Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress.

The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00-2.68, 95% CI [1.27-4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43-3.73, 95% CI [1.95-6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.

Economic Impact of Unused Surgical Instruments in an Orthopaedic Surgery Department at an Academic Medical Center: A Prospective Cross-sectional Study.

Orthopaedic surgical trays contain unused instruments, but we do not know which specific instruments go unused nor do we know the savings from eliminating them from a given tray. This was a single-site, observational study conducted at an academic medical center. The primary outcome was type of unused instruments and percentage of instruments used in two commonly used surgical trays. The secondary outcome was cost savings in United States dollars (USD) that could be attained by eliminating these instruments. In the first tray, five instruments (10.6%) were unused in any of 37 observed cases. In the second tray, nineteen instruments (19.6%) were unused in 37 observed cases. The total annual savings from replacement cost analysis and reprocessing cost analysis was $6,597.00 USD. Unused instruments are common in surgical trays. Eliminating unused instruments can result in immediate cost savings. (Journal of Surgical Orthopaedic Advances 30(3):131-135, 2021).

Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness.

BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. METHODS: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. RESULTS: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). CONCLUSIONS: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.

Social Competence in Parents Increases Children's Educational Attainment: Replicable Genetically-Mediated Effects of Parenting Revealed by Non-Transmitted DNA.

We recently reported an association of offspring educational attainment with polygenic risk scores (PRS) computed on parent's non-transmitted alleles for educational attainment using the second GWAS meta-analysis article on educational attainment published by the Social Science Genetic Association Consortium. Here we test the replication of these findings using a more powerful PRS from the third GWAS meta-analysis article by the Consortium. Each of the key findings of our previous paper is replicated using this improved PRS (N = 2335 adolescent twins and their genotyped parents). The association of children's attainment with their own PRS increased substantially with the standardized effect size, moving from ß = 0.134, 95% CI = 0.079, 0.188 for EA2, to ß = 0.223, 95% CI = 0.169, 0.278, p < .001, for EA3. Parent's PRS again predicted the socioeconomic status (SES) they provided to their offspring and increased from ß = 0.201, 95% CI = 0.147, 0.256 to ß = 0.286, 95% CI = 0.239, 0.333. Importantly, the PRS for alleles not transmitted to their offspring - therefore acting via the parenting environment - was increased in effect size from ß = 0.058, 95% CI = 0.003, 0.114 to ß = 0.067, 95% CI = 0.012, 0.122, p = .016. As previously found, this non-transmitted genetic effect was fully accounted for by parental SES. The findings reinforce the conclusion that genetic effects of parenting are substantial, explain approximately one-third the magnitude of an individual's own genetic inheritance and are mediated by parental socioeconomic competence.

Using Transcultural Nursing Education to Increase Cultural Sensitivity and Cultural Assessment Documentation by Staff in an In-Home Chronic Disease Self-Management Program.

BACKGROUND: Despite literature indicating that culturally sensitive care promotes a positive patient environment and may help improve outcomes, limited data exist on the documentation of patients' cultural concerns in electronic medical records (EMR). OBJECTIVE: The project's objective was to use an educational intervention to increase clinic staff's cultural sensitivity and cultural assessment documentation. METHODS: Researchers conducted this 3-month project at a Midwestern clinic's in-home, self-care chronic disease management program. The voluntary sample of clinical staff (n = 8) received an educational intervention on transcultural nursing practices. Researchers administered the Transcultural Self-Efficacy Tool for the Multidisciplinary Healthcare Provider (TSET-MHP) to participants before and after the intervention. A pre- and postintervention EMR audit was completed on 128 charts to evaluate cultural assessment documentation. RESULTS: TSET-MHP cognitive and practical subscales scores increased postintervention. Affective subscales scores decreased slightly. Electronic cultural assessment documentation increased by 10%. An assessment questionnaire showed an increase in participants' cultural self-awareness and comfort with cultural assessment. CONCLUSIONS: An educational intervention demonstrated an increase in providers' cultural awareness and cultural assessment documentation. IMPLICATIONS FOR NURSING: Transcultural nursing education may help increase providers' perceived cultural self-efficacy, which may improve cultural assessments and culturally competent care.

Single Nucleotide Polymorphisms Associated with Reading Ability Show Connection to Socio-Economic Outcomes.

