An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program.

Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM ( R each and representativeness, 2) E ffectiveness, 3) A doption, 4) I mplementation, and 5) M aintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.

Men's help-seeking in the first year after diagnosis of localised prostate cancer.

This study describes sources of support utilised by men with localised prostate cancer in the first year after diagnosis and examines characteristics associated with help-seeking for men with unmet needs. A cross-sectional survey of 331 patients from a population-based sample who were in the first year after diagnosis (M = 9.6, SD = 1.9) was conducted to assess sources of support, unmet supportive care needs, domain-specific quality of life and psychological distress. Overall, 82% of men reported unmet supportive care needs. The top five needs were sexuality (58%); prostate cancer-specific (57%); psychological (47%); physical and daily living (41%); and health system and information (31%). Professional support was most often sought from doctors (51%). Across most domains, men who were older (Ps ≤ 0.03), less well educated (Ps ≤ 0.04) and more depressed (Ps ≤ 0.05) were less likely to seek help for unmet needs. Greater sexual help-seeking was related to better sexual function (P = 0.03), higher education (P ≤ 0.03) and less depression (P = 0.05). Unmet supportive care needs are highly prevalent after localised prostate cancer diagnosis with older age, lower education and higher depression apparent barriers to help-seeking. Interventions that link across medicine, nursing and community based peer support may be an accessible approach to meeting these needs. Clinical Trial Registry: Trial Registration: ACTRN12611000392965.

Financial toxicity: a potential side effect of prostate cancer treatment among Australian men.

The purpose of this study was to understand the extent, nature and variability of the current economic burden of prostate cancer among Australian men. An online cross-sectional survey was developed that combined pre-existing economic measures and new questions. With few exceptions, the online survey was viable and acceptable to participants. The main outcomes were self-reported out-of-pocket costs of prostate cancer diagnosis and treatment, changes in employment status and household finances. Men were recruited from prostate cancer support groups throughout Australia. Descriptive statistical analyses were undertaken. A total of 289 men responded to the survey during April and June 2013. Our study found that men recently diagnosed (within 16 months of the survey) (n = 65) reported spending a median AU$8000 (interquartile range AU$14 000) for their cancer treatment while 75% of men spent up to AU$17 000 (2012). Twenty per cent of all men found the cost of treating their prostate cancer caused them 'a great deal' of distress. The findings suggest a large variability in medical costs for prostate cancer treatment with 5% of men spending $250 or less in out-of-pocket expenses and some men facing very high costs. On average, respondents in paid employment at diagnosis stated that they had retired 4-5 years earlier than planned.

Palliative care for patients with chronic obstructive pulmonary disease: exploring the landscape.

Patients with chronic obstructive pulmonary disease experience a substantial symptom burden, high levels of psychosocial need and significant mortality. This epidemiological study reveals that the majority of patients are cared for in the public hospital system (64%) and generally die in hospital (72%) with a number of identifiable predictors of 6-month mortality. Our results suggest that palliative care services need to be redirected from a community-based admission focus to a model that is responsive to emergency and acute care hospital systems.

Accuracy of polar F6 in estimating the energy cost of aerobic dance bench stepping in college-age females.

AIM: This study: 1) examined the accuracy of the Polar F6 for estimating energy expenditure (EE) in a sample of college-age women during aerobic dance bench stepping (ADBS) using predicted maximal oxygen consumption (VO2max) and maximal heart rate (HRmax), and 2) determined whether the use of actual measures of VO2max and HRmax improves the accuracy of the Polar F6 for estimating EE. METHODS: Thirty-two females had their VO2max and HRmax predicted by the Polar F6 heart rate monitor (HRM), and then performed a graded maximal exercise treadmill test to determine their actual VO2max and HRmax. The participants then followed a 20-min ADBS routine while stepping up and down off of a 15.24-cm bench at a cadence of 126 beats.min-1. During ADBS, the participants wore two F6 HRM that simultaneously collected data. To estimate EE, one HRM utilized their predicted VO2max and HRmax (PHRM) while the other HRM utilized their actual VO2max and HRmax (AHRM). RESULTS: The predicted HRmax significantly overestimated actual HRmax by 3.75 beats.min-1 on average, and the predicted VO2max overestimated actual VO2max by 2.63 ml.kg-1.min-1 on average (P<0.01). However, there were no significant differences between the PHRM and AHRM (P≥0.05). When compared to indirect calorimetry, the PHRM and AHRM significantly overestimated average EE by 28% (2.4 kcal.min-1) and 27% (2.0 kcal.min-1), respectively (P<0.05). CONCLUSIONS: Even when using actual measures of VO2max and HRmax, the Polar F6 is inaccurate in estimating EE during ADBS for college-age females.

