Development of an electronic medical record based intervention to improve medical care of osteoporosis.

UNLABELLED: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. INTRODUCTION: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age. METHODS: Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009. RESULTS: Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. CONCLUSION: An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.

Storage and export of microbial biomass across the western Greenland Ice Sheet.

The Greenland Ice Sheet harbours a wealth of microbial life, yet the total biomass stored or exported from its surface to downstream environments is unconstrained. Here, we quantify microbial abundance and cellular biomass flux within the near-surface weathering crust photic zone of the western sector of the ice sheet. Using groundwater techniques, we demonstrate that interstitial water flow is slow (~10-2 m d-1), while flow cytometry enumeration reveals this pathway delivers 5 × 108 cells m-2 d-1 to supraglacial streams, equivalent to a carbon flux up to 250 g km-2 d-1. We infer that cellular carbon accumulation in the weathering crust exceeds fluvial export, promoting biomass sequestration, enhanced carbon cycling, and biological albedo reduction. We estimate that up to 37 kg km-2 of cellular carbon is flushed from the weathering crust environment of the western Greenland Ice Sheet each summer, providing an appreciable flux to support heterotrophs and methanogenesis at the bed.

Human hippocampal neurons predict how well word pairs will be remembered.

What is the neuronal basis for whether an experience is recalled or forgotten? In contrast to recognition, recall is difficult to study in nonhuman primates and rarely is accessible at the single neuron level in humans. We recorded 128 medial temporal lobe (MTL) neurons in patients implanted with intracranial microelectrodes while they encoded and recalled word paired associates. Neurons in the amygdala, entorhinal cortex, and hippocampus showed altered activity during encoding (9%), recall (22%), and both task phases (23%). The responses of hippocampal neurons during encoding predicted whether or not subjects later remembered the pairs successfully. Entorhinal cortex neuronal activity during retrieval was correlated with recall success. These data provide support at the single neuron level for MTL contributions to encoding and retrieval, while also suggesting there may be differences in the level of contribution of MTL regions to these memory processes.

Increased dopamine release in the human amygdala during performance of cognitive tasks.

Accumulating data support a critical involvement of dopamine in the modulation of neuronal activity related to cognitive processing. The amygdala is a major target of midbrain dopaminergic neurons and is implicated in learning and memory processes, particularly those involving associations between novel stimuli and reward. We used intracerebral microdialysis to directly sample extracellular dopamine in the human amygdala during the performance of cognitive tasks. The initial transition from rest to either a working memory or a reading task was accompanied by significant increases in extracellular dopamine concentration of similar magnitude. During a sustained word paired-associates learning protocol, increase in dopamine release in the amygdala related to learning performance. These data provide evidence for sustained activation of the human mesolimbic dopaminergic system during performance of cognitive tasks.

Preventing the spread of genital warts: using fear appeals to promote self-protective behaviors.

A fear appeal campaign to decrease the spread of genital warts was conducted and evaluated. Theoretically guided by the Extended Parallel Process Model, this field study illustrated why fear appeal campaigns often appear to fail in public health arenas. Five hypotheses, which predicted when and under what conditions fear appeal campaigns would fail or succeed, were tested and supported. The results demonstrated that fear appeals can be powerful persuasive devices if they induce strong perceptions of threat and fear (which motivate action) and if they induce strong perceptions of efficacy with regard to a recommended response (which channels the action in a health protective direction). Recommendations to researchers and public health practitioners are offered.

Radon awareness and reduction campaigns for African Americans: a theoretically based evaluation.

Radon gas is a significant health threat linked to thousands of preventable deaths each year. One population that may be at increased risk from harm from radon exposure is African Americans. However, little is known about what African Americans think or know about radon. A theoretically based evaluation of radon awareness and reduction campaigns was conducted with African Americans. The knowledge and perceptions results indicate that African Americans often hold inaccurate beliefs regarding radon (e.g., confusing it with carbon monoxide gas), perceive it to be a serious threat, and perceive recommended responses to be inadequate in averting harm. The campaign materials evaluation shows that campaign materials often promote perceptions of threat but not perceptions of efficacy regarding recommended responses. Recommendations are given for public health practitioners.

Preventing medication-related problems among older Americans.

This article provides an overview of the Fleetwood Project, a major three-phase research and demonstration initiative to: (1) evaluate how consultant pharmacist services influence health outcomes and costs by reducing medication-related problems in long-term care settings, (2) compare outcomes from federally mandated drug regimen reviews to prospective reviews and formalized pharmaceutical care planning (the Fleetwood Model) for nursing facility residents at highest risk for medication-related problems, and (3) apply and evaluate this model in a national sample of nursing and assisted-living facilities.

Barriers to influenza vaccination among pregnant women.