Impairments in reading and in language have negative consequences on life outcomes, but it is not known to what extent genetic effects influence this association. We constructed polygenic scores for difficulties with language and learning to read from genome-wide data in ~6,600 children, adolescents and young adults, and tested their association with health, socioeconomic outcomes and brain structure measures collected in adults (maximal N = 111,749). Polygenic risk of reading difficulties was associated with reduced income, educational attainment, self-rated health and verbal-numerical reasoning (p < 0.00055). Polygenic risk of language difficulties predicted income (p = 0.0005). The small effect sizes ranged 0.01-0.03 of a standard deviation, but these will increase as genetic studies for reading ability get larger. Polygenic scores for childhood cognitive ability and educational attainment were correlated with polygenic scores of reading and language (up to 0.09 and 0.05, respectively). But when they were included in the prediction models, the observed associations between polygenic reading and adult outcomes mostly remained. This suggests that the pathway from reading ability to social outcomes is not only via associated polygenic loads for general cognitive function and educational attainment. The presence of non-overlapping genetic effect is indicated by the genetic correlations of around 0.40 (childhood intelligence) and 0.70 (educational attainment) with reading ability. Mendelian randomization approaches will be important to dissociate any causal and moderating effects of reading and related traits on social outcomes.

Assessment of Lowest Instrumented Vertebra Tilt on Radiographic Measurements in Lenke "C" Modifier Curves Undergoing Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Multicenter, retrospective cohort study. OBJECTIVES: The purpose of this study is to determine how the amount of residual lowest instrumented vertebra (LIV) tilt correlates with radiographic measurements. SUMMARY OF BACKGROUND DATA: When performing a selective thoracic posterior spinal fusion for adolescent idiopathic scoliosis (AIS), the LIV may be tilted into the lumbar curve or made horizontal. METHODS: This is a multicenter retrospective study of 33 consecutive patients with AIS, Lenke types 1 to 4, lumbar modifier C, and a minimum follow-up of 2 years, who underwent selective thoracic posterior spinal fusions. Measurements obtained from pre- and postoperative radiographs were correlated with postoperative LIV tilt. RESULTS: At final follow-up, less postoperative LIV tilt significantly correlated with less thoracic apical translation (p = .023) when controlling for the position of the LIV relative to the stable vertebra and preoperative thoracic and lumbar curve flexibility. LIV tilt was not significantly associated with thoracic Cobb angle, lumbar Cobb angle, lumbar apical translation, coronal balance, sagittal balance, or the amount of correction obtained compared to their preoperative measurements (p > .05). CONCLUSION: Decreased LIV tilt was significantly associated with decreased thoracic apical translation. LIV tilt did not significantly correlate with coronal balance or any other radiographic measurement. We caution that these findings may only be applicable in C modifier curves and when the correct LIV is chosen. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Assessment of Lowest Instrumented Vertebra Tilt on Radiographic Measurements in Lenke "C" Modifier Curves Undergoing Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Multicenter, retrospective cohort study. OBJECTIVES: The purpose of this study is to determine how the amount of residual lowest instrumented vertebra (LIV) tilt correlates with radiographic measurements. When performing a selective thoracic posterior spinal fusion for adolescent idiopathic scoliosis (AIS), the LIV may be tilted into the lumbar curve or made horizontal. METHODS: This is a multicenter retrospective study of 33 consecutive patients with AIS, Lenke types 1 to 4, lumbar modifier C, and a minimum follow-up of 2 years, who underwent selective thoracic posterior spinal fusions. Measurements obtained from pre- and postoperative radiographs were correlated with postoperative LIV tilt. RESULTS: At final follow-up, less postoperative LIV tilt significantly correlated with less thoracic apical translation (p =.023) when controlling for the position of the LIV relative to the stable vertebra and preoperative thoracic and lumbar curve flexibility. LIV tilt was not significantly associated with thoracic Cobb angle, lumbar Cobb angle, lumbar apical translation, coronal balance, sagittal balance, or the amount of correction obtained compared to their preoperative measurements (p >.05). CONCLUSION: Decreased LIV tilt was significantly associated with decreased thoracic apical translation. LIV tilt did not significantly correlate with coronal balance or any other radiographic measurement. We caution that these findings may only be applicable in C modifier curves and when the correct LIV is chosen. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Cognitive function in adolescence: testing for interactions between breast-feeding and FADS2 polymorphisms.

