Occurrence of Legionella in UK household showers

Household water systems have been proposed as a source of sporadic, community acquired Legionnaires’ disease. Showers represent a frequently used aerosol generating device in the domestic setting yet little is known about the occurrence of Legionella spp. in these systems. This study has investigated the prevalence of Legionella spp. by culture and qPCR in UK household showers. Ninety nine showers from 82 separate properties in the South of England were sampled. Clinically relevant Legionella spp. were isolated by culture in 8% of shower water samples representing 6% of households. Legionella pneumophila sg1 ST59 was isolated from two showers in one property and air sampling demonstrated its presence in the aerosol state. A further 31% of showers were positive by Legionella spp. qPCR. By multi-variable binomial regression modelling Legionella spp. qPCR positivity was associated with the age of the property (p = 0.02), the age of the shower (p = 0.01) and the frequency of use (p = 0.09). The concentration of Legionella spp. detected by qPCR was shown to decrease with increased frequency of use (p = 0.04) and more frequent showerhead cleaning (p = 0.05). There was no association between Legionella spp. qPCR positivity and the cold water supply or the showerhead material (p = 0.65 and p = 0.71, respectively). Household showers may be important reservoirs of clinically significant Legionella and should be considered in source investigations. Simple public health advice may help to mitigate the risk of Legionella exposure in the domestic shower environment.     

Pathogenic bacteria associated with oysters (Crassostrea brasiliana) and estuarine water along the south coast of Brazil

Oysters and estuarine water samples were collected monthly, from June 1998 to March 1999, in the Cananéia estuary, on the south coast of São Paulo, Brazil, and analyzed for bacterial hazards with and without depuration in filtered estuarine water. Aeromonas spp., Plesiomonas shigelloides, Vibrio cholerae O1, Vibrio parahaemolyticus, and Vibrio vulnificus were counted in oyster samples using the most probable number (MPN) and their presence verified in the surrounding estuarine water samples. The presence of Salmonella, Shigella, Escherichia coli O157:H7, and fecal coliforms counts were determined in oysters and in water samples too. Sixty percent of water samples contained fecal coliforms ranging from <1 to >200 CFU/100 ml and 100%, 30%, 20% and 10% were positive for V. parahaemolyticus, Salmonella, Aeromonas, and V. vulnificus in 5 l of water samples, respectively. In oyster samples, the fecal coliforms concentration ranged from <3.0 to ≥2.4 × 10³ MPN/g in 40% of untreated and from <3.0 to 1.1 × 10³ MPN/g in 40% of treated samples. Vibrio parahaemolyticus Kanagawa-negative was detected in all oyster samples and their concentration varied from 3.6 to ≥2.4 × 10³ MPN/g. For the untreated oyster samples 80%, 70%, and 10% were positive for V. vulnificus (<3 – 11.0 MPN/g), Aeromonas (<3 – 15 MPN/g), and Salmonella (presence in 25 g), respectively. However, for treated oyster samples 60%, 30%, and 0% of them contained the same bacteria, respectively. Escherichia coli O157:H7, Shigella spp., P. shigelloides, and V. cholerae O1 were not detected in any of the samples. Fecal indicators did not correlate with Vibrio presence (p>0.05), although the isolation of Aeromonas species had a positive correlation (p = 0.017). The results showed no correlation between temperature, salinity, and bacteria (p > 0.05). The comparison between bacterial concentration in treated and untreated oyster samples, showed that only Aeromonas was higher in untreated oyster samples (p = 0.039). This study contributes toward creating a more global understanding of food-borne bacterial pathogens. The presence and concentration of viable bacterial hazards in oysters and water surrounding areas was determined for the first time on the south coast of São Paulo and it helps to define better the true microbial hazard in the aquatic environment and oysters.     

Multiple water source use in rural Vanuatu: are households choosing the safest option for drinking?

