Interventions For At-risk Populations Research Articles

Treatment of Post-Inflammatory Hyperpigmentation in Skin of Colour: A Systematic Review.

Post inflammatory hyperpigmentation (PIH) affects all skin types with a heightened predilection for darker skin tones. Its course is chronic once developed and treatment is often difficult. This systematic review aims to summarize the treatment outcomes for PIH with a focus on skin of colour (SOC) individuals. A literature search was conducted using MEDLINE (from 1946), Embase (from 1974), PubMed, and Cochrane in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Results from 48 studies summarized 1356 SOC individuals. The mean age was 29 years (n = 1036) and 78% were female (n = 786). The ethnic prevalence was 70% Black, 27% Asian, and 3% Latin. Overall, 20% were Fitzpatrick skin type (FST) III, 40% FST IV, 34% FST V, and 6% FST VI. Most cases were precipitated by inflammatory conditions (89%) and localized to the face (83%). The most frequently reported interventions were topical retinoids (22%) and laser therapy (17%). Partial improvement was seen in 85% and 66% of participants, respectively. Laser was the only intervention that offered complete resolution in a subgroup of patients (26%); however, there were reported cases of PIH exacerbation following treatment. Chemical peels (9%) and hydroquinone (7%) were among other treatments with less effective outcomes. PIH and its persistence is a prevalent issue, significantly affecting many affected individuals with darker skin tones. Our results show a lack of robust efficacy across all treatment modalities. There is considerable room for improvement in interventions for at-risk populations.

Cortical Structure in Pre-Readers at Cognitive Risk for Dyslexia: Baseline Differences and Response to Intervention.

Early childhood is a critical period for structural brain development as well as an important window for the identification and remediation of reading difficulties. Recent research supports the implementation of interventions in at-risk populations as early as kindergarten or first grade, yet the neurocognitive mechanisms following such interventions remain understudied. To address this, we investigated cortical structure by means of anatomical MRI before and after a 12-week tablet-based intervention in: (1) at-risk children receiving phonics-based training (n = 29; n = 16 complete pre-post datasets), (2) at-risk children engaging with AC training (n = 24; n = 15 complete pre-post datasets) and (3) typically developing children (n = 25; n = 14 complete pre-post datasets) receiving no intervention. At baseline, we found higher surface area of the right supramarginal gyrus in at-risk children compared to typically developing peers, extending previous evidence that early anatomical differences exist in children who may later develop dyslexia. Our longitudinal analysis revealed significant post-intervention thickening of the left supramarginal gyrus, present exclusively in the intervention group but not the active control or typical control groups. Altogether, this study contributes new knowledge to our understanding of the brain morphology associated with cognitive risk for dyslexia and response to early intervention, which in turn raises new questions on how early anatomy and plasticity may shape the trajectories of long-term literacy development.

0244 The Relationship between Sleep and Metabolic Syndrome in Late Adolescents: Racial Differences

Abstract Introduction Disparities in sleep health and metabolic syndrome (MetS) components co-exist in ethnic/racial minorities. Late adolescents (18-21 y.o.) are a high-risk, yet overlooked population to study sleep disparities and the associated metabolic health. This study aimed to examine the interaction between race and sleep health metrics on MetS components in late adolescents. Methods In this cross-sectional study, we enrolled a convenience sample of 60 college students (19.22±1.06 y.o.). Actigraph accelerometers assessed total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO) over one week. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and questions about demographic/socioeconomic information and risk behaviors. A point-of-care test provided the fasting glucose and cholesterol panel. The number (0 vs. >1) of MetS components, including high waist circumference, blood pressure, fasting triglycerides and glucose, and low High-Density Lipoprotein, indicated metabolic health. Logistic regression tested interaction terms controlling for adolescents’ age, sex, alcohol consumption, and parents’ education, marital status, and family income. Results Most participants (n=55; 92%) slept < 7 hours and 43% reported poor sleep (PSQI>5). More than half (n=33; 55%) had at least one MetS component. On average, White (non-Hispanic) participants had higher TST (6.07 vs. 5.63, t=1.93, p=0.06) and SE (84.89% vs. 81.07%, t=2.31, p=0.02) than their racial/ethnic minority (Black/Hispanic/Asian American/other) peers. Race significantly interacted with TST (OR=0.24, p=0.04), SE (OR=0.69, OR=0.10), and WASO (OR=1.08, p=0.02), such that associations of decreasing odds of MetS with increasing TST and SE and decreasing WASO were significant only in the racial/ethnic minority group. Furthermore, racial/ethnic minority adolescents (vs. White) had a greater MetS risk, when TST hours were at low levels (i.e., < 6 hours). Similarly, low SE (< 85%) and high WASO (>60 min) were associated with greater odds of MetS in racial/ethnic minority (vs. White) adolescents. PSQI scores were not independently associated with MetS or interacted with race in the association with MetS. Conclusion Unhealthy sleep is associated with increased MetS risk, particularly for racial/ethnic minority adolescents. Given the greater sensitivity to sleep health, improving sleep quantity and quality may be candidate targets for MetS interventions in at-risk populations who experience health disparities. Support (if any) American Nurses Foundation (18A01422). Center of Biomedical Research Excellence (COBRE) in cardiovascular health (P20GM113125)

