Search

OBJECTIVE To identify the factors associated with first Clostridium difficile infection (CDI) that predict fecal microbiota transplantation (FMT) for recurrent CDI DESIGN We carried out a retrospective single-center cohort study to compare the clinical characteristics of 200 patients who underwent FMT for recurrent CDI to 75 patients who did not. SETTING A single academic hospital in the United States PATIENTS Adult patients RESULTS The time from first to second CDI correlated to subsequent FMT use. Concomitant inflammatory bowel disease (IBD; P=.002), use of immunosuppressive therapy (P=.04), and use of metronidazole within 2 months before the first CDI (P=.02) correlated positively to subsequent FMT in univariate analysis. The use of oral vancomycin for first CDI was more common in those who required FMT than those who did not in univariate (P=.02) and multivariate (P=.03) analyses. In contrast, intravenous vancomycin use within 2 months before the first CDI reduced the risk for FMT in univariate P=.000003) and multivariate (P=.0001) analyses. Black patients with recurrent CDI were less likely to receive FMT than white patients (P=.00005). Patients who received FMT were also less likely to have comorbidities. CONCLUSIONS This study provides important insights into the factors predictive for FMT in patients with recurrent CDI and highlights the potential racial and medical characteristics that affect the access of the patients to FMT. Infect Control Hosp Epidemiol 2018;39:302-306.

Background: Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract-based socioeconomic determinants beyond the effect of individual factors., Objective: To evaluate whether census tract-based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual-level determinants., Methods: We analyzed 33 515 laboratory-confirmed influenza-associated hospitalizations that occurred during the 2009-2010 through 2013-2014 influenza seasons using a population-based surveillance system at 14 sites across the United States., Results: Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72-9.70) for those ≥65 vs 5-17 years old. African Americans had an AOR of 1.67 (95% CI 1.60-1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16-1.26) compared to non-Hispanics. Among census tract-based determinants, those living in a tract with ≥20% vs <5% of persons living below poverty had an AOR of 1.31 (95% CI 1.16-1.47), those living in a tract with ≥5% vs <5% of persons living in crowded conditions had an AOR of 1.17 (95% CI 1.11-1.23), and those living in a tract with ≥40% vs <5% female heads of household had an AOR of 1.32 (95% CI 1.25-1.40)., Conclusion: Census tract-based determinants account for 11% of the variability in influenza hospitalization., (© 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)

Objectives: To examine the health-related quality of life among workers in 22 standard occupation groups using data from the 2013-2014 US Behavioral Risk Factor Surveillance System., Methods: We examined the health-related quality of life measures of self-rated health, frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days by occupation group for 155 839 currently employed adults among 17 states. We performed multiple logistic regression analyses that accounted for the Behavioral Risk Factor Surveillance System's complex survey design to obtain prevalence estimates adjusted for potential confounders., Results: Among all occupation groups, the arts, design, entertainment, sports, and media occupation group reported the highest adjusted prevalence of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. The personal care and service occupation group had the highest adjusted prevalence for fair or poor self-rated health., Conclusions: Workers' jobs affect their health-related quality of life.

Aim: Patient perception measures are gaining increasing interest among scholars and practitioners. The aim of this study was to empirically examine a conceptual model of patient-centred care using patient perception survey data., Background: Patient-centred care is one of the Institute of Medicine's objectives for improving health care in the 21st century. Patient interviews conducted by the Picker Institute/Commonwealth Fund in the 1980s resulted in a theoretical model and survey questions with dimensions and attributes patients defined as patient-centered., Method: The present study used survey data from patients with overnight visits at 142 U.S. hospitals., Results: Regression analysis found significant support for the theoretical model. Perceptions of emotional support had the strongest relationship with overall care ratings. Coordination of care, and physical comfort were strongly related as well., Conclusion: Understanding how patients experience their care can help improve understanding of what patients believe is patient-centred, and of how care processes relate to important patient outcomes., (© 2012 John Wiley & Sons Ltd.)

Increasing incidence of thyroid cancer has been observed in some countries such as the United States, United Kingdom, France, and so on. Joinpoint regression was used to analyze the incidence of thyroid cancer in Shanghai, China, from 1983 to 2007. The results showed that there were 2 distinct slopes: in men, representing a significant annual percentage change (APC) of 2.6% from 1983 to 2000 (P < .001) followed by a sharp APC of 14.4% (P < .001), and in women, representing a significant APC of 4.9% from 1983 to 2003 (P < .001) followed by a sharp APC of 19.9% (P = .001). The sharp increase in thyroid cancer occurred 5 and 8 years after the iodine supplementation by salt, for men and women, respectively, suggesting that either the developed screening techniques or iodine supplementation might have contributed to the rapid increase in the incidence of thyroid cancer. The burden of thyroid cancer cases is expected to be substantial, based on predictions through 2020., (© 2012 APJPH.)

