ABSTRACT
BACKGROUND: Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. We sought to determine the risk of Clostridium difficile infection (CDI) in hospitalization with multiple myeloma (MM), as well as its outcomes and trends, using a nationally representative database. METHODS: The Nationwide Inpatient Sample (NIS) from January 2010 to September 2015 was used for this study. We identified all patients aged 18 years or older with a diagnosis of MM using the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We identified trends in the annual rates of CDI in MM using negative binomial regressions with robust error variance. We conducted multivariate logistic regression to determine the incidence and the associated risk factors of CDI in MM and compared the outcomes between those with and without CDI using the propensity score method inverse probability weighting to adjust for baseline covariates. RESULTS: In our cohort study of 114,249 MM patients, 45.96% were females and 54.04% were males. CDI was present in 3.1% of the MM patients. The number of CDI cases increased over the study period with an average rate of 3.27% per year. The mortality rate decreased over the same period with an average rate of 10% decrease per year. Hematopoietic stem cell transplantation (HSCT), neutropenia, inflammatory disease, atrial fibrillation (AF), and chronic kidney disease (CKD) were significant associated risk factors of CDI in MM patients. After adjusting for covariates, patients with CDI had a prolonged hospital stay, inpatient mortality, and significantly increased odds of acute kidney injury (AKI) and AKI requiring hemodialysis, along with higher healthcare resources utilization with significantly higher hospital costs. CONCLUSION: MM patients with CDI have significantly increased odds of inpatient mortality, AKI, and AKI requiring hemodialysis. They also have increased healthcare resource utilization compared with those without CDI. Despite the increased rate of the CDI over the years, the mortality rate is going down.
ABSTRACT
OBJECTIVE: This article describes Phase 1 of a pilot that aims to develop, implement, and test an intervention to educate and simultaneously engage highly stressed Latino parents in child mental health services. A team of Spanish-speaking academic and community co-investigators developed the intervention using a community-based participatory research approach and qualitative methods. METHOD: Through focus groups, the team identified parents' knowledge gaps and their health communication preferences. RESULTS: Latino parents from urban communities need and welcome child mental health literacy interventions that integrate printed materials with videos, preferably in their native language, combined with guidance from professionals. CONCLUSION: A 3-minute video in Spanish that integrates education entertainment strategies and a culturally relevant format was produced as part of the intervention to educate and simultaneously engage highly stressed Latino parents in child mental health care. It is anticipated that the intervention will positively impact service use among this group.
ABSTRACT
OBJECTIVE: This study examines the relationship between family processes and youth substance use debuts among a sample of youth residing in urban family homeless shelters. METHOD: Data regarding shelter experiences, youth and family characteristics, and the use of three substances (i.e., cigarettes, alcohol, and marijuana) were gathered from a sample of youth (11-14 years) and their respective parents residing in an urban family homeless shelter system. Multinomial logistic regression analysis was used to examine the influences on youth substance use. RESULTS: Of the 198 youth included in the statistical analysis, 72% (n=143) reported no substance use debuts, while 18% (n=35) indicated one and 10% (n=20) indicated two to three substance use debuts. Within the final model, greater substance use debut was associated with being older (13-14 vs. 11-12; OR=7.5; 95% CI =1.8-30.9) and stressors exposure (OR=4.8; 95% CI =1.5-14.7). Furthermore, youth of adult caretakers that reported low levels of the three family processes considered were almost four and a half more likely (OR=4.4; 95% CI =1.2-16.5) to have made two to three substance use debuts. CONCLUSIONS: Family processes may be a particularly important intervention target toward reducing the rate of substance use among youth residing in urban family homeless shelters.
