Home Care Aide Safety Concerns and Job Challenges During the COVID-19 Pandemic.

Home care aides are on the frontlines providing care to vulnerable individuals in their homes during the COVID-19 pandemic yet are often excluded from policies to protect health care workers. The goal of this study was to examine experiences of agency-employed home care aides during the COVID-19 pandemic and to identify ways to mitigate concerns. We used an innovative journaling approach with thirty-seven aides as well as in-depth interviews with fifteen aides and leadership representatives from nine home health agencies in New York and Michigan. Workers described a range of concerns around workplace safety including uncertainty around whether a client had COVID-19, inadequate access to personal protective equipment and safe transportation, as well as fundamental changes to interactions with clients. Agencies also faced challenges acquiring personal protective equipment for their aides. This research points to needed resources to support home care aides and home health agencies both during a public health crisis and in the future.

Implementation of a Community Grant Program to Address Community-Driven Environmental Health Concerns.

Community-engaged approaches to research can increase trust, enhance the relevance and use of research, address issues of equity and justice, and increase community knowledge and capacity. The HERCULES Exposome Research Center sought to engage local Atlanta communities to learn about and address their self-identified environmental health concerns. To do this, HERCULES and their stakeholder partners collaboratively developed a community grant program. The program was evaluated using mixed qualitative methods that included document review and semi-structured interviews. This paper presents the development, implementation, and evaluation of the grant program. HERCULES awarded one-year grants of $2,500 to 12 organizations within the Atlanta region, for a total 13 grants and $32,500 in funding. Grantees reported accomplishments related to community knowledge, awareness, and engagement in addition to material accomplishments. All grantees planned to sustain their programs, and some received additional funding to do so. Some grantees remained actively involved with HERCULES beyond the grant program. The HERCULES Community Grant Program was able to increase awareness of HERCULES among applicant communities, establish or enhance relationships with community-based organizations, and identify local environmental health concerns while providing tangible results for grantees and the communities they serve. Mini-grant programs are a feasible approach to address community environmental health and establish new relationships. This model may benefit others who aim to establish community-academic relationships while addressing community health concerns.

Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women.

OBJECTIVES: The goal of this research was to assess the roles of demographic and home food environment characteristics on diet quality measured with the U.S. Department of Agriculture's Healthy Eating Index (HEI) in a population of low-income overweight and obese African American women. DESIGN: Cross-sectional analysis of baseline data. SETTING: A community-based study of low-income overweight and obese African American women. SUBJECTS: Participants enrolled in the Healthy Homes/Healthy Families study including a home environment survey (e.g., food availability, food practices and social support) and 24-hour recall dietary data collected on one weekday and one weekend day (n = 198). RESULTS: In multivariate regression analyses, demographic characteristics were not significantly associated with diet quality; however, several home food environment characteristics were significantly associated with higher quality diets, including healthy shopping (e.g., regularly purchasing fresh fruits and vegetables), selecting healthy beverages (e.g., without added sugar), healthy food preparation, and serving behaviors. Eating while watching television was associated with lower quality diets. Nearly 33% (p < 0.001) of the variance in HEI total score was explained by the home food environment factors, far surpassing that explained by demographic characteristics (3.5%, p = 0.21). CONCLUSIONS: Interventions targeting the home food environment may improve overall diet quality in low-income overweight African American populations.

Randomized phase II study of ixabepilone or paclitaxel plus carboplatin in patients with non-small-cell lung cancer prospectively stratified by beta-3 tubulin status.

PURPOSE: Retrospective studies have reported that tumor expression of the beta-3 tubulin (ß3T) isoform is an unfavorable prognostic factor in non-small-cell lung cancer (NSCLC) treated with tubulin-inhibiting chemotherapy. Ixabepilone is a tubulin-inhibiting agent with low susceptibility to multiple resistance mechanisms including ß3T isoform expression in several tumor models. This randomized phase II study evaluated ixabepilone-based chemotherapy in stage IIIb/IV NSCLC, compared with paclitaxel-based chemotherapy. Tumor specimens were prospectively evaluated for ß3T expression. PATIENTS AND METHODS: Patients were stratified by ß3T status (positive v negative) and randomly assigned at a ratio of 1:1 to receive ixabepilone (32 mg/m(2)) and carboplatin (area under concentration-time curve [AUC], 6) or paclitaxel (200 mg/m(2)) and carboplatin (AUC, 6) for up to six cycles. The primary end point was progression-free survival (PFS) in the ß3T-positive subgroup. RESULTS: Ninety-five patients (ß3T positive, 52; ß3T negative, 43) received ixabepilone plus carboplatin; 96 patients (ß3T positive, 49; ß3T negative, 47) received paclitaxel plus carboplatin. No significant differences in median PFS were observed between arms for either subgroup (ß3T positive, 4.3 months in both arms; ß3T negative, 5.8 v 5.3 months). Ixabepilone did not significantly improve overall survival (OS) for the ß3T-positive subset or the overall population. Adverse events were similar between the two arms and comparable with those in previous studies. CONCLUSION: There was no predictive value of ß3T in differentiating clinical activity of ixabepilone- or paclitaxel-containing regimens. Ixabepilone did not improve PFS or OS in patients with ß3T-positive tumors. ß3T-positive patients had worse PFS relative to ß3T-negative patients, regardless of treatment; hence, ß3T expression seems to be a negative prognostic factor, but not a predictive factor, in advanced NSCLC treated with either ixabepilone or paclitaxel platinum-based doublets.

The beta-hCG+erythropoietin in acute stroke (BETAS) study: a 3-center, single-dose, open-label, noncontrolled, phase IIa safety trial.

BACKGROUND AND PURPOSE: Animal data suggest the use of beta-human chorionic gonadotropin followed by erythropoietin to promote brain repair after stroke. The current study directly translated these results by evaluating safety of this sequential growth factor therapy through a 3-center, single-dose, open-label, noncontrolled, Phase IIa trial. METHODS: Patients with ischemic stroke 24 to 48 hours old and National Institutes of Health Stroke Scale score of 6 to 24 started a 9-day course of beta-human chorionic gonadotropin (once daily on Days 1, 3, and 5 of study participation) followed by erythropoietin (once daily on Days 7, 8, and 9 of study participation). This study also evaluated performance of serially measured domain-specific end points. RESULTS: A total of 15 patients were enrolled. Two deaths occurred, neither related to study medications. No safety concerns were noted among clinical or laboratory measures, including screening for deep vein thrombosis and serial measures of serum hemoglobin. In several instances, domain-specific end points provided greater insight into impairments as compared with global outcome measures. CONCLUSIONS: Results support the safety of this sequential, 2-growth factor therapy initiated 24 to 48 hours after stroke onset.