Background: Autism spectrum disorders (ASD) represent a common phenotype related to multiple etiologies, such as genetic, brain injury (e.g., prematurity), environmental (e.g., viral, toxic), multiple or unknown causes., Objectives: To devise a clinical classification of children diagnosed with ASD according to etiologic workup., Methods: Children diagnosed with ASD (n = 436) from two databases were divided into groups of symptomatic cryptogenic or idiopathic, and variables within each database and diagnostic category were compared., Results: By analyzing the two separate databases, 5.4% of the children were classified as symptomatic, 27% as cryptogenic and 67.75% as idiopathic. Among other findings, the entire symptomatic group demonstrated language delays, but almost none showed evidence for regression. Our results indicate similarities between the idiopathic and cryptogenic subgroups in most of the examined variables, and mutual differences from the symptomatic subgroup. The similarities between the first two subgroups support prior evidence that most perinatal factors and minor physical anomalies do not contribute to the development of core symptoms of autism., Conclusions: Differences in gender and clinical and diagnostic features were found when etiology was used to create subtypes of ASD. This classification could have heuristic importance in the search for an autism gene(s).

Objectives: To investigate frequency of and reasons for readmission to acute care (RTAC) during inpatient rehabilitation after traumatic spinal cord injury (SCI), and to identify factors associated with RTAC., Design: Prospective observational cohort., Setting: Inpatient rehabilitation., Participants: Individuals with SCI (N=1376) consecutively admitted for inpatient rehabilitation; 1032 randomly selected for model development; 344 selected for model cross-validation., Interventions: Not applicable., Main Outcome Measures: RTAC, RTAC reasons, rehabilitation length of stay (LOS), discharge location and FIM, rehospitalization between discharge and year 1, and 1-year outcomes: FIM, Craig Handicap Assessment and Reporting Technique, and Patient Health Questionnaire-9., Results: Participants (n=116; 11%) experienced RTAC with a total 143 episodes--96 patients experienced only 1 RTAC, while 14 had 2 RTACs, 5 had 3 RTACs, and 1 had 4 RTACs. The most common RTAC reasons were surgery (36%), infection (22%), noninfectious respiratory (14%), and gastrointestinal (8%). Mean days ± SD from rehabilitation admission to first RTAC was 27 ± 30 days. Seventy-four (7%) patients had at least 1 RTAC for medical reasons and 46 (4%) for surgical reasons. Regression analyses indicated several variables were associated with RTACs: greater admission medical severity, lower admission cognitive FIM, pressure ulcer acquired in acute care, and study site. Medical RTACs were associated with higher body mass index, lower admission cognitive and motor FIM, payer, and study site. Predictors of surgical RTAC were longer time from injury to rehabilitation admission and study site. After controlling for the other variables, the only outcome RTAC influenced was longer rehabilitation LOS., Conclusions: Approximately 11% of SCI patients experience RTAC during the course of rehabilitation for a variety of medical and surgical reasons. RTACs are associated with longer rehabilitation LOS., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The federal child-care subsidy program represents one of the government's largest investments in early care and education, but little is known about whether it increases low-income children's access to higher quality child care. This study used newly available nationally representative data on 4-year-old children (N = 750) to investigate whether subsidy receipt elevates child-care quality. Results indicate that subsidy recipients use higher quality care compared to nonrecipients who use no other publicly funded care, but lower quality care compared to nonrecipients who instead use Head Start or public pre-k. Findings suggest that subsidies may have the potential to enhance care quality but that parents who use subsidies are not accessing the highest quality care available to low-income families., (© 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.)

Electroconvulsive Therapy (ECT) practitioners and anti-ECT activists have divergent interpretations of both the treatment and its history. Despite claims by ECT opponents that practitioners do not acknowledge memory side effects, the published literature on the procedure demonstrates psychiatrists' awareness of this issue. And though current ECT practitioners claim that memory side effects were mostly the result of outmoded methods, investigators continue to publish studies that indicate ongoing memory problems. This article explores the conflict between pro- and anti-ECT groups around the issue of memory side effects in the broader context of changes in American psychiatry and society.

