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BACKGROUND: Super-utilizers with 4 or more admissions per year frequently receive low-quality care and disproportionately contribute to healthcare costs. Inpatient care fragmentation (admission to multiple different hospitals) in this population has not been well described. OBJECTIVE: To determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes. RESEARCH DESIGN: We analyzed inpatient data from the Health Care Utilization Project's State Inpatient and Emergency Department database from 6 states from 2013. After identifying hospital super-utilizers, we stratified by the number of different hospitals visited in a 1-year period. We determined how patient demographics, costs, and outcomes varied by degree of fragmentation. We then examined how fragmentation would influence a hospital's ability to identify super-utilizers. SUBJECTS: Adult patients with 4 or more inpatient stays in 1 year. MEASURES: Patient demographics, cost, 1-year hospital reported mortality, and probability that a single hospital could correctly identify a patient as a super-utilizer. RESULTS: Of the 167,515 hospital super-utilizers, 97,404 (58.1%) visited more than 1 hospital in a 1-year period. Fragmentation was more likely among younger, non-white, low-income, under-insured patients, in population-dense areas. Patients with fragmentation were more likely to be admitted for chronic disease management, psychiatric illness, and substance abuse. Inpatient fragmentation was associated with higher yearly costs and lower likelihood of being identified as a super-utilizer. CONCLUSIONS: Inpatient care fragmentation is common among super-utilizers, disproportionately affects vulnerable populations. It is associated with high yearly costs and a decreased probability of correctly identifying super-utilizers.
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Hospitalización , Pacientes Internos , Adulto , Estudios Transversales , Servicio de Urgencia en Hospital , Costos de la Atención en Salud , HumanosRESUMEN
BACKGROUND: Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. METHODS AND FINDINGS: We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was -0.46% (95% CI -0.60% to -0.31%, I2 87.8%, p < 0.001) overall, -0.37% (95% CI -0.64% to -0.10%, I2 60.0%, n = 7, p = 0.020) in multicomponent clinic-based interventions, -0.87% (-1.20% to -0.53%, I2 91.0%, n = 13, p < 0.001) in pharmacist task-sharing studies, and -0.27% (-0.50% to -0.04%, I2 64.1%, n = 7, p = 0.010) in trials of diabetes education or support alone. Other types of interventions had few included studies. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. The certainty of evidence for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types. Limitations include the lack of consensus definitions for health system interventions, differences in the quality of underlying studies, and sparse data availability for non-glycemic outcomes. CONCLUSIONS: In this meta-analysis, we found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies are available from rural areas or low- or lower-middle-income countries. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings.
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Planificación en Salud Comunitaria , Países en Desarrollo/estadística & datos numéricos , Diabetes Mellitus Tipo 2/epidemiología , Educación en Salud/estadística & datos numéricos , Adulto , Asia , Planificación en Salud Comunitaria/economía , Programas de Gobierno/estadística & datos numéricos , Educación en Salud/economía , Humanos , Asistencia Médica/estadística & datos numéricos , Calidad de VidaRESUMEN
BACKGROUND: In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. METHODS: Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. RESULTS: Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P < .05; rho magnitude range: 0.16-0.66). Furthermore, Brief PETS scores differentiated groups based on marital and education status, presence/absence of a self-management routine, and optimal/suboptimal medication adherence (P < .05; ES range: 0.25-1.00). Declines in patient-reported physical or mental health status over time were associated with worsening PETS burden scores, while improvements were associated with improving PETS burden scores (P < .05; ES range: 0.04-0.44). Among clinic patients, 91% were willing to complete the Brief PETS as part of their clinic visits. CONCLUSIONS: The Brief PETS (final version: 32 items) is a reliable and valid tool for assessing person-centered care quality related to treatment burden. It holds promise as a means of giving voice to patient concerns about the complexity of disease management.
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Automanejo , Enfermedad Crónica , Femenino , Humanos , Masculino , Atención Primaria de Salud , Calidad de Vida , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
PURPOSE: Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. METHODS: We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics. RESULTS: Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient. CONCLUSIONS: We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce.
