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The trace element selenium, which is found in selenoproteins, plays an antioxidant role in preventing muscle tissue injury. A positive association between selenium concentrations and hand grip strength has been reported in older adults; however, the evidence of this association is scarce in general adults. In this study, we aimed to evaluate the association between blood selenium concentrations and low hand grip strength using the data from the National Health and Nutrition Examination Survey 2011–2012 and 2013–2014 in the United States (US). Logistic regression was used to calculate the odds ratio (OR) of low hand grip strength, with blood selenium level adjusted for potential confounders. Among 8158 adults (women: 51.59%) with a mean age of 47 (range: 18–80) years, women and non-Hispanic Blacks tended to have low blood selenium concentrations. Notably, participants with high blood selenium concentrations (range, 178.1–192.5 µg/L) were more likely to have a low risk of low hand grip strength after adjusting for the potential covariates (OR: 0.60, 95% confidence interval (CI): 0.38–0.95) than those with low blood selenium concentrations. After excluding participants with chronic diseases, high blood selenium concentrations were found to be associated with a low risk of low hand grip strength (OR: 0.30, 95% CI: 0.14–0.65). A J-shaped relationship was found between selenium concentrations and low hand grip strength (P for nonlinear trend <0.0001). Subgroup analyses revealed a significantly consistent relationship among women, non-Hispanic Whites and others, and individuals with overweight or obesity (P < 0.05). Our study suggests that blood selenium concentrations are inversely associated with hand grip strength in general US adults. However, further prospective studies are required to confirm the causality between selenium concentrations and hand grip strength. [ABSTRACT FROM AUTHOR]

In the United States, home health agencies (HHAs) provide essential services for patients recovering from post-acute care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of US HHAs and compare results by urban/rural location. Cross-sectional study. Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. Similar to national data, most responding HHAs (n = 121, 12% response rate) were for-profit and located in the South. Most HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were affected less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared with urban HHAs. This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically affect agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine whether healthcare-associated infections (HAIs) and nurse staffing are associated using unit-level staffing data. BACKGROUND: Previous studies of the association between HAIs and nurse staffing are inconsistent and limited by methodological weaknesses. METHODS: Cross-sectional data between 2007 and 2012 from a large urban hospital system were analyzed. HAIs were diagnosed using the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. We used Cox proportional-hazards regression model to examine the association of nurse staffing (2 days before HAI onset) with HAIs after adjusting for individual risks. RESULTS: Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later. CONCLUSIONS: Understaffing is associated with increased risk of HAIs. [ABSTRACT FROM AUTHOR]

Purpose: Antihypertensive drugs are prescribed to patients with chronic kidney disease (CKD) for their cardioprotective and renoprotective effects. Nationally representative information on the use of antihypertensive drugs among CKD patients is limited. The purpose of this study was to assess the utilization patterns of antihypertensive drugs among the CKD population (stages I-IV) in the United States. Methods: We conducted a retrospective crosssectional analysis of the National Health and Nutrition Examination Survey (NHANES) panels from 2005-2006, 2007-2008, and 2009-2010. The estimated glomerular filtration rate was calculated and kidney damage was assessed to identify participants with CKD. The demographic and clinical characteristics of the participants with CKD were reported, as were the antihypertensive drugs they used. Findings: A total weighted sample of 116,231,361 participants representative of the CKD population in the United States (stages I-IV) was identified. Less than one half of the participants with CKD in the NHANES were using antihypertensive drugs. β- blockers were the most commonly used and angiotensin II receptor blockers were the least used antihypertensive agents among participants with CKD. Age (Z70 years), awareness of hypertension or diabetes, and higher stage of CKD were associated with an increased likelihood of antihypertensive drug use among participants with CKD. Implications: The results of our analyses suggest that antihypertensive drugs are underused in the CKD population, and the use of preferred agents (ie, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers) is low. Efforts should be directed toward emphasizing the importance of using antihypertensive drugs in the CKD population. [ABSTRACT FROM AUTHOR]

Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies. In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic. Cross-sectional study. Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019. Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies. 35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique. Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections are a significant reason for readmission to hospital post-discharge to the community. In this paper, the authors describe some of the key findings from a programme of work conducted in a home care agency (community care organisation) in the US. A survey was conducted to explore home care nurses' knowledge, attitudes and beliefs around infection control (n=415); 400 nurse-patient visits were observed, and 50 nurses were interviewed about their infection control practices. Nurses reported high compliance with infection control practices. However, the overall average adherence rate to observed hand hygiene practices was 45.6%. Interview data provided valuable insights into specific challenges faced by nurses in a home care setting. This study provides insights that can be used to enhance infection control practice in community care in the UK. [ABSTRACT FROM AUTHOR]

Background: Progression trajectories of patients with mild cognitive impairment (MCI) are currently not well understood.Objective: To classify patients with incident MCI into different latent classes of progression and identify predictors of progression class.Methods: Participants with incident MCI were identified from the US National Alzheimer's Coordinating Center Uniform Data Set (09/2005-02/2019). Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB), Functional Activities Questionnaire (FAQ), and Mini-Mental State Examination (MMSE) score longitudinal trajectories from MCI diagnosis were fitted using growth mixture models. Predictors of progression class were identified using multivariate multinomial logistic regression models; odds ratios (ORs) and 95% confidence intervals (CIs) were reported.Results: In total, 21%, 22%, and 57% of participants (N = 830) experienced fast, slow, and no progression on CDR-SB, respectively; for FAQ, these figures were 14%, 23%, and 64%, respectively. CDR-SB and FAQ class membership was concordant for most participants (77%). Older age (≥86 versus≤70 years, OR [95% CI] = 5.26 [1.78-15.54]), one copy of APOE ɛ4 (1.94 [1.08-3.47]), higher baseline CDR-SB (2.46 [1.56-3.88]), lower baseline MMSE (0.85 [0.75-0.97]), and higher baseline FAQ (1.13 [1.02-1.26]) scores were significant predictors of fast progression versus no progression based on CDR-SB (all p < 0.05). Predictors of FAQ class membership were largely similar.Conclusion: Approximately a third of participants experienced progression based on CDR-SB or FAQ during the  4-year follow-up period. CDR-SB and FAQ class assignment were concordant for the vast majority of participants. Identified predictors may help the selection of patients at higher risk of progression in future trials. [ABSTRACT FROM AUTHOR]