The value of peer support for self-management of diabetes among veterans in the Empowering Patients In Chronic care intervention.

AIM: To examine the value of peer support in the self-management of diabetes among veterans in an integrated health care system. METHODS: We conducted semi-structured in-depth interviews with veterans and clinicians 6 months after their participation in Empowering Patients in Chronic Care (EPIC), a group-based diabetes intervention with a peer-support component. Interviews elicited clinicians' narratives of how peer support unfolded in the groups and veterans' experiences of giving and receiving support from their peers. Data analysis was guided by principles of framework analysis using Heisler's peer-support model. RESULTS: Findings support Heisler's peer-support model and provide evidence supporting professional-led group visits with peer exchange. Clinicians and veterans endorsed informational and emotional support received in EPIC groups. Clinicians often referred to EPIC as an open forum or a support group where veterans could both give and receive help. Veterans noted the benefits of shared problem-solving and the support they received. Clinicians and veterans perceived the peer-support component of EPIC as facilitating increased empowerment in terms of self-efficacy, increased perceived social support and increased understanding of self-care. Ultimately, many veterans acknowledged that their participation in EPIC facilitated improved health-related quality of life, improved health behaviours and improved chronic disease control. CONCLUSIONS: Findings emphasize the value of peer support in managing chronic illness. Peer-support programmes may address veterans' unique challenges and have the potential to improve physical and mental health.

Healthy People 2020: assessment of pharmacists' priorities.

OBJECTIVE: The purpose of this study was to assess perceptions of pharmacy educators on the priorities and roles of pharmacists in meeting the Healthy People 2020 objectives. STUDY DESIGN: Cross-sectional, qualitative online national survey. METHODS: A comprehensive literature review identified documented roles and responsibilities of pharmacists in addressing the 42 topic areas in Healthy People 2020. From this, a 14-item survey was developed to identify priorities of categories to improve the health of the nation and importance of the pharmacist role to achieve the objectives. The survey was sent electronically to the members of the Public Health Special Interest Group of the American Association of Colleges of Pharmacy in May and June 2014. RESULTS: Participants identified the following Healthy People 2020 categories as most important in improving the health of the nation: chronic diseases, health care services, lifestyle, prevention/well-being, and environmental factors. They identified the following Healthy People 2020 categories as possessing the most important roles for pharmacists in working to improve the health of the nation: chronic diseases, health care services, lifestyle, prevention/well-being, and infectious disease. CONCLUSIONS: There exists great congruence between top categories of importance and those that the pharmacist can impact to improve the health of the nation. The results of this study can guide efforts to educate and activate pharmacists as interprofessional team members improving health locally and globally.

Long-term phenotypic correction in factor IX knockout mice by using ΦC31 integrase-mediated gene therapy.

Hemophilia B, a hereditary bleeding disorder caused by a deficiency of coagulation factor IX (FIX), is an excellent candidate for gene therapy. However, to date, success in hemophilia gene therapy clinical trials has been limited due to failure to achieve or sustain therapeutic levels of factor expression. The ΦC31 integrase system efficiently integrates plasmid DNA carrying a transgene and an attB site into a limited number of endogenous pseudo attP sites in mammalian genomes, leading to robust, sustained transgene expression. A strategy utilizing plasmid DNA integrated with ΦC31 integrase may offer a facile and safe alternative for sustained human FIX (hFIX) expression. Hydrodynamic tail vein injection was used for delivery of plasmids encoding ΦC31 integrase and hFIX to the liver of FIX knockout mice. We demonstrated prolonged therapeutic levels of hFIX in this knockout mouse model of hemophilia B over a 6-month time course when ΦC31 integrase was used. Additionally, we observed sustained FIX activity in plasma and phenotypic correction of bleeding after tail clip in ΦC31-treated mice. In the livers that received integrase, we also demonstrated prolonged hFIX expression in hepatocytes by immunohistochemistry and documented sequence-specific genomic integration of the hFIX plasmid. These studies suggest the possibility that a similar approach in large animals and humans could lead to a simple and successful gene therapy for hemophilia.

