Julio A. Ramirez, S. Furmanek, T. Chandler, W. Mattingly, Anupama Raghuram, Ashley M. Wilde, Smita S Ghare, Paula M. Chilton, Shirish S Barve
Community-acquired pneumonia (CAP) affects approximately 1.5 million patients annually in the United States, leading to significant acute and long-term clinical outcomes. CAP is increasingly recognized as a multisystemic disease with potential sequelae affecting various organ systems, including the neurologic, pulmonary, cardiovascular, musculoskeletal, metabolic, and renal systems. The primary objective of this study is to review literature on long-term cognitive impairment, dementia, and decreased survival following CAP hospitalization. Additionally, the potential role of the gut-lung-brain axis in the pathogenesis of these outcomes is explored. A comprehensive review of existing literature was conducted, focusing on studies that examined cognitive impairment, dementia, and mortality in patients hospitalized for CAP. Relevant studies were identified through a systematic search of medical databases, and data were extracted on study design, population characteristics, cognitive assessments, and outcomes. The review also incorporated mechanistic insights into the gut-lung-brain axis to hypothesize its role in the long-term sequelae of CAP. The review identified multiple studies demonstrating an increased risk of cognitive impairment and dementia following CAP hospitalization. Patients hospitalized for CAP had a 1.5 to 2.5 times higher risk of developing cognitive deficits compared to controls. This cognitive decline was not limited to elderly patients but spanned all adult age groups. Furthermore, CAP was associated with a significant reduction in life expectancy. Patients discharged after CAP hospitalization reached 50% mortality within three years, compared to seven years for those hospitalized for other reasons. The most pronounced decrease in survival was observed in CAP patients requiring ICU admission and immunocompromised patients. CAP is associated with significant long-term cognitive impairment and decreased survival. The proposed gut-lung-brain axis mechanism suggests that CAP-related dysbiosis leads to chronic systemic inflammation and neuroinflammation, potentially contributing to cognitive decline and increased mortality. Understanding the role of this axis may offer new therapeutic strategies for managing the long-term neurological consequences of CAP. Future research should focus on high-risk populations to develop targeted interventions aimed at mitigating these severe outcomes.
在美国，社区获得性肺炎（CAP）每年影响约 150 万名患者，导致严重的急性和长期临床后果。人们日益认识到，CAP 是一种多系统疾病，可能会对神经、肺、心血管、肌肉骨骼、新陈代谢和肾脏等多个器官系统造成影响。本研究的主要目的是回顾有关 CAP 住院后长期认知障碍、痴呆和存活率下降的文献。此外，还探讨了肠道-肺-脑轴在这些结果的发病机制中的潜在作用。我们对现有文献进行了全面回顾，重点研究了 CAP 住院患者的认知障碍、痴呆和死亡率。通过对医学数据库进行系统检索，确定了相关研究，并提取了有关研究设计、人群特征、认知评估和结果的数据。综述还纳入了对肠道-肺-脑轴的机理认识，以假设其在 CAP 长期后遗症中的作用。综述发现多项研究表明，CAP 住院后认知功能障碍和痴呆症的风险增加。与对照组相比，因 CAP 住院的患者出现认知障碍的风险要高出 1.5 到 2.5 倍。这种认知能力的下降并不局限于老年患者，而是跨越了所有成年年龄组。此外，CAP 还与预期寿命的显著缩短有关。CAP住院后出院的患者在三年内的死亡率达到50%，而因其他原因住院的患者在七年内的死亡率为50%。需要入住重症监护室的 CAP 患者和免疫力低下的患者的存活率下降最为明显。CAP 与严重的长期认知障碍和生存率下降有关。所提出的肠道-肺-脑轴机制表明，与 CAP 相关的菌群失调会导致慢性全身性炎症和神经炎症，从而可能导致认知能力下降和死亡率升高。了解这一轴心的作用可为控制 CAP 的长期神经后果提供新的治疗策略。未来的研究应重点关注高危人群，以制定有针对性的干预措施，减轻这些严重后果。
