TURN-IT: a novel turning intervention program to improve quality of turning in daily life in people with Parkinson's disease.

BACKGROUND: People with Parkinson's disease (PD) have a high fall rate and many falls are associated with turns. Despite this, there is minimal research on effects of rehabilitation on the quality of turns. Further, quantifying turns in the home may have broader implications since rehabilitation of turns would ideally improve turning in real world mobility. METHODS: Sixty people with PD and a history of falls will be randomized to receive either a novel TURNing InTervention (TURN-IT) or no intervention (control group). The TURN-IT group will be seen for 6 weeks (18 visits) for an individualized, progressive program that is based on the specific constraints of turning in PD. Wearable sensors will be used to measure 7 days of mobility, including turns, before and after intervention or control period. In addition, blinded assessments of gait, mobility and turns will occur before and after intervention for both groups and falls will be monitored for twelve months post intervention with bimonthly email questionnaires. DISCUSSION: This study has the potential to change how we rehabilitate and assess turning in people with PD and falls. There are several novel aspects to our study including a comprehensive turning-focused intervention that is tailored to the underlying constraints that impair turning in people with PD. Further, our outcome measure of turning quality during 7 days of daily life is novel and has implications for determining real-life changes after rehabilitation. The ultimate goal of this rehabilitation intervention is to improve how patients turn in daily life and to reduce falls. TRIALS REGISTRATION: This protocol is registered at clinicaltrials.gov; #NCT04897256; https://clinicaltrials.gov/ct2/show/NCT04897256?term=Horak&cond=Parkinson+Disease&draw=2&rank=4 .

Efficacy of neutralizing buffered peptone water for recovery of Salmonella, Campylobacter, and Enterobacteriaceae from broiler carcasses at various points along a commercial immersion chilling process with peroxyacetic acid.

In 2016, USDA-Food Safety and Inspection Service began using a neutralizing buffered peptone water (nBPW) to rinse broiler carcasses for Salmonella and Campylobacter performance standard testing. The nBPW contains standard buffered peptone water (BPW) with compounds to neutralize residual antimicrobials that may be transferred from the carcass to the sample rinsate. However, a direct comparison of nBPW and BPW on carcasses commercially treated with antimicrobials has not been conducted. On 3 replicate days in a commercial broiler processing plant, an immersion chilling biomap using whole carcass rinse samples taken prior to any chilling treatment (30), after pre-chill treatment (30), after primary chill (30), after secondary chill (30), after post-chill treatment (50), and after post-chill treatment without the pre-chill treatment (49) were tested. Carcasses were rinsed with either BPW (without neutralizer) or nBPW. Rinsates were sampled for Salmonella and Campylobacter prevalence and both Enterobacteriaceae (EB) prevalence and counts. No significant differences were observed between sampling sites or rinse media for Salmonella due to an overall low prevalence (4 positive/219 samples). Campylobacter prevalence significantly decreased from prior to chilling (93%) to after all chilling steps (47%) as anticipated (P < 0.0001); however, overall significantly fewer Campylobacter positive carcasses were detected when nBPW was used (55%) in comparison to BPW (70%, P = 0.0258). Both EB prevalence and counts significantly decreased (both P < 0.0001) from prior to chilling (100%, 2.35 log10 CFU/mL) through after all chilling steps (52%, 0.47 log10 CFU/mL). The use of nBPW versus BPW did not impact EB prevalence; however, samples rinsed with nBPW had significantly higher overall counts (1.26 vs. 1.00 log10 CFU/mL, P = 0.0134). The results from this study indicate that the use of a PAA pre-chill treatment did not significantly impact bacteria recovery following all chilling steps. The use of nBPW was effective in neutralizing residual PAA in carcass rinsates when sampling for EB counts; however, nBPW may lessen the ability to detect Campylobacter in these same samples.

Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men.

BACKGROUND: Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission. METHODS: In community-dwelling US men aged ≥65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000-2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model. RESULTS: We identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0-3.8), poor mental health (OR=1.9, 95% CI: 1.1-3.4), BMI≥25.0 kg m(-2) (OR=1.7, 95% CI: 1.0-2.8), hypertension (OR=1.5, 95% CI: 1.0-2.4) and back pain (OR=1.5, 95% CI: 1.0-2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1-4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2-0.9). CONCLUSIONS: Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.

