Kenn B. Daratha

Comparison of Low-Fat Versus Mediterranean-Style Dietary Intervention After First Myocardial Infarction (from The Heart Institute of Spokane Diet Intervention and Evaluation Trial)

Whether a Mediterranean-style diet reduces cardiovascular events and mortality more than a low-fat diet is uncertain. The objectives of this study were to actively compare low-fat and Mediterranean-style diets after first myocardial infarction (MI) in a randomized, controlled clinical trial and to compare dietary intervention per se with usual care in a case-control analysis. First MI survivors were randomized to a low-fat (n = 50) or Mediterranean-style (n = 51) diet. The 2 diets were low in saturated fat (< or =7% kcal) and cholesterol (< or =200 mg/day); the Mediterranean-style diet was distinguished by greater omega-3 fat intake (>0.75% kcal). Participants received individual dietary counseling sessions, 2 within the first month and again at 3, 6, 12, 18, and 24 months, along with 6 group sessions. Combined dietary intervention groups (cases, n = 101) were compared with a usual-care group (controls, n = 101) matched for age, gender, MI type and treatment, and status of diabetes mellitus and hypertension. Primary-outcome-free survival (a composite of all-cause and cardiac deaths, MI, hospital admissions for heart failure, unstable angina pectoris, or stroke) did not differ between low-fat (42 of 50) and Mediterranean-style (43 of 51) diet groups over a median follow-up period of 46 months (range 18 to 72; log-rank p = 0.81). Patients receiving dietary intervention had better primary-outcome-free survival (85 of 101) than usual-care controls (61 of 101) (log-rank p <0.001), with unadjusted and adjusted odds ratios of 0.33 (95% confidence interval 0.18 to 0.60, p <0.001) and 0.28 (95% confidence interval 0.13 to 0.63, p = 0.002), respectively. In conclusion, active intervention with either a low-fat or a Mediterranean-style diet similarly and significantly benefits overall and cardiovascular-event-free survival after MI.

Compassion fatigue and satisfaction: A cross‐sectional survey among US healthcare workers

Professional quality of life among healthcare providers can impact the quality and safety of patient care. The purpose of this research was to investigate compassion satisfaction and compassion fatigue levels as measured by the Professional Quality of Life Scale self-report instrument in a community hospital in the United States. A cross-sectional survey study examined differences among 139 RNs, physicians, and nursing assistants. Relationships among individual and organizational variables were explored. Caregivers for critical patients scored significantly lower on the Professional Quality of Life subscale of burnout when compared with those working in a noncritical care unit. Linear regression results indicate that high sleep levels and employment in critical care areas are associated with less burnout. Identification of predictors can be used to design interventions that address modifiable risks.

Changes in a Middle School Food Environment Affect Food Behavior and Food Choices

Increasing rates of obesity among children ages 12 to 19 years have led to recommendations to alter the school food environment. The purpose of this study was to determine whether there are associations between an altered school food environment and food choices of middle school students both in and outside of school. In a midsized western city, two of six middle schools allowed only bottled water in vending machines, only milk and fruit on à la carte menus, and offered a seasonal fruit and vegetable bar. Three years after the intervention was initiated, seventh- and eighth-grade students attending the two intervention schools and four control middle schools were surveyed about their food choices. A total of 2,292 surveys were completed. Self-reported frequency of consumption for nine food groups in the survey was low; consumption was higher outside than in school. Boys consumed more milk than girls although girls consumed more fruits and vegetables. Significant socioeconomic differences existed. Compared with students who paid the full lunch fee, students qualifying for free and reduced-price meals consumed more milk and juice in schools but less outside school; more candy and energy drinks in school; and more sweet drinks, candy, pastries, and energy drinks outside school. Students in intervention schools were 24% more likely to consume milk outside school, 27% less likely to consume juice in school, and 56% less likely to consume sweet pastries in school. There were no differences in fruit and vegetable consumption reported by children in control and intervention schools. Overall, there was a positive association between a modified school food environment and student food behavior in and outside school. Policies related to the school food environment are an important strategy to address the obesity epidemic in our country.

Hospital-level variation in the quality of urologic cancer surgery.

