Antecedents of Community Stakeholder Satisfaction Towards an Australian Drug clinic

The aim of the study was to investigate the antecedents of community satisfaction towards an Australian drug clinic, with the aim of developing a general model of community stakeholder satisfaction that may apply to other clinics. A structured survey was administered via the telephone and face to face with 490 community stakeholders including residents, businesses and other health and community service providers. Multilingual interviewers were used because a large percentage of participants were from a non-English-speaking background. Community stakeholder satisfaction was found to correlate positively with variables such as stakeholder's perception of the importance of services, understanding of community needs, contribution to community, usefulness of communication, and staff skill. The antecedents related to quality of service, rather than to knowledge of the clinic, showed consistently stronger correlations with overall satisfaction. Stakeholders were least aware of the clinic's services that were rated the most important and given the highest satisfaction scores. It is concluded that regular surveying of community attitudes helps a clinic to modify its services to meet the needs of its community more accurately. Surveying can also provide early warning of growing problems that may, if left unresolved, impede future survival or growth of the clinic.     

Alcohol Use and Sex Risk Behaviors Among HIV-Infected Female Sex Workers (FSWs) and HIV-Infected Male Clients of FSWs in India

Unprotected heterosexual transactional sex plays a central role in the spread of HIV in India. Given alcohol’s association with risky sex in other populations and alcohol’s role in HIV disease progression, we investigated patterns of alcohol use in HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in Mumbai. Analyses identified factors associated with heavy alcohol use and evaluated the relationship between alcohol use and risky sex. We surveyed 211 female and 205 male individuals; 80/211 FSWs (38%) and 127/205 male clients (62%) drank alcohol in the last 30 days. Among females, 32 and 11% drank heavily and were alcohol-dependent, respectively; among males the respective proportions were 44 and 29%. Men’s heavy alcohol use was significantly associated with inconsistent condom use over the last year (AOR 2.40, 95% CI 1.21–4.77, P = 0.01); a comparable association was not seen in women. These findings suggest a need to address alcohol use both to avoid the medical complications of its heavy use in this population and to mitigate inconsistent condom use, the latter issue possibly requiring gender specific approaches. Such efforts to reduce drinking will be an important dimension to secondary HIV prevention in India.     

Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross‐sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty‐five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m²) was estimated using the four‐variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ≤1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1–3.9), naming (AOR=1.9, 95% CI=1.0–3.3), attention (AOR=2.4, 95% CI=1.3–4.5), executive function (AOR=2.5, 95% CI=1.9–4.4), and delayed memory (AOR=1.5, 95% CI=0.9–2.6) but not on category fluency (AOR=1.1, 95% CI=0.6–2.0) than those with mild to moderate CKD (eGFR 45–59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment.     

The CareFile Project: a feasibility study to examine the effects of an individualised information booklet on patients after stroke

INTRODUCTION: patients have reported a lack of knowledge and understanding of stroke and its risk factors. Uncertainty remains about the most appropriate and effective method of educating patients after stroke. OBJECTIVE: to assess the impact of the CareFile, an individualized information booklet, on patients' knowledge and satisfaction level after stroke. DESIGN: randomised pilot study for a controlled trial. SETTING: a large teaching hospital in Liverpool, UK. METHODS: consecutive stroke patients admitted over a 9-month period, who met the inclusion criteria and consented to participate, were randomised into this study. All patients received the usual stroke information leaflets provided by the stroke unit. In addition, the intervention group received the ;CareFile', a booklet containing general information and patient-specific information on stroke. Patients in both groups completed a stroke knowledge questionnaire at baseline, and at three and six months post-stroke. RESULTS: of the 259 admissions, 100 were eligible to participate, and 50 were randomised to each group. There was no significant difference in patient knowledge between the groups at baseline (P>0.05). However, at three (P<0.05) and six (P<0.005) months post-stroke, the intervention group had significantly better knowledge of stroke. There were no differences between the groups regarding satisfaction with the information received. CONCLUSIONS: a simple education package, in the form of an individualized information booklet, resulted in a significant improvement in knowledge and recognition of risk factors for stroke. The CareFile should make a valuable contribution in meeting the requirements of the National Sentinel Audit and National Service Framework regarding provision of information to patients after stroke.     