Performance of FRAX in a cohort of community-dwelling, ambulatory older men: the Osteoporotic Fractures in Men (MrOS) study.

UNLABELLED: We evaluated performance of FRAX in older men who participated in the Osteoporotic Fractures in Men (MrOS) study. INTRODUCTION: FRAX has been extensively studied in women, but there are few studies of its performance in men. METHODS: FRAX estimates for 10-year hip fracture and major osteoporotic fracture (MOF; either hip, clinical spine, forearm, or shoulder) were calculated from data obtained from MrOS participants and compared to observed 10-year fracture cumulative incidence calculated using product limit estimate methods, accounting for competing mortality risk. RESULTS: Five thousand eight hundred ninety-one men were followed for an average of 8.4 years. Without bone mineral density (BMD) in the FRAX model, the mean 10-year predicted fracture probabilities for hip and MOF were 3.5% and 8.9%, respectively; addition of BMD to the calculations reduced these estimates to 2.3% and 7.6%. Using FRAX without BMD, predicted quintile probabilities closely estimated cumulative incidence of hip fracture (range of observed to predicted ratios 0.9-1.1). However, with BMD in the FRAX calculation, observed to predicted hip fracture probabilities were not close to unity and varied markedly across quintiles of predicted probability. For MOF, FRAX without BMD overestimated observed cumulative incidence (range of observed to predicted ratios 0.7-0.9) and addition of BMD did not improve this discrepancy (range of observed to predicted ratios 0.7-1.1). Addition of BMD to the calculation had mixed effects on the discriminatory performance of FRAX, depending on the analysis tool applied. CONCLUSION: Among this cohort of community-dwelling older men, the FRAX risk calculator without BMD was well calibrated to hip fracture but less well to MOF.

Demographic and health-related factors associated with complementary and alternative medicine (CAM) use in multiple sclerosis.

Complementary and alternative medicine (CAM) use is high among people with multiple sclerosis (MS), yet there are no reports on the association between CAM use and health-related quality of life (HRQL) in MS. To examine this relationship, a cross-sectional survey and SF-12 was used to collect demographic and HRQL data from 1667 survey respondents. Factors examined for their association with CAM use included, age, gender, race, self-reported disease severity, disease-modifying drug (DMT) use, MS duration, MS type, education level, physical and mental well-being. Multiple regression analysis revealed that female gender, high education level, longer MS duration, lower physical well-being and not using DMT were independent factors associated with both 'ever' and 'current' CAM use. The finding that a drop in physical component score (PCS) of the SF-12 is independently associated with an increased odds of 'ever' CAM use, 'current' CAM use, and 'past' CAM reflect an association of CAM use with PCS regardless of time of use. Although, temporality of this relationship cannot be established, as this was a cross-sectional study, a longitudinal study is warranted so that we can establish if HRQL is predictive for CAM use in MS.

The perceived benefit and satisfaction from conventional and complementary and alternative medicine (CAM) in people with multiple sclerosis.

OBJECTIVE: To describe the perceived benefit and satisfaction from complementary and alternative medicine (CAM) and conventional therapies and providers in MS. DESIGN: Cross-sectional mailed survey. SETTING: One thousand nine hundred and thirteen respondents who were members of the Oregon Chapter of the National MS Society. RESULTS: The benefit rating of both conventional therapies and providers was significantly higher than for CAM therapies and providers (p < 0.001 and < 0.001). When stratifying satisfaction rating by MS disease severity, significant differences were found between CAM providers and neurologists, favoring CAM providers in those with moderate disease severity (p = 0.014) and favoring neurologists in those with severe disease severity (p = 0.032). CAM providers were rated significantly higher than MDs on the following: listening skills (p < 0.001), care and concern (p < 0.001), and patient empowerment (p < 0.001). CONCLUSIONS: Although MS patients report significant benefit from conventional therapies and providers; they may seek CAM providers for emotional support. The impact of emotional support gained from providers on quality of life in MS warrant further investigation.

Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage.

