Shimin Zheng

The Potency of Team-Based Care Interventions for Hypertension: A Meta-analysis

BACKGROUND Team-based care is the strategy that has had the greatest effect on improving blood pressure (BP). The purpose of this systematic review was to determine the potency of interventions for BP involving nurses or pharmacists. METHODS A MEDLINE search for controlled clinical trials that involved a nurse or pharmacist intervention was conducted. Mean reductions in systolic (S) and diastolic (D) BP were determined by 2 reviewers who independently abstracted data and classified the different intervention components. RESULTS Thirty-seven articles met the inclusion criteria. Education about BP medications was significantly associated with a reduction in mean BP (-8.75/-3.60 mm Hg). Other strategies that had large effect sizes on SBP include pharmacist treatment recommendations (-9.30 mm Hg), intervention by nurses (-4.80 mm Hg), and use of a treatment algorithm (-4.00 mm Hg). The odds ratios (95% confidence intervals) for controlled BP were: nurses, 1.69 (1.48-1.93); pharmacists within primary care clinics, 2.17 (1.75-2.68); and community pharmacists, 2.89 (1.83-4.55). Mean (SD) reductions in SBP were: nursing studies, 5.84 (8.05) mm Hg; pharmacists in clinics, 7.76 (7.81) mm Hg; and community pharmacists, 9.31 (5.00) mm Hg. There were no significant differences between the nursing and pharmacy studies (P > or = .19). CONCLUSIONS Team-based care was associated with improved BP control, and individual components of the intervention appeared to predict potency. Implementation of new hypertension guidelines should consider changes in health care organizational structure to include important components of team-based care.

Worldwide never-smoking youth susceptibility to smoking

PURPOSE To estimate susceptibility to smoking among never-smoking youth globally and identify factors associated with such behavior. METHODS Cross-sectional data for 168 countries were obtained from the Global Youth Tobacco Survey. Simple and multiple logistic regression analyses were conducted. Frequencies and proportions for descriptive statistics, and adjusted odds ratios with 95% confidence intervals for logistic regression models were reported. RESULTS Approximately 12.5% of never-smoking youth worldwide were susceptible to smoking worldwide, of which 7.2% were males and 5.3% were females. Compared with youth in the Americas, those in other WHO regions were associated with decreased susceptibility to smoking. Regardless of gender, exposure to parental or peer smoking, secondhand smoke inside or outside home, and tobacco industry promotion was associated with increased smoking susceptibility. In contrast, support for smoke-free policies and school antismoking education was associated with decreased susceptibility to smoking among females. Moreover, exposure to antismoking media messages was associated with increased susceptibility to smoking among never-smoking youth. CONCLUSIONS Approximately 1 in 8 never-smoking youth worldwide was found to be susceptible to smoking. A comprehensive approach involving parental and peer education, smoke-free policies, ban on tobacco advertising and promotions, and antismoking education in schools should be developed by policy makers and public health professionals to protect never-smoking youth from being susceptible to smoking and transforming into future regular smokers.

Cancer mortality rates in Appalachia: descriptive epidemiology and an approach to explaining differences in outcomes.

Cancer is a leading cause of death in the Appalachian region of the United States. Existing studies compare regional mortality rates to those of the entire nation. We compare cancer mortality rates in Appalachia to those of the nation, with additional comparisons of Appalachian and non-Appalachian counties within the 13 states that contain the Appalachian region. Lung/bronchus, colorectal, female breast and cervical cancers, as well as all cancers combined, are included in analysis. Linear regression is used to identify independent associations between ecological socioeconomic and demographic variables and county-level cancer mortality outcomes. There is a pattern of high cancer mortality rates in the 13 states containing Appalachia compared to the rest of the United States. Mortality rate differences exist between Appalachian and non-Appalachian counties within the 13 states, but these are not consistent. Lung cancer is a major problem in Appalachia; most Appalachian counties within the 13 states have significantly higher mortality rates than in-state, non-Appalachian counterparts. Mortality rates from all cancers combined also appear to be worse overall within Appalachia, but part of this disparity is likely driven by lung cancer. Education and income are generally associated with cancer mortality, but differences in the strength and direction of these associations exist depending on location and cancer type. Improving high school graduation rates in Appalachia could result in a meaningful long term reduction in lung cancer mortality. The relative importance of household income level to cancer outcomes may be greater outside the Appalachian regions within these states.