Early socioeconomic position and blood pressure in childhood and adulthood: the Cardiovascular Risk in Young Finns Study

Studies have found an association between low socioeconomic position in childhood and high adult blood pressure. It is unclear whether this association is explained by a pathway directly linking disadvantage to elevated blood pressure in childhood and adolescence, which then tracks into adulthood. We assessed parental socioeconomic position and systolic blood pressure in 1807 children and adolescents ages 3 to 18 years at baseline. Adult systolic blood pressure was measured 21 years later at ages 24 to 39 years. There was strong tracking of blood pressure from childhood to adulthood. Lower parental socioeconomic position was associated with higher blood pressure in childhood, adolescence (P<0.01), and adulthood (P<0.0001), with the mean age- and sex-adjusted systolic pressure differences between the highest and lowest socioeconomic groups varying between 2.9 and 4.3 mm Hg. With adjustment for blood pressure in childhood and adolescence, the regression coefficient between parental socioeconomic position and adult blood pressure attenuated by 32%. A similar level of attenuation (28%) occurred with adjustment for adult body mass index (BMI). With adjustment for both preadult blood pressure and adult BMI, the association between parental socioeconomic position and adult blood pressure was attenuated by 45%. Other factors, including birth weight and BMI in childhood and adolescence, had little impact on the association between parental socioeconomic position and adult blood pressure. These data suggest that early socioeconomic disadvantage influences later blood pressure in part through an effect on blood pressure in early life, which tracks into adulthood, and in part through an effect on BMI.     

Chronic graft-versus-host disease is associated with increased numbers of peripheral blood CD4+CD25high regulatory T cells

Chronic graft-versus-host disease (cGVHD) is characterized by a state of profound immunodeficiency in association with alloreactive and autoimmune phenomena. These observations indicate an impairment of immunologic tolerance that could involve both central and peripheral mechanisms. Defective thymic function may contribute to dysregulation of central tolerance, but few studies have addressed peripheral tolerance. Recently a population of CD4+CD25+ T cells (Treg cells) has been characterized, which controls immunologic reactivity in vivo and which on transfer can prevent experimental acute GVHD. We investigated the number and function of peripheral blood CD4+CD25high T cells in patients more than 100 days after allogeneic hematopoietic stem cell transplantation. Patients with cGVHD had markedly elevated numbers of CD4+CD25high T cells as compared to patients without GVHD. CD4+CD25high T cells derived from patients in both groups were of donor origin, lacked markers of recent activation, and expressed intracellular CD152. In contrast to controls, CD4+CD25high T cells derived from patients with cGVHD were characterized by lower surface CD62L expression. In vitro, CD4+CD25high T cells were hyporesponsive to polyclonal stimulation and suppressed the proliferation and cytokine synthesis of CD4+CD25- cells, an effect that was independent of interleukin 10. These results indicate that chronic graft-versus-host injury does not occur as a result of Treg cell deficiency.     

PS1-45: Evaluating the Quality of VDW Pharmacy Data

Background/Aims The HMO Research Network (HMORN) Virtual Data Warehouse (VDW) is a series of dataset standards and automated processes that aim to streamline the process of multi-site research. The Pharmacy file contains data on all outpatient dispensings captured within the HMORN. The objective was to assess the overall quality and completeness of the Pharmacy file. Methods The VDW Pharmacy Working Group created a data verification protocol to assess the overall quality and completeness of Pharmacy file data (e.g., to identify missing data or out-of-range values). A distributed SAS program was run at each HMORN site that maintains a VDW Pharmacy file (n=14 of 19 HMORN sites), and de-identified summary data were returned for analysis. Pharmacy file variables that were assessed included National Drug Code (NDC), days supplied, amount dispensed, and prescribing physician (which joins to the VDW Provider Specialty file). An "invalid" NDC was defined as any value not having exactly 11 digits or containing a non-numeric character. The days supplied variable was considered out-of-range if the value was < 0, = 500, or missing. Amount dispensed was defined as out-of-range for values < 0, = 1000, or missing. Results Fourteen HMORN sites had Pharmacy data from 2000-2009 and participated in this analysis; some sites had > 20 years of data. There were 93.4 million dispensings in 2009, with an average of 7.8 million dispensings per month among 3.1 million monthly users (average per user: 2.6 dispensings per month; range across sites 2.3-5.8). Across all sites from 2000-2009, 0.082% (712,131/870,182,026) and 0.072% (629,656/870,182,026) of dispensings had missing or "invalid" NDCs, respectively; and 0.083% (724,210/870,182,026) and 0.315% (2,736,756/870,182,026) had out-of-range days supplied and amount supplied, respectively. The prescribing physician was identified in 96% (1,038,725,660/1,079,370,265) of all dispensings. The prescriber's specialty was identified in 62% (539,944,688/870,182,078) of dispensings overall and improved from 61% (46,678,731/77,078,104) in 2000 to 63% (60,160,629/95,867,812) in 2009. Discussion The VDW Pharmacy file has excellent overall data quality results, and has improved in identification of prescriber specialty. It has measurably comprehensive and consistent outpatient dispensing data across 14 HMORN sites.