News Article | May 9, 2017
Older adults who have been hospitalized for injuries from an assault are more likely to experience subsequent physical abuse if they are female, widowed, diagnosed with dementia, or return home to live with the perpetrator, according to a new study in the Journal of the American Geriatrics Society. Approximately 8 of every 1,000 adults over 60 in the U.S. are victims of elder mistreatment, according to Adult Protective Services. Thirteen percent of those cases involve physical or sexual abuse, but of those, fewer than 10 percent are reported to Adult Protective Services, studies have shown. Victims face increased risk of being abused again, but the risk factors for revictimization have been unclear. Lee Friedman, associate professor of environmental and occupational health sciences at the University of Illinois at Chicago, and his colleagues in the UIC School of Public Health looked at the medical records of adults over 60 who had been admitted to five of the largest hospitals in the Chicago metropolitan area for physical or sexual abuse between 2000 and 2011 and found 111 such cases. More than half had documented histories of being abused again after leaving the hospital, and about 80 percent of those who were revictimized lived in private residences at the time of the abuse. Repeat victims were most often abused by a relative -- usually a husband, boyfriend, son or son-in-law. "This study is the first to show that many cases where older adults are physically abused not only return to the home where their abuser lives, but that the system for identifying and reporting these cases is broken," said Friedman. Based on hospital records, 57 percent of victims had their abuse reported to Adult Protective Services or police. However, when the researchers compared hospital records to the Adult Protective Services files, they found that only 26.6 percent had investigations on record, indicating that hospital reporting may have been overstated. "Better education for health care workers on the risk factors associated with revictimization and improved adoption of existing screening tools are needed," Friedman said. "The goal should be to connect victims of abuse with community services, police action, and alternative residential options. But this can only be done if we do a better job screening for mistreatment." Co-authors on the paper are Susan Avila and Renee Partida of the John H. Stroger Hospital of Cook County; Dr. Tazeen Rizvi of Advocate Health Care in Downers Grove, Illinois; and Daniel Friedman of the Social Policy Research Institute in Skokie, Illinois. Funding for this research was provided by the Retirement Research Foundation through a competitive grant (2013-034) and the Advocate Charitable Foundation.
Bekker L.-G.,University of Cape Town |
Johnson L.,University of Cape Town |
Wallace M.,University of Cape Town |
Hosek S.,Stroger Hospital of Cook County
Journal of the International AIDS Society | Year: 2015
Adolescents and young adults are at increased risk for HIV due to the many developmental, psychological, social, and structural transitions that converge in this period of the lifespan. In addition, adolescent deaths resulting from HIV continue to rise despite declines in other age groups. There are also young key populations (YKPs) that bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, young people who inject drugs, and adolescent and young adult sex workers. As a society, we must do more to stop new HIV infections and untimely HIV-related deaths through both primary and secondary prevention and better management approaches. Using an interwoven prevention and treatment cascade approach, the starting point for all interventions must be HIV counselling and testing. Subsequent interventions for both HIV-negative and HIV-positive youth must be ''adolescent-centred,'' occur within the socio-ecological context of young people and take advantage of the innovations and technologies that youth have easily incorporated into their daily lives. In order to achieve the global goals of zero infections, zero discrimination and zero deaths, a sustained focus on HIV research, policy and advocacy for YKPs must occur. © - 2015 Bekker L-G et al;.
Fortenberry J.D.,Indiana University |
Martinez J.,Stroger Hospital of Cook County |
Rudy B.J.,New York University |
Journal of Adolescent Health | Year: 2012
Purpose: To understand linkage to care practices at sites providing clinical services to newly diagnosed HIV-positive adolescents. Methods: Qualitative analysis of detailed interviews conducted with 28 personnel involved in linkage to care at 15 sites providing specialty care to HIV-positive adolescents. Results: We showed that multiple models exist for linkage to care, and that both formal and informal community relationships are important for successful linkage to care. Stigma was seen as a universal issue, enhancing the importance of the balance of confidentiality and social support. Barriers to care, such as mental health issues, substance use, and transportation, are common. Conclusions: We conclude that the complexity of linkage to care requires thought and planning as HIV testing is expanded to lower-risk populations. © 2012 Society for Adolescent Health and Medicine.
