Datta R.,Yale University |
Datta R.,University of California at Irvine |
Brown S.,Carnegie Mellon University |
Nguyen V.Q.,University of California at Irvine |
And 6 more authors.
Infection Control and Hospital Epidemiology | Year: 2015
objective. To assess the time-dependent exposure of California healthcare facilities to patients harboring methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae, and Clostridium difficile infection (CDI) upon discharge from 1 hospital. methods. Retrospective multiple-cohort study of adults discharged from 1 hospital in 2005–2009, counting hospitals, nursing homes, cities, and counties in which carriers were readmitted, and comparing the number and length of stay of readmissions and the number of distinct readmission facilities among carriers versus noncarriers. results. We evaluated 45,772 inpatients including those with MRSA (N=1,198), VRE (N=547), ESBL (N= 121), and CDI (N=300). Within 1 year of discharge, MRSA, VRE, and ESBL carriers exposed 137, 117, and 45 hospitals and 103, 83, and 37 nursing homes, generating 58,804, 33,486, and 15,508 total exposure-days, respectively. Within 90 days of discharge, CDI patients exposed 36 hospitals and 35 nursing homes, generating 7,318 total exposure-days. Compared with noncarriers, carriers had more readmissions to hospitals (MRSA:1.8 vs 0.9/ patient; VRE: 2.6 vs 0.9; ESBL: 2.3 vs 0.9; CDI: 0.8 vs 0.4; all P<.001) and nursing homes (MRSA: 0.4 vs 0.1/patient; VRE: 0.7 vs 0.1; ESBL: 0.7 vs 0.1; CDI: 0.3 vs 0.1; all P<.001) and longer hospital readmissions (MRSA: 8.9 vs 7.3 days; VRE: 8.9 vs 7.4; ESBL: 9.6 vs 7.5; CDI: 12.3 vs 8.2; all P< .01). conclusions. Patients harboring antibiotic-resistant pathogens rapidly expose numerous facilities during readmissions; regional containment strategies are needed. © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved.
Bartsch S.M.,Public Health Computational and Operations Research PHICOR |
Umscheid C.A.,University of Pennsylvania |
Nachamkin I.,University of Pennsylvania |
Hamilton K.,University of Pennsylvania |
And 2 more authors.
Clinical Microbiology and Infection | Year: 2015
Accurate diagnosis of Clostridium difficile infection (CDI) is essential to effectively managing patients and preventing transmission. Despite the availability of several diagnostic tests, the optimal strategy is debatable and their economic values are unknown. We modified our previously existing C.difficile simulation model to determine the economic value of different CDI diagnostic approaches from the hospital perspective. We evaluated four diagnostic methods for a patient suspected of having CDI: 1) toxin A/B enzyme immunoassay, 2) glutamate dehydrogenase (GDH) antigen/toxin AB combined in one test, 3) nucleic acid amplification test (NAAT), and 4) GDH antigen/toxin AB combination test with NAAT confirmation of indeterminate results. Sensitivity analysis varied the proportion of those tested with clinically significant diarrhoea, the probability of CDI, NAAT cost and CDI treatment delay resulting from a false-negative test, length of stay and diagnostic sensitivity and specificity. The GDH/toxin AB plus NAAT approach leads to the timeliest treatment with the fewest unnecessary treatments given, resulted in the best bed management and generated the lowest cost. The NAAT-alone approach also leads to timely treatment. The GDH/toxin AB diagnostic (without NAAT confirmation) approach resulted in a large number of delayed treatments, but results in the fewest secondary colonisations. Results were robust to the sensitivity analysis. Choosing the right diagnostic approach is a matter of cost and test accuracy. GDH/toxin AB plus NAAT diagnosis led to the timeliest treatment and was the least costly. © 2014 European Society of Clinical Microbiology and Infectious Diseases.
