Potentially Inappropriate Prescribing in Hospitalized Older Adult High-Cost Health Care Users: A Pilot Study.

Background: High-cost health care users use disproportionate amounts of health care resources relative to the typical patient. It is unclear to what extent poor-quality prescribing, including potentially inappropriate prescribing (PIP), may be contributing to their adverse outcomes and health utilization costs. Objectives: To evaluate the prevalence of PIP and to explore its impact in older adult high-cost health care users. Methods: The charts of older adult high-cost health care users admitted to 2 academic hospitals in Ontario, Canada, in fiscal year 2015/16 were reviewed. Eligible patients were at least 66 years old with at least 5 emergency department visits and 3 hospital admissions in the previous year. A total of 243 patients met these criteria, of whom 100 were randomly selected for review. Cases of PIP were identified using explicit prescribing quality indicators, including the STOPP/START criteria. Types of PIP included potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Log-linear regression was used to characterize the relationship between PIP and future health care utilization. Medications were reconciled to determine the proportion of PIP addressed by the time of discharge. Results: Eighty-nine of the 100 patients had at least 1 instance of PIP. In total, 276 PIMs and 54 PPOs were identified. Of the 271 instances of PIP identified on admission, only 38 (14%) were resolved by the time of hospital discharge. Each additional PPO was associated with a 1.43-fold increase in the rate of future emergency department visits (p < 0.001). Conclusions: The rate of PIP among older adult high-cost health care users was high. Despite frequent interactions with the health care system, many opportunities to improve the quality of prescribing for this vulnerable population were missed. Greater attention to medication optimization is needed.

Contexte: Les grands utilisateurs de soins de santé consomment une proportion disproportionnée des ressources par rapport aux patients moyens. On ne sait pas vraiment dans quelle mesure la prescription de mauvaise qualité, notamment la prescription potentiellement inappropriée (PPI), contribue aux effets indésirables et aux coûts d'utilisation des soins de santé. Objectifs: Évaluer la prévalence des PPI et étudier ses effets chez les grands utilisateurs des soins de santé âgés. Méthodes: Les dossiers des grands utilisateurs de soins de santé âgés admis dans 2 hôpitaux universitaires en Ontario, au Canada, pendant l'exercice 2015­2016 ont été examinés. Les patients admissibles étaient âgés d'au moins 66 ans, avaient effectué au moins 5 visites à l'urgence et avaient été admis 3 fois à l'hôpital au cours de l'année précédente. Au total, 243 patients répondaient à ces critères, dont 100 ont été sélectionnés au hasard pour un examen. Les cas de PPI ont été identifiés à l'aide d'indicateurs explicites de la qualité de prescription, notamment les critères STOPP/START. Les types de PPI comprenaient des médicaments potentiellement inappropriés (MPI) et les omissions potentielles de prescription (OPP). La régression log-linéaire a été utilisée pour caractériser la relation entre la PPI et l'utilisation future des soins de santé. Un bilan comparatif des médicaments prescrits a été effectué pour déterminer la proportion de PPI traités au moment de la sortie de l'hôpital. Résultats: Quatre-vingt-neuf (89 %) des patients présentaient au moins 1 cas de PPI. Au total, 276 MPI et 54 OPP ont été identifiées. Sur les 271 cas de PPI identifiés au moment de l'admission, seuls 38 (14 %) étaient résolus au moment de la sortie de l'hôpital. Chaque OPP supplémentaire était associée à une augmentation de 1,43 fois du taux de futures visites à l'urgence (p < 0,001). Conclusions: Le taux de PPI chez les grands utilisateurs de soins de santé âgés était élevé. Malgré des interactions fréquentes avec le système de santé, de nombreuses occasions d'amélioration de la qualité des prescriptions pour cette population vulnérable ont été manquées. Une plus grande attention doit être portée à l'optimisation des médicaments.

Scabies education in secondary schools: A multicenter study.

