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BACKGROUND: Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment. OBJECTIVES: This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. METHODS: Foreign-born Chinese women aged 18-45 years, with a gestational diabetes index pregnancy of 0.5-5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving. RESULTS: Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants were mainly recruited from social media (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time. DISCUSSION: We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants.

Asunto(s)

Asiático , COVID-19 , Emigrantes e Inmigrantes , Selección de Paciente , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Adulto Joven , Asiático/estadística & datos numéricos , Asiático/psicología , COVID-19/etnología , COVID-19/epidemiología , Diabetes Gestacional/etnología , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Pandemias , Cooperación del Paciente/estadística & datos numéricos , Cooperación del Paciente/etnología , Medios de Comunicación Sociales/estadística & datos numéricos , Estados Unidos/epidemiología

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We describe the case of a 13-year-old girl who presented with a new-onset seizure and fever and subsequently developed severe cardiac dysfunction, coronary artery dilation, and shock due to the surprising diagnosis of multisystem inflammatory syndrome in children (MIS-C). Although the clinical entity we now call MIS-C was first mentioned in the medical literature in April 2020, the full picture of this disease process is still evolving. Neurologic involvement has been described in cases with MIS-C; however, seizures are not a typical presenting symptom. Additionally, because children infected with SARS-CoV-2 are often asymptomatic, a documented preceding COVID-19 infection might not be available to raise suspicion of MIS-C early on. Febrile seizures, meningitis, and encephalitis are childhood illnesses that pediatricians are generally familiar with, but associating these clinical pictures with MIS-C is uncommon. Given the possibility of rapid clinical cardiogenic decline, as seen in our patient, a prompt diagnosis and appropriate monitoring and treatment are of utmost importance. This case report aims to raise awareness that new-onset seizures with fevers can be early or the first presenting symptoms in children with MIS-C, and further workup and close monitoring may be required.

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Chinese immigrants in the US are disproportionately affected by gestational diabetes mellitus (GDM) and type 2 diabetes (T2D). The aims of this study were to describe their physical activity (PA) and sedentary behaviors (SB) patterns and to identify determinates of objectively-measured PA and SB among Chinese immigrants in the US with prior GDM. We conducted a cross-sectional study among 106 Chinese immigrants with prior GDM across the US. PA and SB were measured by GT9X+ hip accelerometers for 7 consecutive days. Validated questionnaires in English and Chinese were used to assess knowledge and risk perceptions as well as cultural and psychosocial characteristics. Descriptive, bivariate, and multiple regression analyses were performed. Only 27% of participants met the PA guidelines. The median duration of moderate-vigorous-intensity PA (MVPA) per week was 79 (IQR 38-151) minutes. Participants had an average of 9.2 ± 1.4 h of sedentary time per day. Living with parents (who may provide family support) was associated with more MVPA minutes per week, more steps per day, and a greater likelihood of meeting PA guidelines. Higher levels of acculturative stress were associated with fewer MVPA minutes per week. Being employed and having a lower BMI were associated with more SB. Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing family support. Different strategies are needed to decrease SB among this population.

Asunto(s)

Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Emigrantes e Inmigrantes , Acelerometría , China/epidemiología , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Gestacional/epidemiología , Ejercicio Físico , Femenino , Humanos , Embarazo , Conducta Sedentaria

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Background: Hospitalizations for serious infections requiring long-term intravenous (IV) antimicrobials related to injection drug use have risen sharply over the last decade. At our rural tertiary care center, opportunities for treatment of underlying substance use disorders were often missed during these hospital admissions. Once medically stable, home IV antimicrobial therapy has not traditionally been offered to this patient population due to theoretical concerns about misuse of long-term IV catheters, leading to discharges with suboptimal treatment regimens, lengthy hospital stays, or care that is incongruent with patient goals and preferences. Methods: A multidisciplinary group of clinicians and patients set out to redesign and improve care for this patient population through a health care innovation process, with a focus on increasing the proportion of patients who may be discharged on home IV therapy. Baseline assessment of current experience was established through retrospective chart review and extensive stakeholder analysis. The innovation process was based in design thinking and facilitated by a health care delivery improvement incubator. Results: The components of the resulting intervention included early identification of hospitalized people who inject drugs with serious infections, a proactive psychiatry consultation service for addiction management for all patients, a multidisciplinary care conference to support decision making around treatment options for infection and substance use, and care coordination/navigation in the outpatient setting with a substance use peer recovery coach and infectious disease nurse for patients discharged on home IV antimicrobials. Patients discharged on home IV therapy followed routine outpatient parenteral antimicrobial therapy (OPAT) protocols and treatment protocols for addiction with their chosen provider. Conclusion: An intervention developed through a design-thinking-based health care redesign process improved patient-centered care for people with serious infections who inject drugs.

