A passive monitoring tool using hospital administrative data enables earlier specific detection of healthcare-acquired infections.

BACKGROUND: Healthcare-associated infections impose a significant burden on the healthcare system. Current methods for detecting these infections are constrained by combinations of high cost, long processing times and imperfect accuracy, reducing their effectiveness. METHODS: This study examined whether the amount of time a patient spends on a ward with other patients clinically suspected of infection, termed 'co-presence', can be used as a tool to predict subsequent healthcare-associated infection. Compared with contact tracing, this leverages passively collected electronic data rather than manually collected data, allowing for improved monitoring. All 133,304 inpatient records between 2011 and 2015 were abstracted from a healthcare system in the UK. The area under the receiver-operator curve (AUROC) for each of five pathogens was calculated based on co-presence time, sensitivity and specificity of the test, and how much earlier co-presence would have predicted infection for the true-positive cases. FINDINGS: For the five pathogens, AUROC ranged from 0.92 to 0.99, and was 0.52 for the negative control. Optimal cut-points of co-presence ranged from 25 to 59 h, and would have led to detection of true-positive cases up to an average of 1 day earlier. INTERPRETATION: These findings show that co-presence time would help to predict healthcare-acquired infection, and would do so earlier than the current standard of care. Using this measure prospectively in hospitals based on real-time data could limit the consequences of infection, both by being able to treat individual infected patients earlier, and by preventing potential secondary infections stemming from the original infected patient.

Colonoscopy use following mutation detection in Lynch syndrome: exploring a role for cancer screening in adaptation.

Lynch syndrome (LS) is the most common inherited form of colorectal cancer. Mutation carriers can reduce the morbidity and mortality associated with colorectal cancer through colonoscopy. Theoretical models suggest that such health-related behaviors might also bring psychological benefits. This study assessed whether colonoscopy following mutation detection was associated with the levels of depressive symptoms. Data were obtained from a prospective family cohort study offering genetic services for LS. Participants completed questionnaires prior to the provision of services and 6 months post-receipt of mutation results. One hundred thirty-four (134) persons were identified to carry a mutation and completed both the questionnaires. Main outcome measures were depressive symptoms 6 months post-receipt of test results. Mutation carriers who did not complete a colonoscopy within the 6 months following receipt of results were six times (p < 0.01; odds ratio = 6.06) more likely to report depressive symptoms at a level of clinical importance post-receipt of test results compared to those who did undergo colonoscopy. Facilitating the expeditious use of colonoscopy following mutation detection may benefit newly identified mutation carriers by addressing the objective risks for cancer and moderating underlying emotional distress responses to genetic risk information. Furthermore, depressive symptoms may interfere with behavioral compliance in some patients, suggesting referral to mental health specialists.

Age differences in genetic knowledge, health literacy and causal beliefs for health conditions.

OBJECTIVES: This study examined the levels of genetic knowledge, health literacy and beliefs about causation of health conditions among individuals in different age groups. METHODS: Individuals (n = 971) recruited through 8 community health centers in Suffolk County, New York, completed a one-time survey. RESULTS: Levels of genetic knowledge were lower among individuals in older age groups (26-35, p = 0.011; 36-49, p = 0.002; 50 years and older, p<0.001) compared to those in the youngest age group (18-25). Participants in the oldest age group also had lower health literacy than those in the youngest group (p <0.001). Those in the oldest group were more likely to endorse genetic (OR = 1.87, p = 0.008) and less likely to endorse behavioral factors like diet, exercise and smoking (OR = 0.55, p = 0.010) as causes of a person's body weight than those in the youngest group. Higher levels of genetic knowledge were associated with higher likelihood of behavioral attribution for body weight (OR = 1.25, p <0.001). CONCLUSIONS: Providing additional information that compensates for their lower genetic knowledge may help individuals in older age groups benefit from rapidly emerging genetic health information more fully. Increasing the levels of genetic knowledge about common complex diseases may help motivate individuals to engage in health promoting behaviors to maintain healthy weight through increases in behavioral causal attributions.