Background: The aim of this study was to educate secondary school students on etiology, risk factors, clinical features, treatment, and prevention of scabies; to evaluate their knowledge base on scabies before and after an educational intervention; and to reassess this knowledge base and behavioral change, 6 months after, on a second visit. Methods: Questionnaires with standard questions on scabies, graded to a maximum score of 10, were administered to students in junior secondary Classes 1 and 2 across 4 states in Nigeria. Information obtained included subjects' demographics, scabies symptomatology, risks, and preventive behaviors. Students with active scabies were diagnosed and treated. Data were analyzed with STATA. Results: The mean test scores for the pretest and posttest at first visit were 2.82 ± 1.38 and 6.30 ± 1.09, respectively. This difference was statistically significant at t = 3.95, P = 0.004. Six months later, when the same schools were re-visited, the mean test scores for the pretest and posttest were 4.63 ± 0.54 and 5.87 ± 0.25, respectively. This difference was also significant at t = 4.13, P = 0.003. The prevalence of scabies was 3.5% at first visit and 4.34% at second visit; t = 0.24, P = 0.41. Conclusions: Secondary school students lack basic education on scabies and exhibit high-risk behaviors for scabies transmission. Knowledge on scabies needs constant reinforcement.

RésuméContexte: Le but de cette étude était d'éduquer les élèves du secondaire sur l'étiologie, les facteurs de risque, les caractéristiques cliniques, le traitement et la prévention de la gale; évaluer leur base de connaissances sur la gale avant et après une intervention éducative; et de réévaluer cette base de connaissances et ce changement de comportement, six mois après, lors d'une deuxième visite. Méthodes: Des questionnaires contenant des questions standard sur la gale, notés à un score maximum de 10, ont été administrés aux élèves des classes 1 et 2 du premier cycle du secondaire dans 4 États du Nigéria. Les informations obtenues comprenaient la démographie des sujets, la symptomatologie de la gale, les risques et les comportements préventifs. Les étudiants atteints de gale active ont été diagnostiqués et traités. Les données ont été analysées avec STATA. Résultats: Les scores moyens aux tests avant et après le test lors de la première visite étaient respectivement de 2,82 ± 1,38 et 6,30 ± 1,09. Cette différence était statistiquement significative à t = 3,95, p = 0,004. Six mois plus tard, lorsque les mêmes écoles ont été revues, les scores moyens aux tests avant et après test étaient respectivement de 4,63 ± 0,54 et 5,87 ± 0,25. Cette différence était également significative à t = 4,13, p = 0,003. La prévalence de la gale était de 3,5% lors de la première visite et de 4,34% lors de la deuxième visite; t = 0,24, p = 0,41. Conclusions: Les élèves du secondaire manquent d'éducation de base sur la gale et présentent des comportements à haut risque de transmission de la gale. Les connaissances sur la gale nécessitent un renforcement constant.

Hospitalidade e integração na arquitetura do comum nas sociabilidades escolares / Hospitalidad e integración en la arquitectura de lo común en las sociabilidades escolares / Hospitalité et intégration dans larchitecture du commun des sociabilites scolaires / Hospitality and integration in the making of the common in school sociability

Resumo O presente artigo parte de dados recolhidos de uma pesquisa centrada nas sociabilidades escolares, pretendendo-se, na esteira de uma sociologia dos envolvimentos e comunalidades, trazer à luz outros ângulos da justiça escolar e do fazer o comum na escola. É, concretamente, mobilizada uma técnica designada por questionário por cenários, em que, a partir de uma narrativa de carácter dilemático, pretende-se aceder aos sentidos morais evidenciados por alunos inquiridos. Analisamos em particular as inquietações em torno do respeito, reconhecimento, hospitalidade e decência trazidas à colação por esses atores nas interações e nos juízos críticos produzidos - juízos esses que transcendem leituras meramente feitas a partir dos dispositivos formais reguladores das condutas no espaço escolar.

