Feasibility of tracking invasive Escherichia coli disease among older adults in a community setting: A prospective observational study.

PURPOSE: Invasive Escherichia coli disease (IED) encompasses a diverse range of sterile site infections. This study evaluated the feasibility of capturing IED among community-dwelling older adults to inform the implementation of a phase 3 efficacy trial of a novel vaccine against IED (NCT04899336). METHODS: EXPECT-1 (NCT04087681) was a prospective, multinational, observational study conducted in medically stable participants aged ≥ 60 years. At least 50% of participants were selected based on a history of urinary tract infection (UTI) in the previous 10 years. The main outcomes were the incidence of IED and the number of hospitalisations reported by the site vs participant. The length of follow-up was 12 months. In a US-based substudy, a smartphone-based geofencing was evaluated to track hospital entries. RESULTS: In total, 4470 participants were enrolled (median age, 70.0 years); 59.5% (2657/4469) of participants had a history of UTI in the previous 10 years. Four IED events were captured through deployment of different tracking methods: a self-report, a general practitioner (GP) report, and a follow-up call. The incidence rate of IED was 98.6 events per 100,000 person-years. The number of reported hospitalisations was 2529/4470 (56.6%) by the site and 2177/4470 (48.7%) by participants; 13.8% of hospitalisations would have been missed if utilising only site reports. Geofencing detected 72 hospital entries. CONCLUSION: Deployment of multiple tracking methods can optimise detection of IED among community-dwelling older adults. Older adults with a history of UTI could be feasibly targeted for a phase 3 vaccine efficacy trial through a network of GPs.

Community health ambassadors: a model for engaging community leaders to promote better health in North Carolina.

Despite public health efforts to address burden of diseases within communities such as diabetes, health disparities remain. Traditional lay health advisor models help address these issues. Yet, few, if any, have a statewide focus that includes education credit and involves broad-based partnerships. The Community Health Ambassadors Program (CHAP) is a training and education demonstration program designed to engage leaders from diverse communities to help eliminate health disparities in North Carolina. The program's current focus is on improving diabetes awareness, management, and prevention. CHAP involves multiple state and local community and healthcare professional partnerships, the community college system, and tribal, community-, and faith-based organizations. CHAP components include recruitment, training (classroom and interactive instruction, fieldwork, and continuing education credits), monitoring/evaluation, and support/education. Since CHAP's inception in June 2006, 146 community health ambassadors (CHAs) from 17 counties have been trained. Preliminary evaluation of the CHA community activities include one-on-one diabetes self-management tips, diabetes talks, and recruitment of citizens to sign healthy living pledges. CHAP may be a comprehensive and cost-effective model for promoting multilevel involvement of community leaders and diverse organizations to concentrate on diabetes health disparities within the state. CHAP will be implemented in the future to address the state's other prevailing health problems.