In reaction to model Ashley Graham gracing the cover of Sports Illustrated's latest swimsuit issue, former Sports Illustrated cover girl and supermodel Cheryl Tiegs sounded not so positive about women with larger waistlines. "I don't like it that we're talking about full-figured women, because it's glamorizing them, and your waist should be smaller than 35 [inches]," Tiegs said in an interview with E! on the red carpet of the 13th Annual Global Green USA pre-Oscar party. She has since clarified her response in a letter published by The Huffington Post, explaining that she did not mean to attack Graham personally and that she, herself, has a 37-inch waist. Celebrity feuds aside, Tiegs' reaction left many people curious about whether a 35-inch waist is a true marker of health. Experts say that, as with most medical guidelines, the facts are complicated. "Like any type of clinical cutoff, it's the result of these larger-scale studies," said Dr. Bruce Y. Lee, director of the Global Obesity Prevention Center and associate professor of international health at Johns Hopkins University, in an interview with Live Science. "Any cutoff is not an absolute, hard cutoff. It's not as if someone at 34.9 is different from someone at 35.1." Rules of thumb like this one represent data that's often distilled from thousands of people, and are meant as generalizations, Lee said. [Your Heart Health: 5 Numbers to Know] In the case of the 35-inch waist, the number gained substantial support from a study published in Circulation that used data from the large and long-running Nurses' Health Study, which followed a group of nearly 45,000 U.S. women over 16 years. The finding was published in 2008. The women in the study who had waists larger than 35 inches had almost double the risk of dying from heart disease, compared with those whose waists were under 28 inches, the researchers said. And the women in the study who had the largest waist circumference also had a much higher risk of dying from cancer or any other cause, than women with the smallest waists. All of the health risks increased steadily as waist circumference increased. Too much fat around the waist, which researchers sometimes call "central obesity," is also associated with an increased risk of developing type 2 diabetes and hypertension, Lee said. The average waist size of U.S women ages 20 and over is 37.5 inches, according to the Centers for Disease Control and Prevention. No one is sure why abdominal fat is more problematic for health than fat elsewhere in the body, but it does seem to act differently. Some experts have suggested that these fat cells around the waistline may interfere with the normal balance of hormones, negatively affecting insulin sensitivity, blood sugar and blood pressure. As a result of this and other research, the American Heart Association and the National Heart, Lung, and Blood Institute tell people to aim for a waist circumference smaller than 35 inches for women, and 40 inches for men. The International Diabetes Foundation goes further, setting a waistline goal of 31.5 inches for European women and 37 inches for European men. The groups' recommended waist sizes for Asian populations are slightly smaller, and it has yet to gather enough data to set specific standards for other ethnic groups. So should you panic if you measure 37 inches around the middle? Probably not, said Lisa Harnack, professor and co-director of the University of Minnesota Obesity Prevention Center, in an interview with Live Science. "There are actually quite a few risk factors for heart disease and type 2 diabetes, and this is just one of them," she said. [The Best Way to Lose Weight Safely] Waist circumference is one of many measures of health and, similar to body mass index (BMI), it can't tell us much on it's own. "The real issue is that each of these measurements is only a single view into the person," Lee said. He likened singular health measurements to a pinhole in a box where the patient is inside. Each only allows a small view into the person's overall health, and no single measurement can show all the important information. Both Harnack and Lee agreed that people can be overweight and healthy, just as people can be thin and unhealthy. However, going back to the general rule, a person's health will very likely be improved if he or she falls within the guidelines for a healthy waist circumference, they said. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Anderson Steeves E.,University of Tennessee at Knoxville |
Jones-Smith J.,Global Obesity Prevention Center |
Hopkins L.,Global Obesity Prevention Center |
Gittelsohn J.,Global Obesity Prevention Center
Journal of Nutrition Education and Behavior | Year: 2016
Objective: Evidence of associations between social support and dietary intake among adolescents is mixed. This study examines relationships between social support for healthy and unhealthy eating from friends and parents, and associations with diet quality. Design: Cross-sectional analysis of survey data. Setting: Baltimore, MD. Participants: 296 youth aged 9-15 years, 53% female, 91% African American, participating in the B'More Healthy Communities for Kids study. Main Outcome Measure(s): Primary dependent variable: diet quality measured using Healthy Eating Index 2010 (HEI) overall score, calculated from the Block Kids Food Frequency Questionnaire. Independent variables: Social support from parents and friends for healthy eating (4 questions analyzed as a scale) and unhealthy eating (3 questions analyzed individually), age, gender, race, and household income, reported via questionnaire. Analysis: Adjusted multiple linear regressions (α, P < .05). Results: Friend and parent support for healthy eating did not have statistically significant relationships with overall HEI scores. Youth who reported their parents offering high-fat foods or sweets more frequently had lower overall HEI scores (β = -1.65; SE = 0.52; 95% confidence interval, -2.66 to -0.63). Conclusions and Implications: These results are novel and demonstrate the need for additional studies examining support for unhealthy eating. These preliminary findings may be relevant to researchers as they develop family-based nutrition interventions. © 2016 Society for Nutrition Education and Behavior.
Sattler M.,Global Obesity Prevention Center |
Hopkins L.,Global Obesity Prevention Center |
Anderson Steeves E.,Global Obesity Prevention Center |
Cristello A.,Global Obesity Prevention Center |
And 2 more authors.
Ecology of Food and Nutrition | Year: 2015
This study explores food preparation behaviors, including types of food prepared, methods of preparation, and frequency of preparation of low-income urban African American youth ages 9–15 in Baltimore City (n = 289) and analyzes a potential association to diet quality as measured through Healthy Eating Index 2010 (HEI) scores. Overall, the youth prepared their own food 6.7 ± 0.33 times per week without significant differences between age groups or genders as measured through pairwise comparison of means. Cereal, noodles, and sandwiches were amongst the foods prepared most frequently. Linear regression analysis found youth food preparation frequency was not significantly associated with total HEI (p = 0.59), sodium (p = 0.58), empty calories (p = 0.96), or dairy scores (p = 0.12). Younger age was associated with higher total HEI scores (p = 0.012) and higher dairy scores (p = 0.01) and female gender was associated with higher total HEI scores (p = 0.03), higher sodium scores (p = 0.03), and lower dairy scores (p = 0.008). Copyright © Taylor & Francis Group, LLC.