Early administration of appropriate antimicrobial agents to improve the outcome of carbapenem-resistant Acinetobacter baumannii complex bacteraemic pneumonia

Carbapenem-resistant Acinetobacter baumannii complex (CRABC) is an emerging pathogen that causes bloodstream infections and nosocomial pneumonia. This study aimed to describe severe infection associated with CRABC bacteraemic pneumonia and to investigate risk factors for 28-day mortality. All patients aged ≥18 years with CRABC bacteraemic pneumonia were enrolled retrospectively at five teaching hospitals in South Korea. Empirical antimicrobial therapy was defined as appropriate if administration of at least one antimicrobial agent, to which the causative pathogen was susceptible, for >48?h, within 5 days of the onset of bacteraemia. During the study period, 146 patients with CRABC bacteraemic pneumonia were enrolled. Among them, 128 (87.7%) patients were treated in the intensive care unit; of these, 110 (75.3%) had ventilator-associated pneumonia. A total of 42 patients (28.8%) received appropriate empirical therapy. There was no difference in baseline characteristics between the appropriate and inappropriate empirical treatment groups. However, 28-day mortality was higher in the inappropriate therapy group (54.8% vs. 76.9%; P?=?0.008). Multivariate Cox regression analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥20 [hazard ratio (HR)? =?1.28, 95% confidence interval (CI) 1.04–1.58; P?=?0.02], septic shock (HR?=?3.49, 95% CI 2.15–5.67; P?<0.001) and inappropriate empirical therapy (HR?=?3.24, 95% CI 1.94–5.42; P?<0.001) were independently associated with an adverse outcome. In conclusion, the mortality rate of CRABC bacteraemic pneumonia was extremely high. Appropriate empirical therapy might improve the outcome of patients with CRABC bacteraemic pneumonia.     

The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening

Objective: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population.

Design: This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture.

Results: Participants who had a regular physician and doctor’s recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR)?=?3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR?=?6.61; 95% CI: 2.63, 16.65, respectively). A doctor’s recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR?=?4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR?=?0.15; 95% CI: 0.03, 0.82 and aOR?=?0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the‘immigrant life,’ who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer.

Conclusions: Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.     

Seltene Erkrankungen in der Zahn‑, Mund- und Kieferheilkunde

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Am 25.&nbsp;November wurde unter der Schirmherrschaft von ACHSE e. V. und Orphanet erstmalig ein nationaler Kongress...     

The effect of almonds on vitamin E status and cardiovascular risk factors in Korean adults: a randomized clinical trial

Purpose

Almonds have shown to beneficially modify some cardiovascular risk factors in clinical trials conducted in diverse ethnic populations but this relationship has never been tested in Koreans. Thus, we tested the impact of almonds consumed as a snack within the context of a typical Korean diet on cardiovascular risk factors.

Methods

We conducted a randomized, crossover trial in a free-living setting with a 2-week run-in period, two 4-week intervention phases, and a 2-week washout period between interventions. Eighty four overweight/obese participants (11 M/73 F; 52.4 ± 0.6 year; 25.4 ± 0.22 kg/m²) consumed either 56 g of almonds or isocaloric cookies daily for 4 weeks.

Results

Mean % daily energy intake at baseline was 64.8, 21.3, and 14.9% from carbohydrate, fat, and protein, respectively. The addition of 56 g of almonds daily decreased carbohydrate energy to 55.0%, increased fat to 32.0%, and maintained protein at 14.7%. Consuming the almonds increased intake of MUFA by 192.3%, PUFA by 84.5%, vitamin E by 102.7%, and dietary fiber by 11.8% and decreased % energy from carbohydrate by 14.1%. Total caloric intake was increased by the almonds, but body weight, waist circumference, and body composition were not affected. Almonds in overweight and obese Korean adults decreased TC, LDL-C, and non-HDL-C by 5.5, 4.6, and 6.4%, respectively, compared to the cookie control (P ≤ 0.05). Almonds increased plasma α-tocopherol by 8.5% (P ≤ 0.05) from the baseline and tended to increase its value as compared to cookies (P = 0.055). Neither the almonds nor cookies altered plasma protein carbonyls, MDA or oxLDL. Of serum inflammatory markers, IL-10 was decreased by almond intake (P ≤ 0.05), and ICAM-1, IL-1β, and IL-6 tended to be lower with almonds, compared to the cookies.

Conclusions

Almonds at 56 g/day consumed as a snack favorably modified the Korean diet by increasing MUFA, PUFA, vitamin E, and dietary fiber intake and decreasing % energy intake from carbohydrate. Almonds also enhanced plasma α-tocopherol status and serum TC and LDL-C in overweight and obese Koreans. Thus, including almonds in typical Korean diets as a snack can help healthy overweight/obese individuals improve nutritional status and reduce their risk for CVD.

     

Salty taste thresholds and preference in patients with chronic kidney disease according to disease stage: A cross‐sectional study

Aim

The present study was performed to evaluate the differences in salty taste thresholds among normal controls and non‐dialysis chronic kidney disease (CKD) patients according to disease stage and to evaluate the relationship between salty taste thresholds or preferences and mean spot urine sodium concentrations.