The impact of familial environment on depression scores after genetic testing for cancer susceptibility.

The associations between characteristics of family relationships and family trends in cancer worry and the psychological adjustment of recipients of genetic testing for cancer susceptibility were investigated. Data provided by 178 individuals from 24 families with Lynch syndrome who participated in a cohort study investigating psychological and behavioral outcomes of genetic testing were used. Responses from multiple family members were aggregated to construct family trends representing norms and departure from norms in cancer worry. Lower perceived family cohesion at baseline and decrease in this variable at 6 months after receipt of test results were associated with higher depression scores at 12 months. More variability in cancer worry among family members at baseline was also associated with higher depression scores at 12 months. Increase in family conflict was associated with decrease in depression scores among individuals from families with higher levels of cancer worry on average and less variability among the members. Family relationships and family trends in levels of cancer worry may play important roles in the psychological adjustment of genetic test recipients. The findings highlight the complexity of familial environment surrounding individuals that undergo genetic testing and suggest the benefits of considering these factors when providing genetic services.

Monitoring coping style moderates emotional reactions to genetic testing for hereditary nonpolyposis colorectal cancer: a longitudinal study.

OBJECTIVES: The emotional effects of genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) provided within a counseling program were assessed among 253 individuals. METHODS: Assessments were scheduled at baseline before testing, and again after 6 and 12 months post-test. Negative emotional reactions were evaluated using the Revised Impact of Event Scale and the Center for Epidemiological Studies-Depression Scale. Monitoring coping style was assessed at baseline using the Miller Behavioral Style Scale. RESULTS: Mean reductions were indicated in distress and depression levels within the first 6 months after counseling and testing. High monitors were generally more distressed than low monitors, specifically if they had indeterminate or positive results. CONCLUSIONS: Genetic counseling and testing for HNPCC do not result in long-term distress for most people. Of the variables investigated, only time and coping style have main effects on emotional reactions, and the impacts of mutation status are moderated by coping style. Psychological interventions, aimed to alleviate adverse emotional effects, were suggested for certain participants, i.e. recipients of positive or indeterminate results who are high monitors.

Monitoring recovery after injury: procedures for deriving the optimal test window.

Researchers studying the impact of treatments designed to facilitate recovery after neural injury face competing demands. On the one hand, because treatment effects often emerge slowly over days, and because researchers seek evidence of stable long-term effects, it is common practice to observe experimental subjects for many weeks after treatment. On the other hand, the cost of performing studies and the need to evaluate a multitude of alternative treatment procedures requires optimal efficiency, pushing researchers towards shorter test procedures. With these issues in mind, researchers have appeared to derive a test window based on previously published methodologies and inspection of their recovery curves, with testing terminated after the recovery curve reaches asymptote (approaches a slope of 0). An alternative procedure is introduced here that evaluates the stability of the data set over time. Using correlational techniques, researchers can determine whether (1) testing should be continued for additional days; or (2) equivalent statistical power can be achieved in fewer days. This provides a rational decision rule to help researchers balance competing demands. Applying these techniques to a procedure that evaluates the impact of acute treatments on recovery from spinal cord injury, it is shown that equal statistical power can be achieved in half the time, greatly increasing the efficiency with which alternative treatments can be evaluated.

Validation of the modified Fagerström tolerance questionnaire with salivary cotinine among adolescents.

This study was conducted to gain evidence of validity for a nicotine dependence measure for adolescent smokers. We hypothesized that the individual item responses and the total Fagerström Tolerance Questionnaire (FTQ) score would be positively correlated with cotinine values. We examined the relationship between a seven-item modified FTQ and saliva continine among 131 adolescent volunteers in a smoking cessation program. As anticipated, the total FTQ score was related to saliva cotinine (r = .40, p < .01), as were six of the seven individual FTQ items (p < .05). Our findings provide preliminary evidence that the modified FTQ scale is valid and applicable to adolescent smokers.

Gender differences in chronic disease risk behaviors through the transition out of high school.

