Improving Physical Activity among Residents of Affordable Housing: Is Active Design Enough?

Physical inactivity increases risk of chronic disease. Few studies examine how built environment interventions increase physical activity (PA). Active design (AD) utilizes strategies in affordable housing to improve resident health. We assessed how AD housing affects PA among low-income families in Brooklyn, New York. Participants were recruited at lease signings in 2016 from a new AD apartment complex and two recently renovated comparison buildings without AD features. Eligibility included age ≥18 years with no contraindications to exercise. Anthropometric data were collected. PA was self-reported using the Recent and Global Physical Activity Questionnaires. Smartphone users shared their tracked step. Data collection was repeated one year after move-in. All data were analyzed using SPSS. Eighty-eight eligible participants completed the initial questionnaire (36 AD and 52 from 2 comparison buildings) at baseline (T0). There were no differences between AD and comparison cohorts in: stair use, PA, sitting time or, mean waist-to-hip ratio (WHR) at T0. However, the AD cohort had a lower baseline BMI (27.6 vs. 31.0, p = 0.019). At one-year follow-up (T1), 75 participants completed our survey including a 64% retention rate among those who previously completed the T0 questionnaire. Among T0 questionnaire respondents, mean daily steps increased at T1 among AD participants who moved from an elevator building (∆6782, p = 0.051) and in the comparison group (∆2960, p = 0.023). Aggregate moderate work-related activity was higher at T1 in the AD building (746 vs. 401, p = 0.031). AD building women reported more work-related PA overall but AD men engaged in more moderate recreational PA. Living in an AD building can enhance low-income residents' PA. More research with objective measures is needed to identify strategies to sustain higher PA levels and overall health.

Elevated Serum Pancreastatin Is an Indicator of Hepatic Metastasis in Patients With Small Bowel Neuroendocrine Tumors.

OBJECTIVES: Serum pancreastatin is a sensitive and specific diagnostic biomarker in neuroendocrine tumors (NETs). Elevated pancreastatin levels are associated with worse progression-free survival and overall survival in small bowel and pancreatic NETs. In this study, we investigated the clinical significance of elevated serum pancreastatin in identifying metastatic disease to the liver. METHODS: Retrospective chart review of patients with NET managed at a single institution was performed. The site of primary tumor, laboratory data, and presence of metastatic disease were reviewed. The sensitivity, specificity, and positive and negative predictive values for pancreastatin as indicator of liver metastasis were ascertained. RESULTS: Data were abstracted from 77 patient records. Small bowel was the primary tumor site in 44 patients (57%), and 49 patients had metastasis to the liver (64%). Sensitivity and specificity of serum pancreastatin was 85.7% and 66.7%, respectively, which compared with 61.5% and 43.8% for chromogranin A, in identifying liver metastasis in patients with primary tumors of the small bowel. CONCLUSIONS: Elevated serum pancreastatin is a sensitive and specific assay for detecting the incidence of liver metastasis in patients with small-bowel NET. Routine measurement of pancreastatin in patients with NET, especially in patients with small bowel primaries, is supported.

Surgical repair of ileovesical fistulas: long-term complications, quality of life, and patient satisfaction.

Ileovesical fistulas (IVFs) are an uncommon complication of Crohn's disease. The aim of this study is to compare long-term surgical outcomes, assess quality of life, and quantify patient satisfaction after IVF repair. A retrospective chart review followed by a prospective survey was carried out. Survey questions focused on patient satisfaction and quality of life after repair of IVF. Fifty-one patients were identified from an administrative database. Mean follow-up was 4.3 years with a response rate of 51 per cent. At the time of the study, 0 per cent mortality and 16 per cent morbidity were recorded. No recurrence was noted. There was no statistical significance in incidence of complications between laparoscopic and open surgery. Statistically significant differences in single-stage versus multistage operations were found in postoperative day of discharge (P < 0.001) and patient satisfaction (P = 0.049). Ninety-eight per cent of patients reported extreme satisfaction with their surgery and an improvement in quality of life. A low incidence of morbidity and recurrence supports early surgical intervention in IVFs.

Comparison of laparoscopic versus open approach to gastrostomy tubes.