Effect of nuclear localization and hydrodynamic delivery-induced cell division on phiC31 integrase activity.

Phage phiC31 integrase is a recombinase that can be expressed in mammalian cells to integrate plasmids carrying an attB sequence into the genome at specific pseudo attP locations. We show by immunofluoresence that wild-type phiC31 integrase is cytoplasmic and that addition of the SV40 nuclear localization signal (NLS) localized phiC31 integrase to the nucleus. Unexpectedly, the NLS depressed integration efficiency in HeLa cells and provided no benefit when used to integrate the human Factor IX (hFIX) gene into mouse liver. As breakdown of the nuclear membrane during mitosis could allow cytoplasmic integrase access to the chromosomes, we analyzed whether cell division was required for integration into liver cells in vivo. Hepatocytes were labeled with iododeoxyuridine to mark cells that underwent DNA replication during the week after hydrodynamic injection. Hydrodynamic delivery led to DNA replication in one-third of hepatocytes. Approximately three out of four cells having phiC31 integrase-mediated stable hFIX expression did not undergo replication, indicating that cell division was not required for integrase function in liver. Therefore, although the bulk of phiC31 integrase protein seems to be cytoplasmic in mammalian cells, integration can still occur in the nucleus, even without cell division.

Influence of uncertainty about a specialty's administrative status on students' specialty choices at a Florida medical school.

At the University of South Florida College of Medicine, there was a statistically significant drop in the number of 1990 graduates entering family practice residencies compared with the numbers entering during the previous decade. A retrospective analysis was carried out to determine what factors could have produced such a change and what specialties benefitted. The only factor identified was an administrative policy change that threatened the departmental status of the family medicine unit. Psychiatry was the only specialty choice that showed significant increases. The findings of this study suggest that medical students' selection of family practice as a specialty choice is detrimentally influenced by uncertainty about the family medicine unit's departmental status, and that family medicine may be competing with psychiatry for students' interest.

The influence on students' specialty selections of faculty evaluations and mini-board scores during third-year clerkships.

The authors investigated whether graduating students' specialty choices were influenced by favorable faculty evaluations and mini-Board scores during their third-year clerkships, and if so, whether the influences were gender-specific. Data were collected from a total of 53 students in two classes, 1988-89 and 1988-90. Univariate and multivariate tests were performed, and the results were analyzed between each class group and between genders in both groups. These results also were compared with information about the students gathered before they matriculated. In general, the results showed a gender-specific correlation: for each rotation where the women's faculty evaluations were significantly higher than the men's, the women subsequently outnumbered the men in choosing that rotation's specialty. Conversely, for each rotation where the men's mini-Board scores were significantly higher than the women's, the men outnumbered the women in choosing that rotation's specialty. The most notable difference was in pediatrics: 8% of the women had indicated an interest in that specialty on the prematriculation questionnaire, while almost one-third of the women in the classes of 1990 and 1991 chose pediatrics residencies. These findings suggest that the favorable scores and evaluations may be one of the influences for students' specialty choices, and that their influence may be gender-specific.

Matriculants' compliance with a required preventive health program.

Several organizations have made recommendations about medical students' health. To determine the University of South Florida College of Medicine's concurrence with published guidelines, a prospective analytic study of the 1990 entering class was carried out, using the 1989 class as a control. Enforcement measures not present in 1989 were initiated in 1990. The requirements for the 1990 matriculants were a history and physical examination; tuberculin testing; immunizations to rubella, rubeola, tetanus-diphtheria, and hepatitis B; status of immunity to chickenpox; and proof of health insurance. The results showed that in 1990 expensive requirements had the lowest rates of compliance, and inexpensive ones, the highest rates of compliance. Comparing 1990 with 1989 showed that the enforcement measures significantly improved compliance for expensive requirements, and for requirements that obligated a student to incur a fee because they needed to be updated. The authors conclude that cost is a major deterrent to compliance and that, in order to improve compliance, medical schools must either implement effective enforcement measures or transfer the cost from the student to the institution.