Objective: To assess the association between potential risk factors and subsequent clinically important abdominal aortic aneurysm events (repairs and ruptures) in women., Design: Large prospective observational cohort study with mean follow-up of 7.8 years., Setting: 40 clinical centres across the United States., Participants: 161 808 postmenopausal women aged 50-79 enrolled in the women's health initiative., Main Outcome Measures: Association of self reported or measured baseline variables with confirmed abdominal aortic aneurysm events assessed with multiple logistic regression., Results: Events occurred in 184 women and were strongly associated with age and smoking. Ever smoking, current smoking, and amount smoked all contributed independent risk. Diabetes showed a negative association (odds ratio 0.29, 95% confidence interval 0.13, 0.68), as did postmenopausal hormone therapy. Positive associations were also seen for height, hypertension, cholesterol lowering treatment, and coronary and peripheral artery disease., Conclusions: Our findings confirm the strong positive associations of clinically important abdominal aortic aneurysm with age and smoking in women and the negative association with diabetes previously reported in men.

The Personality Assessment Inventory's (PAI's) ability to predict psychopathic personality features, as assessed by the Psychopathy Checklist-Revised (PCL-R), was examined. To investigate whether the PAI Antisocial Features (ANT) Scale and subscales possessed incremental validity beyond other theoretically relevant PAI scales, optimized regression equations were derived in a sample of 281 Canadian federal offenders. ANT, or ANT-Antisocial Behavior (ANT-A), demonstrated unique variance in regression analyses predicting PCL-R total and Factor 2 (Lifestyle Impulsivity and Social Deviance) scores, but only the Dominance (DOM) Scale was retained in models predicting Factor 1 (Interpersonal and Affective Deficits). Attempts to cross-validate the regression equations derived from the first sample on a sample of 85 U.S. sex offenders resulted in considerable validity shrinkage, with the ANT Scale in isolation performing comparably to or better than the statistical models for PCL-R total and Factor 2 scores. Results offer limited evidence of convergent validity between the PAI and the PCL-R.

This research project investigated the extent to which nurses engage in two important kinds of ethical behaviours: ethical activism (where they try to make hospitals more receptive to nurses' participation in ethics deliberations) and ethical assertiveness (where they participate in ethics deliberations even when not formally invited). This research probed not only the extent to which nurses engage in these ethical behaviours but also whether this is influenced by professional, training and organizational factors. A random sample of 165 nurses from three major hospitals in Los Angeles provided the data. Regression analyses indicate that both ethical activism and ethical assertiveness are strongly influenced by nurses' perceptions of the receptivity of hospitals to their inclusion in ethics deliberations. In addition, nurses' education in ethics is a significant predictor of ethical activism. The findings have important implications for the content of nurses' ethics training as well as for expanding the boundaries of nurses' participation in ethics deliberations. The authors define ethics deliberations as specific meetings of a number of people to discuss an ethical issue, such as one regarding the care of a patient.

This article compares and contrasts two main aspects of the work of Winnicott and Balint: their theories of infantile development and their theoretical and clinical work on the use of regression as a therapeutic agent. The relationship of their thinking to aspects of the British Independent Group's theories and clinical work is noted vis-à-vis the basic acceptance of classical theory and technique, acknowledgment and use of some of Klein's contributions, the influence of trauma and the external environment on psychic development and psychopathology, the importance of holding and the setting, and the reintegration of previously split off and lost parts of the self.

Objective: To determine the influence of environmental factors on resting energy expenditure (REE) and its relationship to adiposity in two populations of West African origin, Nigerians and U.S. blacks., Research Methods and Procedures: REE and body composition were measured in a cross-sectional sample of 89 Nigerian adults (39 women and 50 men), and 181 U.S. black adults (117 women and 65 men). Both groups represent randomly selected population samples. REE was measured by indirect calorimetry after an overnight fast in both sites using the same instrument. Body composition was estimated using bioelectrical impedance analysis (BIA) in 72 Nigerians and 156 U.S. participants. Multivariate regression analysis was used to determine the significant predictors of REE. The analyses were repeated in a set of 17 Nigerians and 28 U.S. blacks in whom body composition was measured using deuterium dilution., Results: U.S. black adults were significantly heavier and had both more fat-free mass (FFM) and body fat than Nigerians. FFM was the only significant determinant of REE in both population groups, whether body composition was measured using BIA or deuterium dilution. The relationship between REE and body composition did not differ by site. There was no relationship between REE and adiposity., Discussion: Differences in current environmental settings did not impact REE. The differences observed in mean levels of body fat between Nigerians and U.S. blacks were not the result of differences in REE adjusted for body composition.