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OBJECTIVE: To examine the characteristics and effectiveness of lifestyle interventions for gestational diabetes mellitus (GDM) in pregnancy and the postpartum period to prevent Type 2 diabetes. DATA SOURCES: We conducted searches in seven databases, including Ovid MEDLINE, CINAHL, Ovid Embase, Cochrane Central, Web of Science, Ovid PsycInfo, and ProQuest Dissertations and Theses for articles published from inception to January 2021. STUDY SELECTION: We included articles on controlled intervention studies in which researchers evaluated a lifestyle intervention provided during pregnancy and the postpartum period for women with or at risk for GDM that were published in English. DATA EXTRACTION: Twelve articles that were reports of seven studies met the inclusion criteria. In some cases, more than one article was selected from the same study. For example, articles reported different outcomes from the same study. We extracted data with the use of a data collection form and compared and synthesized data on study design, purpose, sample, intervention characteristics, recruitment and retention, and outcomes. DATA SYNTHESIS: All seven studies focused on weight management and/or healthy lifestyle behaviors (diet and physical activity). Outcomes included glucose regulation, weight, lifestyle behaviors, and knowledge. The interventions varied in duration/dosage, strategies, and modes of delivery. In four studies, researchers reported interventions that had significant effects on improving glucose regulation and/or weight change. Some characteristics from the four effective interventions included goal setting, individualized care, and good retention rates. In the other three studies, limitations included low rates of participant retention, lack of personalized interventions, and limited population diversity or lack of culturally sensitive care. CONCLUSION: Lifestyle interventions provided during and after pregnancy to reduce the risk associated with GDM have the potential to improve outcomes. Health care counseling to promote healthy lifestyle behaviors related to the prevention of Type 2 diabetes is needed at different stages of maternity care for women with GDM. Additional high-quality studies are needed to address the limitations of current studies.

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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Servicios de Salud Materna , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Gestacional/prevención & control , Femenino , Humanos , Estilo de Vida , Periodo Posparto/fisiología , Embarazo

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Osteoporosis is a common metabolic disorder diagnosed by lower bone density and higher risk of fracture. Fragility fractures because of osteoporosis are associated with high mortality rate. Deep understanding of fracture healing in osteoporosis is important for successful treatment. Therefore, the FDA approved the use of small and large animal models for preclinical testing. This study investigated the clinical relevance of a fracture defect model in the iliac crest of the osteoporotic sheep model and its several advantages over other models. The osteoporosis was achieved using ovariectomy (OVX) in combination with diet deficiency (OVXD) and steroid administration (OVXDS). Fluorochrome was injected to examine the rate of bone remodelling and bone mineralization. The defect areas were collected and embedded in paraffin and polymethyl metha acrylate (PMMA) for histological staining. OVXDS showed significantly lower bone mineral density (BMD) and bone mineral content (BMC) at all time points. Furthermore, variations in healing patterns were noticed, while the control, OVX and OVXD showed complete healing after 8 months. Bone quality was affected mostly in the OVXDS group showing irregular trabecular network, lower cortical bone thickness and higher cartilaginous tissue at 8 months. The mineral deposition rate showed a declining pattern in the control, OVX, and OVXD from 5 months to 8 months. One the contrary, the OVXDS group showed an incremental pattern from 5 months to 8 months. The defect zone in osteoporotic animals showed impaired healing and the control showed complete healing after 8 months. This unique established model serves as a dual-purpose model and has several advantages: no intraoperative and postoperative complications, no need for fixation methods for biomaterial testing, and reduction in animal numbers, which comply with 3R principles by using the same animal at two different time points.

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INTRODUCTION: Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter-rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario. METHODS: A pilot study using a nonprobability convenience sample was used to evaluate the MCAI. Content validity indices were calculated for the individual items and the overall instrument using data from a panel of expert reviewers. Fourteen student midwives consented to be video recorded while participating in a simulated shoulder dystocia scenario. Three faculty raters used the MCAI to evaluate the student performance. These quantitative data were used to determine the inter-rater reliability of the MCAI. RESULTS: The intraclass correlation coefficient (ICC) was used to assess the inter-rater reliability of MCAI scores between 2 or more raters. The ICC was 0.86 (95% confidence interval, 0.60-0.96). Fleiss's kappa was calculated to determine the inter-rater reliability for individual items. Twenty-three of the 42 items corresponded to excellent strength of agreement. DISCUSSION: This study demonstrates a method to determine the inter-rater reliability of a competence assessment instrument to be used with student midwives. Data produced by this study were used to revise and improve the instrument. Additional research will further document the inter-rater reliability and can be used to determine changes in student competence. Valid and reliable methods of assessment will encourage the use of simulation to efficiently develop the competence of student midwives.