Influence of longitudinal primary care training on medical students' specialty choices.

BACKGROUND: At the University of South Florida College of Medicine, a program designed to give students four years of primary care training began in 1983. As of 1992, six classes that included program participants had graduated. The present study examined the effect of the program on the participants' choices of specialty by comparing their choices with those of other graduates. METHOD: Each year program volunteers were solicited from a class size of about 96 freshmen. Of the 201 volunteers from the classes of 1987-1992, 93 were randomly selected to participate in the program. The participants received primary care education one half-day per week in a community-based clinical setting. The specialty choices of the 543 graduates from 1987-1992 were determined from the National Resident Matching Program and were divided into primary care (family practice, internal medicine, pediatrics); surgery, obstetrics-gynecology, and psychiatry; and other (high-technology specialties). Comparisons were made (1) between volunteers and nonvolunteers and (2) between volunteers who were participants and those who were not. The Z-test was used, with alpha set at .01. RESULTS: Significantly more volunteers--with no difference between participants and nonparticipants--matched with primary care specialties, and more volunteers were women. Significantly more nonvolunteers matched with high-technology specialties--again, no difference between participants and nonparticipants. CONCLUSION: The program did not seem to influence the students' specialty choices, because students interested in participating--regardless of whether they actually participated--were more likely to match with primary care specialties and were more likely to be women.

Delayed-type skin hypersensitivity and in vitro lymphocyte immunostimulation responses of swine following inoculation with Mycobacterium avium cell walls and a mycobacterial immunopotentiating glycolipid.

Miniature swine (n = 5 per group) were inoculated intradermally with mineral oil-in-water emulsions containing either 150 micrograms of mycobacterial immunopotentiating glycolipid P3 (EP3), 150 micrograms of lyophilized Mycobacterium avium (serotype 8) cell walls (E-MaCW), or 150 micrograms P3 and 150 micrograms M. avium cell walls (EP3-MaCW). Swine vaccinated with E-MaCW and EP3-MaCW developed antigen-sensitive lymphocytes detectable with delayed-type hypersensitivity (DTH) skin tests and lymphocyte transformation assays. Swine injected with EP3 were not sensitized. In general EP3-MaCW evoked a more pronounced in vivo DTH tuberculin skin test and in vitro lymphocyte transformation responses than E-MaCW. Time-course studies indicated a more persistent response in swine injected with EP3-MaCW than in those given E-MaCW. Commercial type Yorkshire swine (n = 5) inoculated intradermally with EP3-MaCW developed cell-mediated immune (CMI) responses to avian tuberculin detectable in vivo with delayed-type skin hypersensitivity and in vitro with lymphocyte immunostimulation responses.

Laboratory findings associated with abomasal ulcers/tympany in range calves.

The etiology of abomasal ulcers/tympany was investigated in 48 animals from 36 ranches in Wyoming and Nebraska. Results indicate that subclinical trace mineral deficiencies of copper and/or selenium exist in the range cattle in west central Nebraska and Wyoming. Etiological agents most frequently incriminated by bacteriologic cultures and/or histopathic examination were Clostridium perfringens and Campylobacter species. Histopathologic evaluation of abomasums revealed 31 of 38 cases contained abundant gram-positive bacteria associated with the damaged abomasal mucosa. Campylobacter-like organisms were demonstrated in 9 of 38 cases using the modified Dieterle stain. Clostridium perfringens was isolated in 14 of 38 cases, and Campylobacter jejuni was recovered from 5 of 38 cases.

Prevalence and epidemiology of trichostrongylids in Wyoming cattle with consideration of the inhibited development of Ostertagia ostertagi.