Households in low- and middle-income countries commonly make use of multiple water sources. However, it remains unclear to what extent their drinking water choices are optimal from a health perspective. This matched cohort study across 10 islands in Vanuatu examined communities with both a groundwater and rainwater source to determine whether their preferred drinking option was the safest in microbial terms. In communities that preferred to drink rainwater, 56.5% of rainwater sources had ‘high-risk’ or ‘very high risk’ Escherichia coli contamination (> 10 MPN/100 mL) compared with 26.1% of groundwater sources (p = 0.092). Moreover, a preference for drinking rainwater was significantly associated with rainwater sources having ‘high-risk’ or ‘very high risk’ levels of E. coli contamination (p = 0.045). Results show that communities do not necessarily choose the safest water source for drinking. Findings also highlight the need to bolster local capacity to manage water quality risks and for Sustainable Development Goal monitoring to distinguish between protected and unprotected rainwater tanks.     

Vietnam military service history and prostate cancer

Background

In the last years, international traffic volume has significantly increased, raising the risk for acquisition of infectious diseases. Among travel-associated infections, increased incidence of legionellosis has been reported among travellers. Aim of our study was: to describe the frequency and severity of Legionella spp. contamination in ferries and cruise ships; to compare the levels of contamination with those indicated by the Italian ministerial guidelines for control and prevention of legionellosis, in order to assess health risks and to adopt control measures.

Method

A prevalence study was carried out on 9 ships docked at the seaports of northern Sardinia in 2004. Water samples were collected from critical sites: passenger cabins, crew cabins, kitchens, coffee bars, rooms of the central air conditioning system. It was performed a qualitative and quantitative identification of Legionella spp. and a chemical, physical and bacteriological analysis of water samples.

Results

Forty-two percent (38/90) water samples were contaminated by Legionella spp.. Positive samples were mainly drawn from showers (24/44), washbasins (10/22). L. pneumophila was isolated in 42/44 samples (95.5%), followed by L. micdadei (4.5%). Strains were identified as L. pneumophila serogroup 6 (45.2%; 19 samples), 2–14 (42.9%), 5 (7.1%) and 3 (4.8%). Legionella spp. load was high; 77.8% of the water samples contained > 10⁴ CFU/L. Low residual free chlorine concentration (0–0,2 mg/L) was associated to a contamination of the 50% of the water samples.

Conclusion

Legionella is an ubiquitous bacterium that could create problems for public health. We identified Legionella spp. in 6/7 ferries. Microbial load was predominantly high (> 10⁴ CFU/L or ranging from 10³ to 10⁴ CFU/L). It is matter of concern when passengers are subjects at risk because of Legionella spp. is an opportunist that can survive in freshwater systems; high bacterial load might be an important variable related to disease's occurrence. High level of contamination required disinfecting measures, but does not lead to a definitive solution to the problem. Therefore, it is important to identify a person responsible for health safety in order to control the risk from exposure and to apply preventive measures, according to European and Italian guidelines.     

Microbial contamination of drinking water from risky tubewells situated in different hydrological regions of Bangladesh

This study, conducted in 40 selected upazilas covering four hydrological regions of Bangladesh, aimed at determining the risk of selected shallow tubewells (depth <30m) used for drinking purpose (n = 26,229). This was based on WHO’s sanitary inspection guidelines and identifying the association of sanitary inspection indicators and risk scores with microbiological contamination of shallow tubewells. The main objective of the study was to observe the seasonal and regional differences of microbial contamination and finally reaching a conclusion about safe distance between tubewells and latrines by comparing the contamination of two tubewell categories (category-1: distance ≤10 m from nearest latrine; n = 80 and category 2: distances 11–20 m from nearest latrine; n = 80) in different geographical contexts. About 62% of sampled tubewells were at medium to high risk according to WHO’s sanitary inspection guidelines, while the situation was worst in south-west region. Microbiological contamination was significantly higher in sampled category-1 tubewells compared to category-2 tubewells, while the number of contaminated tubewells and level of contamination was higher during wet season. About 21% (CI₉₅ = 12%–30%), 54% (CI₉₅ = 43%–65%) and 58% (CI₉₅ = 46%–69%) of water samples collected from category-1 tubewells were contaminated by E. coli, FC, and TC respectively during the wet season. The number of category-1 tubewells having E.coli was highest in the north-west (n = 8) and north-central (n = 4) region during wet season and dry season respectively, while the level of E.coli contamination in tubewell water (number of CFU/100 ml of sample) was significantly higher in north-central region. However, the south-west region had the highest number of FC contaminated category-1 tubewells (n = 16 & n = 17; respectively during wet and dry season) and significantly a higher level of TC and FC in sampled Category-1 tubewells than north-west, north-central and south-east region, mainly during wet season. Multivariate regression analysis could identified some sanitary inspection indicators, such as tubewell within <10 m of latrine, platform absent/broken, pollution source (i.e. household’s waste dumping point/poultry/dairy farm) within 10 m of tubewell and unimproved sanitation facility which were significantly associated with presence of microbial contaminants in tubewell water (p < 0.01). A tubewell with high risk level was associated with a higher chance of having FC and TC in tubewell water than a tubewell with a medium risk during wet season, but no such conclusion could be drawn in case of E.coli contamination. Construction of pit latrine in areas with high water table should be highly discouraged. Raised sealed pits or flush/pour flash to septic tank could be installed considering sanitary inspection criteria. Water should be treated before drinking.     