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Actitud del Personal de Salud , Agentes Comunitarios de Salud , Prestación Integrada de Atención de Salud , Modelos Organizacionales , Atención Dirigida al Paciente , Enfermedad Crónica/terapia , Femenino , Humanos , Entrevistas como Asunto , Masculino , Minnesota , Atención Dirigida al Paciente/organización & administración , Investigación Cualitativa , Recursos HumanosRESUMEN
The prevalence of type 2 diabetes is rapidly rising, especially among minority and low-income youth. There is an unmet need to engage youth in identifying solutions to reverse this trajectory. Social marketing campaigns and entertainment education are effective forms of health communication for engaging populations in health-promoting behaviors. Critical to curbing the epidemic is moving the diabetes conversation away from individual behavior alone and toward a socioecologic perspective using a public health literacy framework. The authors developed an academic-community partnership to develop, implement, and evaluate a type 2 diabetes prevention campaign targeting minority and low-income youth. The Bigger Picture campaign uses hard-hitting, youth-generated spoken-word messages around key environmental and social drivers of the type 2 diabetes epidemic. Campaign goals included promoting health capacity and civic engagement. This article focuses on the development and implementation of the campaign, including (a) rationale and theoretical underpinnings, (b) steps in campaign creation, (c) testing the campaign messaging, and (d) campaign dissemination and evaluation planning. A youth-created health communication campaign using a public health literacy framework with targeted, relevant, and compelling messaging appears to be a promising vehicle for reaching at-risk youth to increase knowledge of and attitudes about preventing type 2 diabetes, change social norms, and motivate participation in health-promoting initiatives.
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Diabetes Mellitus Tipo 2/prevención & control , Alfabetización en Salud , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Adolescente , Comunicación en Salud/métodos , Humanos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Mercadeo SocialRESUMEN
INTRODUCTION: Primary care clinician burnout is pervasive and detrimental. How components of teamwork and clinic culture might contribute to burnout remains unsettled. OBJECTIVE: To examine associations between primary care clinician perceptions of specific components of teamwork and of organizational culture, and perceived stress and burnout. METHODS: Cross-sectional survey study of primary care clinicians from 5 county health system clinics. Measures: Perceptions of teamwork related to coordination of care, and clinic provision of chronic disease self-management support; values alignment and workplace equity; and demographics. DATA ANALYSIS: Descriptive statistics and Spearman's correlations to examine associations, controlling for clinic and examining response variability by clinic. RESULTS: Of 72 clinicians, 64% were female and 32% non-white. About 56% had worked at least 4 years and half worked 5 to 6 half days/week or more in their clinic. Clinicians who reported having someone on the clinician's care team routinely schedule follow-up appointments for patients with complex chronic illnesses reported lower stress and burnout. Those who perceived greater values alignment with their clinic and greater personal and employee equitable treatment had lower stress and burnout. CONCLUSIONS: Teamwork among clinicians and non-clinical staff, a component of teamwork that is not well-considered in current literature, could be an important piece of the puzzle to decrease the persistent and challenging issue of stress and burnout among primary care clinicians.
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Agotamiento Profesional , Humanos , Femenino , Masculino , Estudios Transversales , Encuestas y Cuestionarios , Atención Primaria de Salud , PercepciónRESUMEN
BACKGROUND: The aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers. METHODS: Patients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic. RESULTS: Fifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now. CONCLUSION: The PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.
