afgana 2001- , Estudios de Cohortes , Humanos , Guerra de Irak 2003-2011 , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
19.
Am J Occup Ther ; 68(4): 405-11, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25005503

RESUMEN

Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention driving errors were as follows: lane maintenance, 23 versus 7; vehicle positioning, 5 versus 1; signaling, 2 versus 0; speed regulation, 1 versus 1; visual scanning, 1 versus 0; and gap acceptance, 1 versus 0. Although the intervention appeared efficacious for this participant, threats to validity must be recognized and controlled for in a follow-up study.


Asunto(s)
Conducción de Automóvil/psicología , Trastornos de Combate/terapia , Terapia Ocupacional/métodos , Veteranos/psicología , Adulto , Humanos , Masculino
20.
Photochem Photobiol Sci ; 12(10): 1795-802, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23828307

RESUMEN

Photodynamic inactivation (PDI), the light-induced and photosensitizer-mediated overproduction of reactive oxygen species in microorganisms, represents a convincing approach to treat infections with (multi-resistant) pathogens. Due to its favourable photoactive properties combined with excellent biocompatibility, curcumin derived from the roots of turmeric (Curcuma longa) has been identified as an advantageous photosensitizer for PDI. To overcome the poor water solubility and the rapid decay of the natural substance at physiological pH, we examined the applicability of polyvinylpyrrolidone curcumin (PVP-C) in an acidified aqueous solution (solubility of PVP-C up to 2.7 mM) for photoinactivation of Gram(+) and Gram(-) bacteria. Five micromolar PVP-C incubated for 5 minutes and illuminated using a blue light LED array (435 ± 10 nm, 33.8 J cm(-2)) resulted in a >6 log10 reduction of the number of viable Staphylococcus aureus. At this concentration, longer incubation periods result in a lower phototoxicity, most likely due to degeneration of curcumin. Upon an increase of the PVP-C concentration to 50 µM (incubation for 15 or 25 min) a complete eradication of Staphylococcus aureus can be achieved. As expected for a non-cationic photosensitizer, cell wall permeabilization with CaCl2 prior to addition of 50 µM PVP-C for 15 min is necessary to induce a drop in the count of the Gram(-) Escherichia coli for more than 3 log10. As both constituents of the formulation, curcumin (E number E100) and polyvinylpyrrolidone (E1201), have been approved as food additives, a PDI based on PCP-C might allow for a very sparing clinical application (e.g. for disinfection of wounds) or even for employment in aseptic production of foodstuffs.


Asunto(s)
Curcuma/química , Curcumina/química , Escherichia coli/efectos de los fármacos , Fármacos Fotosensibilizantes/química , Staphylococcus aureus/efectos de los fármacos , Cloruro de Calcio/química , Cloruro de Calcio/farmacología , Pared Celular/efectos de los fármacos , Curcuma/metabolismo , Escherichia coli/efectos de la radiación , Concentración de Iones de Hidrógeno , Luz , Fármacos Fotosensibilizantes/farmacología , Raíces de Plantas/química , Raíces de Plantas/metabolismo , Povidona/química , Solubilidad , Staphylococcus aureus/efectos de la radiación , Agua/química
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