Water quality at points-of-use in the Galapagos Islands

Piped drinking water is often considered a gold standard for protecting public health but research is needed to explicitly evaluate the effect of centralized treatment systems on water quality in developing world settings. This study examined the effect of a new drinking water treatment plant (DWTP) on microbial drinking water quality at the point-of-use on San Cristobal Island, Galapagos using fecal indicator bacteria total coliforms and Escherichia coli. Samples were collected during six collection periods before and after operation of the DWTP began from the freshwater sources (n = 4), the finished water (n = 6), and 50 sites throughout the distribution system (n = 287). This study found that there was a significant decrease in contamination by total coliforms (two orders of magnitude) and E. coli (one order of magnitude) after DWTP operation began (p < 0.001). However, during at least one post-construction collection cycle, total coliforms and E. coli were still found at 66% and 28% of points-of-use (n = 50), respectively. During the final collection period, conventional methods were augmented with human-specific Bacteroides assays – validated herein – with the goal of elucidating possible microbial contamination sources.Results show that E. coli contamination was not predictive of contamination by human wastes and suggests that observed indicator bacteria contamination may have environmental origins. Together these findings highlight the necessity of a holistic approach to drinking water infrastructure improvements in order to deliver high quality water through to the point-of-use.     

Influence of Processing Parameters on Microbial Load,Sensory Acceptability,and Mineral Contents of Dehydrated Catfish (Clarias gariepinus)

Catfish was dehydrated to improve handling using Response Surface Methodology for experimental design. Brine concentration (%), brining time (min) and drying temperature (°C) as processing parameters interacted in different combinations. Influence of processing parameters on microbial load, sensory acceptability and mineral contents of dehydrated catfish was investigated. Data analysed using regression, ANOVA and average ranking grade. Low total viable and fungi counts (ranged 1.0x10³-3.0x10³ CFU/g) with no detection of pathogen indicates safety for consumption. Brine concentration significantly (p < 0.05) influenced the texture of catfish. The model accounted for only 29.36% of the total variation (R² = 0.2936). The 6% brine, 90 min and 110°C treatment, significantly improved the overall-acceptability. Calcium content (ranged 19.60–52.60 mg/100 g) was significantly higher which could improve the nutrient intake to facilitate development and maintenance of strong bones. Knowledge about safety, acceptability and nutrient content of dehydrated catfish could contribute positively to reshaping decision-making about catfish consumption.     

Vitamin D Deficiency and Insufficiency in the Georgia Older Americans Nutrition Program

ABSTRACT

Serum 25-hydroxyvitamin D (25(OH)D) status in older adults enrolled in community-based meal programs is not well characterized. The objective was to identify predictors of poor serum 25(OH)D status and the response to vitamin D supplementation in a convenience sample from the Older Americans Act Nutrition Program (OAANP) in northeast Georgia (N = 158, mean age = 77 years, 81% women, 69% Caucasian, 31% African American). Mean serum 25(OH)D was 55 nmol/l, and intakes of vitamin D and calcium from foods were very low. Vitamin D insufficiency (25(OH)D 25- < 50 nmol/l) occurred in 36.7%. Vitamin D deficiency occurred in 8.2% (25(OH)D < 25 nmol/l) and was associated with low milk intake, low sunlight exposure, receiving meals at home, tobacco use, depression, dementia, antianxiety medication, poor instrumental activities of daily living, and low calf circumference (p ≤ 0.05). When non-supplement users (n = 28) were given a multivitamin with vitamin D (10 µg/d) and calcium (450 mg/d) for 4 months, 25(OH)D increased from 50 to 78 nmol/l, the prevalence of poor vitamin D status (25(OH)D < 50 nmol/l) decreased from 61% to 14%, and serum alkaline phosphatase decreased by 10% (p < 0.01). High body weight appeared to attenuate the increase in 25(OH)D in response to the multivitamin supplement (p ≤ 0.05). In conclusion, OAANP services did not prevent poor vitamin D and calcium status, but a supplement with vitamin D and calcium was beneficial.     