BACKGROUND: Current medical management dictates that all cirrhotic patients without a history of variceal hemorrhage undergo endoscopic screening to detect large varices. However, referral for endoscopic screening of only patients at highest risk for varices may be most cost-effective. The aim of this case-control study was to identify clinical, laboratory, and radiologic findings that predict the presence of varices in patients with cirrhosis. METHODS: Three hundred patients without a history of variceal hemorrhage underwent upper endoscopy as part of an evaluation before liver transplantation. Cases defined as the presence of any varices and cases defined as the presence of large varices were used for examining the risks associated with finding varices on upper endoscopy. Logistic regression was performed to evaluate associations between the presence of varices and patient characteristics. RESULTS: Platelet count and Child-Pugh class were independent risk factors for the presence of any varices and the presence of large varices. For the presence of any varices, a platelet count of 90 x 10(3)/microL or less (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.4-4.0) and advanced Child-Pugh class (OR, 3.0; 95% CI, 1.6-5.6) were independent risk factors. For large varices, a platelet count of 80 x 10(3)/microL or less (OR, 2.3; 95% CI, 1.4-3.9) and advanced Child-Pugh class (OR, 2.8; 95% CI, 1.3-5.8) were independent risk factors associated with varices. CONCLUSIONS: Low platelet count and advanced Child-Pugh class were associated with the presence of any varices and with large varices. These factors allow identification of a subgroup of cirrhotic patients who would benefit most from referral for endoscopic screening for varices.

Predicting children's quality of life in an asthma clinical trial: what do children's reports tell us?

OBJECTIVE: To define predictors of disease-specific quality of life (QOL) and the relationship between asthma symptoms and disease-specific QOL. STUDY DESIGN: Three hundred thirty-nine children participated at 4 of 8 Childhood Asthma Management Program clinical centers. Included in the analyses were 2 weeks of asthma symptom data, child-reported health status, and QOL scores from the Pediatric Asthma Quality of Life Questionnaire. Data were obtained 12 months after randomization into the Childhood Asthma Management Program. RESULTS: Children were rated at baseline as having "moderate" asthma (63%) and "mild" asthma (37%). QOL scores were correlated with the child-reported anxiety measures. Factor analysis of the QOL measure resulted in 2 factors. Stepwise multiple regression indicated that the strongest independent predictors of QOL were the child's anxiety level, age, sex, and a measure of the child's tendency to minimize or exaggerate symptoms. CONCLUSIONS: Children had few asthma symptoms in the 2 weeks before their 12-month follow-up clinic visit and a generally positive QOL, suggesting that mild-to-moderate asthma does not significantly impair QOL. A child's QOL was predicted primarily by their level of anxiety.

Women behind bars: health needs of inmates in a county jail.

OBJECTIVES: This study was performed to assess the prevalence of behavioral risk factors and correlates of poor self-reported health among incarcerated women in a county jail in Oregon. METHODS: The authors collected self-reported data from recently incarcerated women at a county jail, focusing on prevalence of high-risk health behaviors, history of health care use, history of physical and sexual abuse, and health care coverage. The authors assessed factors associated with poor self-reported health using logistic regression techniques. RESULTS: More than half of the participants reported a history of intravenous drug use, 67% reported a history of sexual abuse, 79% reported a history of physical abuse, and 43% stated that they had a history of trading sex for money or drugs. Two factors were associated with poor self-reported health: history of physical assault (odds ratio [OR] = 2.7; 95% confidence interval [CI] 1.4, 5.2) and use of heroin during the month prior to arrest (OR = 2.9; 95% CI 1.3, 6.6). CONCLUSIONS: The high prevalence of health risk behaviors among the inmates suggests a number of areas for intervention. These findings may also be used to guide topics addressed during intake interviews of new inmates, and to help identify inmates that require additional medical or social services.

Self-reported exposures and their association with unexplained illness in a population-based case-control study of Gulf War veterans.

Many factors have been considered as possible causes of the unexplained illness reported by veterans of the Gulf War (GW). In this study, we report an analysis of risk factors and unexplained illness in a population-based sample of GW veterans who underwent clinical evaluation. Multiple risk factors were compared in 241 veterans who met criteria for unexplained illness and 113 healthy controls. Results suggest that GW unexplained illness is most highly associated with combat conditions, heat stress, and having sought medical attention during the GW. When controlling for multiple simultaneous exposures during the GW, interactions around pyridostigmine bromide, insecticides and repellents, and stress were not significant. These results indicate that most unexplained illness in GW veterans cannot be explained by neurotoxic effects of exposures to chemicals that inhibit cholinesterase activity.