Unexplained variation in outcomes after common surgeries raises concerns about the quality and appropriateness of surgical care. Understanding variation in surgical outcomes may identify processes that could affect the quality of surgical and postoperative care. The authors of this report examined hospital‐level variation in outcomes after inpatient urologic oncology procedures.

Rapid response team implementation and in-hospital mortality*.

Objective:To determine the relationship between implementation of rapid response teams and improved mortality rate using a large, uniform dataset from one state in the United States. Design:This observational cohort study included 471,062 adult patients hospitalized between 2001 and 2009. Setting:Ten acute tertiary care hospitals in Washington State. Patients or Other Participants:Hospital abstract records on adult patients (18 years old or older) were examined (n = 471,062). Patients most likely to benefit from rapid response team interventions were included and other prognostic factors of severity of illness and comorbidities were controlled. Each participating hospital provided the implementation date of their rapid response team intervention. Mortality rates in 31 months before rapid response team implementation (pre–rapid response team time period) were compared with mortality rates in 31 months following rapid response team implementation (post–rapid response team time period). Intervention(s):Implementation of a rapid response team within each acute tertiary care hospital. Measurements and Main Results:In-hospital mortality. Relative risk for in-hospital mortality improved in the post-rapid response team time period compared with the pre-rapid response team time period (relative risk = 0.76; 95% CI = 0.72–0.80; p < 0.001). Conclusions:In-hospital mortality improved in six of 10 acute tertiary care hospitals in the post-rapid response team time period when compared with the pre-rapid response team time period. Because of a long-term trend of decline in hospital mortality, these decreases could not be unambiguously attributed to rapid response team implementation. Further research should examine additional objective outcomes and optimal configuration of rapid response teams to maximize intervention effectiveness.

Examination of adolescents' screen time and physical fitness as independent correlates of weight status and blood pressure

Abstract Physical fitness performance is an important health correlate yet is often unrelated to sedentary behaviour in early adolescence. In this study, we examined the association of sedentary behaviour (i.e. screen time) with weight-related health markers and blood pressure, after controlling for cardiorespiratory fitness performance. American middle school students (N = 153, 56% females) aged 11–15 years (mean 12.6 years, s = 0.5) completed assessments of cardiorespiratory fitness performance, screen time, weight status (BMI percentile, waist-to-height ratio), and blood pressure. Multivariate analysis of covariance, controlling for cardiorespiratory fitness performance, found those who met the daily recommendation of 2 h or less of screen time (n = 36, 23.5%) had significantly lower BMI (p < 0.05) and systolic blood pressure (p < 0.01) compared with those who exceeded this recommendation. Findings suggest specific intervention programmes may be designed to target both cardiorespiratory fitness and sedentary behaviours to maximize early adolescent health because these behaviours are likely to have unique and independent effects on youth health markers.

Effects of Individual Components, Time, and Sex on Prevalence of Metabolic Syndrome in Adolescents

OBJECTIVES To examine selected clinical characteristics for cohorts of similar adolescents over 4 survey periods from 1999-2006, to examine changes in rates of adolescents who exceed cutoff points for individual components of metabolic syndrome (MetS), to describe sex differences in individual components of MetS, to describe changes in MetS prevalence from 1999-2006 using 4 common MetS definitions, and to describe sex differences in MetS prevalence from 1999-2006. DESIGN Cross-sectional, US representational National Health and Nutrition Examination Survey from 1999-2006. SETTING Mobile examination centers conducted by the Centers for Disease Control and Prevention. PARTICIPANTS For 1999-2000, 613 adolescents (aged 12-19 years); for 2001-2002, 892 adolescents; for 2003-2004, 857 adolescents; and for 2005-2006, 814 adolescents. Exclusions were pregnancy, taking insulin or diabetic pills, and incomplete measurements. MAIN OUTCOME MEASURES Fasting plasma glucose level, triglyceride level, high-density lipoprotein cholesterol level, waist circumference, and systolic and diastolic blood pressures. RESULTS Increases in fasting plasma glucose and high-density lipoprotein cholesterol levels and decreases in diastolic blood pressure were observed. Rates of adolescents exceeding cutoff points for fasting plasma glucose levels have increased. Compared with girls, adolescent boys had higher rates exceeding cutoff points for fasting plasma glucose and high-density lipoprotein cholesterol levels. Adolescent girls had higher rates exceeding cutoff points for waist circumference. The prevalence of MetS among adolescents has not changed. No sex differences in MetS prevalence were observed. CONCLUSIONS Some criteria for MetS have remained stable (triglyceride level and systolic blood pressure) and one has improved for boys (high-density lipoprotein cholesterol level), but waist circumference has increased in girls and the rate of an elevated fasting plasma glucose level has nearly doubled for both boys and girls. Adolescent MetS prevalence has remained stable from 1999-2006.