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Pandemias , Sistemas de Atención de Punto , Humanos , Proyectos Piloto , Atención a la Salud , Costos de la Atención en SaludRESUMEN
Toxigenic Corynebacterium diphtheriae strains cause diphtheria in humans. The toxigenic C. diphtheriae isolate NCTC13129 produces three distinct heterotrimeric pili that contain SpaA, SpaD, and SpaH, making up the shaft structure. The SpaA pili are known to mediate bacterial adherence to pharyngeal epithelial cells. However, to date little is known about the expression of different pili in various clinical isolates and their importance in bacterial pathogenesis. Here, we characterized a large collection of C. diphtheriae clinical isolates for their pilin gene pool by PCR and for the expression of the respective pilins by immunoblotting with antibodies against Spa pilins. Consistent with the role of a virulence factor, the SpaA-type pili were found to be prevalent among the isolates, and most significantly, corynebacterial adherence to pharyngeal epithelial cells was strictly correlated with isolates that were positive for the SpaA pili. By comparison, the isolates were heterogeneous for the presence of SpaD- and SpaH-type pili. Importantly, using Caenorhabditis elegans as a model host for infection, we show here that strain NCTC13129 rapidly killed the nematodes, the phenotype similar to isolates that were positive for toxin and all pilus types. In contrast, isogenic mutants of NCTC13129 lacking SpaA-type pili or devoid of toxin and SpaA pili exhibited delayed killing of nematodes with similar kinetics. Consistently, nontoxigenic or toxigenic isolates that lack one, two, or all three pilus types were also attenuated in virulence. This work signifies the important role of pili in corynebacterial pathogenesis and provides a simple host model to identify additional virulence factors.
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Caenorhabditis elegans/microbiología , Corynebacterium diphtheriae/metabolismo , Corynebacterium diphtheriae/patogenicidad , Fimbrias Bacterianas/metabolismo , Variación Genética , Animales , Carcinoma/microbiología , Línea Celular Tumoral , Corynebacterium diphtheriae/genética , Fimbrias Bacterianas/genética , Genotipo , Humanos , Neoplasias Faríngeas/microbiología , Fenotipo , VirulenciaRESUMEN
Purpose: The aim of this study was to utilize an intersectional framework to examine academic faculty's lived experiences during COVID-19. Specifically, we set out to: (1) describe the multiple intersectional identities (e.g., gender, race/ethnicity, rank, caregiver status, disability status) represented by the faculty, (2) examine potential disparities in well-being, workload, and productivity linked to these intersectional factors, and (3) identify qualitative themes endorsed by faculty as they relate to lived experiences during COVID-19. Methods: This was a cross-sectional mixed-methods research study. The Center for Women in Medicine and Science (CWIMS) at the University of Minnesota developed and implemented a survey between February-June of 2021 in response to national reports of disparities in the impacts of COVID-19 on faculty with lived experiences from multiple intersections. Results: There were 291 full-time faculty who participated in the study. Quantitative findings indicated that faculty with multiple intersectional identities (e.g., woman+assistant professor+caregiver+underrepresented in medicine) reported greater depression symptoms, work/family conflict, and stress in contrast to faculty with fewer intersectional identities. Furthermore, faculty with more intersectional identities reported higher clinical workloads and service responsibilities and lower productivity with regard to research article submissions, publications, and grant submissions in contrast to faculty with fewer intersectional identities. Qualitative findings supported quantitative findings and broadened understanding of potential underlying reasons. Conclusions: Findings confirm anecdotal evidence that faculty with lived experiences from multiple intersections may be disproportionately experiencing negative outcomes from the pandemic. These findings can inform decisions about how to address these disparities moving into the next several years with regard to promotion and tenure, burnout and well-being, and faculty retention in academic medical settings. Given these findings, it is also important to intentionally plan responses for future public health crises to prevent continued disparities for faculty with multiple intersectional identities.
