scholarly journals Smoking Urges During Treatment and Long-Term Cessation among Low-Income African Americans

2017 ◽  
Vol 27 (4) ◽  
pp. 395 ◽  
Author(s):  
Monica Webb Hooper ◽  
Noella A. Dietz ◽  
Joseph C. Wilson
Keyword(s):  
African Americans ◽  
Low Income ◽  
Group Intervention ◽  
Smoking Status ◽  
Nicotine Patch ◽  
Post Intervention ◽  
Patch Use ◽  
Status Assessment ◽  
The Impact

<p><strong>Objective: </strong>The urge to smoke is a predictor of smoking relapse. Little research has focused on the impact of acute urges during treatment among African Americans. This study examined the relationship between smoking urges and long-term abstinence among treatment seekers. <strong></strong></p><p><strong>Design: </strong>Longitudinal prospective investigation. Urges to smoke were assessed at the initial (session 1) and final (session 8) sessions among adult smokers (N=308) enrolled in a 4-week group intervention trial. Nicotine patch use was assessed over 30 days. <strong></strong></p><p><strong>Main Outcome Measures: </strong>Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately postintervention, and at 3-, 6-, and 12-month follow-ups. Hierarchical logistic regressions tested associations between session 1 and session 8 urges and 7-day ppa at each smoking status assessment. <strong></strong></p><p><strong>Results: </strong>There was a significant overall decrease in smoking urges (M=29, SD=15 at session 1; M=17, SD=11 at session 8). After controlling for covariates, urges to smoke at session 1 were unrelated to 7-day ppa at any of the assessment points. However, session 8 urges were inversely associated with 7-day ppa post-intervention (AOR=.94, CI:.92-.97), at 3-months (AOR=.93, CI: .89-.97), 6-months (AOR=.93, CI: .90-.97), and 12-months (AOR=.96, CI: .96-.99). Nicotine patch use was positively associated with 7-day ppa at each assessment. <strong></strong></p><p><strong>Conclusions: </strong>The most robust predictors of abstinence through 12-months postintervention were decreased urges over the 4-week, 8-session group intervention and the frequency of nicotine patch use. Interventions aimed at addressing the needs of African American smokers should address urges and encourage nicotine replacement adherence to increase abstinence rates.</p><p><em>Ethn Dis. </em>2017;27(4):395-402; doi:10.18865/ ed.27.4.395. </p>

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

The impact of low income on long-term mortality of myocardial infarction patients: results from the Brazilian Heart Study

2021 ◽  
pp. 1-1
Author(s):  
Joaquim Barreto ◽  
Luís Carlos V. Matos ◽  
José Carlos Quinaglia ◽  
Andrei C. Sposito ◽  
Luiz Sergio Carvalho
Keyword(s):  
Myocardial Infarction ◽  
Low Income ◽  
Heart Study ◽  
The Impact ◽  
Long Term Mortality

Prepaid debit cards and banking intention

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sophia T. Anong ◽  
Aditi Routh
Keyword(s):  
Low Income ◽  
Transtheoretical Model ◽  
Customer Segmentation ◽  
Future Research ◽  
Bank Account ◽  
Content Type ◽  
Debit Card ◽  
The Impact ◽  
Debit Cards

PurposeThis study examines the relationship between prepaid debit card use and the intention to open a bank account within twelve months. The Transtheoretical Model (TTM) of Behavior Change helped to conceptualize one's stage in the process of changing from unbanked status if desired. The Theory of Planned Behavior (TPB) provided a framework to examine factors that influence banking intention. Prepaid debit card use is considered a social norm as it is a popular alternative to banking, and these accounts have increasingly mimicked bank account features in recent years.Design/methodology/approachThree in-depth focus group interviews with low-income respondents were first conducted in 2012, which revealed a prolific use of prepaid debit cards. Most participants had previous banking history, and despite negative experiences, some requested information about banking terms and “free” banking. These themes and previous studies informed a TPB-based biprobit model, which was estimated using data of an unbanked sample from 2013, 2015 and 2017 waves of the US Survey of Unbanked and Underbanked Households.FindingsThough there was banking interest in the focus groups, no significant empirical association was found between recent prepaid debit card use and banking intention. Going deeper with another sample, we found that current cardholders were equally likely to have become recently banked or to be long-term unbanked but less likely to be long-term banked. Also, factors such as a more recent relationship with banks, use of other alternative financial services for transactions and credit, smartphone ownership, and trust increase banking intention.Research limitations/implicationsThe main limitation of the study is the cross-section quantitative data. Future research may track banking status over time, particularly as financial technology (fintech) evolves with alternatives that may influence banks and customers to adapt.Practical implicationsTo compete with “leapfrog” fintech banking alternatives, bank managers should consider utilizing customer segmentation to target “at-risk” customers and former customers with products and terms tailored to meet their banking needs. Banks can also tailor digital products to capture markets in banking desserts through mobile phones.Originality/valueThis mixed-methods study is unique in that it builds on insights from earlier in-depth interviews with real unbanked groups to examine a trend in prepaid debit card use and the impact on banking interest.