During 1988, monthly collections of abomasa and the cranial portion of the small intestine of 208 native Wyoming cattle were examined for adult and larval helminth parasites. Egg counts were performed on colonic faecal specimens. The animals ranged from 7 months to 8 years of age and were sampled at slaughter houses or diagnostic laboratories from five different counties in the State. Most of the cattle had ranged for a long time on non-irrigated, high altitude grass plains from about 1250 to 2500 m above sea level. All animals examined were found infected. Nematode genera (and number of species) found included Ostertagia (4), Trichostrongylus (2), Haemonchus (1), Cooperia (4) and Nematodirus (2). One trematode, Fasciola hepatica, and a cestode, Moniezia benedeni, also were found. Trichostrongylus axei, Trichostrongylus longispicularis and Cooperia lyrata were found for the first time in Wyoming, Ostertagia circumcincta was found for the first time in cattle in Wyoming, and Haemonchus placei, tentatively identified in a previous survey, was definitively confirmed. Predominant species (and prevalence) were Ostertagia ostertagi (98%), Cooperia oncophora (60.6%), Ostertagia bisonis (41.8%), Cooperia bisonis (33.6%) and T. Axei (27.9%). One or more of the four species of Ostertagia were found in all animals. Inhibited O. ostertagi and O. bisonis larvae predominated from November to April and reached a peak in January to comprise 88% of the total nematode burden for that month. The adult population of abomasal nematodes peaked in April and predominated thereafter until October. Haemonchus placei also spent the autumn-winter period in an inhibited state of development. Faecal egg counts were lowest during winter months, when the highest number of worms were present as L4 larvae, as determined by luminal and mucosal counts. Nematode populations in the small intestine peaked in June and persisted until November. The results of this study showed the magnitude and species composition of nematode parasitism in cattle raised on high altitude grass plains, underscored the inaccuracy of faecal egg counts as an indicator of worm burden during fall and winter seasons, and provided information on which anthelmintic treatment timing would be most efficacious.

Scanning electron microscopy of in vitro serum-mediated destruction of juvenile Fasciola hepatica.

The tegumental surface of immature Fasciola hepatica was damaged when incubated in vitro with serum collected from an experimentally infected calf. Degeneration of the tegumental surface was observed by scanning electron microscopy (SEM) at 4 hr. after incubation. Decomposition was observed 8 to 12 hr after incubation and complete destruction of the tegument occurred by 16 hr. The flukes became inactive after 8 to 12 hr of incubation. None of the above findings were observed for the tegument of flukes incubated in tissue culture media or in media containing normal calf serum and the trematodes remained motile throughout the incubation period. Latex particles were used as an immunological marker for SEM studies to determine if gamma globulin could be responsible for the observed changes and, if so, the site of antibody attachment. The coated latex particles covered the entire surface of flukes recovered from mice 5 days after infection with metacercariae. In contrast, latex particles coated with either normal gamma globulin or gamma globulin from serum of the experimentally infected calf that had been adsorbed with disrupted adult flukes were not attached to the surface of the flukes. Absorption of the serum with disrupted, adult flukes decreased the concentrations of immunoglobulins (Ig)G1 and G2 whereas IgA and IgM were apparently not affected.

Does early clinical exposure enhance performance during third-year clerkship?

This study was undertaken to assess the effects of early clinical exposure in an indigent care free clinic on third-year clerkship mini-board scores (clinical knowledge), faculty evaluation (especially rapport with colleagues and patients), and final rotation grades. After completion of third-year clerkships, a sample of participants was compared with nonparticipants. Comparative statistics, repeated measure analysis, and analyses of variance were performed on the entire group as well as by sex and by individual rotation. No statistically significant differences were found in the mainframe, but subgroup findings indicate further study is warranted. Negative findings might be explained in part by small sample size and the fact that the clinic is exclusively outpatient, while the third-year clerkship experience is inpatient. Data collection is being continued, and studies are ongoing to look at the long-term effect of the program on participants.

Immunoglobulin levels in serum and colostral whey or protein-metabolisable energy restricted beef cows.