BACKGROUND: Major life transitions (e.g., graduation from high school) are times when many changes occur in a person's social and physical environment. Men and women likely experience aspects of these changes differently. As a result, health-related behaviors likely change at these times with possible differences in these changes by gender. METHODS: Gender differences in the performance of chronic disease risk-related behaviors (fruit, juice, and vegetable intake; physical activity; tobacco and alcohol use; and sexual practices) through the transition out of high school (HS) were assessed in a secondary analysis of a nationally representative sample from the 1992 National Health Interview Survey-Youth Risk Behavior Survey. The survey was completed by 5881 young people aged 14 to 21 years. Regression discontinuity analysis with piecewise regression was performed. RESULTS: Statistically significant gender by transition effects were obtained for exercise/physical activity (decreases at the transition point for males), snuff use (decrease for females in HS), binge drinking and number of days drinking alcohol (increases for males at the transition point), and use of alcohol or drugs before sexual intercourse (decrease for females post HS). Fruit intake decreased for males and females and daily and heavy cigarette smoking increased during the HS years. Effect sizes were small but promising, given that the data set was not designed to test this hypothesis. CONCLUSION: These data offer evidence of differences by gender in chronic disease risk behaviors through the HS transition. Longitudinal studies are needed to assess the true nature of these differences, the tracking of these risk behaviors and their personal, social, and environmental determinants, including gender-specific determinants, that may explain these changes and inform future intervention development.

Smoking withdrawal and relapse in head and neck cancer patients.

BACKGROUND: Smoking withdrawal and relapse were characterized among newly diagnosed head and neck cancer patients participating in a physician-delivered smoking cessation intervention. METHODS: Patients completed questionnaires at baseline, 1, 6, and 12 months following intervention delivery. RESULTS: Significant baseline predictors of smoking relapse included medical treatment (XRT versus surgical treatment), stage of change/readiness to quit (precontemplators), age of initiation (younger), and greater addiction (smoking

Ethnic differences in cancer risk behaviors through the transition out of high school.

Differences were assessed by ethnic group in the performance of cancer risk related lifestyle behaviors through the transition out of high school. Data were obtained from a nationally representative probability sample survey, the 1992 National Health Interview Survey-Youth Risk Behavior Survey. A cross-sectional sub-sample included adolescents with an age range from high school freshmen to young adults within four years after high school. Self reported indicators of diet, physical activity, cigarette smoking, smokeless tobacco use, alcohol use, and sexual practices were the primary dependent measures. Cancer risk increased at the transition out of high school through changes in cancer related behaviors. Hispanic-American males experienced somewhat higher risks after the transition for chewing tobacco and snuff. African Americans experienced somewhat higher risks after the transition for physical activity, chewing tobacco, and number of sexual partners. Further research needs to verify these findings with longitudinal designs, assessment of tracking of behaviors through the transition, and of the ecological, social and psychosocial correlates that may explain why these changes occurred.

Measuring stage of change for fruit and vegetable consumption in 9- to 12-year-old girls.

This paper presents results of the pilot-testing of a stage of change measure for eating fruit and vegetables (F & V) in 9- to 12-year-old girls. During troop meetings, 259 girls from 22 troops completed a 1-day food recognition form, a brief stage of change algorithm for fruit and for vegetables, and a questionnaire measuring psychosocial variables associated with F & V consumption. Stages for F & V consumption were different and MANOVAs revealed overall significant differences across stages for each variable. F & V intake increased with higher stages, as did preferences, self-efficacy for selecting, preparing, and eating F & V, subjective norms, and F & V preparation skills; reported barriers decreased. Stepwise discriminant analyses between Precontemplation and Contemplation stages identified fruit preferences and barriers differentiating the two stages for fruit consumption and subjective norms and self-efficacy differentiating the two stages for vegetable consumption. Barriers and F & V preparation responsibilities/skills were significant between the Contemplation and the Action stages for both fruit and vegetable consumption, with the additional variable of subjective norms for fruit stage and vegetable preferences for vegetable stage. Findings support the use of this measure to identify stage for children's adoption of F & V consumption behavior and as a guide for intervention development.