Screening, brief intervention, and referral to treatment for tobacco consumption, alcohol misuse, and physical inactivity: an equity-informed rapid review.

OBJECTIVE: This rapid review systematically synthesizes evidence of the effectiveness of the Screening, Brief Intervention, and Referral (SBIR/T) approach for tobacco use, alcohol misuse, and physical inactivity. STUDY DESIGN: This was a rapid review. METHODS: We searched primary studies between 2012 and 2022 in seven electronic databases. The search strategy used concepts related to alcohol-related disorders, intoxication, cigarette, nicotine, physical activity, exercise, sedentary, screening, therapy, and referral. We reviewed both title/abstract and full-text using a priori set inclusion and exclusion criteria to identify the eligible studies. We appraised study quality, extracted data, and summarized the characteristics of the included studies. We applied health equity lenses in the synthesis. RESULTS: Of the 44 included studies, most focused on alcohol misuse. SBIR/T improved patients' attitudes toward alcohol behavior change, improved readiness and referral initiation for change, and effectively reduced alcohol consumption. Few studies pertained to smoking and physical inactivity. Most studies on smoking demonstrated effectiveness pertaining to patients' acceptance of referral recommendations, improved readiness and attempts to quitting smoking, and reduced or cessation of smoking. Findings were mixed about the effectiveness of SBIR/T in improving physical activity. Minimal studies exist on the impacts of SBIR/T for these three risk factors on healthcare resource use or costs. Studies considering diverse population characteristics in the design and effectiveness assessment of the SBIR/T intervention are lacking. CONCLUSIONS: More research on the impacts of SBIR/T on tobacco use, alcohol misuse, and physical inactivity is required to inform the planning and delivery of SBIR/T for general and disadvantaged populations.

Performance of comorbidity measures for predicting outcomes in population-based osteoporosis cohorts.

UNLABELLED: The performance of five comorbidity measures, including the Charlson and Elixhauser indices, was investigated for predicting mortality, hospitalization, and fracture outcomes in two osteoporosis cohorts defined from administrative databases. The optimal comorbidity measure depended on the outcome of interest, although overall the Elixhauser index performed well. INTRODUCTION: Studies that use administrative data to investigate population-based health outcomes often adopt risk-adjustment models that include comorbidities, conditions that coexist with the index disease. There has been limited research about the measurement of comorbidity in osteoporotic populations. The study purpose was to compare the performance of comorbidity measures for predicting mortality, fracture, and health service utilization outcomes in two cohorts with diagnosed or treated osteoporosis. METHODS: Administrative data were from the province of Saskatchewan, Canada. Osteoporosis cohorts were identified from diagnoses in hospital and physician data and prescriptions for osteo-protective medications using case definitions with high sensitivity or high specificity. Five diagnosis- and medication-based comorbidity measures and five 1-year outcomes, including mortality, hospitalization (two measures), osteoporotic-related fracture, and hip fracture, were defined. Performance of the comorbidity measures was assessed using the c-statistic (discrimination) and Brier score (prediction error) for multiple logistic regression models. RESULTS: In the specific cohort (n = 9,849) for the mortality outcome, the Elixhauser index resulted in the largest improvement (8.96%) in the c-statistic and lowest Brier score compared to a model that contained demographic and socioeconomic variables, followed by the Charlson index (6.06%). For hospitalization, the number of different diagnoses resulted in the largest improvement (14.01%) in the c-statistic. The Elixhauser index resulted in significant improvements in the c-statistic for osteoporosis-related and hip fractures. Similar results were observed for the sensitive cohort (n = 28,068). CONCLUSIONS: Recommendations about the optimal comorbidity measure will vary with the outcome under investigation. Overall, the Elixhauser index performed well.

A review of evidence on the reliability and validity of Minimum Data Set data.

This paper reviews the reliability and validity of the Minimum Data Set (MDS) assessment, which is being used increasingly in Canadian nursing homes and continuing care facilities. The central issues that surround the development and implementation of a standardized assessment such as the MDS are presented, including implications for health care managers in how to approach data quality concerns. With other sectors such as home care and inpatient psychiatry using MDS for national reporting, these issues have importance in and beyond residential care management.

Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury.

PURPOSE: To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI). METHOD: This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7-24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes. RESULTS: Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes. CONCLUSIONS: The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.

Risk adjustment of quality indicators in French long term care facilities for elderly people. A preliminary study.

BACKGROUND: In France, the funding reform for long term care facilities mandates quality improvement efforts and the measurement of quality of care indicators. In the United States, the Center for Health Systems Research and Analysis (CHSRA) has proposed 24 indicators, which measure practices and outcomes ("events") in long term care facilities. The objective of this preliminary study was to propose risk adjustments on the CHSRA indicators for future use in France. METHODS: The unit of analysis was residents assessments (558) in eight French facilities wich voluntarily participated to the experimentation of the Resident Assessment Instrument (RAI) from January 1996 to June 1999. This preliminary study focused on nine of the CHSRA's indicators: "prevalence of falls", "use of nine or more different medications", "prevalence of bladder or bowel incontinence", "prevalence of occasional or frequent bladder or bowel incontinence without a toileting plan", "prevalence of urinary tract infections", "prevalence of dehydration", "prevalence of bedfast residents", "prevalence of little or no activity" and "prevalence of stage 1-4 pressure ulcers". A working group selected residents'characteristics for risk adjustment based on the literature, risk adjustments selected by CHSRA, and their own propositions. For each event, candidate independent characteristics were screened using univariate analyses and, when significant, were entered into a stepwise selection analysis to obtain the final model. The proposed indicator was the ratio between observed and expected numbers of events. RESULTS: Six indicators were left unadjusted. For the event "prevalence of occasional or frequent bladder or bowel incontinence without a toileting plan", we proposed a stratification on "dementia - neurological diseases" (p<0.001). We proposed two models of prediction: for the event "prevalence of bladder or bowel incontinence" we adjusted on "severe cognitive impairment" (OR=4.00), "dementia- neurological diseases" (OR=1.75) and "total dependence in mobility" (OR=9.30); for the event "prevalence of stage 1-4 pressure ulcers" we adjusted on "dependence for bed mobility" (OR=4.97), "leaves 25% or more food uneaten at most meals" (OR=1.82) and "diabetes mellitus" (OR=3.45). CONCLUSION: This preliminary study underlines the importance of considering risk-adjustment for quality indicators in elderly care facilities.

A new assessment for elders admitted to acute care: reliability of the MDS-AC.

Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between pre-hospital and hospital admission status can be systematically evaluated using the Minimum Data Set for Acute Care (MDS-AC). Content was developed by literature review and consultation with professionals working in acute areas. Dual independent assessments were conducted on hospital in-patients in 4 countries. Inter-assessor reliability coefficients were calculated for each item. Kappa was calculated for all binary and multi-level nominal variables. Quadratically weighted Kappa was estimated for all ordinal multi-level variables. Where one level of the variable contained 90% or more of the subjects, total observed agreement is reported. Separate reliability estimates were calculated for pre-hospitalization and inpatient items. Subjects had a mean age of 78. Completion of pre-hospitalization and hospital period assessment (combined) required 20 and 30 minutes. Excluding items for which 90% or more of subjects were classified into a single scoring level, average inter-assessor reliability coefficient for the pre-hospital period items was 0.57 and for in hospital 0.58. Overall exact agreement was 83% for pre-hospitalization assessment items, and 79% for the in-hospital items. The reliability achieved in the highly unstable situation of the acute admission phase is sufficient for use in clinical care and research. Differences in pre-hospital and admission status necessary for case-mix adjusted comparison of outcomes were illustrated. Development of a means for systematically comparing changes in older people during the course of illness is of increasing importance when addressing questions of the appropriate and inappropriate use of medical technology.

Group-level factors associated with chemotherapeutic treatment regimens in land-based trout farms in Ontario, Canada.