{"title":"Cognitive Impairment and Mortality after Hospitalization for Community-Acquired Pneumonia","authors":"Julio A. Ramirez, S. Furmanek, T. Chandler, W. Mattingly, Anupama Raghuram, Ashley M. Wilde, Smita S Ghare, Paula M. Chilton, Shirish S Barve","doi":"10.59541/001c.118874","DOIUrl":"https://doi.org/10.59541/001c.118874","url":null,"abstract":"Community-acquired pneumonia (CAP) affects approximately 1.5 million patients annually in the United States, leading to significant acute and long-term clinical outcomes. CAP is increasingly recognized as a multisystemic disease with potential sequelae affecting various organ systems, including the neurologic, pulmonary, cardiovascular, musculoskeletal, metabolic, and renal systems. The primary objective of this study is to review literature on long-term cognitive impairment, dementia, and decreased survival following CAP hospitalization. Additionally, the potential role of the gut-lung-brain axis in the pathogenesis of these outcomes is explored. A comprehensive review of existing literature was conducted, focusing on studies that examined cognitive impairment, dementia, and mortality in patients hospitalized for CAP. Relevant studies were identified through a systematic search of medical databases, and data were extracted on study design, population characteristics, cognitive assessments, and outcomes. The review also incorporated mechanistic insights into the gut-lung-brain axis to hypothesize its role in the long-term sequelae of CAP. The review identified multiple studies demonstrating an increased risk of cognitive impairment and dementia following CAP hospitalization. Patients hospitalized for CAP had a 1.5 to 2.5 times higher risk of developing cognitive deficits compared to controls. This cognitive decline was not limited to elderly patients but spanned all adult age groups. Furthermore, CAP was associated with a significant reduction in life expectancy. Patients discharged after CAP hospitalization reached 50% mortality within three years, compared to seven years for those hospitalized for other reasons. The most pronounced decrease in survival was observed in CAP patients requiring ICU admission and immunocompromised patients. CAP is associated with significant long-term cognitive impairment and decreased survival. The proposed gut-lung-brain axis mechanism suggests that CAP-related dysbiosis leads to chronic systemic inflammation and neuroinflammation, potentially contributing to cognitive decline and increased mortality. Understanding the role of this axis may offer new therapeutic strategies for managing the long-term neurological consequences of CAP. Future research should focus on high-risk populations to develop targeted interventions aimed at mitigating these severe outcomes.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"24 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Pneumonia Severity Index (PSI) and CURB-65 scores are well-defined as tools to predict short-term mortality in patients with community-acquired pneumonia (CAP). The role of these scores in predicting long-term mortality is not well defined. The objective of this study was to evaluate the role of PSI and CURB-65 as predictors of long term mortality in patients discharged alive after an episode of CAP. This was a secondary analysis of the University of Louisville Pneumonia Study (ULPS) database. The PSI and CURB-65 were calculated at the time of hospital admission. For patients discharged alive, mortality was evaluated one-year after hospital discharged. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic performance of the PSI and CURB-65 in predicting long-term mortality. From a total study population of 6,870 patients, 1,744 (25%) patients died within one-year post discharge, and 5,126 (75%) patients were alive one-year post-discharge. Areas under the curve (AUC) for PSI was 0.72 and for CURB-65 was 0.66. Even though the PSI is more accurate than CURB-65, both scores are weak predictors of long-term mortality in hospitalized patients with CAP. Future research studies are necessary to improve the prediction of long-term mortality in hospitalized patients with CAP.