Deaf Persons' English Reading Levels and Associations with Epidemiological,Educational, and Cultural Factors

One hundred six Michigan d/Deaf persons, part of a study evaluating how to improve d/Deaf persons' understanding of cancer prevention recommendations, had reading levels determined using the Test of Reading Comprehension, Syntactic Sentences. Respondents averaged 52 years old, 59% female, 84% Caucasian, 58% married, and 75% Deaf community members. The mean Test of Reading Comprehension, Syntactic Sentences score was 6.1 (women: 6.2, men: 6.0). Higher scores were associated with greater income (p = .02), employment (p = .01), education (high school p = .002, some college p < .001), English use (child at home, teacher in school, at home now: all p < .001), a hearing spouse (p = .003), hard of hearing/d/Deaf father (p = .02), losing hearing after age 20 years, believing smoking is bad (p < .001), speaking with and satisfaction with physicians and nurses (p < .001), good communication with (p = .01), and comfort discussing cancer with doctors (p < .001). Lower scores were associated with using American Sign Language with physicians and nurses (.019) and Deaf community membership (p = .02). In multivariate analysis, higher scores were associated with higher income, college degree, and teacher using English. Reading levels of a predominantly Deaf population were low. Higher income, college degree, and teacher using English were associated with higher reading levels.     

Microbiological quality of water in a city with persistent and recurrent waterborne diseases under tropical sub-rural conditions: The case of Kikwit City,Democratic Republic of the Congo

The availability of safe drinking water in sub-Saharan countries remains a major challenge because poor sanitation has been the cause of various outbreaks of waterborne disease due to the poor microbiological quality of water used for domestic purposes. The faecal indicator bacteria (FIB) used in the present study included Escherichia coli (E. coli) and Enterococcus (ENT). FIB and aerobic mesophilic bacteria (AMB) were quantified during July 2015 (dry season) and November 2015 (rainy season) in order to assess the quality of drinking water from wells (n = 3; P1–P3), and two rivers, the River Lukemi (RLK, n = 3) and River Luini (RLN, n = 2) in the city of Kikwit, which is located in the province of Kwilu in the Democratic Republic of the Congo. Kikwit is well known for its outbreaks of persistent and recurrent waterborne diseases including Entamoeba, Shigella, typhoid fever, cholera, and Ebola Viral Hemorrhagic Fever. Consequently, E. coli, ENT, and AMB were quantified in water samples according to the standard international methods for water quality determination using the membrane filtration method. The FIB characterization was performed for human-specific Bacteroides by PCR using specific primers. The results obtained revealed high FIB concentrations in river samples collected during both seasons. For example, E. coli respectively reached 4.3 × 10⁴ and 9.2 × 10⁴ CFU 100 mL^?1 in the dry season and the wet season. ENT reached 5.3 × 10³ CFU 100 mL^?1 during the dry season and 9.8 × 10³ CFU 100 mL^?1 in the wet season. The pollution was significantly worse in the wet season compared to the dry season. Surprisingly, no faecal contamination was observed in well water samples collected in the dry season while E. coli and ENT were detected in all wells in the wet season with values of 6, 7, and 11 CFU mL^?1 for E. coli in wells P1–P3, respectively and 3, 5, 9 CFU mL^?1for ENT in the same wells. Interestingly, the PCR assays for human-specific Bacteroides HF183/HF134 indicated that 97–100% captured in all analyses of isolated FIB were of human origin. The results indicate that contamination of E. coli, ENT, and AMB in the studied water resources increases during the wet season. This study improves understanding of the microbiological pollution of rivers and wells under tropical conditions and will guide future municipal/local government decisions on improving water quality in this region which is characterised by persistent and recurrent waterborne diseases. Although the epidemiology can be geographically localised, the effects of cross border transmission can be global. Therefore, the research results presented in this article form recommendations to municipalities/local authorities and the approach and procedures can be carried out in a similar environment.     