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COVID-19 , Marco Interseccional , Humanos , Femenino , Carga de Trabajo , Estudios Transversales , Pandemias , Docentes MédicosRESUMEN
Rrp1 is the sole c-di-GMP-producing protein (diguanylate cyclase) of Borrelia burgdorferi. To test the hypothesis that Rrp1 regulates critical processes involved in the transmission of spirochetes between ticks and mammals, an rrp1 deletion mutant (B31-Δrrp1) and a strain that constitutively produces elevated levels of Rrp1 (B31-OV) were constructed. The strains were assessed for progression through the enzootic cycle using an Ixodes tick/C3H-HeJ mouse model and tick immersion feeding methods. B31-Δrrp1 infected mice as efficiently as wild type but had altered motility, decreased chemotactic responses to N-acetylglucosamine (NAG) and attenuated ability to disseminate or colonize distal organs. While this strain infected mice, it was not able to survive in ticks. In contrast, B31-OV displayed normal motility patterns and chemotactic responses but was non-infectious in mice. Using immersion feeding techniques, we demonstrate that B31-OV can establish a population in ticks and survive exposure to a natural bloodmeal. The results presented here indicate Rrp1, and by extension, c-di-GMP, are not strictly required for murine infection, but are required for the successful establishment of a productive population of B. burgdorferi in ticks. These analyses provide significant new insight into the genetic regulatory mechanisms of the Lyme disease spirochetes.
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Borrelia burgdorferi/enzimología , Borrelia burgdorferi/patogenicidad , Proteínas de Escherichia coli/metabolismo , Ixodes/microbiología , Enfermedad de Lyme/microbiología , Liasas de Fósforo-Oxígeno/metabolismo , Factores de Virulencia/metabolismo , Animales , Borrelia burgdorferi/genética , Borrelia burgdorferi/fisiología , Quimiotaxis , Modelos Animales de Enfermedad , Proteínas de Escherichia coli/genética , Eliminación de Gen , Expresión Génica , Locomoción , Ratones , Ratones Endogámicos C3H , Viabilidad Microbiana , Liasas de Fósforo-Oxígeno/genética , Enfermedades de los Roedores/microbiología , Virulencia , Factores de Virulencia/genéticaRESUMEN
Objectives: Determine whether there are different longitudinal patterns of treatment burden in people living with multiple chronic conditions (MCC) and, if so, explore predictors that might reveal potential routes of intervention. Methods: We analyzed data from a prospective mailed survey study of 396 adults living with MCC in southeastern Minnesota, USA. Participants completed a measure of treatment burden, the Patient Experience with Treatment and Self-management (PETS), and valid measures of health-related and psycho-social concepts at baseline, 6, 12, and 24 months. Latent class growth mixture modeling (LCGM) determined trajectories of treatment burden in two summary index scores of the PETS: Workload and Impact. Multivariable logistic regressions were used to identify independent predictors of the trajectories. Results: LCGM supported a 2-class model for PETS Workload, including a group of consistently high workload (N = 69) and a group of consistently low workload (N = 311) over time. A 3-class model was supported for PETS Impact, including groups of consistently high impact (N = 62), consistently low impact (N = 278), and increasing impact (N = 51) over time. Logistic regression analyses showed that the following factors were associated with patterns of consistently high or increasing treatment burden over time: lower health literacy, lower self-efficacy, more interpersonal challenges with others, and worse subjective reports of physical and mental health (all p < .05). Conclusions: Different longitudinal patterns of treatment burden exist among people with MCC. Raising health literacy, enhancing self-efficacy, and lessening the effects of negative social interactions might help reduce treatment burden.
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Pathogenic members of the genus Corynebacterium cause a wide range of serious infections in humans including diphtheria. Adhesion to host cells is a crucial step during infection. In Corynebacterium diphtheriae, adhesion is mediated primarily by filamentous structures called pili or fimbriae that are covalently attached to the bacterial cell wall. C. diphtheriae produces three distinct pilus structures, SpaA-, SpaD- and SpaH-type pili. Similar to other types, the prototype SpaA pilus consists of SpaA forming the pilus shaft and two minor pilins SpaB and SpaC located at the base and at the tip, respectively. The minor pilins SpaB/SpaC are critical for bacterial binding to human pharyngeal cells, and thus represent the major adhesins of corynebacteria. Like pili of many other gram-positive microbes, the assembly of corynebacterial pili occurs by a two-step mechanism, whereby pilins are covalently polymerized by a transpeptidase enzyme named pilin-specific sortase and the generated pilus polymer is subsequently anchored to the cell wall peptidoglycan via the base pilin by the housekeeping sortase or a non-polymerizing sortase. This chapter reviews the current knowledge of corynebacterial adhesion, with a specific focus on pilus structures, their assembly, and the mechanism of adhesion mediated by pili.
