Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review

Purpose

To inform health system improvements for care of elderly populations approaching the end of life (EOL) by identifying important elements of care and implementation barriers and facilitators.

Prevalence of Substance Use Among Patients of Community Health Centers in East Los Angeles and Tijuana

Background: Given the increased use of psychoactive substances on the United States–Mexico border, a binational study (Tijuana, Mexico–Los Angeles, USA) was conducted to identify the prevalence of substance use in primary care settings. Objectives: To compare the prevalence and characteristics of patients at risk for substance use disorders in Tijuana and East Los Angeles (LA) community clinics with special attention paid to drug use. Methods: This was an observational, cross-sectional, analytical study, comparing substance use screening results from patients in Tijuana and LA. The settings were 2 community clinics in LA and 6 in Tijuana. Participants were 2,507 adult patients in LA and 2,890 in Tijuana eligible for WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screening during March–October 2013. Patients anonymously self-administered the WHO ASSIST on a tablet PC in the clinic waiting rooms. Results: Of eligible patients, 96.4% completed the ASSIST in Tijuana and 88.7% in LA (mean 1.34 minutes and 4.20 minutes, respectively). The prevalence of patients with moderate-to-high substance use was higher in LA than Tijuana for each substance: drugs 19.4% vs. 5.7%, alcohol 15.2% vs. 6.5%, tobacco 20.4% vs. 16.2%. LA patients born in Mexico had 2x the odds and LA patients born in the United States had 6x the odds of being a moderate-to-high drug user compared to Tijuana patients born in Mexico. Conclusions: Moderate-to-high drug use is higher in LA than in Tijuana but rates are sufficiently high in both to suggest that screening for drug use (along with alcohol and tobacco use) should be integrated into routine primary care of community clinics in both cities.     

Survey on International Health Professional Training and Attitudes on Sexuality After Traumatic Brain Injury

Traumatic brain injury (TBI) is associated with a range of deficits that may negatively impact sexuality. Few studies have explored how professionals respond to sexuality issues among individuals with TBI. The present study aimed to examine the attitudes and level of training of international health professionals working with individuals with TBI and whether guidelines exist in their work settings related to sexual issues. A survey composed of 53 questions was developed to evaluate attitudes, professional training, and assessment related to sexuality among health professionals working with individuals with TBI. The sample consisted of 324 self-identified health care professionals. During their training, 83% of professionals reported not taking any specific courses, and 61% reported not taking any type of clinical practice related to sexuality issues after TBI. Approximately 70% reported knowing little information about sexuality issues related to TBI and believed it affected the way in which they address the topic with their patients. Professionals believed sexual expression among both cognitively intact (100%) and cognitively impaired (90%) patients was healthy. Sixty-nine percent reported their work setting had no guidelines to determine if an individual with TBI can consent to sexual activity or not. Sixty-six percent of professionals believed that a patient with severe TBI could consent to sexual activities; however 58% believed it is not their responsibility to determine that. Results demonstrated a need for enhanced educational curriculums with specific courses related to sexuality after TBI. Furthermore, institutions should develop guidelines for the assessment of capacity to consent to sexual activity.     

Anthocyanins from roselle extract arrest cell cycle G2/M phase transition via ATM/Chk pathway in p53‐deficient leukemia HL‐60 cells

Cell cycle regulation is an important issue in cancer therapy. Delphinidin and cyanidin are two major anthocyanins of the roselle plant (Hibiscus sabdariffa ). In the present study, we investigated the effect of Hibiscus anthocyanins (HAs) on cell cycle arrest in human leukemia cell line HL‐60 and the analyzed the underlying molecular mechanisms. HAs extracted from roselle calyces (purity 90%) markedly induced G2/M arrest evaluated with flow cytometry analysis. Western blot analyses revealed that HAs (0.1–0.7 mg mL^?1) induced G2/M arrest via increasing Tyr15 phosphorylation of Cdc2, and inducing Cdk inhibitors p27 and p21. HAs also induced phosphorylation of upstream signals related to G2/M arrest such as phosphorylation of Cdc25C tyrosine phosphatase at Ser216, increasing the binding of pCdc25C with 14‐3‐3 protein. HAs‐induced phosphorylation of Cdc25C could be activated by ATM checkpoint kinases, Chk1, and Chk2. We first time confirmed that ATM‐Chk1/2‐Cdc25C pathway as a critical mechanism for G2/M arrest in HAs‐induced leukemia cell cycle arrest, indicating that this compound could be a promising anticancer candidate or chemopreventive agents for further investigation. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1290–1304, 2017.     