Isolation and identification of Legionella pneumophila from material reclamation facilities

Sampling points at a material reclamation facility (MRF) were monitored over three months for the presence of Legionella spp. A number of different Legionellae were isolated and typed to identify L. pneumophila serogroup 1, the serotype which is the most common human pathogen. Phenotypic methods resulted in a total of 61 presumptive isolates of Legionella spp. Using latex agglutination, 26 out of the 61 were identified as L. pneumophila serogroup 1, 23 as L. pneumophila serogroups 2–14, and the remaining 12 were Legionella spp. However, on typing using pulse field gel electrophoresis, the 26 L. pneumophila serotype 1 isolates were a diverse group of 25 PFGE types with none persisting in the environment over time. This diversity suggests that there are a number of contamination sources for this important human pathogen in the MRF environment which constitute a risk to health for operatives in these facilities.     

Validation of the Diabetes Numeracy Test With Adolescents With Type 1 Diabetes

There is currently a lack of valid instruments to measure adolescent diabetes numeracy. The Diabetes Numeracy Test (DNT) was adapted for type 1 diabetes and was administered to 2 samples of adolescents. Sample 1 was administered the 39-item version of the DNT (DNT-39) with measures of self-management, responsibility, reading, and glycemic control (A1C). Sample 2 was administered the 14-item version of the DNT (DNT-14) with measures of self-management, responsibility, problem solving, and A1C. Both versions of the DNT showed adequate internal reliability. In Sample 1, the DNT-39 and DNT-14 were related (r = .87, p = .001), and both DNT versions were related to parent education (for DNT-14, r = .31, p = .02; for DNT-39, r = .29, p = .03) and reading (for DNT-14, r = .36, p = .005; for DNT-39, r = .40, p = .001). In Sample 2, the DNT-14 was related to A1C (r = ?.29, p = .001), reading skills (r = .36, p = .005), diabetes problem solving (r = .27, p = .02), adolescent age (r = .19, p = .03), and parent education (r = .31, p = .02). In combined analyses, 75% of items were answered correctly on the DNT-14 (range = 7–100), and performance was associated with age (r = .19, p = .03), pump use (r = .33 p = .001), and A1C (r = ?.29, p = .001). The DNT-14 is a feasible, reliable, and valid numeracy assessment that indicated adolescents with type 1 diabetes have numeracy deficits that may affect their glycemic control.     

Possible influence of the environmental pollutant bisphenol A on the cardiometabolic risk factors

Bisphenol A (BPA) is a ubiquitous environmental pollutant which is often associated with various health issues. In this study 103 healthy female volunteers in reproductive age from Serbian north province Vojvodina were enrolled and examined for the BPA exposure in the urine samples after 12 h of fasting. BPA was found in 35.92 % (37/103) of subjects. Statistically significant increment in waist circumference (p = 0.045) and waist-to-height ratio (p = 0.037) was observed among the BPA positive women in comparison with the women who had the same energetic balance and had not been exposed to BPA. Linear correlation was obtained between the BPA concentration in urine samples and body mass index (r² = 0.35, p = 0.003) waist circumference (r² = 0.21, p = 0.02) and waist-to-height ratio (r² = 0.25, p = 0.01) among the obese. High energetic intake and reduced physical activity additionally pronounced BPA positive association with obesity. No statistically significant difference was observed in triglycerides, HDL and LDL cholesterol levels between the BPA exposed and BPA non-exposed female volunteers.     