scholarly journals Impact of an Antibiotic Stewardship Program in Long-term Care Facilities: A Nursing Home Network Experience

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Fabian Andres Romero ◽  
Evette Mathews ◽  
Ara Flores ◽  
Susan Seo
Keyword(s):  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Post Intervention ◽  
Term Care ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Care Facilities ◽  
The Impact

Abstract Background Antibiotic stewardship program (ASP) implementation is paramount across the healthcare spectrum. Nursing homes represent a challenge due to limited resources, complexity of medical conditions, and less controlled environments. National statistics on ASP for long-term care facilities (LTCF) are sparse. Methods A pilot ASP was launched in August 2016 at a 270-bed nursing home with a 50-bed chronic ventilator-dependent unit. The program entailed a bundle of interventions including leadership engagement, a tracking and reporting system for intravenous antibiotics, education for caregivers, Infectious Disease (ID) consultant availability, and implementation of nursing protocols. Data were collected from pharmacy and medical records between January 2016 and March 2017, establishing pre-intervention and post-intervention periods. Collected data included days of therapy (DOT), antibiotic costs, resident-days, hospital transfers, and Clostridium difficile infection (CDI) rates. Variables were adjusted to 1,000 resident-days (RD) and findings between periods were compared by Mann–Whitney U test. Results A total of 47,423 resident-days and 1,959 DOT were analyzed for this study. Antibiotic use decreased from 54.5 DOT/1000 RD pre-intervention to 27.6 DOT/1000 RD post-intervention (P = 0.017). Antibiotic costs were reduced from a monthly median of US $17,113 to US $7,073 but was not statistically significant (P = 0.39). Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics and found statistically significant reduction in vancomycin use (14.4 vs. 6.5; P = 0.023). Reduction was also found for cefepime/ceftazidime (6.9 vs. 1.3; P = 0.07), ertapenem (6.8 vs. 3.6; P = 0.45), and piperacillin/tazobactam (1.8 vs. 0.6; P = 0.38). Meropenem use increased (1.3 vs. 3.2; P = 0.042). Hospital transfers slightly trended up (6.73 vs. 7.77; P = 0.065), and there was no change in CDI (1.1 s 0.94; P = 0.32). Conclusion A bundle of standardized interventions tailored for LTCF can achieve successful reduction of antibiotic utilization and costs. Subsequent studies are needed to further determine the impact on clinical outcomes such as transfers to hospitals and CDI in these settings. Disclosures All authors: No reported disclosures.

Schoolinary art: practical cooking skills issues for the future

2015 ◽  
Vol 117 (2) ◽  
pp. 629-650 ◽  
Author(s):  
Dawn Mc Dowell ◽  
Una McMahon-Beattie ◽  
Amy Burns
Keyword(s):  
Low Income ◽  
Policy Decision ◽  
Skills Training ◽  
Time Frame ◽  
Home Economics ◽  
Structured Learning ◽  
Content Type ◽  
Cooking Skills ◽  
The Impact