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Adhesión Bacteriana/fisiología , Corynebacterium/fisiología , Corynebacterium/patogenicidad , Adhesinas Bacterianas/genética , Adhesinas Bacterianas/fisiología , Adhesión Bacteriana/genética , Corynebacterium/genética , Corynebacterium diphtheriae/patogenicidad , Corynebacterium diphtheriae/fisiología , Difteria/epidemiología , Difteria/etiología , Difteria/historia , Fimbrias Bacterianas/genética , Fimbrias Bacterianas/fisiología , Genes Bacterianos , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Interacciones Huésped-Patógeno/fisiología , Humanos , Modelos Biológicos , Virulencia/genética , Virulencia/fisiologíaRESUMEN
INTRODUCTION: New hypertension guidelines in the United States may require more people to take multiple medications or implement lifestyle changes. Increased treatment burden may be an unintended consequence and lead to worse health outcomes. Our study examined whether treatment burden is associated with factors related to self-management in those with hypertension. METHODS: We conducted a cross-sectional mailed survey of patients from 2 medical centers in Minnesota. Participants with 2 or more medical conditions completed the Patient Experience with Treatment and Self-management (PETS), a validated treatment burden questionnaire, as well as measures of confidence in self-management ability, health literacy, health care-related financial difficulties, and perception of provider interpersonal skills. We used partial correlation analyses, controlling for age, sex, race, and education, to test relationships among study variables. RESULTS: Of 254 respondents who had a diagnosis of hypertension, 54% were female, 74% were non-Hispanic White, and the mean age was 67 years. People with hypertension who reported having lower confidence in self-management ability, lower health literacy, more financial difficulties, and health care providers with poorer interpersonal skills reported higher treatment burden scores (PETS scales correlation magnitude range 0.09 to 0.62, P < .05 on all but 4). The strongest associations were observed for medical information and physical/mental exhaustion with self-management (correlation magnitudes from 0.25 to 0.54, P < .01). DISCUSSION: Hypertension treatment guideline stringent blood pressure criteria may lead to more interventions-medical or lifestyle-creating strains on populations already challenged by abstract disease self-management and at risk of experiencing disparities in cardiovascular health outcomes.
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Hipertensión , Automanejo , Anciano , Estudios Transversales , Femenino , Humanos , Hipertensión/terapia , Evaluación del Resultado de la Atención al Paciente , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Two-component systems (TCS) are universal among bacteria and play critical roles in gene regulation. Our understanding of the contributions of TCS in the biology of the Borrelia is just now beginning to develop. Borrelia burgdorferi, a causative agent of Lyme disease, harbours a TCS comprised of open reading frames (ORFs) BB0419 and BB0420. BB0419 encodes a response regulator designated Rrp1, and BB0420 encodes a hybrid histidine kinase-response regulator designated Hpk1. Rrp1, which contains a conserved GGDEF domain, undergoes phosphorylation and produces the secondary messenger, cyclic diguanylate (c-di-GMP), a critical signaling molecule in numerous organisms. However, the regulatory role of the Rrp1-Hpk1 TCS and c-di-GMP signaling in Borrelia biology are unexplored. In this study, the distribution, conservation, expression and potential global regulatory capability of Rrp1 were assessed. rrp1 was found to be universal and highly conserved among isolates, co-transcribed with hpk1, constitutively expressed during in vitro cultivation, and significantly upregulated upon tick feeding. Allelic exchange replacement and microarray analyses revealed that the Rrp1 regulon consists of a large number of genes encoded by the core Borrelia genome (linear chromosome, linear plasmid 54 and circular plasmid 26) that encode for proteins involved in central metabolic processes and virulence mechanisms including immune evasion.