[An exploration of the association between disability pension and psychiatric diseases]. / Frühberentung aufgrund psychiatrischer Erkrankungen. Eine Analyse von 94 Berufsunfähigkeitsgutachten.

OBJECTIVE: The necessity to establish disability and invalidity pensions due to psychiatric diseases has become more and more demanding in recent years. So far there is little knowledge about the aetiology and socio-demographic aspects of this phenomenon. METHODS: The presented explorative analyses included 94 examinations (43 women, 51 men) to address, if a person should be medically certified as partly or permanently unfit for work. The data, including psychiatric diagnosis and socio-demographic data were obtained between 1999 and 2006 in a German specialised psychiatric university unit. RESULTS: The diagnoses of neurotic diseases, stress related and somatoform disorders (ICD-10 F 40 - 48) were the most prevalent group (48 %) within the sample. It was a statistically significant predictive factor in a later declaration of disability and invalidity. In this diagnosis group (F 40 - 48) more participants were female when compared to other diagnosis groups. In general, participants were more likely to be divorced and have a lower education level when compared to the general population. However, the mean level of intelligence was similar to the general population. CONCLUSION: The results of the presented study could be beneficial for a better understanding of the association between disability pensions and psychiatric diseases. The increase of neurotic diseases, stress related and somatoform disorders may justify the development of targeted prevention strategies.

Assessment of the anthelmintic effect of natural plant cysteine proteinases against the gastrointestinal nematode, Heligmosomoides polygyrus, in vitro.

We examined the mechanism of action and compared the anthelmintic efficacy of cysteine proteinases from papaya, pineapple, fig, kiwi fruit and Egyptian milkweed in vitro using the rodent gastrointestinal nematode Heligmosomoides polygyrus. Within a 2 h incubation period, all the cysteine proteinases, with the exception of the kiwi fruit extract, caused marked damage to the cuticle of H. polygyrus adult male and female worms, reflected in the loss of surface cuticular layers. Efficacy was comparable for both sexes of worms, was dependent on the presence of cysteine and was completely inhibited by the cysteine proteinase inhibitor, E-64. LD50 values indicated that the purified proteinases were more efficacious than the proteinases in the crude latex, with purified ficin, papain, chymopapain, Egyptian milkweed latex extract and pineapple fruit extract containing fruit bromelain, having the most potent effect. The mechanism of action of these plant enzymes (i.e. an attack on the protective cuticle of the worm) suggests that resistance would be slow to develop in the field. The efficacy and mode of action make plant cysteine proteinases potential candidates for a novel class of anthelmintics urgently required for the treatment of humans and domestic livestock.

A survey of the use of matrix bands and their decontamination in general dental practice.

AIMS: The aims of this study were to determine the pattern of use and re-use of matrix bands in general practice in Scotland, to demonstrate which type of matrix band is most commonly used and to examine infection control measures of relevance to the safe use and re-use of matrix bands. SUBJECTS: 621 of Scotland's 1,849 general dental practitioners were randomly selected. DATA COLLECTION: A 19-item self-reported questionnaire was mailed in June 1999 with a follow-up mailing sent in August 1999. ANALYSIS: Data analysis involved descriptive statistics and cross-tabulation. Where appropriate, differences between categories were tested for significance by a Chi-square test. RESULTS: A total of 479 questionnaires were returned, representing a response rate of 77%. Reported compliance with routine glove wearing was high (91%). Most dentists (92%) provided training on instrument cleaning and sterilisation for their dental nurses. Ultrasonic baths were used by 59% of practitioners; the remainder soaked or manually scrubbed instruments to remove debris before autoclaving. The Siqveland matrix was the matrix of choice for 96% of respondents. 7% provided a new matrix band for each patient. Most (64%) changed bands only when they were bent or damaged; 29% changed them daily or weekly. Deterrents to use of a new band for each patient were cost (39%) and time (52%). A total of 54% of respondents considered matrix band replacement unnecessary between patients. CONCLUSIONS: The Siqveland matrix band is the most popular among the study group of dental practitioners. Re-use of matrix bands is common. Guidelines for the safe re-use of matrix bands are required.