Epigenetic Mediation of Prenatal Tobacco and Alcohol Exposure and Infant Neurodevelopment in a South African Birth Cohort: A High-Dimensional Mediation Analysis

BACKGROUND AND AIMS Prenatal tobacco exposure (PTE) and prenatal alcohol exposure (PAE) have been associated with an increased risk of delayed neurodevelopment in children as well as differential newborn DNA methylation (DNAm). However, the biological mechanisms connecting PTE and PAE, DNAm, and neurodevelopment are largely unknown. Here we aim to determine whether differential DNAm in cord blood mediates the association between PTE and PAE and neurodevelopment in 113 children of 6 months of age from the South African Drakenstein Child Health Study. METHODS PTE and PAE were assessed antenatally using urine cotinine measurements and the ASSIST questionnaire, respectively. DNAm was measured from cord blood using the EPIC and 450K BeadChips. Neurodevelopment was measured at 6 months across five domains (cognitive, language, motor, adaptive behavior, socioemotional) using the Bayley Scale of Infant and Toddler Development, Third Edition. We conducted a high-dimensional mediation analysis using a novel approach called the divide-aggregate composite null test (DACT), followed by causal mediation analysis to estimate the average causal mediation effects (ACME) and total effect (TE). RESULTS In this population, 35% of mothers actively smoked and 23% of mothers consumed alcohol during pregnancy. We identified 31 CpG sites and 8 CpG sites to have a significant mediating effect (ACME and TE P <0.05) between PTE and cognitive and motor development, respectively. For PAE, 16 CpG sites and 1 CpG site had a significant mediating effect on motor and adaptive behavior development, respectively. CONCLUSIONS These findings suggest that changes in the methylome may in part explain the biological mechanisms underlying the relationship between PTE and PAE and infant neurodevelopment. The identification of significant CpG sites could provide novel insights for early detection of disease and potential prevention targets in translational research and community interventions in at-risk populations. KEYWORDS: epigenomics; mediation analysis; neurodevelopment; prenatal smoking; prenatal alcohol exposure

The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries.

SummaryBackgroundAs lifestyle modification offers a unique strategy to prevent diabetes, we evaluated the effectiveness of lifestyle interventions in the prevention of type 2 diabetes and gestational diabetes in low- and middle-income countries (LMICs).MethodsWe did a systematic literature review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and Cochrane Library for randomised controlled trials published in English, Spanish, French, and Portuguese between 1 January 2000 and 15 June 2022, evaluating multi-target and multi-component lifestyle interventions in at-risk populations conducted in LMICs. The main outcomes were incidence of type 2 diabetes and gestational diabetes, and indicators of glycaemic control. We assessed the methodological quality of the studies using the Cochrane risk of bias tool. Inverse-variance random-effects meta-analyses estimated the overall effect sizes. Sources of heterogeneity and study bias were evaluated. The study protocol was registered in PROSPERO (CRD42021279174).FindingsFrom 14 330 abstracts, 48 (0·3%) studies with 50 interventions were eligible of which 56% were conducted in lower-middle-income countries, 44% in upper-middle, and none in low-income. 54% of the studies were assessed as moderate risk of bias and 14% as high risk. A median of 246 (IQR 137-511) individuals participated in the interventions with a median duration of 6 (3-12) months. Lifestyle interventions decreased the incidence risk ratio of type 2 diabetes by 25% (0·75 [95% CI 0·61 to 0·91]), and reduced the levels of HbA1c by 0·15% [−0·25 to −0·05], fasting plasma glucose by 3·44 mg/dL [−4·72 to −2·17], and 2-hr glucose tolerance by 4·18 mg/dL [−7·35 to −1·02]. No publication bias was suggested for these outcomes. High levels of heterogeneity (I²≥ 81%) were found in most meta-analyses. Exploration using meta-regressions could not identify any explanatory variable, except for fasting glucose for which the quality score of the articles seems to be an effect modifier decreasing slightly the heterogeneity (72%) in the low risk of bias pooled estimate. The effect on gestational diabetes could not be evaluated due to the scarcity of available studies.InterpretationComprehensive lifestyle interventions are effective strategies to prevent type 2 diabetes among at-risk populations in LMICs. The heterogeneity identified in our results should be considered when using these interventions to address the onset of type 2 diabetes.FundingNone.