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Proteínas Bacterianas/metabolismo , Borrelia burgdorferi/metabolismo , GMP Cíclico/análogos & derivados , Secuencia de Aminoácidos , Proteínas Bacterianas/genética , Borrelia burgdorferi/genética , GMP Cíclico/metabolismo , Eliminación de Gen , Perfilación de la Expresión Génica , Regulación Bacteriana de la Expresión Génica , Genes Bacterianos , Genes Reguladores , Datos de Secuencia Molecular , Mutagénesis , Análisis de Secuencia por Matrices de Oligonucleótidos , ARN Bacteriano/genética , Regulón , Alineación de Secuencia , Análisis de Secuencia de ADNRESUMEN
Colorectal Cancer (CRC) is common in Lao Americans, but screening is suboptimal. To investigate CRC screening rates of Lao Americans in Minnesota, and how predisposing characteristics, enabling resources, and perceived need are associated with screening. We conducted a convenience-sample cross-sectional survey of 50-75-year-old Lao Americans, using step-wise multivariate logistic regression to identify factors associated with ever being screened. Of the 118 survey participants, 45% ever received CRC screening. In univariate regression, some enabling resources (having a primary care provider, higher self-efficacy in pursuing screening) and perceived needs (knowledge of who should be screened, higher number of chronic illnesses) were associated with screening. In multivariate logistic regression, the odds of ever being screened was 12.4 times higher for those with a primary care provider than for those without (p = 0.045). The findings reinforce a need for developing culturally tailored interventions focused on Lao-American immigrants to promote CRC screening.
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Asiático , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etnología , Detección Precoz del Cáncer , Emigrantes e Inmigrantes , Tamizaje Masivo , Anciano , Estudios Transversales , Femenino , Humanos , Laos/etnología , Masculino , Persona de Mediana Edad , Minnesota , Encuestas y CuestionariosRESUMEN
Borrelia burgdorferi CspZ (BBH06/BbCRASP-2) binds the complement regulatory protein factor H (FH) and additional unidentified serum proteins. The goals of this study were to assess the ligand binding capability of CspZ orthologs derived from an extensive panel of human Lyme disease isolates and to further define the molecular basis of the interaction between FH and CspZ. While most B. burgdorferi CspZ orthologs analyzed bound FH, specific, naturally occurring polymorphisms, most of which clustered in a specific loop domain of CspZ, prevented FH binding in some orthologs. Sequence analyses also revealed the existence of CspZ phyletic groups that correlate with FH binding and with the relationships inferred from ribosomal spacer types (RSTs). CspZ type 1 (RST1) and type 3 (RST3) strains bind FH, while CspZ type 2 (RST2) strains do not. Antibody responses to CspZ were also assessed. Anti-CspZ antibodies were detected in mice by week 2 of infection, indicating that there was expression during early-stage infection. Analyses of sera collected from infected mice suggested that CspZ production continued over the course of long-term infection as the antibody titer increased over time. While antibody to CspZ was detected in several human Lyme disease serum samples, the response was not universal, and the titers were generally low. Vaccination studies with mice demonstrated that while CspZ is immunogenic, it does not elicit an antibody that is protective or that inhibits dissemination. The data presented here provide significant new insight into the interaction between CspZ and FH and suggest that there is a correlation between CspZ production and dissemination. However, in spite of its possible contributory role in pathogenesis, the immunological analyses indicated that CspZ is likely to have limited potential as a diagnostic marker and vaccine candidate for Lyme disease.