Purpose – The purpose of this paper is to consider the importance of structured and consistent practical cookery skills intervention in the 11-14-year age group. This paper reviews the impact and development of statutory and non-statutory cooking skills interventions in the UK and considers limitations in relation to life skills training. Currently practical cooking skills are mainly derived from two sources namely the non-statutory sector (community cooking interventions) and the statutory sector (Home Economics teaching). Design/methodology/approach – The paper compares the two interventions in terms of effective long-term outcomes. Non-statutory cooking interventions are generally lottery funded and therefore tend to be single teaching blocks of, on average, six to eight weeks targeting mostly low-income adults and the literature emphasises a deficit of empirical measurement of the long-term impact. In contrast Home Economics classes offer a structured learning environment across genders and socio-economic groups. In addition it is taught over a substantial time frame to facilitate a process of practical skills development (with relevant theoretical teaching), reflection, group communication and consolidation, where according to current educational theory (Kolb, 1984) learning is more thoroughly embedded with the increased potential for longer term impact. Findings – The review identifies the limitations of too many community initiatives or “project-itis” (Caraher, 2012, p. 10) and instead supports the use of the school curriculum to best maximise the learning of practical cooking skills. Originality/value – This review will be of particular value to educationalists and health policy decision makers.

142 Long term nicotine patch use in pregnancy: Safety and effectiveness

2001 ◽  
Vol 185 (6) ◽  
pp. S120
Author(s):  
Paul Ogburn ◽  
Kirk Ramin ◽  
Darrell Schroeder ◽  
Richard Hurt ◽  
Ivana Croghan ◽  
...  
Keyword(s):  
Nicotine Patch ◽  
Patch Use ◽  
In Pregnancy

scholarly journals Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

2020 ◽  
Author(s):  
Ravena Melo Ribeiro da Silva ◽  
Ana Cláudia de Brito Câmara ◽  
Ellen Karla Chaves Vieira Koga ◽  
Iza Maria Fraga Lobo ◽  
Wellington Barros da Silva
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Polymyxin B ◽  
Intervention Period ◽  
Post Intervention ◽  
Short Period ◽  
Active Feedback ◽  
The Impact ◽  
Antimicrobial Administration

Abstract Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides (PRE = 284 DOT / 1000pd vs POST = 234 DOT / 1000pd; p = 0.014) and polymyxin B (PRE = 121 DOT / 1000pd vs POST = 88 DOT / 1000pd; p = 0.029), and significant increases for penicillins (PRE = 25 DOT / 1000pd vs POST = 45 DOT / 1000pd; p = 0.009), and tigecycline ( PRE = 3 DOT / 1000pd vs POST = 27 DOT / 1000pd; p = 0.046).Conclusions: In general, the intervention of infectologists in intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

scholarly journals Long-term trends of hospital admissions among patients with cancer following the 2015 earthquake: a single institution observational study in Kathmandu, Nepal

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026746 ◽  
Author(s):  
Anup Uprety ◽  
Akihiko Ozaki ◽  
Asaka Higuchi ◽  
Bikal Ghimire ◽  
Toyoaki Sawano ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Low Income ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Patients With Cancer ◽  
Nepal Earthquake ◽  
Patient Admissions ◽  
The Impact ◽  
2015 Nepal Earthquake

ObjectivesLittle is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu.Design, setting and participantsWe considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake).Outcome measuresThe number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change.ResultsThe total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts.ConclusionsAfter a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.

scholarly journals Fruit in Diets for Diabetes (P08-086-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
John Monro ◽  
Suman Mishra
Keyword(s):  
Repeated Measures ◽  
Group Intervention ◽  
Metabolic Effects ◽  
Partial Substitution ◽  
Glycemic Response ◽  
Clinical Biomarkers ◽  
Long Term Study ◽  
The Impact