Aberdeen Angus cows were fed adequate diets or diets restricted in protein and, or metabolisable energy for the last 156 days of gestation to determine effects of nutritional restriction on concentrations of immunoglobulins in serum and colostral whey. There were no significant interactions between the effects of low protein and metabolisable energy on immunoglobulin concentrations. Thus, observed differences in immunoglobulin concentrations between the restricted and adequate dietary groups were attributed to the main effects of treatment. Low protein or metabolisable energy had little overall effect on serum IgM concentrations although levels began to decrease sooner in gestation in restricted animals than in those fed adequate diets. Concentrations of IgG1 in serum of all animals were similar and a precipitous decrease in concentration was noted at about 240 days of gestation and this decrease continued until parturition. Serum IgG2 concentrations increased in all animals as parturition approached. Immunoglobulin concentrations in colostral whey were either similar to or tended to be slightly higher in dietary restricted animals than in animals fed adequate diets although the differences were not significant.

Effects of supplemental protein type on productivity of primiparous beef cows.

Effects of supplemental degradable (DIP) and undegradable (UIP) intake protein on forage intake, BW change, body condition score (BCS), postpartum interval to first estrus, conception rate, milk production and composition, serum metabolites and metabolic hormones, and calf gain were determined using 36 primiparous Gelbvieh x Angus rotationally crossed beef cows. On d 3 postpartum, cows (average initial BW = 495 +/- 10 kg and BCS = 5.5 +/- 0.1) were randomly assigned to one of three dietary supplements (12 cows/treatment). Date of parturition was evenly distributed across treatment (average span of calving date among treatments = 2.4 +/- 2.5 d). Individually fed (d 3 through 120 postpartum) dietary supplements were 0.82 kg of corn and 0.23 kg of soybean meal per day (DIP), the DIP + 0.12 kg of blood meal and 0.13 kg of corn gluten meal per day (DIP + UIP), and 0.82 kg of corn, 0.07 kg of blood meal, and 0.08 kg of corn gluten meal per day in an isonitrogenous replacement of soybean meal (UIP IsoN). Cows had ad libitum access to native grass hay (8.5% CP) and trace-mineralized salt. Total OM intake was greater (P = 0.06) for DIP + UIP than UIP IsoN cows. At 30 d postpartum, DIP + UIP cows produced more milk than UIP IsoN, with DIP being intermediate; however, at 60 d postpartum, DIP + UIP and DIP cows were not different, but both had greater milk production than UIP IsoN (treatment x day interaction; P = 0.08). A treatment x day interaction (P = 0.06) for BCS resulted from DIP + UIP cows having the greatest BCS at 60, 90, and 120 d d postpartum and DIP having greater BCS than UIP IsoN cows only on d 60 postpartum. Serum insulin concentrations were highest (treatment x day interaction; P = 0.09) for DIP + UIP cows at 30 d postpartum but did not differ among treatment thereafter. Serum insulin-like growth factor-binding protein (IGFBP)-2 (34 kDa) and -3 (40 and 44 kDa) were greatest (P < 0.0003) for DIP cows. Serum urea-N concentrations were greater (P < 0.01) in DIP + UIP cows than in either DIP or UIP IsoN cows. However, postpartum interval to first estrus, conception rate, and calf weaning weights were unaffected (P = 0.35, 0.42, and 0.64, respectively) by treatment. Although UIP in addition to or in replacement of DIP affected milk production and blood metabolites, the productivity of these primiparous beef cows was not altered. Thus, the type of supplemental protein does not seem to influence productivity of primiparous beef cows in production systems with conditions similar to our experimental conditions.

Seasonality of Chlamydia trachomatis genital infections in university women.

Previous studies have shown seasonal fluctuations in the incidence of most sexually transmitted diseases, with a peak in the third quarter, but none have specifically evaluated Chlamydia trachomatis genital infections. From 1989 to 1991, 8,234 women presenting to the student health centers of Florida's two largest universities for routine gynecologic care and diagnosis of sexually transmitted diseases were tested for Chlamydia trachomatis genital infections. The bimonthly variation in incidence was statistically significant, with a significant peak in the months of August and September of 10.70%, compared with the yearly average of 8.74%. Because the pattern of incidence of chlamydia in university women is seasonal, those concerned with healthcare should increase their efforts during the third quarter to identify infected individuals and to provide preventive programs.