{"title":"Pneumonia Severity Index And CURB-65 Scores Are Poor Predictors For Long-Term Mortality In Hospitalized Patients With Community-Acquired Pneumonia","authors":"T. Chandler, S. Furmanek, Julio Ramirez","doi":"10.59541/001c.115517","DOIUrl":"https://doi.org/10.59541/001c.115517","url":null,"abstract":"The Pneumonia Severity Index (PSI) and CURB-65 scores are well-defined as tools to predict short-term mortality in patients with community-acquired pneumonia (CAP). The role of these scores in predicting long-term mortality is not well defined. The objective of this study was to evaluate the role of PSI and CURB-65 as predictors of long term mortality in patients discharged alive after an episode of CAP. This was a secondary analysis of the University of Louisville Pneumonia Study (ULPS) database. The PSI and CURB-65 were calculated at the time of hospital admission. For patients discharged alive, mortality was evaluated one-year after hospital discharged. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic performance of the PSI and CURB-65 in predicting long-term mortality. From a total study population of 6,870 patients, 1,744 (25%) patients died within one-year post discharge, and 5,126 (75%) patients were alive one-year post-discharge. Areas under the curve (AUC) for PSI was 0.72 and for CURB-65 was 0.66. Even though the PSI is more accurate than CURB-65, both scores are weak predictors of long-term mortality in hospitalized patients with CAP. Future research studies are necessary to improve the prediction of long-term mortality in hospitalized patients with CAP.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140387797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Community-acquired pneumonia (CAP) has increased recognition for long-term mortality after acute infection. In this study, we reviewed our prior work with the objective to define the incidence in long-term mortality in special populations of patients hospitalized with CAP. This study was a secondary analysis of two study databases for patients hospitalized in Louisville, KY. Long-term mortality was defined as all-cause mortality within one year of hospitalization, and was evaluated for the following groups: adults hospitalized without CAP, adults hospitalized with CAP, adults hospitalized with CAP for special populations. Long term mortality was also evaluated at the census tract level and geospatial epidemiology was performed to identify areas of risk within Louisville. Long-term mortality for adults hospitalized without CAP was 19.5%. For adults hospitalized with CAP, long-term mortality was 29.8% to 31.7%, depending on study database. For special populations, patients with CAP needing ICU care, patients with CAP experiencing cardiovascular events during hospitalization, and immunocompromised patients with CAP had the highest long term mortality, at 46.6%, 48.6%, and 53.6%, respectively. Geospatial epidemiology found no areas at increased risk for long term mortality. Patients hospitalized with CAP have higher long-term mortality than patients hospitalized due to other reasons. Long-term mortality concentrates in special populations of hospitalized patients with CAP. These populations should take priority in future research studies evaluating pathogenesis and prevention strategies.
社区获得性肺炎（CAP）在急性感染后的长期死亡率越来越高。在本研究中，我们回顾了之前的工作，目的是确定 CAP 住院患者中特殊人群的长期死亡率。本研究对肯塔基州路易斯维尔市住院患者的两个研究数据库进行了二次分析。长期死亡率的定义是住院一年内的全因死亡率，评估对象包括以下几组：未患 CAP 而住院的成人、患 CAP 而住院的成人、特殊人群患 CAP 而住院的成人。还对人口普查区的长期死亡率进行了评估，并通过地理空间流行病学来确定路易斯维尔市内的风险区域。未患 CAP 而住院治疗的成人的长期死亡率为 19.5%。对于患有 CAP 的住院成人，根据研究数据库的不同，长期死亡率为 29.8% 至 31.7%。就特殊人群而言，需要重症监护室护理的 CAP 患者、住院期间发生心血管事件的 CAP 患者以及免疫力低下的 CAP 患者的长期死亡率最高，分别为 46.6%、48.6% 和 53.6%。地理空间流行病学没有发现长期死亡率风险增加的地区。与因其他原因住院的患者相比，CAP 住院患者的长期死亡率更高。长期死亡率主要集中在 CAP 住院患者中的特殊人群。在未来评估发病机制和预防策略的研究中，应优先考虑这些人群。