OBJECTIVE: Despite pregnant women's increased morbidity and mortality from influenza, vaccination rates remain low. This study intended to evaluate barriers to pregnant women's uptake of influenza vaccine. STUDY DESIGN: A survey was designed that assessed participant demographics, knowledge, beliefs, attitudes, and general experiences with seasonal and 2009 novel H1N1 influenza. Associations between patient characteristics and vaccine uptake were then assessed. RESULTS: 88 women completed the survey. Women who correctly answered >75% of knowledge questions regarding influenza were significantly more likely to accept the influenza vaccine (seasonal: p=0.04, H1N1: p<0.01). Conversely, patients who declined the vaccine were more likely to hold false beliefs, such as perceiving that the vaccine was not protective (seasonal: p<0.01, H1N1: p<.01) and that they were not at risk for influenza (seasonal: p< 0.01). CONCLUSION: The reasons for influenza vaccine declination in pregnant patients include lower levels of knowledge and unfavorable attitudes regarding the safety and efficacy of the vaccine, and suggest the importance of education as a tool to improve vaccination uptake.

Does obstetrician knowledge regarding influenza increase HINI vaccine acceptance among their pregnant patients?

OBJECTIVES: Although numerous studies have demonstrated the safety and benefits of influenza vaccination in pregnancy, vaccination rates of pregnant women have remained low. The objective of this study is to evaluate whether physicians' level of knowledge regarding H1N1 influenza in pregnancy is associated with vaccination frequency among their patients. METHODS: Between October 2009 and May 2010, all obstetricians (attending and resident physicians) at an urban tertiary care hospital were asked to complete a test that assessed knowledge of influenza. During this same time period, the vaccination status of all inpatient parturients was recorded. Associations between physician characteristics, physician test scores, and patient vaccination rates were assessed. RESULTS: 110 providers (85% of those eligible) belonging to 16 practices completed the knowledge assessment. The mean (±SD) test score was 72% (±11%). Provider test scores were not associated with whether the provider was a trainee, the number of years since completion of training, or provider age. Test scores were not correlated with the number of providers or number of deliveries per month in a given practice. Mean scores were significantly higher (75% vs 68%, p=004) among those who attended a hospital-sponsored educational forum on H1N1, and were positively and significantly associated with the percentage of patients cared for by that group who were vaccinated against H1N1 influenza (r=.50, p=.045). CONCLUSION: Increased physician knowledge regarding H1N1 influenza, represented as higher test scores on a knowledge assessment test, was significantly associated with the frequency of H1N1 vaccination among their patients.

Calibration of retinal image size with distance in the Mongolian gerbil: rapid adjustment of calibrations in different contexts.

Mongolian gerbils were trained to jump from one platform to another across a gap whose size varied randomly from trial to trial. In test sessions, probe landing platforms differing in width from those used in training were used, and the distance that the animals jumped was measured. The first experiment demonstrated that the gerbils learned to calibrate the retinal image size of the landing platform with its distance and that they could learn more than one calibration at a time. The second experiment provided evidence that such calibrations are rapidly adjusted to environmental contingencies. These findings suggest that retinal image size might be a useful distance cue for gerbils in a variety of ecological contexts.

A theoretically based evaluation of HIV/AIDS prevention campaigns along the trans-Africa highway in Kenya.

Print HIV/AIDS prevention campaign materials (e.g., posters, pamphlets, stickers) from 10 public health organizations in Kenya were evaluated according to the Extended Parallel Process Model (EPPM), a health behavior change theory based on the fear appeal literature, at various sites along the Trans-Africa Highway in Kenya. Three groups each of commercial sex workers (CSWs), truck drivers (TDs) and their assistants (ASSTs), and young men (YM) who live and work at the truck stops participated in focus group discussions where reactions to the campaign materials were gathered according to this theoretical base. Reactions to campaign materials varied substantially, according to the poster or pamphlet viewed. Overall, most participants wanted more detailed information about (a) the proper way to use condoms, (b) ideas for how to negotiate condom use with reluctant partners, and (c) accurate information on symptoms of AIDS and what to do once one contracted HIV. Both quantitative and qualitative analyses of the campaign materials are reported.

Predicting risk behaviors: development and validation of a diagnostic scale.

The goal of this study was to develop and validate the Risk Behavior Diagnosis (RBD) Scale for use by health care providers and practitioners interested in promoting healthy behaviors. Theoretically guided by the Extended Parallel Process Model (EPPM; a fear appeal theory), the RBD scale was designed to work in conjunction with an easy-to-use formula to determine which types of health risk messages would be most appropriate for a given individual or audience. Because some health risk messages promote behavior change and others backfire, this type of scale offers guidance to practitioners on how to develop the best persuasive message possible to motivate healthy behaviors. The results of the study demonstrate the RBD scale to have a high degree of content, construct, and predictive validity. Specific examples and practical suggestions are offered to facilitate use of the scale for health practitioners.