Comparative efficacy of an experimental S45/20 bacterin and a reduced dose of strain 19 vaccine against bovine brucellosis.

Yearling beef heifers were vaccinated with 2 doses of an experimental Brucella abortus S45/20 bacterin or a reduced dose of strain 19 (S19) vaccine, or were used as nonvaccinated controls. None of the vaccinated heifers was positive by the acidified plate, Rivanol, complement-fixation, or card tests 5 months after inoculation. Sixteen of 21 heifers given S45/20 bacterin with trehalose dimycolate adjuvant had delayed hypersensitivity when skin was tested 7 months after initial vaccination, whereas none of the S19 vaccinates or controls was reactive. After natural breeding, pregnant heifers were challenge exposed at 3.5 to 5 months of gestation with 2.5 X 10(7) viable B abortus S2308 organisms in the conjunctival sac. Abortions occurred as follows: 16/19 (84.2%) of heifers given S45/20 bacterin, 6/12 (50.0%) of heifers vaccinated with S19, and 17/18 (94.4%) of the nonvaccinated controls. Of the 10 heifers that calved normally, only 3 (1 in each group) were seropositive. A correlation was not seen between skin hypersensitivity and acquired resistance. Possible reasons for the poor protection with a reduced dose of S19 vaccine and the failure of S45/20 bacterin to enhance cellular resistance are discussed.

Allergenic activity and biochemical analysis of three soluble antigen preparations from Brucella abortus strain 45/20.

Three Brucella abortus strain 45/20 antigen preparations were compared with regard to their chemical composition and allergenic potential. A popular method of extracting soluble antigens from whole cells with hypertonic saline solution and ethanol precipitation was compared with the method of trichloroacetic acid (TCA) or ammonium sulfate (AS) precipitation of antigens released into solution by ultrasonic cell disruption. Biochemical analysis of the preparations revealed that TCA and AS precipitates had considerably more protein and DNA and less carbohydrates and RNA than did the saline-ethanol extracts. Strain 19-vaccinated cattle were simultaneously skin tested with the three antigen preparations which had been standardized to an equal protein content. Significant (P less than 0.01) delayed hypersensitivity reactions were observed in response to all three antigen preparations. However, TCA-prepared allergens were more active in eliciting delayed hypersensitivity (P less tha 0.05) than were the two other allergens. Increased agglutinating antibodies were not observed in response to the skin-test reagents.

An enzyme-linked immunosorbent assay for the detection of bovine antibodies to vesicular stomatitis virus.

An indirect enzyme-linked immunosorbent assay (ELISA) was developed to detect bovine antibody to vesicular stomatitis virus (VSV). Serum samples from cows experimentally infected with the New Jersey serotype of VSV (VSV-NJ) were assayed by the ELISA and serum-neutralization (SN) assay. The ELISA was as sensitive as the SN assay in detecting bovine antibody to VSV. The correlation between SN titers and ELISA values at absorbance at 405 nm was statistically significant. The ELISA was not specific for VSV-NJ, however, and could detect serum samples positive to the Indiana serotype of VSV that had SN titers of greater than or equal to 480. Nonspecific reactions were due to cross-reactive group-specific viral proteins that are shared by both serotypes. The cross-reactivity allows the use of a single rapid test in identifying both serotypes of VSV from the other exotic vesicular diseases, especially foot-and-mouth disease. The ELISA titers of serum samples positive for VSV-NJ were comparable with the corresponding SN titers of each sample. The sensitivity, rapidity, and ease of the ELISA system and the use of a single test in identifying both serotypes of VSV from the other exotic vesicular diseases make this ELISA suitable as a rapid diagnostic assay for VS.