The lowest level at which fish farmers ordinarily make management decisions is the individual holding unit. To identify factors associated with chemotherapeutic treatment initiation at the holding-unit level, we created a unit of measurement called the "farm-tank-lot" (FTL), which allowed the movements and mixing of groups of fish to be followed during an entire production cycle. Each FTL was comprised of fish with a common history housed in a specific holding unit. Our 21-month prospective observational study (conducted on 14 land-based trout farms in Ontario, Canada) showed that the FTL was a biologically meaningful unit of concern and a feasible unit of measurement on land-based trout farms.Multivariable logistic and Poisson regressions revealed that fish size and growth rate both were associated negatively with the probability and frequency of treatment. FTLs that existed for longer periods of time were more likely to be treated and treated more often. There was a significant farm effect. Future field studies of disease in cultured fish should incorporate these factors into their design and analysis.

The relationship between E. coli indicator bacteria in well-water and gastrointestinal illnesses in rural families.

OBJECTIVES: To determine the relationship between consumption of E. coli contaminated well-water and gastrointestinal illness in rural families. METHODS: One hundred and eighty-one families with well-water as a drinking source participated in a one-year follow-up study. Water was tested for E. coli bacteria and health outcomes were monitored for house-hold members. RESULTS: E. coli in well-water was significantly associated with gastrointestinal illness in family members, however the relationship was modified by the distance from the septic tank to the well. E. coli had an odds ratio of 2.16 [95% CI 1.04, 4.42] if the septic tank was greater than 20 metres from the well and 0.46 [95% CI 0.07, 2.95] if the septic tank was within 20 metres. CONCLUSIONS: Consumption of contaminated well-water is associated with gastrointestinal illness. E. coli can be a useful marker for detecting wells that pose a potential public health problem in rural areas.

Integrated health information systems based on the RAI/MDS series of instruments.

There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

Long-term tracking of lymphocytes in vivo: the migration of PKH-labeled lymphocytes.

Studies of in vivo cell migration using cell markers such as 51Cr, 111In, FITC, or XRITC have been limited to short time periods due to the elution, toxicity, or rapid loss of label detectability. We have labeled sheep lymphocytes in vitro with PKH-2, a new fluorescent cell membrane label, and, after their intravenous injection back into donor sheep, have been able to detect them in efferent lymph, using flow cytometry, for longer than 38 days. The PKH-2-labeled lymphocytes migrated with similar kinetics, efficiency, and tissue specificity as lymphocytes labeled with cell markers used previously. PKH-2-labeled cells mediated graft versus host reactions indistinguishable from those mediated by unlabeled cells, and cell surface antigens were equally detectable on the surface of labeled and unlabeled lymphocytes. According to the slow, consistent loss of fluorescence intensity of the labeled cells in vivo, we predict that labeled lymphocytes could remain detectable by flow cytometry for greater than 7 weeks with the labeling protocol used in these experiments.

The relevance of lymphoid cell migration to immunodeficiency syndromes.

It has been known for some time that antigen stimulation can alter lymphocyte traffic patterns and that viruses are particularly potent in this respect; such alterations may be a consequence of host-derived factors. The retention of lymphocytes in lymph nodes can be sustained for several hours with locally administered interferon (IFN)alpha. The extravasation of lymphocytes from blood into non-lymphoid tissues can be induced in the skin with IFN gamma and particularly tumor necrosis factor (TNF)alpha. Recent evidence supports the concept that the migratory capacity of CD4+ cells differs from the capacity of CD8+ cells. Agents (cytokines?) which differentially affect the traffic of these two sub-sets have not yet been described but such a possibility has not been adequately tested. Several new molecules have been defined which alter the interactions between lymphocytes and blood vascular endothelial cells, and these may be important in the critical adhesive event in lymphocyte traffic. In both rat and sheep, it has been possible to cultivate post-capillary endothelial cells from lymphoid tissue, and this may be a helpful approach to studying the mechanisms and molecules involved in adhesion. New cell tracking dyes recently available (Zynaxis Cell Science) permit more significant, long-term studies on the life span of lymphocyte sub-sets and their migratory status. In our experiments, labeled lymphocytes can be followed in vivo for over 30 days. Traffic alterations may explain some of the abnormalities in immunodeficiency states.