Use of a tick-borne disease manual increases accuracy of tick identification among primary care providers in Lyme disease endemic areas.

Given the high incidence of tick bites and tick-borne diseases in the United States, it is important for primary care providers to recognize common ticks and the pathogens they may transmit. If a patient has removed and saved an attached tick, identifying the tick helps guide clinical management and determine whether antibiotic prophylaxis for Lyme disease is appropriate. To investigate providers' ability to recognize common ticks and the pathogens they may transmit, we asked 76 primary care providers from Lyme disease endemic areas to identify the common name or genus of preserved ticks found in their area. At baseline, 10.5%, 46.1%, and 57.9% of participants correctly identified an adult female blacklegged tick (engorged), dog tick, and lone star tick, respectively. Less than half of participants identified the three pathogens most frequently transmitted by blacklegged ticks. Use of a reference manual with tick photographs and drawings substantially improved identification of ticks and associated pathogens and therefore should be encouraged in clinical practice.

Tick-borne disease preventive practices and perceptions in an endemic area.

Lyme disease is the most commonly reported vector-borne illness in the United States. Since the institution of Nationally Notifiable surveillance efforts for Lyme disease in the United States in 1991, there has been a consistent increase in the number of reported cases. Thus, the need for targeted prevention strategies is underscored. The purpose of this study was to investigate knowledge about tick-borne diseases as well as beliefs and practices related to a variety of personal tick-borne disease prevention methods among individuals in southwestern Connecticut, a Lyme disease-endemic area. Between June and September 2014, an anonymous questionnaire was administered to 275 participants through a point-of-contact convenience sample obtained at community events in southwestern Connecticut. The questionnaire assessed individuals' general knowledge about tick-borne diseases, performance of four selected tick-borne disease prevention methods, and perceived effectiveness and burdensomeness of those four behaviors. Some 80% of participants were female; median age was 55 years (IQR 45-64 years); 30% reported having been treated for a tick-borne illness and 50% reported a family member having been treated for a tick-borne illness. Overall, participants' knowledge of tick-borne diseases was poor; the average knowledge score was only 57% (SD 22.6%). The reported frequency of performing preventive behaviors was variable. The most commonly reported behavior was performing a tick check (68%); use of tick repellent was the least commonly reported behavior (38%). Those who were more knowledgeable about Lyme disease were more likely to perform tick checks but knowledge score was not significantly associated with any of the other three behaviors studied. Respondents largely believed preventive behaviors to be effective at reducing the risk of tick-borne diseases. Belief that a prevention behavior is effective was highly correlated with performing that behavior but perceived burdensomeness does not appear to influence behavior performance. The reasons for differential uptake of preventive behaviors remains unknown; further study of barriers to performance of personal preventive behaviors is needed to better target public health interventions.

Effects of krill oil on endothelial function and other cardiovascular risk factors in participants with type 2 diabetes, a randomized controlled trial.

OBJECTIVE: The purpose of this trial was to evaluate the effect of krill oil supplementation, a source of ω-3 fatty acids, on cardiovascular disease risk factors and blood glucose control among participants with type 2 diabetes. RESEARCH DESIGN AND METHODS: A randomized, double-blind controlled cross-over trial was employed. Outcomes assessed were: endothelial function, blood lipids, glucose, glycated hemoglobin, serum antioxidant level, C peptide, and calculated Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) scores. Participants were randomized to either krill oil or olive oil supplementation for 4 weeks, underwent a 2-week washout period, and then crossed to the other supplementation for 4 weeks. All participants were then offered an additional 17 weeks of krill supplementation. Testing occurred at 3 time points: baseline, after first supplementation, and after second supplementation. Testing also occurred after an optional 17 weeks of krill oil supplementation. Difference scores were calculated for each participant in both sequences (ie, differences in outcome measures in the first and second period of the sequence). The mean and SD of the scores in the 2 sequence groups were used to test for differences between treatment effects at a significance level of p<0.05. RESULTS: A total of 47 participants were included in the initial cross-over study. Participants who received krill oil for 4 weeks had an improvement in their endothelial function and a reduction in blood C peptide levels and HOMA scores as compared with the olive oil. A total of 34 participants completed the additional 17-week supplementation period. When compared with their respective baseline measures, these participants had a statistically significant improvement in endothelial function and blood high-density lipoprotein (HDL). CONCLUSIONS: Krill oil may lead to moderate improvement of cardiovascular risks, specifically endothelial dysfunction and HDL in patients with type 2 diabetes. TRIAL REGISTRATION NUMBER: Registered with ClinicalTrials.gov: NCT02091193.