Resumen El presente artículo parte de los datos recogidos de una pesquisa centrada en las sociabilidades escolares, pretendiéndose, en la huella de una sociología de las participaciones y comunidades, traer a la luz otros ángulos de la justicia escolar y del quehacer habitual en la escuela. Es, concretamente, movilizada una técnica designada por cuestionario por situaciones, en que, a partir de una narrativa de carácter dilemático, se pretende acceder a los sentidos morales evidenciados por alumnos inquiridos. Analizamos en particular las preocupaciones en torno del respeto, reconocimiento, hospitalidad y decencia planteadas por esos actores en las interacciones y en los juicios críticos producidos - juicios esos que transcienden lecturas meramente hechas a partir de los dispositivos formales reguladores de las conductas en el espacio escolar.

Résumé Cet article part des données d'une recherche axée sur les sociabilités scolaires. Dans le sillage d'une sociologie des engagements et des communalités, il s'agit de mettre en lumière d'autres aspects de la justice scolaire et du faire commun en milieu scolaire. Concrètement, à l'aide d'une technique denommée questionnaire par scénarios, à partir d'un récit à caractère dilemmatique, on vise à accéder aux significations morales mises en évidence par les étudiants interrogés. Nous analysons en particulier les préoccupations relatives au respect, à la reconnaissance, à l'hospitalité et à la décence soulevées par ces acteurs dans leurs interactions et leurs jugements critiques, jugements transcendant les lectures qui sont faites uniquement à partir des dispositifs formels régissant les conduites dans l'espace scolaire.

Abstract This article is based on data collected from a research project centred on school sociability, aiming, through a sociology of engagements and commonalities, to shed light on other angles of school justice and the making of the common in the school territory. Specifically, a technique termed scenario survey is mobilized, in which, based on a dilemmatic narrative, the intention is to access the moral meanings evidenced by the inquired students. We analysed particularly their inquietude around respect, recognition, hospitality and decency brought up by these actors in their interactions and critical judgments - judgments that transcend interpretations merely based on the formal governing devices of actor's conduct in the school space.

Elevated aldolase 1A, retrogene 1 expression induces cardiac apoptosis in rat experimental autoimmune myocarditis model.

Acute myocarditis is an unpredictable heart disease that is caused by inflammation-associated cell death. Although viral infection and drug exposure are known to induce acute myocarditis, the molecular basis for its development remains undefined. Using proteomics and molecular analyses in myosin-induced rat experimental autoimmune myocarditis (EAM), we identified that elevated expression of aldolase 1A, retrogene 1 (Aldoart1) is critical to induce mitochondrial dysfunction and acute myocarditis development. Here, we demonstrate that cardiac cell death is associated with increased expressions of proapoptotic genes in addition to high levels of glucose, lactate, and triglyceride in metabolite profiling. The functional protein association network analysis also suggests that Aldoart1 upregulation correlates with high levels of dihydroxyacetone kinase and triglyceride. In H9c2 cardiac cells, lipopolysaccharides (LPS) or high glucose exposure significantly increases the cytochrome c release and the conversion of pro-caspase 3 into the cleaved form of caspase 3. We also found that LPS- or glucose-induced toxicities are almost completely reversed by siRNA-mediated knockdown of Aldoartl, which consequently increases cell viability. Together, our study strongly suggests that Aldoart1 may be involved in inducing mitochondrial apoptotic processes and can be a novel therapeutic target to prevent the onset of acute myocarditis or cardiac apoptosis.

Early childhood predictors of boys' antisocial and violent behavior in early adulthood.