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Competencia Clínica , Distocia , Evaluación Educacional/normas , Partería/educación , Enfermeras Obstetrices/educación , Hombro , Entrenamiento Simulado/métodos , Educación en Enfermería/métodos , Evaluación Educacional/métodos , Femenino , Humanos , Recién Nacido , Variaciones Dependientes del Observador , Proyectos Piloto , Embarazo , Reproducibilidad de los Resultados , Grabación en Video

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OBJECTIVE: This study examined whether particular maternal and infant factors can identify mothers at risk for increased stress upon admission to the neonatal intensive care unit (NICU). METHODS: Eighty-five mothers of preterm infants (25-34 weeks gestation) were assessed using the Parental Stressor Scale (PSS:NICU) and the Edinburgh Postnatal Depression Scale (EPDS) within 3.24 ± 1.58 d postpartum. Hierarchical linear regression models were used to determine the extent to which maternal stress is influenced by individual factors. RESULTS: Fifty-two percent of mothers experienced increased stress (PSS:NICU score ≥3) and 38% had significant depressive symptoms (EPDS score ≥10). Stress related to alterations in parental role was the most significant source of stress among NICU mothers. Distance from the hospital and married marital status were significant predictors for stress related to alterations in parental role (p = 0.003) and NICU sights and sounds (p = 0.01), respectively. Higher stress levels were associated with higher depressive scores (p = 0.001). Maternal mental health factors, demographic factors, pregnancy factors and infant characteristics were not associated with increased stress. CONCLUSION: Elevated stress levels and depressive symptoms are already present in mothers of preterm infants upon NICU admission. Being married or living long distance from the hospital is associated with higher stress. Future work is needed to develop effective interventions for alleviating stress in NICU mothers and preventing its potential development into postnatal depression.

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Depresión/epidemiología , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Madres/psicología , Estrés Psicológico/epidemiología , Adulto , Depresión/diagnóstico , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Depresión Posparto/prevención & control , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro/psicología , Madres/estadística & datos numéricos , Periodo Posparto/psicología , Embarazo , Pronóstico , Factores de Riesgo , Apoyo Social , Factores Socioeconómicos , Estrés Psicológico/diagnóstico , Adulto Joven

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Preterm infants in the neonatal intensive care unit (NICU) often close their eyes in response to bright lights, but they cannot close their ears in response to loud sounds. The sudden transition from the womb to the overly noisy world of the NICU increases the vulnerability of these high-risk newborns. There is a growing concern that the excess noise typically experienced by NICU infants disrupts their growth and development, putting them at risk for hearing, language, and cognitive disabilities. Preterm neonates are especially sensitive to noise because their auditory system is at a critical period of neurodevelopment, and they are no longer shielded by maternal tissue. This paper discusses the developmental milestones of the auditory system and suggests ways to enhance the quality control and type of sounds delivered to NICU infants. We argue that positive auditory experience is essential for early brain maturation and may be a contributing factor for healthy neurodevelopment. Further research is needed to optimize the hospital environment for preterm newborns and to increase their potential to develop into healthy children.

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Corteza Auditiva/crecimiento & desarrollo , Ruido/efectos adversos , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Relaciones Madre-Hijo , Música , Embarazo

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Energy drink consumption has been anecdotally linked to the development of adverse cardiovascular effects in consumers, although clinical trials to support this link are lacking. The effects of Red Bull energy drink on cardiovascular and neurologic functions were examined in college-aged students enrolled at Winona State University. In a double-blind experiment where normal calorie and low calorie Red Bull were compared to normal and low calorie placebos, no changes in overall cardiovascular function nor blood glucose (mg/dL) were recorded in any participant (n = 68) throughout a 2-h test period. However, in the second experiment, nine male and twelve female participants subjected to a cold pressor test (CPT) before and after Red Bull consumption showed a significant increase in blood sugar levels pre- and post Red Bull consumption. There was a significant increase in diastolic blood pressure of the male volunteers immediately after submersion of the hand in the 5 degrees C water for the CPT. Under the influence of Red Bull, the increase in diastolic pressure for the male participants during the CPT was negated. There were no significant changes in the blood pressure of the female participants for the CPT with or without Red Bull. Finally, the CPT was used to evaluate pain threshold and pain tolerance before and after Red Bull consumption. Red Bull consumption was associated with a significant increase in pain tolerance in all participants. These findings suggest that Red Bull consumption ameliorates changes in blood pressure during stressful experiences and increases the participants' pain tolerance.