{"title":"Long Term Mortality in Community-Acquired Pneumonia: Incidence In Special Populations","authors":"S. Furmanek, T. Chandler, Julio Ramirez","doi":"10.59541/001c.115498","DOIUrl":"https://doi.org/10.59541/001c.115498","url":null,"abstract":"Community-acquired pneumonia (CAP) has increased recognition for long-term mortality after acute infection. In this study, we reviewed our prior work with the objective to define the incidence in long-term mortality in special populations of patients hospitalized with CAP. This study was a secondary analysis of two study databases for patients hospitalized in Louisville, KY. Long-term mortality was defined as all-cause mortality within one year of hospitalization, and was evaluated for the following groups: adults hospitalized without CAP, adults hospitalized with CAP, adults hospitalized with CAP for special populations. Long term mortality was also evaluated at the census tract level and geospatial epidemiology was performed to identify areas of risk within Louisville. Long-term mortality for adults hospitalized without CAP was 19.5%. For adults hospitalized with CAP, long-term mortality was 29.8% to 31.7%, depending on study database. For special populations, patients with CAP needing ICU care, patients with CAP experiencing cardiovascular events during hospitalization, and immunocompromised patients with CAP had the highest long term mortality, at 46.6%, 48.6%, and 53.6%, respectively. Geospatial epidemiology found no areas at increased risk for long term mortality. Patients hospitalized with CAP have higher long-term mortality than patients hospitalized due to other reasons. Long-term mortality concentrates in special populations of hospitalized patients with CAP. These populations should take priority in future research studies evaluating pathogenesis and prevention strategies.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140387009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elena A. Swingler, Wes M. Johnson, Sarah E. Moore, Matthew Song, Jamison Montes de Oca, Clover N. Truong, Ashley M. Wilde, Julio A. Ramirez
Intravenous (IV) to oral (PO) transition of antimicrobial therapy is a common antimicrobial stewardship activity. Inpatient institutions seeking to create new IV to PO switch services or enhance existing services may benefit from a review of practices utilized at other institutions. The objective of this review is to summarize IV to PO switch practices utilized by healthcare institutions with established antimicrobial stewardship programs across Kentucky. The Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) invited pharmacists on the Advisory Board to share current IV to PO switch practices utilized at their institutions. The submitted documents were evaluated in a systematic approach and summarized. Nine of ten institutions represented by the Advisory Board submitted an IV to PO switch practice document for analysis. All institutions utilized pharmacist-driven protocols to allow automatic conversion from IV to PO for select antimicrobials based on specific patient criteria. All protocols included the following antimicrobials eligible for conversion: azithromycin, doxycycline, fluconazole, levofloxacin, linezolid, and metronidazole. Majority of protocols also had inclusion and exclusion criteria based on patient specific factors such as ability to use the enteral route, clinical stability, and infection type. There was variation in the level of restriction placed on conversion eligibility criteria among protocols. IV to PO switch practices for antimicrobials vary across the state of Kentucky. Institutions should tailor protocols based on specific needs, clinical leadership support, and feasibility of implementation.