Research on early childhood predictors of violent behaviors in early adulthood is limited. The current study investigated whether individual, family, and community risk factors from 18 to 42 months of age were predictive of violent criminal arrests during late adolescence and early adulthood using a sample of 310 low-income male participants living in an urban community. In addition, differences in trajectories of overt conduct problems (CP), hyperactivity/attention problems (HAP), and co-occurring patterns of CP and HAP from age 1½ to 10 years were investigated in regard to their relationship to violent and nonviolent behaviors, depression, and anxiety at age 20. Results of multivariate analyses indicated that early childhood family income, home environment, emotion regulation, oppositional behavior, and minority status were all significant in distinguishing violent offending boys from those with no criminal records. In addition, trajectories of early childhood CP, but not attention deficit hyperactivity disorder, were significantly related to self-reports of violent behavior, depressive symptoms, and anxiety symptoms. Implications for the prevention of early childhood risk factors associated with adolescent and adult violent behavior for males are discussed.

Considering the role of early discrimination experiences and the parent-child relationship in the development of disruptive behaviors in adolescence.

Discrimination has been shown to be related to diminished psychological adjustment and greater risk for substance use when personally experienced by adolescents and when their caregivers experience discrimination. Our research considers the impact of primary caregiver experiences of racial- and socioeconomic-based discrimination in early (age 3-5 years) and late childhood (age 9½) on adolescent disruptive behaviors (age 14) with a large sample of diverse caregiver-child dyads (N = 634). In addition, we examine the potential protective effects of parent-child relationship quality in early and late childhood in buffering the effects of caregiver discrimination on adolescent disruptive behaviors. We also explore possible gender differences in children's vulnerability to engage in disruptive behaviors in the context of caregiver experiences of discrimination. The findings from this study indicate that at trend level, early childhood experiences of primary caregiver discrimination (ages 3-5) predicted adolescent disruptive behaviors, accounting for the effects of more recent (age 9½) caregiver discrimination. In addition, parent-child relationship quality at age 9½ years was found to buffer the effects of late childhood (age 9½) primary caregiver discrimination on adolescent disruptive behaviors for both male and female youth. The findings highlight the need for prevention and intervention techniques that foster healthy and positive primary caregiver-child relationships.

A global profile of glucose-sensitive endothelial-expressed long non-coding RNAs.

Hyperglycemia-related endothelial dysfunction is believed to be the crux of diabetes-associated micro- and macro-vascular complications. We conducted a systematic transcriptional survey to screen for human endothelial long non-coding RNAs (lncRNAs) regulated by elevated glucose levels. lncRNAs and protein-coding transcripts from human umbilical vein endothelial cells (HUVECs) cultured under high (25 mmol/L) or normal (5 mmol/L) glucose conditions for 24 h were profiled with the Arraystar Human LncRNA Expression Microarray V3.0. Of the 30 586 lncRNAs screened, 100 were significantly upregulated and 186 appreciably downregulated (P < 0.05) in response to high-glucose exposure. In the same HUVEC samples, 133 of the 26 109 mRNAs screened were upregulated and 166 downregulated. Of these 299 differentially expressed mRNAs, 26 were significantly associated with 28 differentially expressed long intergenic non-coding RNAs (P < 0.05). Bioinformatics analyses indicated that the mRNAs most upregulated are primarily enriched in axon guidance signaling pathways; those most downregulated are notably involved in pathways targeting vascular smooth muscle cell contraction, dopaminergic signaling, ubiquitin-mediated proteolysis, and adrenergic signaling. This is the first lncRNA and mRNA transcriptome profile of high-glucose-mediated changes in human endothelial cells. These observations may prove novel insights into novel regulatory molecules and pathways of hyperglycemia-related endothelial dysfunction and, accordingly, diabetes-associated vascular disease.

Four minutes of in-class high-intensity interval activity improves selective attention in 9- to 11-year olds.