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Bebidas/efectos adversos , Fenómenos Fisiológicos Cardiovasculares , Estimulantes del Sistema Nervioso Central , Suplementos Dietéticos/efectos adversos , Suplementos Dietéticos/toxicidad , Riñón/fisiología , Adaptación Fisiológica , Adolescente , Adulto , Glucemia/análisis , Presión Sanguínea , Cafeína/efectos adversos , Cafeína/análisis , Cafeína/metabolismo , Frío/efectos adversos , Carbohidratos de la Dieta/administración & dosificación , Carbohidratos de la Dieta/efectos adversos , Carbohidratos de la Dieta/metabolismo , Método Doble Ciego , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Dimensión del Dolor , Umbral del Dolor , Saliva/química , Caracteres Sexuales , Estrés Fisiológico , Factores de Tiempo , Adulto Joven

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The United States spends more of its wealth on healthcare than any other developed country, and that share is rising. Supporters of the free market system point to the regulatory burden on the healthcare industry. Estimates of the regulatory costs of US healthcare range from dollars 58 billion to dollars 339 billion. A recent report indicates that approximately dollars 8 billion of the US healthcare budget of dollars 1.9 trillion is spent on physicians' extra income derived from their ownership in outpatient facilities, such as ambulatory surgery centers, diagnostic imaging centers, and diagnostic testing and procedure laboratories. It is essential for an interventionalist to understand fraud and abuse, self-referrals, and the implications of the Stark law and anti-kickback statutes, among a maze of other regulations. It is important for interventionalists to understand and also be able to invest in protected and approved investments and also be involved in business dealings which are within the law. Various reasons include: decreasing reimbursements by Medicare, Medicaid, managed care, and all other third-party payors; increased competition in providing interventional pain management; increasing costs of overhead and doing business; the popularity of interventional pain management, leading each and every pain physician to want to provide the service; concerns in multiple settings, including offices, ambulatory surgery centers (ASCs), hospitals, private practices, and academic settings; and finally, the failure to develop strategies to remove oneself from questionable investments and business associations. Self-referrals occur when physicians refer to medical facilities in which they have financial interest. Multiple concerns related to self-referral, including conflict of interest and increased costs to the Medicare program, resulted in a ban on self-referral arrangements for clinical laboratory services under the Medicare program in 1989 known as Stark I. In 1993, the Stark I prohibition on self-referrals by physicians expanded to include 10 additional healthcare services known as designated health services or DHS. The 1993 expansion of Stark I was enacted in 1995 as Stark II. In 2007, CMS adopted Phase III of the regulations interpreting Stark II. Phase III made multiple changes and clarified many previous issues, and it becomes effective December 4, 2007. While it is mandatory to obtain expert legal advice and this manuscript in no way provides the extensive navigation required through the maze of Stark laws and other anti-kickback statutes, it is incumbent on interventionalists in all settings of practice to have appropriate knowledge of the Stark laws and exceptions and of the anti-kickback statute and safe harbors. Penalties for violating the Stark laws are severe, including fines of up to dollars 15,000 per service and the economic threat of exclusion from participation in federal healthcare programs, which may result in exclusion of any type of healthcare program and loss of privileges at hospitals and surgery centers. This manuscript reviews physician practices in general, physician payments, and self-referral patterns in particular, the evolution of the Stark law and regulations and its implications for physician practices. This article is not, and should not be, construed as legal advice or an opinion on specific situations.