OBJECTIVES: Breast-fed C-allele carriers of the rs174575 single nucleotide polymorphism in the fatty acyl desaturase 2 (FADS2) gene have been reported to show a 6.4 to 7 IQ point advantage over formula-fed C-allele carriers, with no effect of breast-feeding in GG carriers. An Australian sample was examined to determine if an interaction between breast-feeding and the rs174575 single nucleotide polymorphism had any effect on IQ. METHOD: This hypothesis was tested in more than 700 families of adolescent twins assessed for IQ and breast-feeding, birth weight, and FADS2 polymorphisms, and parental socioeconomic status and education, and maternal FADS2 status. RESULTS: No significant evidence for a moderating effect on IQ of rs174575 C-carrier status and breast-feeding was found, and there no effects of maternal FADS2 status on offspring IQ. In addition, no main effects of any FADS2 polymorphisms on IQ were found when the genotype was kept as two-homozygote and one-heterozygote categories and indeed no evidence for effects of breast-feeding on IQ scores after controlling for parental socioeconomic status and education. The investigation was extended to two additional FADS2 polymorphisms (rs1535 and rs174583), but again, although these polymorphisms code alleles affecting fatty acid metabolism, no main or interaction effects were found on IQ. CONCLUSION: These results support the view that apparent effects of breast-feeding on IQ reflect differential likelihood of breast-feeding as a function of parental education and did not support the predicted interaction effect of FADS2 and breast-feeding on IQ.

Multidimensional assessment of resilience in mothers who are child sexual abuse survivors.

OBJECTIVE: There has been relatively little attention given to positive adaptation following childhood sexual abuse (CSA), and typically such resilience has been explored primarily in the intrapersonal domain. This study explored questions about later resilience following CSA within a multidimensional framework by assessing resilience across intrapersonal, interpersonal, and intrafamilial domains. METHOD: This community sample consisted of 79 mothers with a history of CSA who had a child living at home with them. Participants completed four outcome measures (Center for Epidemiologic Studies--Depression Scale, Parenting Stress Index [PSI] Health Scale, PSI Parenting Competence Scale, and a measure of marital satisfaction). Risk and protective factors examined in relation to outcome included mother's age, socioeconomic status, severity of the CSA experience, coping strategy (avoidance, seeking social support, and problem solving), child characteristics, and spousal/partner support. RESULTS: Results indicated that when multiple adaptational domains were assessed, mothers showed discrepancies in how adequately they functioned across domains. While severity of the CSA experience was only weakly associated with outcome, use of avoidant coping emerged as a significant risk factor and was strongly and consistently associated with negative outcome across domains. Spousal/partner support was a strong protective factor and buffered the relationship between depressive symptoms and parenting competence. Difficult child characteristics were significantly associated with mothers' perceptions of physical health and parenting competence. CONCLUSIONS: The findings suggest the importance of comprehensive multimethod assessments of resilience and extend the knowledge of factors associated with positive outcome. The results highlight the need for further research exploring current contextual risk and protective factors associated with resilience in each domain.

Genetic and environmental sources of covariance between reading tests used in neuropsychological assessment and IQ subtests.

In this study, we examined genetic and environmental influences on covariation among two reading tests used in neuropsychological assessment (Cambridge Contextual Reading Test [CCRT], [Beardsall, L., and Huppert, F. A. (1994). J. Clin. Exp. Neuropsychol. 16:232-242], Schonell Graded Word Reading Test [SGWRT], [Schonell, F. J., and Schonell, P. E. (1960). Diagnostic and attainment testing. Edinburgh: Oliver and Boyd.]) and among a selection of IQ subtests from the Multidimensional Aptitude Battery (MAB), [Jackson, D. N. (1984). Multidimensional aptitude battery, Ontario: Research Psychologists Press.] and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) [Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised (WAIS-R). San Antonio: The Psychological Corporation]. Participants were 225 monozygotic and 275 dizygotic twin pairs aged from 15 years to 18 years (mean, 16 years). For Verbal IQ subtests, phenotypic correlations with the reading tests ranged from 0.44 to 0.65. For Performance IQ subtests, phenotypic correlations with the reading tests ranged from 0.23 to 0.34. Results of Structural Equation Modeling (SEM) supported a model with one genetic General factor and three genetic group factors (Verbal, Performance, Reading). Reading performance was influenced by the genetic General factor (accounting for 13% and 20% of the variance for the CCRT and SGWRT, respectively), the genetic Verbal factor (explaining 17% and 19% of variance for the CCRT and SGWRT), and the genetic Reading factor (explaining 21% of the variance for both the CCRT and SGWRT). A common environment factor accounted for 25% and 14% of the CCRT and SGWRT variance, respectively. Genetic influences accounted for more than half of the phenotypic covariance between the reading tests and each of the IQ subtests. The heritabilities of the CCRT and SGWRT were 0.54 and 0.65, respectively. Observable covariance between reading assessments used by neuropsychologists to estimate IQ and IQ subtests appears to be largely due to genetic effects.

Coital debut: the role of religiosity and sex attitudes in the Add Health Survey.

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, Randall, in press; Wilcox, Rostosky, Randall, Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15-21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls - but not boys - who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non-Hispanic males and African American males who were less religious and/or who had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.