抗菌药物治疗从静脉注射（IV）到口服（PO）的转换是一项常见的抗菌药物管理活动。住院机构若想创建从静脉注射到口服药物的新转换服务或加强现有服务，可参考其他机构的做法。本次审查的目的是总结肯塔基州已建立抗菌药物管理计划的医疗机构将静脉注射转为 PO 治疗的做法。肯塔基州抗菌药物管理创新联合会（KASIC）邀请顾问委员会的药剂师分享其所在机构目前采用的从静脉注射到 PO 转换的做法。我们对提交的文件进行了系统的评估和总结。顾问委员会所代表的 10 家机构中有 9 家提交了从静脉注射到 PO 的转换实践文件以供分析。所有机构都采用了药剂师驱动的方案，允许根据特定患者标准将特定抗菌药物从静脉注射自动转换为 PO。所有方案都包括以下符合转换条件的抗菌药物：阿奇霉素、强力霉素、氟康唑、左氧氟沙星、利奈唑胺和甲硝唑。大多数方案还根据患者的具体因素（如使用肠道途径的能力、临床稳定性和感染类型）制定了纳入和排除标准。不同方案对转换资格标准的限制程度存在差异。肯塔基州各地将抗菌药物从静脉注射转为口服的做法各不相同。医疗机构应根据具体需求、临床领导的支持和实施的可行性来定制协议。
{"title":"Antimicrobial IV to PO switch practices at 9 institutions in Kentucky with Established Antimicrobial Stewardship Programs","authors":"Elena A. Swingler, Wes M. Johnson, Sarah E. Moore, Matthew Song, Jamison Montes de Oca, Clover N. Truong, Ashley M. Wilde, Julio A. Ramirez","doi":"10.59541/001c.89676","DOIUrl":"https://doi.org/10.59541/001c.89676","url":null,"abstract":"Intravenous (IV) to oral (PO) transition of antimicrobial therapy is a common antimicrobial stewardship activity. Inpatient institutions seeking to create new IV to PO switch services or enhance existing services may benefit from a review of practices utilized at other institutions. The objective of this review is to summarize IV to PO switch practices utilized by healthcare institutions with established antimicrobial stewardship programs across Kentucky. The Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) invited pharmacists on the Advisory Board to share current IV to PO switch practices utilized at their institutions. The submitted documents were evaluated in a systematic approach and summarized. Nine of ten institutions represented by the Advisory Board submitted an IV to PO switch practice document for analysis. All institutions utilized pharmacist-driven protocols to allow automatic conversion from IV to PO for select antimicrobials based on specific patient criteria. All protocols included the following antimicrobials eligible for conversion: azithromycin, doxycycline, fluconazole, levofloxacin, linezolid, and metronidazole. Majority of protocols also had inclusion and exclusion criteria based on patient specific factors such as ability to use the enteral route, clinical stability, and infection type. There was variation in the level of restriction placed on conversion eligibility criteria among protocols. IV to PO switch practices for antimicrobials vary across the state of Kentucky. Institutions should tailor protocols based on specific needs, clinical leadership support, and feasibility of implementation.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139308674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valenchia Brown, Salwa Rashid, Thomas Chandler, Stephen Furmanek, Delanor Manson, Ruth Carrico
The COVID-19 pandemic has underscored the pivotal role of vaccination in preventing severe illness, hospitalization, and fatalities resulting from SARS-CoV-2 infection. This virus has disproportionately impacted minority communities, revealing a stark disparity in vaccination rates. The pandemic has worsened existing disparities in the United States concerning race, social status, and economic conditions, resulting in a greater risk of exposure to the SARS-CoV-2 virus, limited access to protective resources, and disparities in illness and increased death rates among individuals living in low-income neighborhoods, indigenous populations, and communities with predominantly non-white populations. Vaccine hesitancy stemming from mistrust of vaccine safety information and skepticism regarding traditional vaccination procedures has further exacerbated lower vaccination rates and higher COVID-19 hospitalization rates among non-white populations. This paper explores the transition from mass immunization to mobile vaccination clinics in Louisville, Kentucky, with a particular focus on the community-based versus community-placed approach. It outlines the training program and challenges encountered in the implementation of this crucial strategy during a dynamic pandemic landscape.
