Step On It! Impact of a Workplace New York City Taxi Driver Health Intervention to Increase Necessary Health Care Access

Objectives. We describe the impact of the Step On It! intervention to link taxi drivers, particularly South Asians, to health insurance enrollment and navigate them into care when necessary.Methods. Step On It! was a worksite initiative held for 5 consecutive days from September 28 to October 2, 2011, at John F. Kennedy International Airport in New York City. Data collected included sociodemographics, employment, health care access and use, height, weight, blood pressure, and random plasma glucose. Participants were given their results, counseled by a medical professional, and invited to participate in free workshops provided by partner organizations.Results. Of the 466 drivers participated, 52% were uninsured, and 49% did not have a primary care provider. Of 384 drivers who had blood pressure, glucose, or both measured, 242 (63%) required urgent or regular follow-up. Of the 77 (32%) requiring urgent follow-up, 50 (65%) sought medical care at least once, of whom 13 (26%) received a new diagnosis. Of the 165 (68%) requiring regular follow-up, 68 (41%) sought medical care at least once, of whom 5 (7%) received a new diagnosis.Conclusions. This study provides encouraging results about the potential impact of an easy-to-deliver, easily scalable workplace intervention with a large, vulnerable population.New York City alone has more than 50 000 yellow taxi drivers and a similar number of livery drivers.1 A large majority, 94%, are immigrants, mainly originating from India, Bangladesh, Pakistan, Haiti, and West African countries.1 Taxi drivers are often at greater risk for cardiovascular disease (CVD) and associated risk factors than the general population.2,3 Studies looking exclusively at taxi drivers have found a correlation between the occupation and myocardial infarctions, multivessel disease, obesity, insulin resistance, high blood pressure, high triglycerides, and high low-density lipoproteins.3 By nature of their occupation, drivers have a sedentary lifestyle.4,5 Sedentariness in the general population has been linked to a higher CVD mortality rate, secondary to coronary heart disease, sudden heart failure, hypertension, and diabetes.6–11 Environmental exposures are also to blame for high CVD and lung cancer risk for taxi drivers. Exposure to particulate matter, which is often found at high levels in closed vehicles, has been linked to lower heart rate variability, a predictor of CVD, and to lung cancer.12–14Other factors, such as high stress, poor working conditions, long hours, unstable income, unhealthy diet, significant concern about personal safety on the job, and institutional and organizational barriers further contribute to poorer health among taxi drivers.5,15–17 Several reports and studies on the working and living conditions of taxi drivers have been released in California; Chicago, Illinois; and New York City and described similar health profiles for this population.5,15,16 In New York City, drivers typically work 10- to 12-hour shifts 6 days a week.4,16,18 Studies have also shown that a major systems-level obstacle for taxi drivers is lack of adequate health care; 60% of taxi drivers were found to be uninsured in a Chicago study19 and 52% in a New York City study.20 The occupation-related barriers to care experienced by this largely immigrant community are further exacerbated by literacy and language barriers, financial pressures, family obligations, and cultural values.4,19,21 South Asian taxi drivers, the largest group of yellow taxi drivers in New York City, potentially face a double burden for CVD because of both the nature of their occupation and the increased CVD risk associated with South Asian ethnicity.22–27Several studies have demonstrated the successful use of occupation-based interventions to effect lifestyle changes.17,28–31 A literature review of dietary promotion programs in the workplace demonstrated that, with industry cooperation and use of a social–ecological model of intervention, worksite interventions can have gradual and favorable results.17 In one social–ecological study, changes to workplace cafeteria food service in conjunction with behavioral interventions for workers resulted in a significant increase in fruit and vegetable consumption among participants.17 Support from workplace management was crucial for the success of this program.17 Although a paucity of data exist on interventions specifically for US taxi drivers, a number of European studies have had good results for exercise and diet interventions for taxi and other drivers.29–31 A British pilot study used a peer video to encourage drivers to make healthy lifestyle changes over a 1-year study period, resulting in 73% of participating drivers reporting a significant lifestyle change, with greater physical activity, positive diet changes, and more time spent on family activities.29 Another British study used a peer education model for CVD risk education. Peer “health champions” disseminated information about free screenings and medical referrals; more than 66% of those who received medical appointments at screenings subsequently attended them.30 In Sweden, a healthy eating workplace intervention conducted at rest stops resulted in improved nutritional balance in meal choices among truck drivers.31 The results of these studies suggest that the workplace can be an effective setting for taxi driver health interventions in the United States.28The Immigrant Health and Cancer Disparities Service (IHCD) at Memorial Sloan-Kettering Cancer Center designed and implemented a taxi driver workplace health intervention, Step On It!, in 2011 at the John F. Kennedy (JFK) International Airport yellow cab holding lot in New York City. The Step On It! intervention incorporates specific components addressing drivers’ barriers to care, including

1. health insurance enrollment education and enrollment assistance to address lack of health insurance;
2. referrals to low-cost or free health clinics and hospitals to address financial barriers to obtaining health insurance;
3. referrals to culturally and linguistically appropriate care to address language and cultural barriers;
4. events held during work hours, providing a window of opportunity, and assistance with finding clinics with flexible hours, to address drivers’ long work hours; and
5. onsite health screening and counseling with triage to urgent or regular follow-up to address lack of knowledge related to current health status and need for care.