Trends in prevalence of leisure time physical activity and inactivity: results from Australian National Health Surveys 1989 to 2011

Objective: To examine trends in leisure time physical activity and inactivity in Australians aged 15 years or older from 1989 to 2011. Method: We used data from six Australian National Health Surveys conducted from 1989/90 to 2011/12 in which physical activity was assessed using comparable questions. Analyses examined trends in the prevalence of sufficient physical activity (≥150 minutes/week moderate‐to‐vigorous physical activity) and of inactivity (<30 minutes/week moderate‐to‐vigorous physical activity). Results: The proportion of sufficiently active adults was 39.2% in 1989 and 40.7% in 2011 with an overall declining trend of 0.2% per year (p=0.012). The prevalence of inactivity was 38.7% in 1989 and 37.3% in 2011; the overall time trend by year was stable (OR=0.999, p=0.242). In women, sufficient physical activity decreased by 0.3% per year from 35.5% in 1989 (p=0.025); inactivity increased from 39.5% by 0.3% per year (p=0.004). In men, sufficient physical activity prevalence was 43.1% in 1989 with a steady trend; inactivity decreased from 37.9% by 0.5% per year (p<0.0001). Conclusions: The prevalence of sufficient physical activity remains low and inactivity high. Women appear to be a key target group for intervention. Public health efforts have been ineffective over two decades for improving physical activity among Australian adults. Implications for public health: This research supports calls for a national physical activity action plan given the multitude of benefits from sufficient physical activity. Maintenance of consistent physical activity questions in future National Health Surveys will facilitate long term tracking of physical activity levels in the Australian population.     

Validation study of a Chinese version of Partners in Health in Hong Kong (C-PIH HK)

Background

The Partners in Health (PIH) scale is a measure designed to assess the generic knowledge, attitudes, behaviors, and impacts of self-management. A cross-cultural adaptation of the PIH for use in Hong Kong was evaluated in this study. This paper reports the validity and reliability of the Chinese version of PIH (C-PIH[HK]).

Method

A 12-item PIH was translated using forward–backward translation technique and reviewed by individuals with chronic diseases and health professionals. A total of 209 individuals with chronic diseases completed the scale. The construct validity, internal consistency, and test–retest reliability were evaluated in two waves.

Results

The findings in Wave 1 (n = 73) provided acceptable psychometric properties of the C-PIH(HK) but supported the adaptation of question 5 to improve the cultural relevance, validity, and reliability of the scale. An adapted version of C-PIH(HK) was evaluated in Wave 2. The findings in Wave 2 (n = 136) demonstrated good construct validity and internal consistency of C-PIH(HK). A principal component analysis with Oblimin rotation yielded a 3-factor solution, and the Cronbach’s alphas of the subscales ranged from 0.773 to 0.845. Participants were asked whether they perceived the self-management workshops they attended and education provided by health professionals as useful or not. The results showed that the C-PIH(HK) was able to discriminate those who agreed and those who disagreed related to the usefulness of individual health education (p < 0.0001 in all subscales) and workshops (p < 0.001 in the knowledge subscale) as hypothesized. The test–retest reliability was high (ICC = 0.818).

Conclusion

A culturally adapted version of PIH for use in Hong Kong was evaluated. The study supported good construct validity, discriminate validity, internal consistency, and test–retest reliability of the C-PIH(HK).