Recipient clinical risk factors predominate in possible transfusion-related acute lung injury.

BACKGROUND: Possible transfusion-related acute lung injury (pTRALI) cases by definition have a clear temporal relationship to an alternative recipient risk factor for acute respiratory distress syndrome (ARDS). We questioned whether transfusion factors are important for the development of pTRALI. STUDY DESIGN AND METHODS: In this nested case-control study, we prospectively identified 145 consecutive patients with pTRALI and randomly selected 163 transfused controls over a 4-year period at the University of California at San Francisco and the Mayo Clinic (Rochester, Minnesota). RESULTS: For pTRALI, we found evidence against transfusion being important: receipt of plasma from female donors (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.29-2.3; p = 0.70), total number of units transfused (OR, 0.99; 95% CI, 0.89-1.10; p = 0.86), and number of red blood cell and whole blood units transfused (OR, 0.78; 95% CI, 0.59-1.03; p = 0.079). In contrast, we found that risk for pTRALI was associated with additional recipient factors: chronic alcohol abuse (OR, 12.5; 95% CI, 2.8-55; p < 0.001), current smoker (OR, 4.2; 95% CI, 1.67-10.8; p = 0.0024), shock before transfusion (OR, 4.6; 95% CI, 2.0-10.7; p < 0.001), and positive fluid balance before transfusion (OR, 1.32/L; 95% CI, 1.20-1.44; p < 0.001). CONCLUSION: Recipient risk factors for ARDS rather than transfusion risk factors predominate in pTRALI.

Prospective study on the clinical course and outcomes in transfusion-related acute lung injury*.

OBJECTIVE: Transfusion-related acute lung injury is the leading cause of transfusion-related mortality. A prospective study using electronic surveillance was conducted at two academic medical centers in the United States with the objective to define the clinical course and outcomes in transfusion-related acute lung injury cases. DESIGN: Prospective case study with controls. SETTING: University of California, San Francisco and Mayo Clinic, Rochester. PATIENTS: We prospectively enrolled 89 patients with transfusion-related acute lung injury, 164 transfused controls, and 145 patients with possible transfusion-related acute lung injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients with transfusion-related acute lung injury had fever, tachycardia, tachypnea, hypotension, and prolonged hypoxemia compared with controls. Of the patients with transfusion-related acute lung injury, 29 of 37 patients (78%) required initiation of mechanical ventilation and 13 of 53 (25%) required initiation of vasopressors. Patients with transfusion-related acute lung injury and possible transfusion-related acute lung injury had an increased duration of mechanical ventilation and increased days in the ICU and hospital compared with controls. There were 15 of 89 patients with transfusion-related acute lung injury (17%) who died, whereas 61 of 145 patients with possible transfusion-related acute lung injury (42%) died and 7 of 164 of controls (4%) died. Patients with transfusion-related acute lung injury had evidence of more systemic inflammation with increases in circulating neutrophils and a decrease in platelets compared with controls. Patients with transfusion-related acute lung injury and possible transfusion-related acute lung injury also had a statistically significant increase in plasma interleukin-8, interleukin-10, and interleukin-1 receptor antagonist posttransfusion compared with controls. CONCLUSIONS: In conclusion, transfusion-related acute lung injury produced a condition resembling the systemic inflammatory response syndrome and was associated with substantial in-hospital morbidity and mortality in patients with transfusion-related acute lung injury compared with transfused controls. Patients with possible transfusion-related acute lung injury had even higher in-hospital morbidity and mortality, suggesting that clinical outcomes in this group are mainly influenced by the underlying acute lung injury risk factor(s).

Health, community, and spirituality: evaluation of a multicultural faith-based diabetes prevention program.

PURPOSE: The purpose of this study was to evaluate Fine, Fit, and Fabulous (FFF), a faith-based diabetes prevention program for black and Latino congregants at churches in low-income New York City neighborhoods. FFF includes nutrition education and fitness activities while incorporating Bible-based teachings that encourage healthy lifestyles. METHODS: FFF is a 12-week, bilingual program developed by the Bronx Health REACH coalition, a Centers for Disease Control and Prevention-funded Center of Excellence for the Elimination of Disparities. This program has been implemented in 15 Bronx and Harlem churches, engaging a primarily black and Latino overweight and obese urban population. Pre-post surveys, nutrition tests, and weight logs were collected to assess knowledge, attitudes, and behaviors regarding healthy eating and physical activity. RESULTS: Participants (n = 183) reported statistically significant improvements in knowledge and healthy behaviors from baseline. Increased numbers of participants reported exercising in the past 30 days, eating fruit daily, being able to judge portion sizes, and reading food labels. Statistically significant numbers reported that they ate less fast food and were less likely to overeat at follow-up. The average weight loss across churches was 4.38 lbs or 2% of participants' initial body weight. Significant differences were observed when stratifying by race/ethnicity. CONCLUSION: Evaluation results show FFF's success at engaging overweight adults in behavior changes related to healthy eating and exercise. FFF demonstrates the potential of faith-based health interventions to address obesity and diabetes risk in high-need communities of color.