The amount of time allocated to physical activity in schools is declining. Time-efficient physical activity solutions that demonstrate their impact on academic achievement-related outcomes are needed to prioritize physical activity within the school curricula. "FUNtervals" are 4-min, high-intensity interval activities that use whole-body actions to complement a storyline. The purpose of this study was to (i) explore whether FUNtervals can improve selective attention, an executive function posited to be essential for learning and academic success; and (ii) examine whether this relationship is predicted by students' classroom off-task behaviour. Seven grade 3-5 classes (n = 88) were exposed to a single-group, repeated cross-over design where each student's selective attention was compared between no-activity and FUNtervals days. In week 1, students were familiarized with the d2 test of attention and FUNterval activities, and baseline off-task behaviour was observed. In both weeks 2 and 3 students completed the d2 test of attention following either a FUNterval break or a no-activity break. The order of these breaks was randomized and counterbalanced between weeks. Neither motor nor passive off-task behaviour predicted changes in selective attention following FUNtervals; however, a weak relationship was observed for verbal off-task behaviour and improvements in d2 test performance. More importantly, students made fewer errors during the d2 test following FUNtervals. In supporting the priority of physical activity inclusion within schools, FUNtervals, a time efficient and easily implemented physical activity break, can improve selective attention in 9- to 11-year olds.

Impact of the removal of chocolate milk from school milk programs for children in Saskatoon, Canada.

Studies in the United States report inclusion of flavoured milk in the diets of children and youth improves nutrient intakes. No research has investigated the contribution of flavoured milk to overall milk intake or the milk preferences of Canadian children. The objective of the study was to measure milk consumption (plain milk and flavoured milk) by children in an elementary school environment and investigate factors contributing to milk choice. A mixed-method research design was applied across 6 schools for 12 weeks. Milk waste was measured in grades 1-8 for 12 weeks. Weeks 1-4 (phase 1) and 9-12 (phase 3) provided both plain milk and flavoured milk as chocolate milk while weeks 5-8 (phase 2) provided plain milk only. Beverage Frequency Questionnaires were used in each phase (in grades 5-8 only) to assess usual beverage consumption. Statistical nutrient modelling was conducted to determine the effects of removing chocolate milk during phase 2 as a milk choice. Later, focus groups were conducted with students in grades 5-8 to determine what influences them to choose/not choose to drink milk. Total milk intake decreased by 12.3% when chocolate milk was removed from the schools (26.6% ± 5.2% to 14.31% ± 1.6%, p < 0.001). Milk choice was influenced by environmental factors as well as taste, cost, convenience, and variety. Total milk intake was associated with location (p = 0.035) and cost (p < 0.001), with rural students and/or those students receiving free milk drinking the greatest amount of milk. Nutrient modelling revealed chocolate milk is more cost-efficient and convenient at providing nutrients than alternative food/drink combinations.

[Smoking behavior among nursing students in Sousse, Tunisia: a preliminary study]. / Comportements tabagiques chez les étudiants infirmiers de Sousse, Tunisie: étude préliminaire.

INTRODUCTION: Smoking is an entirely preventable, man-made, epidemic. It is a major, worldwide, public health problem whose social costs are very high. Health care workers have an important role to play in tobacco control. We conducted a study among nursing students to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention. METHODS: This descriptive, transverse study was conducted in March 2011 during which an anonymous self-completion questionnaire was administered to nursing students. RESULTS: The study included 150 students aged between 18 and 25 years with a sex ratio of 1:3. The prevalence of smoking was 32.6%. Male students began smoking at an earlier age (16.5±2.3 years vs 18.9±1.1 years). The main initiating factors were stress (55%), pleasure (46.9%) and peer influence (36.5%). The Fagerstrom score showed a high level of dependency in 26.5% of smokers. More than 75% of student smokers have tried to quit. Most of the students surveyed (93%) think that health care workers should set a good example by not smoking and 91% of them think they should help others quit smoking. CONCLUSION: Health care workers should be well informed about the harmful effects of tobacco. They should be convinced of the need for their participation in smoking prevention and the fight against this medico-social scourge. It is essential that their training prepares them for this task and that their environment helps them fulfill their responsibility.