Abstract Objectives Determine the effect on glycemic response of equi-carbohydrate partial exchange of fruit for cereal, identify mechanisms of its effectiveness, and establish the metabolic safety of long-term fruit consumption in individuals at risk of type 2 diabetes. Methods Randomised repeated measures human intervention studies were conducted with healthy participants ingesting 40 g available carbohydrate meals of wheaten starch biscuit (WB), WB plus kiwifruit (WB + KF), and WB plus the same sugars in the same quantity as consumed in the kiwifruit (WB + KFS). Postprandial glycemic responses were measured. Associated in vitro studies aimed to identify mechanisms of glycemic response reduction by fruit. Physicochemical and rheological properties of fruit digested under simulated gastro-intestinal conditions, and the impact of the fruit remnants on physical and enzymatic processes of digestion were determined. In a follow-up parallel group intervention study, prediabetic (HBA1c > 4%) participants consumed 2 kiwifruit per day for 12 weeks, to establish the metabolic safety of long term kiwifruit consumption through clinical biomarkers. Results Partial substitution by kiwifruit (WB + KF) significantly (P < 0.05) and substantially (−35%) reduced glycemic response peak height compared with unsubstituted WB. Also, substitution by kiwifruit (WB + KF) caused significantly (P < 0.001) lower (−20%) peak glycaemic response than substitution with the kiwifruit sugars alone (WB + KFS), indicating the glycemia reducing effect of the fruit was due to more than fructose substitution of digestible starch. The mechanistic studies showed several gut-level factors by which kiwifruit could reduce glycemic impact; high gastric acidification and buffering capacity, swelling and dispersion of the fruit cell walls (dietary fiber) leading to rheological changes retarding digestion, glucose diffusion and intraluminal mixing, all involved in transport of digestion products to the gut wall for absorption. The long term study could not detect adverse metabolic effects. Conclusions Including fruit in the diet in a carbohydrate exchange format may suppress glycemic response through a number of mechanisms and without metabolic risk. Funding Sources New Zealand National Science Challenge.

scholarly journals 893. The SHIELD Orange County Project: A Decolonization Strategy in 35 Hospitals and Nursing Homes Reduces Multi-Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S23-S24
Author(s):  
James A McKinnell ◽  
Raveena Singh ◽  
Loren G Miller ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Resistant Organism ◽  
Equal Weight ◽  
Post Intervention ◽  
Term Care ◽  
Contact Precautions ◽  
Acute Care Facilities ◽  
Southern California Region ◽  
The Impact

Abstract Background Patient movement between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) contributes to MDRO spread. SHIELD OC is a regional decolonization collaborative among adult facilities with high patient sharing designed to reduce countywide MDRO prevalence. We report pre- and post-intervention MDRO colonization prevalence. Methods Decolonization included chlorhexidine bath (CHG) (4% liquid or 2% cloth) and twice-daily nasal swab 10% povidone–iodine (PI). LTAC and NH used CHG for all baths and PI 5 days on admission and Monday–Friday every other week. Patients in contact precautions (CP) at hospitals had daily CHG and 5-days PI on admission. Point-prevalence screening for MRSA, VRE, ESBL, and CRE using nares, axilla/groin, and peri-rectal swabs was conducted pre-intervention (September 2016–March 2017) and post-intervention (August 2018–April 2019); 50 random LTAC and 50 CP hospitalized patients were sampled; for NH up to 50 were sampled at baseline and all residents post-intervention. Raw impact of the intervention was assessed by the average change in colonization prevalence, with each facility carrying equal weight. Generalized linear mixed models (GLM) stratified by facility type were used to assess the impact on MDRO colonization when clustering by facility. Results Across 35 facilities (16 hospitals, 16 NHs, 3 LTACs), the overall MDRO prevalence was reduced 22% in NHs (OR 0.58, P < 0.001), 34% LTACs (OR = 0.27, P < 0.001), and 11% CP patients (OR = 0.67, P < 0.001, Table 1). For MRSA, raw reductions were 31% NHs (OR = 0.58, P < 0.001), 39% LTACs (OR = 0.51, P = 0.01), and 3% CP patients (OR = 0.88, P = NS). For VRE, raw reductions were 40% NHs (OR = 0.62, P = 0.001), 55% LTACs (OR = 0.26, P < 0.001), and 15% CP patients (OR = 0.67, P = 0.004). For ESBLs, raw reductions were 24% NHs (OR = 0.65, P < 0.001), 34% LTACs (OR = 0.53, P = 0.01), and 26% CP patients (OR = 0.64, P < 0.001). For CRE, raw reductions were 24% NHs (OR = 0.70, P = NS), and 23% LTACs (OR = 0.75, P = NS). CRE increased by 26% in CP averaged across hospitals, although patient -level CRE declined 2.4% to 1.8% (OR = 0.74, P = NS). Conclusion MDRO carriage was common in highly inter-connected NHs, LTACs and hospitals. A regional collaborative of universal decolonization in long-term care and targeted decolonization of CP patients in hospitals led to sizeable reductions in MDRO carriage. Disclosures All Authors: No reported Disclosures.

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