Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes

ObjectivesWorkplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care.DesignWe examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents.Setting and ParticipantsThe setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States.MethodsOutcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics.ResultsThe intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates.Conclusions and ImplicationsA team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.     

Surveillance for Guillain-Barré syndrome after 2015–2016 and 2016–2017 influenza vaccination of Medicare beneficiaries

BackgroundGuillain-Barré syndrome (GBS) is a serious acute demyelinating disease, an increased risk of which was found after the 1976 swine flu vaccinations. The U.S. Food and Drug Administration, in collaboration with the Centers for Medicare & Medicaid Services, has been conducting active surveillance for GBS after influenza vaccinations of Medicare Fee-For-Service beneficiaries since 2009.MethodsWe conducted active surveillance for GBS claims in the 2015–2016 and 2016–2017 influenza seasons using the Updating Sequential Probability Ratio Test (USPRT) to monitor for signals of GBS risk. We performed self-controlled risk interval (SCRI) analyses at the end of both seasons, including chart confirmation in the 2015–2016 season, to estimate the odds ratio of GBS risk. We used 1–42 and 8–21 days post-vaccination as primary and secondary risk windows, respectively, and 43–84 days post-vaccination as the control window.ResultsOver 13 million beneficiaries were vaccinated in each season. USPRT found a low magnitude signal for GBS in both seasons. SCRI analyses did not find excess GBS risk following any influenza vaccine for days 1–42 post-vaccination in either season. In the 2015–2016 season, for the 8–21 day window, our chart-confirmation showed an attributable GBS risk of 0.87 (95% CI: 0.16, 1.49) and 1.68 (95% CI: 0.69, 2.41) cases per million vaccinees after all seasonal and high dose (HD) vaccines, respectively, an elevated GBS risk for beneficiaries aged ≥75 years following all seasonal vaccines (OR: 2.25; 95% CI: 1.15, 4.39) and HD vaccine (OR: 3.67, 95% CI: 1.52, 8.85), and an elevated GBS risk for males who received seasonal vaccines (OR: 2.18; 95% CI: 1.15, 4.15) and HD vaccine (OR: 3.33; 95% CI: 1.35, 8.20). The finding of elevated GBS risk with advancing age and in males is consistent with literature; however, a distinction between HD and SD was a new finding. In the 2016–17 season, for the 8–21 day window, attributed cases showed an attributable GBS risk of 0.87 (95% CI: 0.03, 1.61) and 1.11 (95% CI: 0.00, 2.01) cases per million vaccinees after all seasonal and HD vaccines, respectively. We found no excess GBS risk for standard dose vaccines in the 8–21 day window in either season.ConclusionsOur primary analysis finding of no excess GBS risk during both seasons was reassuring. The slightly elevated GBS risk, although in the expected range, in the 8–21 day window after all seasonal and high dose vaccines, but not after standard dose vaccines is hypothesis-generating because the difference may be due to vaccine factors such as antigen amount or strains in various seasons or due to host factors.     

2013年中国25岁及以上人群身体活动不足归因死亡和对期望寿命的影响

目的 探讨中国≥ 25岁人群不同性别、不同地区身体活动不足归因死亡和对期望寿命的影响。方法 利用中国死因监测数据、慢性病危险因素调查数据以及全球疾病负担研究中身体活动相关健康结局及其相对危险度的数据,计算中国≥ 25岁人群身体活动相关不同健康结局的归因分值以及身体活动不足造成的归因死亡数和期望寿命的影响。结果 全死因死亡中,≥ 25岁人群归因于身体活动的死亡为4.24%,其中女性为4.86%,男性为3.82%。身体活动的疾病健康结局包括乳腺癌、直肠癌、缺血性心脏病、缺血性脑卒中和糖尿病,其归因分值分别为9.04%、13.96%、14.96%、17.80%和16.92%。身体活动归因死亡总数为388 954人,导致死亡最多的疾病为缺血性心脏病,其次为缺血性脑卒中。身体活动不足共造成人群的期望寿命损失0.43岁,其中女性损失0.47岁,男性损失0.39岁。结论 增加身体活动可以获得健康效益,降低慢性病疾病负担和延长期望寿命。     

Emotion Dysregulation and Workplace Satisfaction in Direct Care Worker Burnout and Abuse Risk

Background/ObjectivesDirect care workers frequently encounter difficult interactions with the patients they serve and experience frustration and burnout. The current study tested a hypothesized model in which predictors of caregiver abuse risk (emotional dysregulation, difficulty managing patient behavior, and workplace satisfaction) were mediated by symptoms of burnout.DesignThe study used an online cross-sectional survey design.Setting and ParticipantsThe study was implemented online via Qualtrics. Participants were 206 direct care workers (eg, certified nursing assistants, patient care technicians, home health aides, and medical assistants).MeasurementsAll respondents completed the Caregiver Abuse Screen (CASE), Difficulty with Emotional Regulation Scale (DERS-SF), and the Abbreviated Maslach Burnout Inventory. Demographic data and employment history were also collected. Correlational methods, including path analysis, were used to assess associations between study variables.ResultsMore than half of this heterogenous sample endorsed significant risk for engaging in patient abuse. Path analysis suggested emotional dysregulation and low workplace satisfaction were associated with greater risk of patient abuse, and these associations were partially and simultaneously mediated by burnout facets of depersonalization and emotional exhaustion.Conclusions and ImplicationsThis study provided preliminary support for a model of caregiver abuse in which underlying difficulties regulating emotions convey risk for caregiver abuse via burnout facets including emotional exhaustion and depersonalization. Enhancing basic emotion regulation skills and reducing burnout in direct care staff may reduce the risk of abuse for older adults. Thus, providing training necessary to help direct care workers manage their own emotions in order to better recognize, understand, and respond effectively to the needs of older adults may reduce staff burnout and, consequently, lower the risk of abuse for older adults.     