Dietary patterns in Blacks and Hispanics with diagnosed diabetes in New York City's South Bronx.

BACKGROUND: An understanding of dietary patterns in diverse populations may guide the development of food-based, rather than nutrient-based, recommendations. OBJECTIVE: We identified and determined predictors of dietary patterns in low-income black and Hispanic adults with diagnosed diabetes. DESIGN: A food-frequency questionnaire was used to assess dietary intake in 235 adults living in the South Bronx, New York City, NY. We used principal factor analysis with promax rotation to identify dietary patterns. Multivariate linear regression models were used to test associations between demographic variables and dietary pattern scores. RESULTS: The following 5 dietary patterns were identified: pizza and sweets, meats, fried foods, fruit and vegetables, and Caribbean starch. The Caribbean starch and fruit and vegetables patterns were high in fruit and vegetables and low in trans fats. In multivariate analyses, sex, language spoken, years living in the United States, and region of birth were significant predictors of dietary patterns. Compared with English speakers, Spanish speakers were less likely to have high scores in pizza and sweets (P = 0.001), meat (P = 0.004), and fried food (P = 0.001) patterns. Participants who lived longer in the United States were less likely to have a meat (P = 0.024) or Caribbean starch pattern (P < 0.001). In Hispanics, the consumption of foods in the Caribbean starch pattern declined for each year that they lived in the United States. CONCLUSIONS: In adults with diagnosed diabetes who were living in the South Bronx, a Caribbean starch pattern, which included traditional Hispanic and Caribbean foods, was consistent with a healthier dietary pattern. In developing dietary interventions for this population, one goal may be to maintain healthy aspects of traditional diets. This trial was registered at clinicaltrials.gov as NCT00797888.

Transfusion-related acute lung injury: incidence and risk factors.

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To determine TRALI incidence by prospective, active surveillance and to identify risk factors by a case-control study, 2 academic medical centers enrolled 89 cases and 164 transfused controls. Recipient risk factors identified by multivariate analysis were higher IL-8 levels, liver surgery, chronic alcohol abuse, shock, higher peak airway pressure while being mechanically ventilated, current smoking, and positive fluid balance. Transfusion risk factors were receipt of plasma or whole blood from female donors (odds ratio = 4.5, 95% confidence interval [CI], 1.85-11.2, P = .001), volume of HLA class II antibody with normalized background ratio more than 27.5 (OR = 1.92/100 mL, 95% CI, 1.08-3.4, P = .03), and volume of anti-human neutrophil antigen positive by granulocyte immunofluoresence test (OR = 1.71/100 mL, 95% CI, 1.18-2.5, P = .004). Little or no risk was associated with older red blood cell units, noncognate or weak cognate class II antibody, or class I antibody. Reduced transfusion of plasma from female donors was concurrent with reduced TRALI incidence: 2.57 (95% CI, 1.72-3.86) in 2006 versus 0.81 (95% CI, 0.44-1.49) in 2009 per 10 000 transfused units (P = .002). The identified risk factors provide potential targets for reducing residual TRALI.

Survey of transfusion policies at US and Canadian children's hospitals in 2008 and 2009.

BACKGROUND: Previous surveys have reported variation in transfusion practice or policies in specific pediatric populations. Our objective was to determine the current transfusion policies in US and Canadian children's hospitals for both neonatal and pediatric general populations. STUDY DESIGN AND METHODS: US and Canadian blood bank (BB) personnel at children's hospitals that provide blood products between the dates of October 2008 and January 2009 were surveyed. RESULTS: Of the 90 US and Canadian children's hospitals identified, 51 (56.7%) blood bankers or their designees responded. There were 42 of 51 (82.4%) respondents from the United States and 9 of 51 (17.6%) from Canada. There was wide variation in beliefs regarding the effect of red blood cell (RBC) storage age on outcomes with 66.6% of respondents interested in a prospective randomized trial in critically ill children. There was also wide variation in policies restricting the storage age of RBCs according to patient age and clinical condition. In the United States 28 of 33 (84.8%) respondents provide universal leukoreduction of RBCs whereas it is 9 of 9 (100%) in Canada. Variation of policies existed for RBC irradiation and washing. The majority of respondents indicated that RBC transfusions were audited if the pretransfusion hemoglobin level was more than 8 to 10mg/dL. Fresh whole blood is available at 6 of 40 (15%) responding children's hospitals. CONCLUSIONS: There is a wide variation in BB policies regarding RBC transfusions at children's hospitals in the United States and Canada. Prospective randomized controlled trials are needed to allow for evidence-based standards of care regarding RBC transfusions.

Stirring up the mud: using a community-based participatory approach to address health disparities through a faith-based initiative.

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institutionalization and sustainability.