Secondhand Smoke Exposure Among Never-Smoking Youth in 168 Countries

PURPOSE To estimate the prevalence of secondhand smoke (SHS) exposure among never-smoking adolescents and identify key factors associated with such exposure. METHODS Data were obtained from nationally representative Global Youth Tobacco Surveys conducted in 168 countries during 1999-2008. SHS exposure was ascertained in relation to the location-exposure inside home, outside home, and both inside and outside home, respectively. Independent variables included parental and/or peer smoking, knowledge about smoke harm, attitudes toward smoking ban, age, sex, and World Health Organization region. Simple and multiple logistic regression analyses were conducted. RESULTS Of 356,414 never-smoking adolescents included in the study, 30.4%, 44.2%, and 23.2% were exposed to SHS inside home, outside home, and both, respectively. Parental smoking, peer smoking, knowledge about smoke harm, and positive attitudes toward smoke ban were significantly associated with increased odds of SHS exposure. Approximately 14% of adolescents had both smoking parents and peers. Compared with never-smoking adolescents who did not have both smoking parents and peers, those who had both smoking parents and peers had 19 (adjusted odds ratio [aOR], 19.0; 95% confidence interval [CI], 16.86-21.41), eight (aOR, 7.71; 95% CI, 7.05-8.43), and 23 times (aOR, 23.16; 95% CI, 20.74-25.87) higher odds of exposure to SHS inside, outside, and both inside and outcome home, respectively. CONCLUSIONS Approximately one third and two fifths of never-smoking adolescents were exposed to SHS inside or outside home, and smoking parents and/or peers are the key factors. Study findings highlight the need to develop and implement comprehensive smoke-free policies consistent with the World Health Organization Framework Convention on Tobacco Control.

Substance Abuse Associated with Elder Abuse in the United States

Background: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. Objective: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Methods: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Results: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. Conclusion: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community’s environment, especially if older persons are involved. Scientific Significance: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

Screening for Elder Mistreatment among Older Adults Seeking Legal Assistance Services

Introduction: The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to elder mistreatment (EM). The purpose of this study was to assess the prevalence and correlates of EM among a sample of older adults using legal assistance services in Atlanta, Georgia. Methods: Researchers administered surveys to consenting older adults (aged 60+) in 5 metro Atlanta community centers that hosted legal assistance information sessions as part of the Elderly Legal Assistance Program. The surveys screened for risk factors and prevalence of EM risk using valid and reliable measures and included additional questions regarding demographics characteristics and healthcare use behaviors. Results: Surveys were completed by 112 participants. Findings reveal that 32 (28.6%) respondents met the criteria for elder abuse / neglect risk; 17 (15.2%) respondents met criteria for depression; and 105 (93.7%) had visited a healthcare provider during the past 6 months. Conclusion: The rates of EM risk in this sample were higher than those previously reported in research. Findings support continued examination of unique risks that may be present among older adults who may be possibly facing legal issues. Additionally, the reported frequency of healthcare visits among participants reveals a promising opportunity to examine development of a more widespread EM screening approach to be conducted in non-emergency settings. Interdisciplinary collaboration is required to inform screening approaches that account for complexities that EM cases present.

A novel locus for body mass index on 5p15.2: a meta-analysis of two genome-wide association studies.

OBJECTIVE Genetic factors play an important role in modulating the vulnerability to body mass index (BMI). The purpose of this study is to identify novel genetic variants for BMI using genome-wide association (GWA) meta-analysis. METHODS PLINK software was used to perform meta-analysis of two GWA studies (the FUSION and Marshfield samples) of 5218 Caucasian individuals with BMI. A replication study was conducted using the SAGE sample with 762 individuals. RESULTS Through meta-analysis we identified 33 SNPs associated with BMI with p<10(-4). The most significant association was observed with rs2967951 (p=1.19×10(-6)) at 5p15.2 within ROPN1L gene. Two additional SNPs within ROPN1L and 5 SNPs within MARCH6 (the top SNP was rs2607292 with 4.27×10(-6)) further supported the association with BMI on 5p15.2 (p<1.8×10(-5)). Conditional analysis on 5p15.2 could not distinguish the effects of ROPN1L and MARCH6. Several SNPs within MARCH6 and ROPN1L were replicated in the SAGE sample (p<0.05). CONCLUSION We identified a novel locus for BMI. These findings offer the potential for new insights into the pathogenesis of BMI and obesity and will serve as a resource for replication in other populations to elucidate the potential role of these genetic variants in BMI and obesity.