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Proteínas Bacterianas/metabolismo , Borrelia burgdorferi/patogenicidad , Factor H de Complemento/metabolismo , Enfermedad de Lyme/microbiología , Factores de Virulencia/metabolismo , Secuencia de Aminoácidos , Estructuras Animales/microbiología , Animales , Anticuerpos Antibacterianos/sangre , Proteínas Bacterianas/inmunología , Borrelia burgdorferi/inmunología , Borrelia burgdorferi/aislamiento & purificación , Análisis por Conglomerados , Humanos , Enfermedad de Lyme/inmunología , Ratones , Datos de Secuencia Molecular , Filogenia , Polimorfismo Genético/genética , Unión Proteica , Homología de Secuencia de Aminoácido , Factores de Virulencia/inmunologíaRESUMEN
Nothing is currently known regarding the global regulatory networks of Treponema denticola and other oral spirochetes. In this report, we assess the properties and potential phosphotransfer capability of a putative two-component regulatory system (TCS) of T. denticola that is formed by the products of open reading frames tde0032 (a sensor kinase) and tde0033 (a response regulator), henceforth designated AtcS and AtcR, respectively. Using PCR and DNA sequence analyses, atcS and atcR were demonstrated to be widely distributed and conserved among T. denticola isolates. Reverse transcription-PCR (RT-PCR) analyses revealed that these genes are cotranscribed and may also be expressed as part of a larger operon that includes several flanking genes. Analyses using 5' rapid amplification of cDNA ends identified the transcriptional start sites for these operons and provided evidence that some of these genes may be independently transcribed from internal promoters. Real-time RT-PCR and Western blot analysis revealed significant upregulation of atcRS during late-stage growth, indicating growth-phase-dependent expression. Lastly, the phosphorelay capability of the AtcRS system was assessed and demonstrated using recombinant proteins. AtcS was found to undergo autophosphorylation and to transfer phosphate to AtcR. These analyses represent the first description of a functional TCS in an oral spirochetes and provide insight into the transcriptional regulatory mechanisms of these important bacteria.
Asunto(s)
Proteínas Bacterianas/genética , Regulación Bacteriana de la Expresión Génica , Enfermedades Periodontales/microbiología , Treponema denticola/crecimiento & desarrollo , Treponema denticola/genética , Infecciones por Treponema/microbiología , Secuencia de Aminoácidos , Proteínas Bacterianas/química , Proteínas Bacterianas/metabolismo , Secuencia de Bases , Humanos , Datos de Secuencia Molecular , Sistemas de Lectura Abierta , Operón , Fosforilación , Regiones Promotoras Genéticas , Estructura Terciaria de Proteína , Transcripción Genética , Treponema denticola/química , Treponema denticola/metabolismoRESUMEN
PURPOSE: To examine the reach, efficacy, and adoption of The Bigger Picture, a type 2 diabetes (T2DM) social marketing campaign that uses spoken-word public service announcements (PSAs) to teach youth about socioenvironmental conditions influencing T2DM risk. DESIGN: A nonexperimental pilot dissemination evaluation through high school assemblies and a Web-based platform were used. SETTING: The study took place in San Francisco Bay Area high schools during 2013. SUBJECTS: In the study, 885 students were sampled from 13 high schools. INTERVENTION: A 1-hour assembly provided data, poet performances, video PSAs, and Web-based platform information. A Web-based platform featured the campaign Web site and social media. MEASURES: Student surveys preassembly and postassembly (knowledge, attitudes), assembly observations, school demographics, counts of Web-based utilization, and adoption were measured. ANALYSIS: Descriptive statistics, McNemar's χ2 test, and mixed modeling accounting for clustering were used to analyze data. RESULTS: The campaign included 23 youth poet-created PSAs. It reached >2400 students (93% self-identified non-white) through school assemblies and has garnered >1,000,000 views of Web-based video PSAs. School participants demonstrated increased short-term knowledge of T2DM as preventable, with risk driven by socioenvironmental factors (34% preassembly identified environmental causes as influencing T2DM risk compared to 83% postassembly), and perceived greater personal salience of T2DM risk reduction (p < .001 for all). The campaign has been adopted by regional public health departments. CONCLUSION: The Bigger Picture campaign showed its potential for reaching and engaging diverse youth. Campaign messaging is being adopted by stakeholders.