After drivers were assessed for health care access and utilization, medical history, and CVD risk factors; screened for hypertension and elevated random plasma glucose; and measured for body mass index (BMI), Step On It! used a health care access navigation and case management intervention to link drivers to health insurance enrollment and navigate them into care when necessary. We describe the impact of this intervention on the primary outcome of interest, drivers’ engagement in needed medical care.     

Evaluating the landscape of gene cooperativity with receptor tyrosine kinases in liver tumorigenesis using transposon-mediated mutagenesis

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Efficacy and safety of,and patient satisfaction with,colonoscopic-administered fecal microbiota transplantation in relapsing and refractory community- and hospital-acquired Clostridium difficile infection

OBJECTIVE:

To report the efficacy and safety of, and patient satisfaction with, colonoscopic fecal microbiota transplantation (FMT) for community- and hospital-acquired Clostridium difficile infection (CDI).

METHODS:

A retrospective medical records review of patients who underwent FMT between July 1, 2012 and August 31, 2013 was conducted. A total of 22 FMTs were performed on 20 patients via colonoscopy. The patients were divided into ‘community-acquired’ and ‘hospital-acquired’ CDI. Telephone surveys were conducted to determine procedure outcome and patient satisfaction. Primary cure rate was defined as resolution of diarrhea without recurrence within three months of FMT, whereas secondary cure rate described patients who experienced resolution of diarrhea and return of normal bowel function after a second course of FMT.

RESULTS:

Nine patients met the criteria for community-acquired CDI whereas 11 were categorized as hospital-acquired CDI. A female predominance in the community-acquired group (88.89% [eight of nine]) was found (P=0.048). The primary cure rate was 100% (nine of nine) and 81.8% (nine of 11 patients) in community- and hospital-acquired CDI groups, respectively (P=0.189). Two patients in the hospital-acquired group had to undergo a repeat FMT for persistent symptomatic infection; the secondary cure rate was 100%. During the six-month follow-up, all patients were extremely satisfied with the procedure and no complications or adverse events were reported.

CONCLUSION:

FMT was a highly successful and very acceptable treatment modality for treating both community- and hospital-acquired CDI.     

Supramolecular self-assembly and physical-gel formation in disc-like liquid crystals: a scalable predictive model for gelation and an application in photovoltaics

The application of triphenylene-based discotic liquid crystal derivatives as physical gelators is investigated. In particular, we focus on 2,3,6,7,10,11-hexakis-pentyloxytriphenylene (HAT5) and the longer alkyl chain homologue (HAT6). The driving mechanisms behind and parameter space of non-covalent physical gel formation is studied. A Hansen solubility parameter (HSP) approach is used to predict physical gelation of these disc-like liquid crystalline molecules in a variety of common organic and inorganic solvents important to electrochemical devices. Our results show that HSP analysis is very useful for the prediction of gel formation. The results are transferrable and can form the basis for future investigations into liquid crystalline physical gels. Furthermore, we use acetonitrile as a solvent and apply the gels as electrolytes in dye sensitized solar cells. It is observed that using a binary mixture of gelators results in average photovoltaic power conversion efficiencies as high as 7.21%, compared to a 5.9% reference electrolyte. This is attributed to a reduction in electron recombination at the n-type interface and provides further insight about hybrid gelators. Coupled with an increase in device stability, the results are promising for gel-based dye sensitized solar cells as well as potentially other electrolytic devices such as batteries and supercapacitors.

The application of triphenylene-based discotic liquid crystal derivatives as physical gelators is investigated.     

PDGF: the nuts and bolts of signalling toolbox

PDGF is a growth factor and is extensively involved in multi-dimensional cellular dynamics. It switches on a plethora of molecules other than its classical pathway. It is engaged in various transitions of development; however, if the unleashed potentials lead astray, it brings forth tumourigenesis. Conventionally, it has been assumed that the components of this signalling pathway show fidelity and act with a high degree of autonomy. However, as illustrated by the PDGF signal transduction, reinterpretation of recent data suggests that machinery is often shared between multiple pathways, and other components crosstalk to each other through multiple mechanisms. It is important to note that metastatic cascade is an intricate process that we have only begun to understand in recent years. Many of the early steps of this PDGF cascade are not readily targetable in the clinic. In this review, we will unravel the paradoxes with reference to mitrons and cellular plasticity and discuss how disruption of signalling cascade triggers cellular proliferation phase transition and metastasis. We will also focus on the therapeutic interventions to counteract resultant molecular disorders.     

Journey of begomovirus betasatellite molecules: from satellites to indispensable partners

Betasatellites are a group of circular, single-stranded DNA molecules that are frequently found to be associated with monopartite begomoviruses of the family Geminiviridae. Betasatellites require their helper viruses for replication, movement, and encapsidation and they are often essential for induction of typical disease symptoms. The βC1 protein encoded by betasatellites is multifunctional that participates in diverse cellular events. It interferes with several cellular processes like normal development, chloroplasts, and innate immune system of plants. Recent research has indicated βC1 protein interaction with cellular proteins and its involvement in modulation of the host’s cell cycle and symptom determination. This article focuses on the functional mechanisms of βC1 and its interactions with other viral and host proteins.