Use of Pediatric Primary Care Telephone Advice by Families Whose Usual Language Spoken at Home Is Not English.

Language barriers and access to telephone advice have been shown to affect patient care. Less is known about access to telephone advice for families whose usual language is not English. The objective was to characterize the use of pediatric primary care telephone advice by families based on usual language spoken at home. A total of 277 surveys were completed by families presenting for sick visits at an academic pediatric primary care practice. No meaningful differences in the use of telephone advice when a child was sick were found by language category. Overall, 80.5% reported calling the clinic first when the clinic was open, but 77.6% went to the emergency department when the clinic closed. In conclusion, use of telephone advice was similar among families regardless of usual language. Most families reported going to the emergency department when the clinic was closed. More research is needed to identify barriers to the use of telephone advice, particularly after hours.

Use of Language Services for Telephone Advice by Limited English Proficiency Families in a Pediatric Primary Care Setting.

BACKGROUND: Families limited in English proficiency (LEP) often do not receive appropriate medical language services, resulting in health disparities. Little is known about the use and effectiveness of language services provided via telephone when families call for medical advice. OBJECTIVE: To characterize language service provision to LEP families calling for medical advice in a pediatric primary care setting. METHODS: A self-administered survey was given to parents of children presenting for sick visits at an urban academic pediatric primary care practice. RESULTS: 277 out of 300 surveys were completed, 92% in English and 8% in Spanish. 7% (19/271) of those who answered the language proficiency question reported LEP (spoke English "not well," or "not at all"). Among LEP parents, 68% calling for advice during clinic hours received appropriate language services (a trained interpreter or a bilingual provider). 53% received these services when calling after hours. CONCLUSIONS: Over half of LEP families seeking telephone advice from their pediatric primary care office received adequate language services. Future research should identify barriers to providing telephone language services to LEP families.

Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital.

INTRODUCTION: This study sought to identify common causes of death as well as the factors associated with the high inpatient mortality rate of HIV-infected patients at the Korle-Bu Teaching Hospital (KBTH). METHODS: The retrospective study reviewed the medical records of 547 HIV-infected adults aged 18 years or older admitted to the KBTH between the months of January 2012 and October 2013. Using standardized abstraction forms, clinical and demographic data of eligible patients was collected. Data was summarized using descriptive statistics. Demographic and clinical characteristics of patients who died within 7 days (early) and after (late) admission were compared using Rank Sum tests or Chi-square tests. RESULTS: Of 547 eligible patients during the period, 222 (40.6%) died during hospitalization, with 124 (55.9%) of them dying within a week of admission. Of the 222 patients who died, 190 (85.6%) were previously known HIV-positive. Yet, 141 (63.5%) of the 222 patients who died had no prior highly active antiretroviral therapy (HAART). The most common admitting diagnoses were anemia (34.2%), cerebral toxoplasmosis (29.3%), and pneumonia (25.7%); the most common causes of death were tuberculosis (34.7%), anemia (30.2%) and cerebral toxoplasmosis (27.5%). Tuberculosis was the only factor significantly associated with early death (P<0.05). CONCLUSION: The inpatient mortality rate among HIV-infected adults admitted to the KBTH is high. A majority of the patients were not receiving HAART despite known HIV diagnosis. Earlier initiation of HAART may lower the risk of opportunistic infections and HIV mortality rates. Additionally, a high index of suspicion and initiation of empiric treatment for TB may reduce early deaths.

Alternative end-joining and classical nonhomologous end-joining pathways repair different types of double-strand breaks during class-switch recombination.

Classical nonhomologous end-joining (C-NHEJ) and alternative end-joining (A-EJ) are the main DNA double-strand break (DSB) repair pathways when a sister chromatid is not available. However, it is not clear how one pathway is chosen over the other to process a given DSB. To address this question, we studied in mouse splenic B cells and CH12F3 cells how C-NHEJ and A-EJ repair DSBs initiated by the activation-induced deaminase during IgH (Igh) class-switch recombination (CSR). We show in this study that lowering the deamination density at the Igh locus increases DSB resolution by microhomology-mediated repair while decreasing C-NHEJ activity. This process occurs without affecting 53BP1 and γH2AX levels during CSR. Mechanistically, lowering deamination density increases exonuclease I recruitment and single-stranded DNA at the Igh locus and promotes C-terminal binding protein interacting protein and MSH2-dependent DSB repair during CSR. Indeed, reducing activation-induced deaminase levels increases CSR efficiency in C-NHEJ-defective cells, suggesting enhanced use of an A-EJ pathway. Our results establish a mechanism by which C-NHEJ and this C-terminal binding protein interacting protein/MSH2-dependent pathway that relies on microhomology can act concurrently but independently to repair different types of DSBs and reveal that the density of DNA lesions influences the choice of DSB repair pathway during CSR.