Deletion of the vacJ gene affects the biology and virulence in Haemophilus parasuis serovar 5

Haemophilus parasuis is an important pathogen causing severe infections in pigs. However, the specific bacterial factors that participate in pathogenic process are poorly understood. VacJ protein is a recently discovered outer membrane lipoprotein that relates to virulence in several pathogens. To characterize the function of the vacJ gene in H. parasuis virulent strain HS49, a vacJ gene-deletion mutant ΔvacJ and its complemented strain were constructed. Our findings supported that VacJ is essential for maintenance of cellular integrity and stress tolerance of H. parasuis, by the demonstrations that the ΔvacJ mutant showed morphological change, increased NPN fluorescence and, and decreased resistance to SDS-EDTA, osmotic and oxidation pressure. The increased susceptibility to several antibiotics in the ΔvacJ mutant further suggested that the stability of the outer membrane was impaired as a result of the mutation in the vacJ gene. Compared to the wild-type strain, the ΔvacJ mutant strain caused a decreased survival ratio from the serum and complement killing, and exhibited a significant decrease ability to adhere to and invade PK-15 cell. In addition, the ΔvacJ mutant showed reduced biofilm formation compared to the wild-type strain. Furthermore, the ΔvacJ was attenuated in a murine (Balb/C) model of infection and its LD50 value was approximately fifteen-fold higher than that of the wild-type or complementation strain. The data obtained in this study indicate that vacJ plays an essential role in maintaining outer membrane integrity, stress tolerance, biofilm formation, serum resistance, and adherence to and invasion of host cells related to H. parasuis and further suggest a putative role of VacJ lipoprotein in virulence regulation.

Late-life depressive symptoms: an international study

OBJECTIVES Evaluate differences in depressive symptoms, compare sociodemographic and health-related variables associated with depressive symptoms and report level of impact of depressive symptoms on daily activities. METHODS Cross-sectional study using a self-administered questionnaire and Patient Health Questionnaire-9 (PHQ-9) diagnostic survey on 1115 patients aged 60-93 years who attended a primary care clinic in Korea, Russia or USA. RESULTS At least mild depression (PHQ-9 score of ≥ 5) occurred in 28% of Koreans, 65% of Russian and 27% of US participants. Russians scored more depressed on all PHQ-9 items (P < 0.01) and more suicidal thoughts (P < 0.001), while Koreans had less feelings of worthlessness (P < 0.001). Depression predictors included poorer self-rated health [odds ratio (OR) 2.47, 95% confidence interval (CI) 1.84-3.33, P < 0.0001], chronic diseases (OR 1.34, CI 1.21-1.48, P < 0.0001), female gender (OR 1.56, CI 1.15-2.12, P = 0.0046) and religious attendance (OR 0.88, CI 0.79-0.97, P = 0.0099) for all subjects. Being employed was protective in Korea (OR 0.41, CI 0.21-0.77, P = 0.0061) and being married (OR 0.42, CI 0.27-0.66, P = 0.0002) and of older age (OR 0.95, CI 0.93-0.98, P = 0.0006) protective in US participants. Vascular disease was associated with depressive symptoms in Russia (OR 3.47, CI 1.23-9.80, P = 0.0187). In regression analyses stratified by country for a given level of depressive symptoms, the Russian sample had less impact on daily activities (Russia R (2) = 0.107 versus Korea R (2) = 0.211 and US R (2) = 0.419) P = 0.029. CONCLUSIONS Depressive symptoms were more common in Russia than in Korea and USA but had less impact on daily functioning. Cultural or environmental factors may account for this finding.

Relationship Between Physical Activity and Suicidal Behaviors Among 65,182 Middle School Students

BACKGROUND The psychosocial benefits of participating in physical activity (PA) are well known; less is known about the relationship between suicidal behaviors and PA among adolescents, especially among middle school-aged youth. This study seeks to fill that gap by assessing the cross-sectional relationship between these variables. METHODS A secondary analysis of the 2010 Tennessee Middle School Youth Risk Behavior Survey data was conducted among 65,182 middle school students. Items examined were PA, sports team engagement, physical education (PE) class, screen time, suicidal behaviors, drug/substance use, extreme weight control behaviors, weight status and weight misperceptions, and selected personal characteristics. Multiple logistic regression analysis was used to estimate the association between PA, sports team engagement, and PE class attendance on suicidal behaviors. RESULTS Sports team engagement was significantly associated with suicidal thoughts, plans, and attempts even after controlling for other important variables. There was no relationship, however, between total PA or PE class attendance in univariate or multivariate models, respectively. CONCLUSIONS Findings suggest that sports team engagement is associated with reduced risk for suicidal thoughts, plans, and attempts, whereas, no relationships were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help clinicians screen for risk of suicidal behaviors.