Limited health literacy in advanced kidney disease.

Limited health literacy may reduce the ability of patients with advanced kidney disease to understand their disease and treatment and take part in shared decision making. In dialysis and transplant patients, limited health literacy has been associated with low socioeconomic status, comorbidity, and mortality. Here, we investigated the prevalence and associations of limited health literacy using data from the United Kingdom-wide Access to Transplantation and Transplant Outcome Measures (ATTOM) program. Incident dialysis, incident transplant, and transplant wait-listed patients ages 18 to 75 were recruited from 2011 to 2013 and data were collected from patient questionnaires and case notes. A score >2 in the Single-Item Literacy Screener was used to define limited health literacy. Univariate and multivariate analyses were performed to identify patient factors associated with limited health literacy. We studied 6842 patients, 2621 were incident dialysis, 1959 were wait-listed, and 2262 were incident transplant. Limited health literacy prevalence was 20%, 15%, and 12% in each group, respectively. Limited health literacy was independently associated with low socioeconomic status, poor English fluency, and comorbidity. However, transplant wait-listing, preemptive transplantation, and live-donor transplantation were associated with increasing health literacy.

Sildenafil citrate in a donation after circulatory death experimental model of renal ischemia-reperfusion injury.

INTRODUCTION: Phosphodiesterase-5 inhibitors prevent the breakdown of cyclic guanosine 3',5'-monophosphate (cGMP) and therefore may be useful in reducing the detrimental effects of ischemia-reperfusion (I/R) injury. The aim of this study was to assess the effects of the phosphodiesterase-5 inhibitor sildenafil, on I/R injury in a porcine model of donation after circulatory death kidney transplantation. METHODS: Kidneys were subjected to 20 min warm ischemia followed by 2 or 18 hr of cold storage (n=6 kidneys per group). After preservation kidneys were reperfused on an ex vivo perfusion system for 3 hr with an oxygenated blood based solution. Kidneys were treated with 1.4 mg/kg sildenafil infused 10 min before and for 20 min after reperfusion (n=6 kidneys per group). Renal function and injury markers were measured throughout reperfusion. RESULTS: Prolonged cold ischemia (CI) significantly reduced levels of cGMP (2 hr 3.5 [1.5-5.7] vs. 18 hr 1.2 [0.3-2.8] pmol/mL; P=0.010). The administration of sildenafil significantly increased the levels (P=0.047, 0.064). Sildenafil improved the renal blood flow for the first 30 min in the 2-hr group (sildenafil, 81.8 [43.8-101.9] vs. control 40.2 [6.4-76.9] mL/min/100 g; P=0.026) and up to 60 min in the 18-hr group (sildenafil, 67.4 [38.0-87.0] vs. control 36.2 [30.5-50.0] mL/min/100 g; P=0.009) during reperfusion. Renal function was significantly impaired after 18-hr CI (P=0.0.26), and treatment with sildenafil did not improve renal function in the 2-hr (P=0.384) or 18-hr CI (P=0.099) groups. CONCLUSION: Sildenafil had a vasodilatory action and increased levels of cGMP but did not affect recovery of renal function or protect against I/R injury.

Risk Assessment: Abscessation of Head Lymph Nodes and Carcass Inspection at Two High-Line-Speed Beef Abattoirs in Western Canada.

Canadian inspection procedures for railing out young beef heifer and steer carcasses in high-line-speed abattoirs because of head lymph node abscessation (HLNA) were evaluated. A total of 231,405 animals were inspected and 3,368 that had HLNA were railed out to a stationary line and subjected to further detailed examination. These were compared to 1,659 control carcasses lacking any visual abnormalities, including HLNA, in the judgment of inspection personnel. Four carcasses and 7 portions of carcasses with HLNA and 2 portions of control carcasses were condemned. Histopathological and limited bacteriological examinations were carried out. It was concluded that use of HLNA detection exclusively for more detailed carcass inspection was inefficient and lacked scientific validity. Other criteria are essential for the identification of carcasses that pose a significant hazard to human health.

Verification of the level of Microbiological Control for the Slaughter and Cooling Processes of Beef Carcass Production at a High-line-Speed Abattoir.

Methods are described which were used to verify the microbiological adequacy of the processes of production and chilling of carcasses at a high-line-speed abattoir. Ten excision samples (5 by 5 by 0.2 cm) were taken from each of 16 to 20 carcasses for each evaluation of these processes. Twelve monthly evaluations were made for the slaughter of steers, heifers, and cows and additional evaluations for each of the slaughter of cows and the chill process of carcasses. The ranges of the estimated mean log10 most probable number of growth units per square centimeter (LMPN, for 236 carcasses) and Escherichia coli per square centimeter (LEC, for 240 carcasses) enumerated by hydrophobic-grid membrane filter technology for the 12 monthly evaluations of the slaughter floor were 1.11 to 1.62 (LMPN) for single samples and 0.20 to 0.65 (LEC) for pooled samples. Based on a published advisory scale for the slaughter floor the aerobic bacterial counts reflect a cleanliness level of "excellent" to "good." For single evaluations of cow carcasses at the end of slaughter and of chilled carcasses the mean LMPN was 1.78 ("good") and 1.40 respectively. From pooled samples of each of the 236 steer, heifer, and cow carcasses the pathogen E. coli O157:H7 was identified by polymerase chain reaction on one carcass whereas Listeria monocytogenes was identified on 14 carcasses. Verocytoxigenic E. coli (6 isolates) and L. monocytogenes were not isolated from the same carcasses. These low isolation rates dictate a large sample size and therefore these pathogens are excluded from use to routinely verify the workings of hazard analyses and critical control point (HACCP) systems for beef slaughter processes in Alberta. Alternatively the use of aerobic bacterial counts to directly measure cleanliness or of E. coli counts to indirectly measure fecal contamination appears to be more practical than the use of specific pathogen counts for regulatory agencies to verify the workings of quality control programs, including HACCP systems.

Visual Demerit and Microbiological Evaluation of Beef Carcasses: Methodology.

A repeatable, automated method was developed for estimating aerobic bacterial populations on surfaces of groups of beef carcasses. Ten sample cluster sites (CS) were identified by localizing visual demerits (Canadian Streamlined Inspection System) on 200 carcasses at one plant. Most probable number growth units per cm2 (MPNGU/cm2) on hydrophobic grid membrane filters (HGMF) were assessed by an automated HGMF interpreter for excision samples from the centers of these CS. Between-sample variation of more than 90% of the total log10 MPNGU/cm2 variance indicated good repeatability between HGMF of the same sample and interpretations of the same HGMF. Variance component estimates indicated that there was considerable variation in MPNGU/cm2 between carcasses and between paired adjacent samples for a CS. A statistically significant but weak association was found between the demerit scores of a CS and MPNGU at its center. The variance component estimates will be used to estimate the sample size required for future group-carcass evaluations.