Amino Acids, B Vitamins, and Choline May Independently and Collaboratively Influence the Incidence and Core Symptoms of Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a developmental disorder of variable severity, characterized by difficulties in social interaction, communication, and restricted or repetitive patterns of thought and behavior. In 2018, the incidence of ASD was 2.4 times higher than estimated in 2000. Behavior and brain development abnormalities are present in the complex disorder of ASD. Nutritional status plays a key role in the incidence and severity of the core symptoms of ASD. The aim of this study was to review the available peer-reviewed studies that evaluated the relationship between amino acids, choline, B vitamins, and ASD incidence and/or severity of symptoms. Through examining plasma profiles, urine samples, and dietary intake, researchers found that low choline, abnormal amino acid, and low B vitamin levels were present in children with ASD compared to those without ASD. The evidence supports the need for future research that implements simultaneous supplementation of all essential nutrients in individuals with ASD and among prenatal mothers. Future evidence could lead to scientific breakthroughs, ultimately reducing the rates of ASD incidence and severity of symptoms by applying nutritional interventions in at-risk populations.

Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures

Preterm infants undergo early separation from parents and are exposed to frequent painful clinical procedures, with resultant short- and long-term effects on their neurodevelopment. We aimed to establish whether the mother’s voice could provide an effective and safe analgesia for preterm infants and whether endogenous oxytocin (OXT) could be linked to pain modulation. Twenty preterm infants were exposed to three conditions—mother’s live voice (speaking or singing) and standard care—in random order during a painful procedure. OXT levels (pg/mL) in saliva and plasma cortisol levels were quantified, and the Premature Infant Pain Profile (PIPP) was blindly coded by trained psychologists. During the mother’s live voice, PIPP scores significantly decreased, with a concomitant increase in OXT levels over baseline. The effect on pain perception was marginally significant for singing. No effects on cortisol levels were found. The mother’s live voice modulated preterm infants’ pain indicators. Endogenous OXT released during vocal contact is a promising protective mechanism during early painful interventions in at-risk populations.

Hepatitis C in Uganda: Identification of infected blood donors for micro-elimination

BackgroundThe drive to eliminate viral hepatitis by 2030 is underway. However, locally generated data on active infection is required to focus such efforts. We performed a regionally-inclusive survey to determine prevalence of active HCV, genotypes and related factors among Ugandan blood donors. MethodsParticipants from regional blood banks and blood collection centers were surveyed for information on demographic, clinical and lifestyle factors. Blood was assayed for HCV infection, HCV genotypes and subtypes. Logistic regression was performed to determine factors associated with active HCV infection. ResultsOf 1243 participants, 1041 (83.7%) were male, average age (SD), 27.7 (9.8). Prevalence of active HCV infection was 7.8% and we identified 3 genotypes. Median age (adj. OR (95% CI) = 1.03 (1.01–1.06), p-value = 0.040)), Northern region of birth versus Central or Eastern (adj. OR (95% CI) = 10.25 (2.65–39.68), p-value = 0.001)), Northern residence, versus Central or Eastern (adj. OR (95% CI) = 0.23 (0.08–0.65), p-value = 0.006)), and being married (versus single/divorced) adj. OR 2.49(1.3–4.79), p-value = 0.006 were associated with active HCV infection. ConclusionTargeted interventions in at-risk populations coupled with linkage to care and treatment will help achieve the WHO elimination goals in this setting.