The construction of a network at Health Waikato. The "towards clinical budgeting" project.

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato (HW), in the centre of the North Island of New Zealand. The themes will be explicated and theorised, drawing on the sociology of translation (Latour). A central idea will be the use of accounting techniques to influence decision makers both within and outside the health institutions. The power of accounting in the translation and inscription of data (the fabrication of accounting systems per Preston et al.), will be a central theme in understanding the role of accounting systems as technology. Drawing from Latour has helped to provide a frame of reference to allow an assimilation of disparate changes and influences as they have come to affect the health sector at a national level, within New Zealand, and also at an organisational level, within a large regional health provider. This paper provides a detailed description of events at the research site, a large regional hospital (HW). The paper consists primarily of a descriptive case study of aspects of the change process as it has impacted on the research site.

Cultural aspects of African American eating patterns.

The high mortality from diet-related diseases among African Americans strongly suggests a need to adopt diets lower in total fat, saturated fat and salt and higher in fiber. However, such changes would be contrary to some traditional African American cultural practices. Focus group interviews were used to explore cultural aspects of eating patterns among low- and middle-income African Americans recruited from an urban community in Pennsylvania. In total, 21 males and 32 females, aged 13-65+ years were recruited using a networking technique. Participants identified eating practices commonly attributed to African Americans and felt that these were largely independent of socioeconomic status. They were uncertain about links between African American eating patterns and African origins but clear about influences of slavery and economic disadvantage. The perception that African American food patterns were characteristically adaptive to external conditions, suggest that, for effective dietary change in African American communities, changes in the food availability will need to precede or take place in parallel with changes recommended to individuals. Cultural attitudes about where and with whom food is eaten emerged as being equivalent in importance to attitudes about specific foods. These findings emphasize the importance of continued efforts to identify ways to increase the relevance of cultural context and meanings in dietary counseling so that health and nutrition interventions are anchored in values as perceived, in this case, by African Americans.

Reducing variation in patient care. Nursing responds to capitation.

As managed care and capitation methods of payment become more common to hospitals, a strategy to improve quality and reduce costs is introduced in response to these new pressures. Nursing leaders must take the initiative and respond to these changes by reducing the variations in patient care. The author describes seven initiatives undertaken by the nursing leaders of The St. Joseph Healthcare System in Albuquerque. New Mexico during a 3-year period. The success of these initiatives and their universal application is discussed.

Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.

This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.

Laser lithotripsy. Patient care, staff education.

The high cost of laser equipment and the required specialization of staff members make extension of laser lithotripsy to every hospital impractical. At present, in Ontario, laser lithotripsy is available only in Toronto and Kingston, and ESWL is available only in Toronto and London. Laser lithotripsy is a viable alternative to invasive surgical treatment of urinary calculi that are resistant to ESWL. For the suitable candidate, laser lithotripsy is a welcome alternative to an extensive surgical procedure and recovery period. Hospitalization is reduced significantly, and patients can return to work after the calculus and residue have been passed. Patients can be managed safely and effectively, resulting in reduced morbidity and mortality and reduced cost in time and expense to the patient and hospital.

A new monoclonal anti-A. Culture supernatants with the performance of hyperimmune human reagents.

By proper selection for good growth and high avidity, we have prepared a new anti-A monoclonal antibody producing cell line that gives culture supernatants as potent as US-licensed commercial hyperimmune human reagents and which meet USA FDA standards without the need for concentration. The production and use of this reagent is cost effective and makes it a candidate to replace conventional anti-A typing reagents.