Estimating the Mahalanobis distance from mixed continuous and discrete data.

We present a method for estimating the Mahalanobis distance between two multivariate normal populations when a subset of the measurements is observed as ordered categorical responses. Asymptotic properties of the proposed estimator are developed. Two examples are discussed.

Neurocognitive functioning in children with mild and moderate asthma in the childhood asthma management program. The Childhood Asthma Management Program (CAMP) Research Group.

BACKGROUND: The Childhood Asthma Management Program (CAMP) is a multicenter double-blind, randomized, placebo-controlled, clinical trial of two anti-inflammatory agents and placebo in children with mild and moderate asthma. OBJECTIVE: The interrelationship between asthma severity and neurocognitive functioning among 1041 children (age range, 5-12 years) enrolled in the CAMP trial was examined. METHODS: Asthma severity was established at baseline with a clinical history of asthma symptomatology and measures of lung function (spirometry and methacholine challenge). Diary cards were used in a screening to record nighttime awakenings and doctor contacts caused by asthma symptoms, symptom severity, and number of puffs from a rescue inhaler. All children received a comprehensive neurocognitive assessment at the end of the 28-day screening period (before randomization), including measures of intelligence, attention, memory, and academic achievement. RESULTS: Significant differences were found between children with mild and moderate asthma on lung function and symptom outcome variables (log(e)FEV(1)PC(20), DeltaFEV(1) percent predicted, change in peak flow percent predicted, nighttime awakenings caused by asthma, average symptom severity score, and average daily number of puffs from a rescue inhaler) but not on neurocognitive variables. Multiple regression analyses revealed that asthma outcomes could not be predicted by neurocognitive variables despite controlling for socioeconomic status. The prevalence of neurocognitive dysfunction, as indicated by the use of psychostimulant medication, was found to be consistent with that found in the existing literature. CONCLUSION: Mild and moderate asthma symptoms are not related to neurocognitive functioning in the children enrolled in CAMP. Mean performance on neurocognitive variables was found to be similar to that of national normative data.

Prehospital treatment of acute asthma in a rural state.

BACKGROUND: Acute asthma exacerbations can be life threatening and are recognizable to emergency medical service (EMS) personnel; however, the therapies and medications which these emergency service personnel can use to treat exacerbations are limited. Several studies have demonstrated the effective use of beta2-agonist therapy in the treatment of patients complaining of wheezing or dyspnea, yet few EMS personnel can administer them. OBJECTIVE: The purpose of this study was to determine what therapeutic interventions emergency personnel around the state of New Mexico could use when responding to a call for a severe asthma exacerbation. METHODS: Questionnaires were distributed over a period of three years, 1992-1994, to all Emergency Service Agencies in New Mexico. RESULTS: Eighty percent of the emergency medical personnel administer oxygen to patients experiencing acute asthma exacerbations. Seventeen percent of EMS personnel administer epinephrine, 4% administer steroids, and only 23% administer beta2 agonists. Only in more populated areas were EMS personnel allowed to administer beta2 agonists, and those personnel had to have at least intermediate-level training. Most emergency response teams in the state consisted of EMT Basics and provided only basic life support services. In rural New Mexico, transport to a hospital can often take over one hour, which left EMS crews feeling helpless. CONCLUSIONS: We conclude that due to the rural nature of New Mexico, EMS personnel should be trained in the use of beta2 agonists and allowed to administer them to patients with acute asthma exacerbations. In addition, standard protocols for the pre-hospital management of acute asthma exacerbations should be instituted.

Prehospital EMS treatment of pediatric asthma and what happens before help arrives?

Many asthmatic children require assistance by emergency medical services (EMS) secondary to an acute asthma episode. What medication interventions are being utilized by EMS when responding to an asthma call for a child, and how does EMS management compare to home management given before ambulance arrival (pre EMS)? Sixty-one ambulance reports pertaining to acute asthma episodes in children aged 1 month to 15 years were collected and analyzed. There was no significant difference between likelihood to receive a beta 2-agonist nebulizer treatment pre-EMS arrival or by EMS. Oxygen was the most common EMS intervention.