The Importance of Neighborhood in 9-1-1 Ambulance Contacts: A Geospatial Analysis of Medical and Trauma Emergencies in Denver

Background: Prehospital emergency care is a vital component of healthcare access, and emergency medical services (EMS) plays an essential role in healthcare delivery. Understanding the distribution of medical and trauma EMS calls at the neighborhood level would be beneficial to identify at-risk communities and facilitate targeted interventions. Objectives: The primary objective was to evaluate and characterize 9-1-1 ambulance contacts for medical and trauma-related events in Denver. The secondary objective was to evaluate the co-existence of medical and trauma-related EMS calls to determine if these emergencies occur in the same neighborhoods. Methods: We conducted a secondary analysis of prospectively collected EMS calls in Denver between January 1, 2011, through August 8, 2017. The primary outcome was the incidence of trauma and medical EMS calls in each census tract. EMS events were aggregated to tracts and incidence rates were calculated based on the adult daytime and nighttime population. Three different spatial analysis methods (SaTScan’s spatial scan statistic, Gini coefficient, and Local Moran’s I) were utilized to identify clusters of medical and trauma EMS events at the tract level. Results: A total of 425,527 EMS calls in 142 census tracts occurred during the study period. The median age of study participants was 48 (IQR 33, 62), 56% were male, and the majority (74%) of EMS calls were for medical events. An emergent EMS return to the hospital occurred in 5% of all calls. We identified several high-risk census tracts with a coexistence of medical and trauma EMS events. When compared to the Denver County population, the tracts with high EMS call rates were diverse, with many tracts exhibiting a higher proportion of black, unemployment, below poverty, and lower median income while other tracts demonstrated a smaller proportion of black, unemployment, below poverty, and a higher median income. Conclusions: Disparities exist in the distribution of medical and trauma EMS calls in varied census tracts in Denver. Identifying neighborhoods in which there is an incidence of higher medical and trauma emergencies is important to guide EMS care delivery and may help facilitate targeted public health interventions for at-risk populations to improve health outcomes.

Neglected tropical diseases and vitamin B12: a review of the current evidence.

Vitamin B12 deficiency is an urgent public health problem that disproportionately affects individuals in low- and middle-income settings, where the burden of neglected tropical diseases (NTDs) is also unacceptably high. Emerging evidence supports a potential role of micronutrients in modulating the risk and severity of NTDs. However, the role of vitamin B12 in NTD pathogenesis is unknown. This systematic review was conducted to evaluate the evidence on the role of vitamin B12 in the etiology of NTDs. Ten studies were included in this review: one study using an in vitro/animal model, eight observational human studies and one ancillary analysis conducted within an intervention trial. Most research to date has focused on vitamin B12 status and helminthic infections. One study examined the effects of vitamin B12 interventions in NTDs in animal and in vitro models. Few prospective studies have been conducted to date to examine the role of vitamin B12 in NTDs. The limited literature in this area constrains our ability to make specific recommendations. Larger prospective human studies are needed to elucidate the role of vitamin B12 in NTD risk and severity in order to inform interventions in at-risk populations.

The Effect of Buffering High Acid Load Meal with Sodium Bicarbonate on Postprandial Glucose Metabolism in Humans-A Randomized Placebo-Controlled Study.

Background: High dietary acid load relates to increased risk of type 2 diabetes in epidemiological studies. We aimed to investigate whether buffering a high acid load meal with an alkalizing treatment changes glucose metabolism post meal. Methods: Non-diabetic participants (n = 32) were randomized to receive either 1680 mg NaHCO3 or placebo, followed by a high acid load meal in a double-blind placebo-controlled crossover (1–4 weeks apart) study. Thirty (20 men) participants completed the study. Venous blood pH, serum bicarbonate, blood glucose, serum insulin, C-peptide, non-esterified fatty acid (NEFA), and plasma glucagon-like peptide-1 (GLP-1) concentrations were measured at baseline (fasting) and at 15–30 min intervals for 3 h post meal. Results: The treatment was well tolerated. Venous blood pH declined in the first 15 min post meal with the placebo (p = 0.001), but not with NaHCO3 (p = 0.86) and remained decreased with the placebo for 3 h (pinteraction = 0.04). On average over the 3 h blood pH iAUC was greater with NaHCO3 compared with placebo (p = 0.02). However, postprandial glucose, insulin, C-peptide, NEFA and GLP-1 were not different between treatments (pinteraction ≥ 0.07). Conclusions: An alkalizing medication administered pre-meal has no acute effect on glycaemia and insulin response in healthy individuals. Long-term interventions in at-risk populations are necessary to investigate the effect of sustained alkalization on glucose metabolism.