Shankar P.,Georgia Southern University |
Ahuja S.,Jefferson Nutrition |
Sriram K.,Stroger Hospital of Cook County
Nutrition | Year: 2013
Obesity has become an epidemic, not just in the United States, but also across the globe. Obesity is a result of many factors including poor dietary habits, inadequate physical activity, hormonal issues, and sedentary lifestyle, as well as many psychological issues. Direct and indirect costs associated with obesity-related morbidity and mortality have been estimated to be in the billions of dollars. Of the many avenues for treatment, dietary interventions are the most common. Numerous diets have been popularized in the media, with most being fads having little to no scientific evidence to validate their effectiveness. Amidst this rise of weight loss diets, there has been a surge of individual products advertised as assuring quick weight loss; one such product group is non-nutritive sweeteners (NNS). Sugar, a common component of our diet, is also a major contributing factor to a number of health problems, including obesity and increased dental diseases both in adults and children. Most foods marketed towards children are sugar-laden. Obesity-related health issues, such as type 2 diabetes mellitus, cardiovascular diseases, and hypertension, once only commonly seen in older adults, are increasing in youth. Manufacturers of NNS are using this as an opportunity to promote their products, and are marketing them as safe for all ages. A systematic review of several databases and reliable websites on the internet was conducted to identify literature related to NNS. Keywords that were used individually or in combination included, but were not limited to, artificial sweeteners, non-nutritive sweeteners, non-caloric sweeteners, obesity, sugar substitutes, diabetes, and cardiometabolic indicators. The clinical and epidemiologic data available at present are insufficient to make definitive conclusions regarding the benefits of NNS in displacing caloric sweeteners as related to energy balance, maintenance or decrease in body weight, and other cardiometabolic risk factors. Although the FDA and most published (especially industry-funded) studies endorse the safety of these additives, there is a lack of conclusive evidence-based research to discourage or to encourage their use on a regular basis. While moderate use of NNS may be useful as a dietary aid for someone with diabetes or on a weight loss regimen, for optimal health it is recommended that only minimal amounts of both sugar and NNS be consumed. © 2013 Elsevier Inc.
Sriram K.,Stroger Hospital of Cook County |
Manzanares W.,University of the Republic of Uruguay |
Joseph K.,Stroger Hospital of Cook County
Nutrition in Clinical Practice | Year: 2012
Clinicians involved with nutrition therapy traditionally concentrated on macronutrients and have generally neglected the importance of micronutrients, both vitamins and trace elements. Micronutrients, which work in unison, are important for fundamental biological processes and enzymatic reactions, and deficiencies may lead to disastrous consequences. This review concentrates on vitamin B1, or thiamine. Alcoholism is not the only risk factor for thiamine deficiency, and thiamine deficiency is often not suspected in seemingly well-nourished or even overnourished patients. Deficiency of thiamine has historically been described as beriberi but may often be seen in current-day practice, manifesting as neurologic abnormalities, mental changes, congestive heart failure, unexplained metabolic acidosis, and so on. This review explains the importance of thiamine in nutrition therapy and offers practical tips on prevention and management of deficiency states. © 2012 The American Society for Parenteral and Enteral Nutrition.
Trick W.E.,Stroger Hospital of Cook County
Obstetrics and Gynecology | Year: 2010
Objective: To evaluate whether use of a computer-based clinical decision-support algorithm that used data stored in the electronic medical record increased administration of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to postpartum women. Methods: We performed a before and after cohort study of postpartum women at an urban public teaching hospital. We compared the frequency of Tdap vaccination during the preintervention (October 1, 2008-January 14, 2009) and postintervention (January 15-April 30, 2009) time periods. We intervened by automating electronic presentation of preselected orders to physicians who provided postpartum care. The order was displayed when physicians ordered iron supplementation or patient discharge to a woman who met certain criteria. We evaluated whether patient characteristics were associated with receipt of vaccine. Results: Tetanus, diphtheria, and acellular pertussis vaccination was more likely for postpartum women postintervention compared with preintervention (147 of 248 [59%] compared with zero of 183 [0%]; difference=59%; 95% confidence interval [CI] 53-65%). Among 248 women who delivered during the postintervention period, those who met pharmacologic criteria for decision support rule activation were vaccinated more often than those who did not meet criteria (146 of 232 [63%] compared with one of 16 [6%]; difference=57%; 95% CI 43-70%). Race and ethnicity and cesarean delivery were not associated with vaccine receipt; however, there was a lower likelihood of vaccination among older women (P=.05 by a trend test across age quartiles). Conclusion: We implemented a computer-based clinical decision-support algorithm that dramatically increased Tdap vaccination of postpartum women. Deployment of our algorithm in hospitals that have clinical decision support systems should increase rates of this important postpartum preventive intervention. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Martinez J.,Stroger Hospital of Cook County |