“I'm Not Telling”: The Effects of Racial Disparities Communications on Task Persistence Among Blacks

Research suggests that communications about racial health disparities may adversely affect Blacks. In this study, we varied the message content (Black–White cardiovascular-related disparities + neutral health topics vs. neutral health topics only) embedded in public service announcements given to Black and White participants (N = 86) and had them complete a purported health self-assessment. We used the number of items completed as a measure of task persistence. Our results showed that participants in the disparities condition completed fewer items on average than participants in the neutral condition (p < .01). Planned contrasts revealed that this effect was driven by the responses of Blacks who completed fewer items in the disparities condition (p < .01), though Whites evinced a comparable condition-based trend (p = .12). We found no Black–White differences in the number of items completed in either of our experimental conditions (ps ≥ .53). Although preliminary, our findings suggest that Blacks and Whites exposed to comparative racial disparities messaging about cardiovascular diseases could experience reduced task persistence. Research implications and study limitations are also discussed.     

Predictors of Health Care System and Physician Distrust in Hospitalized Cardiac Patients

Trusting relationships among patients, physicians, and the health care system is important in encouraging self-care behaviors in cardiovascular patients. This study aimed to assess the prevalence of health care system and physician distrust in this population, compare the 2 forms of distrust, and describe the demographic, socioeconomic, and psychosocial predictors of high distrust. A total of 1,232 hospitalized adults with acute coronary syndrome or heart failure were enrolled in a prospective, observational study assessing health care system distrust and physician distrust. High health care system distrust (35%) was observed across the population, with lower levels of interpersonal physician distrust (16%). In a multivariate analysis, poor social support and coping skills were strong predictors of both health care system (p = .026, p = .003) and physician distrust (p < .001, p = .006). Individuals with low or marginal health literacy had a higher likelihood of physician distrust (p < .001), but no relation was found between health literacy and health care system distrust. In conclusion, distrust is common among acutely ill cardiac patients. Those with low social support and low coping skills are more distrusting of physicians and the health care system.     

Prevalence,characterisation and antimicrobial resistance of Campylobacter and Salmonella in raw poultrymeat in the UK, 2003–2005

This study was conducted to determine the prevalence and antimicrobial resistance of Campylobacter and Salmonella isolates from retail poultrymeat in the UK during 2003–2005. Poultrymeat (n = 2104) were more frequently contaminated with Campylobacter (57.3%) than with Salmonella (6.6%). Chicken exhibited the highest contamination from Campylobacter (60.9%), followed by duck (50.7%), turkey (33.7%) and other poultrymeat (34.2%). Duck had the highest contamination from Salmonella (29.9%), compared with chicken (5.6%), turkey (5.6%), and other poultrymeat (8.6%). C. jejuni predominated in raw chicken, whereas C. coli predominated in turkey and duck. C. coli isolates were more likely to exhibit antimicrobial drug resistance, including quinolones, than C. jejuni. Salmonella Enteritidis was the most frequent Salmonella serotype isolated. Salmonella isolates from turkey exhibited higher rates of multiple drug resistance (55.6%) than isolates from chicken (20.9%) and duck (13.6%). The findings reinforce the importance of thorough cooking of poultrymeat and good hygiene to avoid cross-contamination.     

AIDS Knowledge Gaps: Results from the First Decade of the Epidemic and Implications for Future Public Information Efforts

Sri Lankan inpatients receive a discharge summary in English known as a diagnosis card. The authors investigated whether supplementing the diagnosis summary with native language improved patients’ knowledge of illness and medication. Participants were 130 newly diagnosed patients with noncommunicable chronic diseases (92 men, 70.8%; 38 women, 29.2%; M age = 55.4 years, SD age = 12.8 years) who were randomized to a control group receiving an English discharge summary and intervention group receiving a supplementary native language discharge summary. A questionnaire assessed knowledge of illness and prescribed medications at discharge and at 2 weeks. The groups were comparable for knowledge of diagnosis and prescribed medications at discharge. At 2 weeks, the intervention group had significantly higher scores than did the control group for knowledge on diagnosis, M = 81.41, SD = 34.63, versus M = 27.95, SD = 41.26, respectively, p < .001; and on medications, M = 54.48, SD = 33.91, versus M = 12.55, SD = 20.44, respectively, p < .001. The increase in scores was explained by the dichotomous variable, whether supplementary discharge summary was given or not (p < .001). A higher proportion in the intervention group read the discharge summary to gain knowledge of diagnosis (81.5%) and medication (80%) than in the control group (4.6% and 6.2%, respectively; p < .001). A total of 121 participants (92.1%) preferred a discharge summary in native language. This simple model may be useful to improve patient knowledge relating to illness in countries that predominantly use another language for medical communications, rather than a native language.     