Influence of 5-HTT variation, childhood trauma and self-efficacy on anxiety traits: a gene-environment-coping interaction study.

Environmental vulnerability factors such as adverse childhood experiences in interaction with genetic risk variants, e.g., the serotonin transporter gene linked polymorphic region (5-HTTLPR), are assumed to play a role in the development of anxiety and affective disorders. However, positive influences such as general self-efficacy (GSE) may exert a compensatory effect on genetic disposition, environmental adversity, and anxiety traits. We, thus, assessed childhood trauma (Childhood Trauma Questionnaire, CTQ) and GSE in 678 adults genotyped for 5-HTTLPR/rs25531 and their interaction on agoraphobic cognitions (Agoraphobic Cognitions Questionnaire, ACQ), social anxiety (Liebowitz Social Anxiety Scale, LSAS), and trait anxiety (State-Trait Anxiety Inventory, STAI-T). The relationship between anxiety traits and childhood trauma was moderated by self-efficacy in 5-HTTLPR/rs25531 LALA genotype carriers: LALA probands maltreated as children showed high anxiety scores when self-efficacy was low, but low anxiety scores in the presence of high self-efficacy despite childhood maltreatment. Our results extend previous findings regarding anxiety-related traits showing an interactive relationship between 5-HTT genotype and adverse childhood experiences by suggesting coping-related measures to function as an additional dimension buffering the effects of a gene-environment risk constellation. Given that anxiety disorders manifest already early in childhood, this insight could contribute to the improvement of psychotherapeutic interventions by including measures strengthening self-efficacy and inform early targeted preventive interventions in at-risk populations, particularly within the crucial time window of childhood and adolescence.

Follow-up and chain of care in the prevention of suicide recurrence

Suicide constitutes one of the most important problems in global public health. However, assessment as well as corresponding verification of suicide risk, either in case histories or clinical reports, is handled poorly in several clinical settings. Aspects as important as the existence of a personal history of suicidal tendencies are frequently omitted, despite this being one of the risk factors that most clearly predict the possibility of a complete suicide in the future. During this presentation, I would like to refer specific interventions in at-risk populations, with special emphasis on individuals who have made previous suicide attempts. Suicidal behaviour is a very complex phenomenon, making a specific treatment for it difficult to produce. Consequently, when the most appropriate therapeutic approach for an at-risk population is raised, the following fact is mentioned: in approximately 90% of suicide cases, there is an underlying psychiatric disorder. This makes psychopharmacological treatment of the base pathology the most adequate. Still totally in agreement with that affirmation, we want to point out that we often forget there is proven evidence of the preventative utility of non-pharmacological interventions designed to increase clinical follow-up and adherence to post-attempt outpatient treatment. It is important to indicate that these interventions are not aimed at specific disorders or population groups, but rather they are of a more universal character and are thus more easily generalised. During this presentation, some of these approaches will be addressed and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

Poor maternal nutrition and accelerated postnatal growth induces an accelerated aging phenotype and oxidative stress in skeletal muscle of male rats.