Methods

This cross‐sectional study enrolled 436 patients with non‐dialysis CKD and 74 normal controls. We evaluated detection and recognition thresholds, salty taste preferences and salt usage behaviours (through a questionnaire) in CKD patients and normal controls. We averaged the three most recent spot urine sodium concentrations and used this ‘mean spot urine sodium’ value to estimate sodium intake in CKD patients.

Results

Detection thresholds of stages 3 and 5 and recognition thresholds of stage 3 CKD patients were higher than those of normal controls. Salty taste preferences of stage 5 and salt usage behaviour scores of stages 4 and 5 CKD patients were lower than those of normal controls. Univariate analysis showed that estimated glomerular filtration rate (eGFR), salt usage behaviour score, salty taste preference, smoking, gender and zinc level were significantly associated with mean spot urine sodium in CKD patients. Multiple regression analysis showed that the eGFR and salty taste preference were independently correlated with mean spot urine sodium.

Conclusions

Education to change salty taste preferences and regular follow up are necessary to decrease salt intake in CKD patients.     

Acculturation,Acculturative Stress,and Depressive Symptoms in International Migrants: A Study with Vietnamese Women in South Korea

Globally, there have been increasing numbers of migrant women; these women are at an increased risk for depressive symptoms. The purpose of this study was to examine the associations among acculturation, acculturative stress and depressive symptoms in Vietnamese women who migrated to South Korea through marriages. We hypothesized that acculturative stress would serve as a mediator in the relationship between acculturation and depressive symptoms. Our findings from surveys with 217 Vietnamese immigrant women showed that the indirect effect of acculturation on depressive symptoms, mediated through acculturative stress [??.15 (.04)], was significant (bias corrected 95% confidence interval for the indirect effect?=???.25, ??.08). Low levels of acculturation increased acculturative stress, which in turn led to the elevated symptoms of depression. Our findings not only illuminate the adaptation processes of international, female migrants but also suggest avenues to protect and promote their mental well-being.     

‘I’m on the train and I can't stop it': Western Canadians' reactions to prediabetes and the role of self‐compassion

Prediabetes, a condition characterised by impaired glucose regulation, is on the rise worldwide. This condition puts people at risk for cardiovascular disease, and 50% of people with prediabetes will develop type 2 diabetes (T2D). People with prediabetes can reduce their risk of developing T2D through lifestyle changes such as regular physical activity and healthy eating. However, the experience of health risks can be associated with negative reactions that can undermine people's ability to self‐regulate the health behaviours that would reduce such risk. Self‐compassion, or treating oneself kindly in the face of challenge, is known to help people manage negative emotions and facilitate self‐regulation. Therefore, self‐compassion may be helpful for people with prediabetes who have to manage their health behaviours in the context of a health threat. The purpose of this study was to explore how people, from a small Canadian city who learn that they have prediabetes, react emotionally to their prediabetes diagnosis. We also explored participants' receptivity to applying self‐compassion in the context of their prediabetes. Twenty‐one adults, recently notified by their doctors as having HbA1c scores indicative of prediabetes (M_age = 57.76, SD = 5.43), engaged in a semi‐structured interview between June 2017 and January 2018. Inductive thematic analysis was used to analyse the data and four themes emerged. Participants' reactions to learning that they had prediabetes were characterised by (a) distress and concern, (b) downplay of T2D risks, (c) guilt and shame, and participants were receptive to (d) self‐compassion as a beneficial approach to take in relation to their prediabetes. Findings suggest that people experience negative reactions to their prediabetes diagnosis yet are receptive to self‐compassion, which could mitigate these reactions. These findings can inform lifestyle behaviour change programmes for individuals living with prediabetes by providing a better understanding of their perspectives of disease diagnosis.     

Statistical Methods for Conditional Survival Analysis

We investigate the survival distribution of the patients who have survived over a certain time period. This is called a conditional survival distribution. In this paper, we show that one-sample estimation, two-sample comparison and regression analysis of conditional survival distributions can be conducted using the regular methods for unconditional survival distributions that are provided by the standard statistical software, such as SAS and SPSS. We conduct extensive simulations to evaluate the finite sample property of these conditional survival analysis methods. We illustrate these methods with real clinical data.     

Nanoparticulate vaccine inhibits tumor growth via improved T cell recruitment into melanoma and huHER2 breast cancer

Nanoparticulate vaccines are promising tools to overcome cancer immune evasion. However, a deeper understanding on nanoparticle–immune cell interactions and treatments regime is required for optimal efficacy. We provide a comprehensive study of treatment schedules and mode of antigen-association to nanovaccines on the modulation of T cell immunity in vivo, under steady-state and tumor-bearing mice. The coordinated delivery of antigen and two adjuvants (Monophosphoryl lipid A, oligodeoxynucleotide cytosine-phosphate-guanine motifs (CpG)) by nanoparticles was crucial for dendritic cell activation. A single vaccination dictated a 3-fold increase on cytotoxic memory-T cells and raised antigen-specific immune responses against B16.M05 melanoma. It generated at least a 5-fold increase on IFN-γ cytokine production, and presented over 50% higher lymphocyte count in the tumor microenvironment, compared to the control. The number of lymphocytes at the tumor site doubled with triple immunization. This lymphocyte infiltration pattern was confirmed in mammary huHER2 carcinoma, with significant tumor reduction.