Identification of underserved areas for urologic cancer care.

The delivery of urologic oncology care is susceptible to regional variation. In the current study, the authors sought to define patterns of care for patients undergoing genitourinary cancer surgery to identify underserved areas for urologic cancer care in Washington State.

Co-occurring mood disorders among hospitalized patients and risk for subsequent medical hospitalization

OBJECTIVE The objective was to determine if patients hospitalized with a primary medical diagnosis and any co-occurring serious mental illness (SMI) were more likely than patients without any co-occurring SMI diagnosis to experience a subsequent medical hospitalization. METHOD This was a longitudinal cohort study of 925,705 adult persons (aged 18+ years). Patients hospitalized in Washington State from 2004 to 2008 were followed through 2009 (for an average of 43 months). RESULTS Compared to patients hospitalized for medical conditions without co-occurring SMI, patients with co-occurring dysthymia, bipolar and major depressive disorders were at an elevated risk for long-term subsequent hospitalization. Patients in the combined co-occurring mood disorders cohort were more likely (hazard ratio=1.13; 99% confidence interval=1.10-1.16; P<.001) than patients in the reference cohort to experience a subsequent medical hospitalization. A significant interaction between substance and mood disorders that increased risk for subsequent hospitalization was also observed. CONCLUSION Hospitalized patients with co-occurring mood disorders are at high risk for repeat hospitalization for a medical reason. This high-risk population, including those with substance abuse, should be a focus of research efforts to identify and address ambulatory-care-sensitive conditions amenable to strategies that decrease complications and illness leading to subsequent hospitalizations.

Diabetes Prevalence and Influence on Resource Use in Washington State Inpatient Rehabilitation Facilities, 2001 to 2007

OBJECTIVE To determine the prevalence of diabetes in inpatient rehabilitation facilities in Washington State from 2001 to 2007, and to determine the impact of diabetes on length of stay (LOS) and charges per day. DESIGN Longitudinal retrospective cohort analysis of inpatient rehabilitation discharge data from the Washington State Department of Health Comprehensive Hospital Abstract Reporting System. SETTING Inpatient rehabilitation. PARTICIPANTS Adults (N=56,382) who were discharged from inpatient rehabilitation in Washington State between 2001 and 2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Evidence of an established diagnosis of diabetes from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes; comorbid conditions reported in ICD-9-CM codes; LOS; and charges per stay. RESULTS For all discharges from 2001 to 2007, diabetes prevalence was 17.8%; prevalence within specific impairment groups was 21.3% for the stroke subgroup, 14.2% for the orthopedic disorders subgroup, and 25% for the medically complex conditions subgroup. For all discharges, and within each impairment subgroup, prevalence did not change significantly from year to year. When adjusted for burden of nondiabetes comorbidities, LOS was significantly shorter for all discharges with diabetes younger than 65 years. The association between a diabetes codiagnosis and LOS in specific impairment groups was complex, ranging from a significantly shorter LOS for discharges with diabetes in the stroke subgroup to a finding of no significant difference in LOS among discharges with or without diabetes in the orthopedic impairments subgroup. Across all discharges, charges per day from 2003 to 2007 were significantly greater in discharges with diabetes. Within each specific impairment subgroup, charges per day across the entire study period were significantly greater for discharges with diabetes. CONCLUSIONS The high prevalence of diabetes, coupled with its impact on resource use, suggests that substantial pressures may be placed on the inpatient rehabilitation care system to respond to the needs of those with diabetes.