First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.

BACKGROUND: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. AIM: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. METHODS: This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. RESULTS: Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service. CONCLUSION: An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

Seasonal influenza vaccination and technologies.

Seasonal influenza is a serious respiratory illness that causes annual worldwide epidemics resulting in significant morbidity and mortality. Influenza pandemics occur about every 40 yrs, and may carry a greater burden of illness and death than seasonal influenza. Both seasonal influenza and pandemic influenza have profound economic consequences. The combination of current vaccine efficacy and viral antigenic drifts and shifts necessitates annual vaccination. New manufacturing technologies in influenza vaccine development employ cell culture and recombinant techniques. Both allow more rapid vaccine creation and production. In the past 5 years, brisk, highly creative activity in influenza vaccine research and development has begun. New vaccine technologies and vaccination strategies are addressing the need for viable alternatives to egg production methods and improved efficacy. At present, stubborn problems of sub-optimal efficacy and the need for annual immunization persist. There is an obvious need for more efficacious vaccines and improved vaccination strategies to make immunization easier for providers and patients. Mitigating this serious annual health threat remains an important public health priority.

High prevalence of diabetes among Indo-Guyanese adults, Schenectady, New York.

INTRODUCTION: The Indo-Guyanese population is the largest immigrant minority population in Schenectady, New York. A clinic-based study in Schenectady and surveillance reports from Guyana found high diabetes prevalence and mortality among Guyanese of Indian descent. No community-based study has focused on diabetes among Indo-Guyanese immigrants in the United States. We sought information on the prevalence of diabetes and its complications in Indo-Guyanese adults in Schenectady and compared it with the prevalence among non-Hispanic white adults in Schenectady. METHODS: We administered a cross-sectional health survey at community venues in Schenectady in 2011. We identified diagnosed diabetes and its complications through self-reports by using a reliability-tested questionnaire. The final data set included 313 Indo-Guyanese and 327 non-Hispanic white adults aged 18 years or older. We compared the prevalence of diagnosed diabetes and diabetes complications between Indo-Guyanese and non-Hispanic whites. RESULTS: Most Indo-Guyanese participants were born in Guyana, whereas most non-Hispanic whites were born in the United States. The crude prevalence of diagnosed diabetes among Indo-Guyanese participants and non-Hispanic whites was 30.3% and 16.1%, respectively. The age-standardized prevalence was 28.7% among Indo-Guyanese participants, significantly higher than that among non-Hispanic whites (14.5%, P < .001). Indo-Guyanese participants who had diabetes had a lower body mass index and were more likely to report poor or fair general health and eye or vision complications than non-Hispanic whites who had diabetes. CONCLUSION: Our study confirms the higher prevalence of diabetes in Indo-Guyanese adults in Schenectady. The higher prevalence of complications suggests poor control of diabetes. Excess burden of diabetes in this population calls for further research and public health action.

The 5-10-25 challenge: an observational study of a web-based wellness intervention for a global workforce.

We conducted and evaluated a 4-year, web-based wellness program involving 2498 global employees. The program was designed to encourage improvement in diet, exercise level, and weight control. Each month, after enrollment, participants were prompted to log on and enter personal data. Four years' worth of nonparametric data were analyzed. Seventy-seven percent of participants were men, 53% were overweight or obese, and mean beginning body mass index (BMI) was 25.9. Only 35% of starting participants ate five or more servings of fruit and vegetables daily, and fewer than 38% engaged in 30 min of activity or 10,000 steps. At the end of the intervention, there was a statistically significant (p < 0.05) improvement in the diet, exercise habits, and weight of participants. Results suggests that our web-based wellness intervention was successful in improving key health indicators for a mobile, global workforce.