BACKGROUND AND OBJECTIVES: Gastrostomy tube insertion for enteral access may be performed through laparotomy (open) or through the laparoscopic approach. This study's purpose is to compare outcomes of these different approaches. METHODS: A retrospective chart review of all patients (age >18 years) who underwent insertion of a gastrostomy tube as a single elective procedure between 2004 and 2012 was performed. Primary end points included postoperative overall and tube-related morbidity, tube revision rates, and operative time. RESULTS: During the study period, 71 patients had a gastrostomy tube inserted via either the open (n 46) or the laparoscopic (n 25) approach. Preoperative variables including age, gender, body mass index, albumin, and American Society of Anesthesiologists score were statistically comparable between groups. There was no difference in rates of previous upper abdominal surgery (24% vs 26%, P = .590) or gastric surgery (12% vs 13%, P = .720) in the laparoscopic and open groups, respectively. Previous percutaneous endoscopic gastrostomy tube insertion rates were higher in the laparoscopic group (32% vs 6.5%, P = .005). Operative time was significantly longer in the laparoscopic group (76.8 ± 7 vs 55.8 ± 3, P = .003) but was not affected by previous abdominal surgery or higher body mass index. Overall morbidity, tube-related morbidity, and tube revision rates were similar between groups. However, there was a trend toward increased major complication rates in the open group (6.5% vs 0%, P = .190). CONCLUSION: Laparoscopic gastrostomy tube insertion is safe and feasible, even in patients who have had prior upper abdominal surgery. Patients with a prolonged prognosis, obesity, and intact neurologic capacity may benefit the most from this approach.

Serum markers for predicting abdominal surgery outcomes in patients with cirrhosis.

BACKGROUND: Determinants of adverse events for cirrhotic patients undergoing abdominal surgery have not been adequately assessed. Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) have estimated perioperative outcomes with inconsistent results. Our study sought to combine novel serum markers with CTP and MELD to improve prognostication of 30-day postoperative mortality or liver transplant in cirrhotic patients undergoing abdominal surgery. METHODS: A review was performed on 120 cirrhotic patients undergoing nonhepatic abdominal surgeries at Mount Sinai Medical Center from 2001-2011. Preoperative serum markers were evaluated by logistic regression and receiver-operator characteristics. Prognostic ability of scoring systems was assessed using Youden's J statistic (J). RESULTS: Albumin and hematocrit were independently predictive of 30-day mortality or transplant with optimal cutoff values of albumin at <3.05 mg/dl and hematocrit at <35.55 %. Adding these criteria to CTP>A, CTP>B, MELD ≥ 10, MELD ≥ 15, and MELD ≥ 20 improved sensitivity and specificity by an average of 6.1 and 32.1 %, respectively. The highest J values resulted from combining novel criteria with CTP>A (sensitivity, 80 %; specificity, 82 %; p < 0.01; J, 0.63) and MELD ≥ 10 (sensitivity, 63 %; specificity, 90 %; p < 0.01; J, 0.53). CONCLUSION: Augmenting CTP and MELD with albumin and hematocrit significantly improved the identification of cirrhotic patients at risk of 30-day mortality or transplantation following nonhepatic abdominal surgery.

The surgical management of active ulcerative colitis complicated by Clostridium difficile infection.

INTRODUCTION: Clostridium difficile stool toxin is detected in 5-20 % of patients with acute exacerbations of ulcerative colitis (UC). There is little data regarding the safety of surgery for UC with concurrent C. difficile. METHODS: A retrospective review was performed of 23 patients undergoing colectomy for refractory UC complicated by C. difficile infection between January 2002 and June 2012. Patients were stratified into those who completed a full antibiotic course for C. difficile infection prior to surgery (group A, n = 7) and those who proceeded directly to surgery (group B, n = 16). The primary endpoints of perioperative mortality, ICU requirement, reoperation, readmission, and surgical site infection were assessed within 30 days after surgery. RESULTS: Postoperatively, no mortalities, ICU admissions, readmission, or reoperations occurred. One group A patient developed a superficial wound infection, which resolved with a course of outpatient antibiotics (14 vs. 0 %, p = 0.12). Average days until return of bowel function and average length of postoperative stay were comparable between group A and B (3.9 vs. 3.6 days, p = 0.70; 7.0 vs. 6.9 days, p = 0.87; respectively). Ninety-one percent of patients subsequently underwent ileal pouch-anal anastomosis. CONCLUSION: Colectomy for ulcerative colitis complicated by C. difficile can be performed safely without completing a course of antibiotic therapy.