Mold populations and dust mite allergen concentrations in house dust samples from across Puerto Rico

Lifetime childhood asthma prevalence (LCAP) percentages in Puerto Rico Health Regions (HR) are substantially higher in northeastern vs. southwestern HR. Higher average relative humidity in the northeast might promote mold and mite exposures and possibly asthma prevalence. To test this hypothesis, mold contamination, Environmental Relative Moldiness Index (ERMI) values were measured in floor dust (n = 26) and dust mite allergen concentrations in bed dust (n = 14). For this analysis, the eight HR were divided into those with LCAP >?30?% (n = 3) and < 30?% (n = 5). The average ERMI value was significantly greater (Wilcoxon Rank Sum, p < 0.001) in high than in low LCAP HR (14.5 vs. 9.3). The dust mite antigens Der p 1, Der f 1, and Blo t 5 were detected in 90?% of bed samples, but the concentrations were not significantly different in high vs. low LCAP HR. Mold exposures might partially explain the differences in LCAP HR in Puerto Rico.     

The prevalence and associated risk factors of elder abuse among older people applied to the family health center in the rural district of Turkey

ABSTRACT

In this study, face-to-face interviews were conducted with older people who applied to the family health center (N = 152) in the traditional rural district of Turkey. Although the prevalence rate was 23%, the mean value of “Characteristics of the elder that make him or her vulnerable to abuse” subscale (X? = .37) was highest among other subscales. The mean values for “Characteristics of potentially abusive situations” (X? = .06) and “Overt violation of personal rights and direct abuse” (X? = .05) were quite low. The majority of the elder abuse prevalence was composed of participants who were vulnerable to elder abuse. The rural area makes older individuals vulnerable to abuse. Also, risk factors associated with elder abuse in rural areas were interaction with family (p = .000), interaction with neighbors/friends (p = .001), chronic diseases (p = .002), psychiatric diseases (p = .007), gender and marital status (p = .008), and additional income (p = .028), respectively. The only predictor of elder abuse in rural areas was family interaction. There was a significant negative relationship between rural elder abuse and family interaction (T= ?4.239, p < .001).     

Predictors of recurrent hypoglycemia following a severe hypoglycemic event among hospitalized patients

Objectives: Severe hypoglycemia is associated with poor hospital outcomes, but variables contributing to the adequacy of treatment have not been described. The objective of this study was to determine predictors of recurrent hypoglycemia among hospitalized patients with a severe hypoglycemic event. Methods: Patients with severe hypoglycemia (glucose <40 mg/dl) with a concomitant insulin order were identified using the study institution’s Information Warehouse. The primary outcome was the prevalence of recurrent hypoglycemia (defined as <70 mg/dl within 24 hours) and to identify independent predictors of recurrent hypoglycemia. Secondary outcomes included time to blood glucose recheck, time to blood glucose ≥70 mg/dl, and rebound hyperglycemia (defined as glucose >300 mg/dl within 24 hours). Multivariable linear and logistic regression models were performed. Results: A total of 129 patients with severe hypoglycemia were identified. The median time to repeat glucose measurement was 29 (IQR 15–61) minutes, while the time to resolution of hypoglycemia was 49 (IQR 26–103) minutes. Recurrent hypoglycemia occurred in 49% of patients, while 19% of patients experienced rebound hyperglycemia. Independent predictors of recurrent hypoglycemia included lower repeat glucose (p = 0.025), low glomerular filtration rate (p = 0.033), and lack of insulin adjustment (p = 0.012). Independent predictors of maximum glucose post-event were type 1 diabetes (p = 0.0003), history of any diabetes (p = 0.013), and total bolus dose of insulin (p < 0.0001). Overnight timing of events was the only predictor of shorter time to hypoglycemia resolution (p < 0.0001). Conclusions: Recurrent hypoglycemia following severe hypoglycemia is common in the hospital, suggesting the need for enhanced monitoring in such patients. Further research is needed to identify methods to reduce the incidence of recurrent hypoglycemia.