Notwithstanding Freud's (1921) early linkage of psychoanalytic group psychology with patriarchal themes (i.e., father-leader), more recent findings suggest that the regression in group behavior in general, and in group psychotherapy in particular, tends to evoke frequent maternal ideations. In this connection, this article points to a phenomenological relationship between the individual's universal need to be at one with the internalized mother, as exemplified in the Japanese concept of amae and that of the Mother-Group. With amae serving as an explanatory construct for the group members' interpersonal relations (i.e., identifications and transferences), the idea of the Mother-Group ties in with the group entity's simultaneous supportive functions (i.e., "we are all in the same boat") coupled with its role as a collective arena for the reactivation of unconscious wishes for the nurturing mother of early childhood. In linking a Japanese psychological concept with another, which was developed in the West, I am disproving Rudyard Kipling's often quoted assertion that "never the East and the West shall meet." I was encouraged in this task by Takeo Doi's written comment to me that the idea of the Mother-Group "certainly can be linked with that of Amae. For instance, when the group functions as the Mother-Group, you can say that the participants are experiencing Amae in one way or another" (T. Doi, Sept. 17, 1993, personal communication). In an extended sense, one hopes this essay might even serve to revive our interest in the interrupted well-known early collaboration of psychoanalysts and of anthropologists, which had begun to forge a way to connect personality formation with its cultural context (LeVine, 1974). The insufficient attention paid to the influence of cultural factors on attachment behavior was recently decried by Bretherton (1997).

Expenditures on family dental care by U.S. active duty soldiers were explored in this 1992 worldwide survey. Of 9,560 respondents (62% response rate), 7,187 claimed dependents and 5,569 provided reliable data. Mean annual expenditures and multinomial regression on a distribution of expenditures were calculated. Results show average family dental care expenditures were as follows: total sample, $135; childless couples, $59; couples with children, $154; and single parents, $120. Between 72 and 83% of families spent $0 on dental care. Excluding non-spenders, overall expenditures averaged as follows: total sample, $531; childless couples, $354; couples with children, $560; and single parents, $470. Regression results show that expenditures on family dental care by soldiers are influenced by different factors depending on family composition. Policy measures to encourage optimal dental care by families of active duty soldiers should focus on increasing insurance coverage and use.

Part 1 of this two-part article addressed the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility was emphasized and a number of ethical dilemmas were reviewed, including confidentiality issues. Part 2 addresses strategies for handling difficult psychological issues that often come up in the process of internal consulting. Transference, resistance, regressions, and counterproductive group dynamics are reviewed. These psychological issues may be the predominant source of stress in an internal consulting experience. Case examples are presented along with some empowering strategies. It is hoped that through this review, the quality professional will be better prepared to meet the exciting and rewarding challenges of internal consulting.

Etiological theories of suicide are reviewed from epidemiological, individual (both biological and psychological), and psychosocial perspectives. Cohort and population-model approaches as explanations for the two- to three-fold increase in completed suicide rates observed in adolescents and young adults over the past 25 years are presented. The results of the authors' study of suicides in adolescents and young adults in Cuyahoga County, Ohio, to test these hypotheses are summarized. This study revealed marked cohort differences in suicide rates and provided partial support for the "population-model" approach. Differences between suicide rates in adolescents and other age groups are discussed, as are data from some minority groups. The role of depression in adolescents and various studies of diagnostic approaches (e.g., structured diagnostic assessments, biological markers, clues during intensive psychotherapy or psychoanalysis, studies of high-risk diagnostic groups) are reviewed. Lastly, treatment employing individual, family, and group approaches to classical psychoanalytic or cognitive psychotherapy as well as the role of pharmacological treatments are considered.

Child sexual abuse is sometimes mistakenly over-reported. This discussion of seven cases focuses on one potential area which can generate a substantial segment of false positives: conflicted domestic relations litigation situation. Such situations generate striking, regressive affect and behavior especially when issues of child custody or visitation erupt. Parental regression has been discussed in the literature, but children regress too: behavioral symptoms erupt with vegetative and social disruption, and instinctual material regarding both sex and anger is more accessible to consciousness than is age-appropriate. Heightened instinctual forces in children and regressive loosening of pre-litigation character defenses in adults, both in the context of stressful family breakdown, combine to generate genuine perceptions of abuse but invalid reports.

Positive mental health is used as a bio-adaptive concept, operationally defined in terms of four components: emotional capital (EC), autonomy (A), self-regulation (SR) and competence (C). It is argued that the current adaptive crisis of Western man is due, amongst other factors, to the failure of key social institutions in Western Society, including the family, to provide conditions conducive to the development and/or exercise of these components of mental health. Western man's solutions to this adaptive crisis are shown to fall into two categories-one, representing destructive (anarchist) and the other, a constructive approach. The position is taken that the latter approach needs to be applied more extensively in the functional rehabilitation of the family.