{"title":"Enhancing Equitable Access to COVID-19 Vaccination through the Implementation of Mobile Vaccination Clinics: A Community-Based Approach in Louisville, Kentucky","authors":"Valenchia Brown, Salwa Rashid, Thomas Chandler, Stephen Furmanek, Delanor Manson, Ruth Carrico","doi":"10.59541/001c.89010","DOIUrl":"https://doi.org/10.59541/001c.89010","url":null,"abstract":"The COVID-19 pandemic has underscored the pivotal role of vaccination in preventing severe illness, hospitalization, and fatalities resulting from SARS-CoV-2 infection. This virus has disproportionately impacted minority communities, revealing a stark disparity in vaccination rates. The pandemic has worsened existing disparities in the United States concerning race, social status, and economic conditions, resulting in a greater risk of exposure to the SARS-CoV-2 virus, limited access to protective resources, and disparities in illness and increased death rates among individuals living in low-income neighborhoods, indigenous populations, and communities with predominantly non-white populations. Vaccine hesitancy stemming from mistrust of vaccine safety information and skepticism regarding traditional vaccination procedures has further exacerbated lower vaccination rates and higher COVID-19 hospitalization rates among non-white populations. This paper explores the transition from mass immunization to mobile vaccination clinics in Louisville, Kentucky, with a particular focus on the community-based versus community-placed approach. It outlines the training program and challenges encountered in the implementation of this crucial strategy during a dynamic pandemic landscape.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"174 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135931967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Bonavire, J. Dharod, D. Nunnery, Virginia S. Williams, L. Sastre
Individuals within rural Nicaragua have demonstrated elevated risk for hypertension (HTN); however, research examining socio-economic and dietary risk factors is limited. Therefore, the objective of this study was to examine the relationship between food security, dietary patterns, and HTN risk in rural Nicaragua. This cross-sectional study included adult participants recruited from volunteer-led health clinics in the mountainous region of the Central Highlands in the state of Matagalpa, Nicaragua, in March 2018. Data collection included an oral survey focusing on household socio-demographics, food security, dietary patterns, and anthropometric and blood pressure measurements. A total of 123 men and women aged 18 years and up participated in the study (85% of whom were female). Participants were 32.2(± 15.7) years old on average. Food insecurity risk was high, with 78.4% of households identified as severely food insecure. The most commonly consumed daily foods included beans (88%), corn tortillas (84%), and rice (80%). The mean BMI was 26.2 kg/m2 (± 3.9), with 45 percent of participants were identified as overweight and 17.4% as obese. Sixty-three percent exhibited elevated blood pressure, and independent t-test results demonstrated food insecurity was marginally associated with blood pressure (p=0.077) and geographic location (p= 0.060) but not weight status (p=0.97). No significant associations were identified via regression analysis Participants from rural Nicaragua reported a lack of dietary variety which contrasts dietary patterns recommended for optimal blood pressure control and a lack of healthful food access as demonstrated by elevated food insecurity and related HTN. This study highlights the link between nutrition, socio-economic risks, and health disparities, as well as the need to for future research around healthful food access and hypertension.
{"title":"Food Insecurity, Diet Quality, and Hypertension Risk in Rural Nicaragua","authors":"K. Bonavire, J. Dharod, D. Nunnery, Virginia S. Williams, L. Sastre","doi":"10.59541/001c.84102","DOIUrl":"https://doi.org/10.59541/001c.84102","url":null,"abstract":"Individuals within rural Nicaragua have demonstrated elevated risk for hypertension (HTN); however, research examining socio-economic and dietary risk factors is limited. Therefore, the objective of this study was to examine the relationship between food security, dietary patterns, and HTN risk in rural Nicaragua. This cross-sectional study included adult participants recruited from volunteer-led health clinics in the mountainous region of the Central Highlands in the state of Matagalpa, Nicaragua, in March 2018. Data collection included an oral survey focusing on household socio-demographics, food security, dietary patterns, and anthropometric and blood pressure measurements. A total of 123 men and women aged 18 years and up participated in the study (85% of whom were female). Participants were 32.2(± 15.7) years old on average. Food insecurity risk was high, with 78.4% of households identified as severely food insecure. The most commonly consumed daily foods included beans (88%), corn tortillas (84%), and rice (80%). The mean BMI was 26.2 kg/m2 (± 3.9), with 45 percent of participants were identified as overweight and 17.4% as obese. Sixty-three percent exhibited elevated blood pressure, and independent t-test results demonstrated food insecurity was marginally associated with blood pressure (p=0.077) and geographic location (p= 0.060) but not weight status (p=0.97). No significant associations were identified via regression analysis Participants from rural Nicaragua reported a lack of dietary variety which contrasts dietary patterns recommended for optimal blood pressure control and a lack of healthful food access as demonstrated by elevated food insecurity and related HTN. This study highlights the link between nutrition, socio-economic risks, and health disparities, as well as the need to for future research around healthful food access and hypertension.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128890044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After the introduction of successful antiretroviral therapy (ART) HIV has become a chronic infection with significantly increased survival. However, even HIV-infected patients who are considered “optimally treated” have a high prevalence of non-AIDS defining illnesses (cardiovascular, respiratory, neurologic, metabolic, renal, and liver disease) along with different types of solid and hematologic malignancies which led to the concept of “Accelerated aging” due to persistent inflammation and immune-activation “Inflammaging”. This review emphasizes the importance of the dysfunctional GI mucosa on the genesis of systemic inflammation and provides insights about possible future clinical trials to reach a functional cure along with ART. Microbial translocation, the Th17 and MAIT cells, the “Warburg-like” immunophenotype switch of immune cells, the indoleamine 2,3-dioxygenase (IDO-1) activity, the alteration of the microbiome (Dysbiosis), and the central role of Short Chain Fatty Acids (SCFAs) are all important parts of this model of inflammaging. Future studies focused on the tight junction alterations at the GI mucosa level will be essential to develop strategies in order to reach a functional cure.