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Honorarios Médicos/legislación & jurisprudencia , Inversiones en Salud/legislación & jurisprudencia , Propiedad/legislación & jurisprudencia , Auto Remisión del Médico/legislación & jurisprudencia , Administración de la Práctica Médica/legislación & jurisprudencia , Servicios de Diagnóstico/economía , Servicios de Diagnóstico/estadística & datos numéricos , Honorarios Médicos/ética , Fraude/economía , Fraude/legislación & jurisprudencia , Regulación Gubernamental , Costos de la Atención en Salud , Humanos , Reembolso de Seguro de Salud , Inversiones en Salud/ética , Laboratorios/economía , Laboratorios/estadística & datos numéricos , Responsabilidad Legal/economía , Medicare/legislación & jurisprudencia , Propiedad/ética , Dolor/prevención & control , Auto Remisión del Médico/ética , Administración de la Práctica Médica/economía , Centros Quirúrgicos/economía , Centros Quirúrgicos/estadística & datos numéricos , Estados Unidos

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Physician practices that transmit any health information in electronic form in connection with a transaction covered by the HIPAA transactions and code sets rule will be required to comply with the rule no later than October 16, 2003. Under the rule, if certain transactions, such as the filing of claims, are conducted electronically, they must contain certain data content and be formatted in a particular way. On and after October 16, 2003, Medicare will require claims to be submitted electronically unless a physician practice has less than 10 full-time equivalent employees. Practices with fewer than 10 FTEs can continue to submit paper claims to Medicare without any further action on their part. At a minimum, physician practices must have the ability to capture the data required by the rule for covered transactions conducted electronically, and either use a clearinghouse to translate the data to X12N format or obtain a translator and electronic connectivity to ensure that the practice can send electronically compliant claims by October 16, 2003. Trading partner agreements may specify the duties and responsibilities of each party to the agreement in conducting a covered transaction electronically, but they are not required under HIPAA. Business associate agreements are required under HIPAA if a practice chooses to use a business associate (a person who performs an activity falling under the rule on behalf of the practice), including a health care clearinghouse, to conduct electronic covered transactions for it, and the agreement must comply with the HIPAA transactions and code sets rule, the privacy rule, and the security rule. This article is not, and should not be construed as, legal advice or an opinion on specific situations.

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On February 20, 2003, the Department of Health and Human Services (HHS), pursuant to its authority under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), issued the final rule on Security Standards for electronic protected health information (PHI). The rule addresses the duties of providers who conduct electronic transactions covered under the HIPAA transactions and code sets rule to address the security issues surrounding the storage and transmission of electronic PHI. Providers who are required to comply with the security rule must do so by April 20, 2005. While this may seem like a long time, the compliance requirements are lengthy and burdensome, so providers would be well advised to start compliance efforts now. Appointing a security officer and beginning a risk analysis should be the first priorities of any practice. While the security officer will be integral in a practice's compliance, it is ultimately the burden of the practice to ensure compliance with the rule. Penalties for non-compliance are stiff: civil money penalties of up to a $100 fine for every violation of each requirement or prohibition, capped at $25,000 per year for all violations of an identical requirement or prohibition. Criminal penalties must be imposed if a person knowingly and in violation of the security rule: obtains individually identifiable health information relating to an individual or discloses individually identifiable information to another person. This article is not, and should not be construed as, legal advice or an opinion on specific situations.

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Over the past several months, the Department of Health and Human Services (DHHS) has issued new final and proposed rules pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The privacy rule was finalized on August 14, 2002. Changes made to the original rule were in general beneficial to providers. Consent forms will no longer be required for treatment, although providers may choose to continue to use them. Physicians will still be required to use and disclose only the "minimum necessary" protected health information (PHI) to accomplish the purpose for which the information is being used or disclosed, but the new final rule excludes some situations in which the minimum necessary requirement will apply. A model business associates contract is provided in the final rule, making it easier for providers to comply with the rule's requirement that they have written business associate contracts with vendors who need access to the provider's PHI to perform tasks on behalf of providers. Researchers now only need to provide one form for consent and authorization, instead of two. There are also proposed changes in the transaction rule. Certain data elements that were required by the final rule are now situational in the proposed rule. Unnecessary data elements have been removed. Certain items, like special program indicator codes, will now be able to be reported via external code sets rather than as data elements in a transaction. The proposed rule also adopts requests from the industry by adding data elements, codes, or loops to enable covered entities to perform certain business functions in the standardized transactions, such as cross-referencing two subscriber IDs (e.g., surviving spouse and dependents). A final rule was published in May 2002 that created a standard employer identifier. The Employer Identifier Number (EIN) that is already in use by the IRS will be the standardized unique employer identifier number. A proposed rule to cease using the National Drug Codes in transactions for nonretail pharmacy transactions was published in May 2002. DHHS developed the proposal in response to widespread industry concern over the tremendous cost of implementing the National Drug Codes (NDC). The NDC will either not be replaced at all, or will be replaced by the HCPCS. This article is not, and should not be construed as, legal advice or an opinion on specific situations.