Lemos D.,Stroger Hospital of Cook County |
Hosek S.,Stroger Hospital of Cook County
AIDS Patient Care and STDs | Year: 2012
Little is known of the experience of Latino youth with HIV infection in the United States, especially with respect to stressors and how these youth cope with said stressors. This study reports on a subset (Latino/Hispanic self-identified youth, n=14) of qualitatively interviewed youth (n=30), both in individual interviews and in focus group discussion settings, aware of their HIV diagnosis for 12-24 months (mean: 16.7 months; standard deviation [SD], 4.89) Youth were 16-24 years old (M=21.5 years), female (43%) and males (57%). Youth were recruited from three cities: Chicago, New York, and San Juan (Puerto Rico). Interviews of Latinos (n=14) were reviewed for sources of stressors and support. Seven themes emerged in analyzing stated sources of stressors: (1) initial psychosocial responses to HIV diagnosis, (2) disclosure to family and friends, (3) stigma related to receiving an HIV diagnosis, (4) body image and concerns of the physical changes associated with HIV and antiretroviral medications, (5) taking antiretroviral medications and side effects, (6) the disruption of their future life goals, and (7) reproductive health concerns. Identified sources of support and coping were described including; gaining appreciation for what matters in life, adapting and developing achievable goals, reordering priorities and relying on religion and spiritual beliefs for health outcomes. The information gathered is from individual interviews and from focus group discussions can be used to increase the understanding of this understudied population while improving services to engage and retain these youth in care. © Copyright 2012, Mary Ann Liebert, Inc.
Valentino D.,Stroger Hospital of Cook County |
Sriram K.,Stroger Hospital of Cook County |
Shankar P.,Georgia Southern University
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2011
Purpose of Review: Obesity is a growing worldwide epidemic. Obese patients are often deficient in micronutrients despite macronutrient excess. Bariatric surgery is an increasingly utilized modality in the treatment of obesity and obesity-related conditions. Bariatric surgery itself may cause or exacerbate micronutrient deficiencies with serious sequelae. This review will focus on perioperative strategies to detect, prevent and treat micronutrient deficiencies in patients undergoing bariatric surgery, and will highlight practical and clinical aspects of these nutritional problems. Recent Findings: Micronutrient deficiency is common in obese patients undergoing bariatric surgery both preoperatively and postoperatively. Bariatric procedures with a malabsorptive component are more likely to result in postoperative micronutrient deficiency. A system-based approach will facilitate clinical suspicion of specific or combined micronutrient deficiencies, leading to appropriate laboratory tests for confirmation. Supplementation by the oral route is always tried first, reserving parenteral administration for specific situations. Summary: Clinicians should be aware that micronutrient deficiencies are common in obese patients who may have macronutrient excess. Micronutrient deficiency may exist preoperatively or be caused by bariatric procedures themselves. A systematic and team-based approach will decrease morbidity associated with delays in diagnosis and treatment. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Harper G.W.,University of Michigan |
Lemos D.,Stroger Hospital of Cook County |
Hosek S.G.,Stroger Hospital of Cook County
AIDS Patient Care and STDs | Year: 2014
This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma - personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV - as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women. © Mary Ann Liebert, Inc. 2014.
Agarwal R.,Stroger Hospital of Cook County |
Schwartz D.N.,Stroger Hospital of Cook County |
Schwartz D.N.,Rush University Medical Center
Clinical Infectious Diseases | Year: 2011
Can the use of serum procalcitonin levels safely reduce antimicrobial use in intensive care unit (ICU) patients? We performed a systematic literature review that identified 6 published randomized controlled trials comparing PCT-guided antimicrobial therapy to usual care in ICU patients, extracting data on ICU and patient characteristics, PCT guideline content, intensity of antimicrobial exposure, ICU length of stay, infection relapse and mortality. Procalcitonin guidance was associated with significantly reduced antimicrobial exposure (effect sizes, 19.5%-38%) in all 5 studies assessing its impact on treatment duration but did not significantly impact antimicrobial exposure in the study assessing treatment initiation only. Length of ICU stay was significantly decreased in 2 studies but was unchanged in the others. Neither infection relapse nor mortality varied significantly in any of the studies. Procalcitonin guidance of antimicrobial duration appears to decrease antimicrobial use in the ICU safely and significantly and may also decrease the length of stay in the ICU. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.