{"title":"HIV and Aging: HIV seen as a Chronic Inflammatory Intestinal Disease.","authors":"M. Gnoni","doi":"10.59541/001c.84063","DOIUrl":"https://doi.org/10.59541/001c.84063","url":null,"abstract":"After the introduction of successful antiretroviral therapy (ART) HIV has become a chronic infection with significantly increased survival. However, even HIV-infected patients who are considered “optimally treated” have a high prevalence of non-AIDS defining illnesses (cardiovascular, respiratory, neurologic, metabolic, renal, and liver disease) along with different types of solid and hematologic malignancies which led to the concept of “Accelerated aging” due to persistent inflammation and immune-activation “Inflammaging”. This review emphasizes the importance of the dysfunctional GI mucosa on the genesis of systemic inflammation and provides insights about possible future clinical trials to reach a functional cure along with ART. Microbial translocation, the Th17 and MAIT cells, the “Warburg-like” immunophenotype switch of immune cells, the indoleamine 2,3-dioxygenase (IDO-1) activity, the alteration of the microbiome (Dysbiosis), and the central role of Short Chain Fatty Acids (SCFAs) are all important parts of this model of inflammaging. Future studies focused on the tight junction alterations at the GI mucosa level will be essential to develop strategies in order to reach a functional cure.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132753610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Song, Ashley M. Wilde, Chelsea M. Song, Sarah E. Moore, Elena A. Swingler, Wes M Johnson, Jamison E. Montes de Oca, Clover N Truong, R. Carrico, S. Furmanek, Madeline Shipley, T. Chandler, Paul S. Schulz, Julio A Ramirez
Antimicrobial resistance is a significant threat to modern healthcare and is driven by antimicrobial overuse. Hospital antimicrobial use in Kentucky exceeds national rates and long-term care facility antimicrobial stewardship implementation is low. Partnering with the Kentucky Department for Public Health, the Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) was created to facilitate antimicrobial stewardship across the Commonwealth of Kentucky. This manuscript describes KASIC objectives, defines the KASIC target audience, and describes KASIC methods
{"title":"Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC): A Program to Improve Antibiotic Use in the Commonwealth","authors":"Matthew Song, Ashley M. Wilde, Chelsea M. Song, Sarah E. Moore, Elena A. Swingler, Wes M Johnson, Jamison E. Montes de Oca, Clover N Truong, R. Carrico, S. Furmanek, Madeline Shipley, T. Chandler, Paul S. Schulz, Julio A Ramirez","doi":"10.59541/001c.83286","DOIUrl":"https://doi.org/10.59541/001c.83286","url":null,"abstract":"Antimicrobial resistance is a significant threat to modern healthcare and is driven by antimicrobial overuse. Hospital antimicrobial use in Kentucky exceeds national rates and long-term care facility antimicrobial stewardship implementation is low. Partnering with the Kentucky Department for Public Health, the Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) was created to facilitate antimicrobial stewardship across the Commonwealth of Kentucky. This manuscript describes KASIC objectives, defines the KASIC target audience, and describes KASIC methods","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116529724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valenchia Brown, Madeline Shipley, Sarah Draud, Salwa Rashid, Dawn Balcom, W. Hayden, Delanor Manson, Mary Romelfanger, R. Carrico