ABSTRACT‘Developmental programming’, which occurs as a consequence of suboptimal in utero and early environments, can be associated with metabolic dysfunction in later life, including an increased incidence of cardiovascular disease and type 2 diabetes, and predisposition of older men to sarcopenia. However, the molecular mechanisms underpinning these associations are poorly understood. Many conditions associated with developmental programming are also known to be associated with the aging process. We therefore utilized our well-established rat model of low birth weight and accelerated postnatal catch-up growth (termed ‘recuperated’) in this study to establish the effects of suboptimal maternal nutrition on age-associated factors in skeletal muscle. We demonstrated accelerated telomere shortening (a robust marker of cellular aging) as evidenced by a reduced frequency of long telomeres (48.5-8.6 kb) and an increased frequency of short telomeres (4.2-1.3 kb) in vastus lateralis muscle from aged recuperated offspring compared to controls. This was associated with increased protein expression of the DNA-damage-repair marker 8-oxoguanine-glycosylase (OGG1) in recuperated offspring. Recuperated animals also demonstrated an oxidative stress phenotype, with decreased citrate synthase activity, increased electron-transport-complex activities of complex I, complex II-III and complex IV (all markers of functional mitochondria), and increased xanthine oxidase (XO), p67phox and nuclear-factor kappa-light-chain-enhancer of activated B-cells (NF-κB). Recuperated offspring also demonstrated increased antioxidant defense capacity, with increased protein expression of manganese superoxide dismutase (MnSOD), copper-zinc superoxide dismutase (CuZnSOD), catalase and heme oxygenase-1 (HO1), all of which are known targets of NF-κB and can be upregulated as a consequence of oxidative stress. Recuperated offspring also had a pro-inflammatory phenotype, as evidenced by increased tumor necrosis factor-α (TNFα) and interleukin-1β (IL1β) protein levels. Taken together, we demonstrate, for the first time to our knowledge, an accelerated aging phenotype in skeletal muscle in the context of developmental programming. These findings may pave the way for suitable interventions in at-risk populations.

Paraprofessional-Delivered Home-Visiting Intervention for American Indian Teen Mothers and Children: 3-Year Outcomes From a Randomized Controlled Trial

The Affordable Care Act provides funding for home-visiting programs to reduce health care disparities, despite limited evidence that existing programs can overcome implementation and evaluation challenges with at-risk populations. The authors report 36-month outcomes of the paraprofessional-delivered Family Spirit home-visiting intervention for American Indian teen mothers and children. Expectant American Indian teens (N=322, mean age=18.1 years) from four southwestern reservation communities were randomly assigned to the Family Spirit intervention plus optimized standard care or optimized standard care alone. Maternal and child outcomes were evaluated at 28 and 36 weeks gestation and 2, 6, 12, 18, 24, 30, and 36 months postpartum. At baseline the mothers had high rates of substance use (>84%), depressive symptoms (>32%), dropping out of school (>57%), and residential instability (51%). Study retention was ≥83%. From pregnancy to 36 months postpartum, mothers in the intervention group had significantly greater parenting knowledge (effect size=0.42) and parental locus of control (effect size=0.17), fewer depressive symptoms (effect size=0.16) and externalizing problems (effect size=0.14), and lower past month use of marijuana (odds ratio=0.65) and illegal drugs (odds ratio=0.67). Children in the intervention group had fewer externalizing (effect size=0.23), internalizing (effect size=0.23), and dysregulation (effect size=0.27) problems. The paraprofessional home-visiting intervention promoted effective parenting, reduced maternal risks, and improved child developmental outcomes in the U.S. population subgroup with the fewest resources and highest behavioral health disparities. The methods and results can inform federal efforts to disseminate and sustain evidence-based home-visiting interventions in at-risk populations.

Discharge of late preterm newborn: appropriated, controlled…namely safe

Late-preterm newborns accounted for 8.7% of all US births in 2009, while in Italy, according to Euro-Peristat Report 2010, rate of preterm live births between 32 and 36 weeks accounts for 6.4%: therefore late-preterm incidence is around 5% [1]. In the literature is reported that late preterm infants are at increased risk of neonatal mortality and morbidity, including feeding problems, hyperbilirubinemia, hypoglycemia, and respiratory problems. So, in recent years, research has focused on hospital care, with little known about the real needs of care after discharge and in the home setting. However, it’s known that early discharge places these infants at greater risk of complications such as rehospitalizazion, particularly in breastfed infants [2]. Therefore in this population it’s fundamental to plan an “appropriate” discharge. What does “appropriateness” mean? In health care the appropriateness has two aspects: 1) the “clinical” appropriateness that refers to the criteria of efficacy and safety ; 2) the so-called “administrative” appropriateness that indicates the extent of provision of health according to the criterion of efficiency, that is the best use of available resources, with respect to the clinical case to be treated. Because the resources available vary by context, administrative appropriateness is a very dynamic concept. In the discharge of late-preterm baby, clinical appropriateness requires individualization and involvement of family. Discharge criteria are substantially similar to those of full-term [3] but include longer observation times, more attention to the real understanding and involvement of the family in the scheme of nutrition and follow-up, and an increased need for planning follow-up and integration with local services. Although discharge criteria for late preterm infants are quite precise, however there is a large inter-center heterogeneity regarding the timing of discharge. It’s clear that the choices on the discharge of late preterm newborns are strongly influenced by the organizational context. It should be essential to have accurate population-based surveillance data and organizational data, as well as clinical ones. Only in this way it is possible to evaluate the efficacy (and on which outcomes) of programs of protected discharge, and their compatibility with the available resources. For example, some studies suggest that home visiting promotes improved parent-infant interaction; however further studies are needed to demonstrate whether such interventions in at-risk populations may strengthen their impact and cost benefits [4].