2018年中国居民归因于吸烟的脑卒中死亡分析

目的了解中国居民2018年脑卒中归因于吸烟的死亡情况,为进一步采取控烟措施提供科学依据。方法利用2013年中国慢性病及其危险因素监测数据和2018年死因监测数据,计算2013年吸烟流行率和吸烟量、戒烟年数等吸烟暴露水平以及2018年我国脑卒中死亡情况,使用2017年全球疾病负担研究(GBD 2017)的最新吸烟归因疾病负担的测算方法,计算我国吸烟导致脑卒中的人群归因分值(PAF),以及吸烟导致的脑卒中死亡情况。应用SAS 9.4对数据进行统计分析。结果2013年中国30岁及以上人群总体现在吸烟率为28.4%,其中男性为53.4%,女性为2.7%。30岁及以上人群戒烟率为5.8%,其中男性为10.9%,女性为0.6%。农村吸烟率(29.2%)和戒烟率(5.9%)均高于城市(分别为26.8%、5.7%)。脑卒中死亡率总体上随着年龄的增加而上升,并且男性各年龄组死亡率均高于女性。2018年中国30岁及以上人群归因于吸烟的脑卒中死亡人数为39.0万人,其中男性死亡人数为34.4万人,远高于女性死亡人数(4.6万人)。30岁及以上人群的PAF为21.8%,男性为34.1%,高于女性(5.9%)。吸烟归因脑卒中死亡率随年龄增加而上升。男性各年龄组的PAF均高于女性。结论我国男性人群吸烟率远高于女性。吸烟导致脑卒中的死亡水平较高,亟须采取更加严格的控烟措施,降低脑卒中等疾病的疾病负担。     

VZV-specific cell-mediated immunity,but not humoral immunity,correlates inversely with the incidence of herpes zoster and the severity of skin symptoms and zoster-associated pain: The SHEZ study

Onset of herpes zoster (HZ) is thought to be related to a decline in cell-mediated immunity (CMI). However, until recently, there have been no large-scale prospective studies on the relationship between varicella-zoster virus (VZV)-specific CMI and the onset and severity of HZ. The Japanese researchers conducted a cohort study on VZV immunity in a population living on an island cluster, Shozu County in Japan, and examined the people who developed HZ during a follow-up period of three years to clarify the relationship between the onset and severity of HZ and immunity. In this study, they focused on the relationship between cell-mediated and humoral immunity and the onset and severity of HZ. CMI was measured by VZV skin test, and humoral immunity was assessed with serological tests for VZV-specific antibodies. A total of 12,522 people over the age of 50 were enrolled in this study, and 401 registrants were diagnosed as HZ. VZV-specific CMI assessed by VZV skin test showed a significant inverse relationship with the incidence of HZ and the severity of skin lesions and acute and subacute pain, and with the occurrence of postherpetic neuralgia. In contrast, VZV-specific antibody titer was not associated with the incidence and severity of HZ. These results suggest that VZV-specific CMI, but not humoral immunity, plays a key role in controlling the onset of HZ, the severity of skin lesions, and zoster-associated pain.     

Glutamic acid at position 152 and serine at position 191 are key residues required for the metallo-β-lactamase activity of NDM-7

New Delhi metallo-β-lactamase (NDM) is of significant public-health concern due to its enormous potential to hydrolyse all of the major β-lactams, including carbapenems. Previous reports indicate that amino acid substitutions affect NDM activity despite being located outside of the active site. In this study, we attempted to identify specific mutations in loops near the active site that can influence the function of NDM-7. Overall, six substitutions were performed through site-directed mutagenesis near the active-site of NDM-7 and the change in antimicrobial resistance was subsequently monitored by expressing each mutant in a suitable bacterial host. Among the six mutants, serine at position 191 (S191) and glutamic acid at position 152 (E152) were identified as the most influencing residues for NDM-7. β-Lactam resistance of NDM-7 was remarkably affected by substitution of both residues with alanine, and the results were in accordance with the changes in kinetic parameters. Purified NDM-7 ordinarily hydrolyses β-lactams efficiently, but purified NDM-7_E152A, NDM-7_S191A and the double mutant NDM-7_E152A+S191A had lost their ability to hydrolyse the β-lactams tested, especially penicillins and carbapenems. Although the substitutions did not affect the overall folding pattern of the NDM-7 enzyme, substantial differences in thermal stability were observed. Therefore, we hypothesise that the residues S191 and E152 together play a crucial role in conferring the β-lactamase character of NDM-7.     

Effectiveness of weak wiping pressure during bed baths in hospitalized older adults: A single-blind randomized crossover trial

This study evaluated the effectiveness of weak wiping pressure on skin barrier function and patient satisfaction in comparison to ordinary pressure in hospitalized older adults. Forty-seven participants in a general hospital were blindly and randomly assigned a sequence of two bed baths: wiping three times with weak pressure (12–14 mmHg) and ordinary pressure (23–25 mmHg). Transepidermal water loss and stratum corneum hydration were measured before and after the intervention, and patient satisfaction was assessed using a Likert scale. Ordinary pressure significantly decreased skin barrier function compared to weak pressure; however, neither of the pressures caused discomfort. Weak pressure was more effective than ordinary pressure in preventing skin disorders and providing satisfaction. Subgroup cluster analysis showed that ordinary pressure was likely to impair the skin barrier function in older adults with diabetes/dyslipidemia and renal dysfunction. The application of weak pressure during bed baths, especially for these patients, is recommended.