Testing for COVID-19 is an essential component of pandemic response, but equitable access across the communities has been a challenge due to failure of federally-funded programs to reach areas of greatest need. A partnership between the Louisville Metro Department of Public Health and Wellness, the Kentucky Nurses Association, and community leaders helped enable and facilitate a novel, community-based approach. Using a core of trained nurses and a larger group of volunteers, a mobile testing clinic process was developed and implemented in Louisville, Kentucky. From November 11, 2020 through June 30, 2022, 187 mobile testing clinics were held at 26 unique sites with 9337 tests performed. Sites focused on areas of Louisville where poverty density is the greatest, where recognized outbreaks occurred, and where community partners requested testing access. Fourteen nurse team leaders and more than 750 volunteers supported these efforts which were largely funded by existing resources. Standard Operating Procedures were developed to enable standardized training and activities across all clinics. The result is a process that has continued and has formed the basis for mobile vaccination clinics using many of the same processes.
{"title":"Testing for COVID-19 Using a Mobile Clinic Approach: A Collaborative Approach Focused on Underserved and At-Risk Populations in Louisville Kentucky","authors":"Valenchia Brown, Madeline Shipley, Sarah Draud, Salwa Rashid, Dawn Balcom, W. Hayden, Delanor Manson, Mary Romelfanger, R. Carrico","doi":"10.59541/001c.82147","DOIUrl":"https://doi.org/10.59541/001c.82147","url":null,"abstract":"Testing for COVID-19 is an essential component of pandemic response, but equitable access across the communities has been a challenge due to failure of federally-funded programs to reach areas of greatest need. A partnership between the Louisville Metro Department of Public Health and Wellness, the Kentucky Nurses Association, and community leaders helped enable and facilitate a novel, community-based approach. Using a core of trained nurses and a larger group of volunteers, a mobile testing clinic process was developed and implemented in Louisville, Kentucky. From November 11, 2020 through June 30, 2022, 187 mobile testing clinics were held at 26 unique sites with 9337 tests performed. Sites focused on areas of Louisville where poverty density is the greatest, where recognized outbreaks occurred, and where community partners requested testing access. Fourteen nurse team leaders and more than 750 volunteers supported these efforts which were largely funded by existing resources. Standard Operating Procedures were developed to enable standardized training and activities across all clinics. The result is a process that has continued and has formed the basis for mobile vaccination clinics using many of the same processes.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129138998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah E. Moore, Elena A. Swingler, Wes M Johnson, J. Harting, Ashley Ross, Matthew Song, Adele Venable, Shaina Doyen, Sarah E. Cotner, Ashley M. Wilde
The southern United States, including the Commonwealth of Kentucky has higher rates of antimicrobial use relative to the rest of the country. Antimicrobial stewardship experts discuss the state of antimicrobial use and explore stewardship issues and opportunities based on their practice experiences.
{"title":"Challenges and Opportunities in Antimicrobial Stewardship in the American South: The Experience of the Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) Advisory Board","authors":"Sarah E. Moore, Elena A. Swingler, Wes M Johnson, J. Harting, Ashley Ross, Matthew Song, Adele Venable, Shaina Doyen, Sarah E. Cotner, Ashley M. Wilde","doi":"10.59541/001c.81034","DOIUrl":"https://doi.org/10.59541/001c.81034","url":null,"abstract":"The southern United States, including the Commonwealth of Kentucky has higher rates of antimicrobial use relative to the rest of the country. Antimicrobial stewardship experts discuss the state of antimicrobial use and explore stewardship issues and opportunities based on their practice experiences.","PeriodicalId":273029,"journal":{"name":"Norton Healthcare Medical Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114487919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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