Proprotein Convertases in Gynecological Cancers

ABSTRACT Gynecological cancers include neoplasias of internal female genital organs, mainly ovarian, endometrial and cervical tumors, and cancers of the external female genital structures. Current scientific evidence indicates that both up- and down-regulation of the expression of PCs are part of the multiple changes occurring in these gynecological tumors. Nevertheless, the physiological significance of this puzzling pattern of PC expression remains elusive. The fact that PCs can activate both pro- and anticarcinogenic substrates may indicate that the nature of the overexpressed substrates in certain cancer types could determine the final outcome; i.e., slowing or accelerating cancer development. The expression of PCs in gynecological cancers and the correlation of this expression with other markers may facilitate preventive and therapeutic interventions in at-risk populations. Several studies single out furin as the main PC overexpressed in ovarian and endometrial cancers. For instance, furin expression...

Abstract NS 9: An Educational Intervention to Enhance Acute Stroke Symptom Recognition Skills Among Nursing Home Nursing Assistants

Background: Treatment of stroke requires a coordinated effort by clinicians educated to identify and transfer presumed acute stroke patients to hospital Emergency Departments (EDs) for expedited evaluation. With the aging of the population and the increasing demand for nursing home (NH) services, the community of clinicians educated to identify acute symptoms of stroke needs to be inclusive of Nursing Assistants (CNAs) in NH settings, who provide 70 to 80% of direct-care hours to NH residents. Approximately 25% of NH residents are referred to EDs for emergency care each year. Poorly executed transitions between EDs and NHs have the potential to delay assessment and intervention in a context in which “time is brain.” Purpose: The goal of this educational intervention was to integrate evidence-based messages for acute stroke symptom recognition into NH CNA practice and to assess knowledge change by comparing stroke-related knowledge at baseline to knowledge acquired immediately post-intervention. Methods: An educational module on acute stroke symptom recognition based on the Massachusetts Department of Public Health’s “Stroke Heroes Act FAST Education Guide” was delivered live by an advanced practice nurse to a convenience sample of 39 CNAs from 4 of an urban NH’s skilled nursing units. Pre- and post-test surveys, based on the “Hip Hop Stroke” survey questions, were administered to participants and results were analyzed using descriptive statistics. Results: Mean age of participants was 43.2 years (SD = 8.1), 82.1% were female, and 74.4% were Black. Mean years of clinical experience were 12.6 (SD = 8.2). Most (94.7%) described stroke as involving the brain on the pre-test, but only 22.2% of CNAs could select all 4 signs of stroke from the eight options offered on the pre-test. Post-intervention, 100% indicated that a stroke involves the brain and 33.3% correctly selected all 4 signs of stroke. In addition, 78.6% accurately described the meaning of all 4 “FAST” letters on the post-test. Conclusions: This educational intervention improved NH CNA knowledge of stroke symptoms. While this intervention could be replicated in other NH settings, the effect of early stroke symptom recognition on the quality of the emergency care provided to NH residents, and the impact of that emergency care on stroke-related morbidity and mortality among NH residents, warrant further study. It is notable that most participants were Black, as it is well documented that racial-ethnic minorities are less likely to be aware of acute stroke symptoms and the need for urgent treatment. Further research is needed to determine the optimal design of educational interventions in at-risk populations.