Explore the vast range of titles available.

Nursing home (NH) residents in the United States routinely attend interactive visits for services such as therapy or dialysis, creating opportunities for pathogen transmission. A paucity of studies exist which delineate spread of pathogens beyond residents’ in-room environment. In this prospective cohort study, we recruited 197 newly-admitted residents across three Veterans Affairs NHs to characterize multidrug-resistant organism (MDRO) prevalence, acquisition, and transmission. Participant hands, nares, groin, and seven environmental surfaces were swabbed during 758 regularly scheduled in-room visits; participant hands, healthcare personnel hands, and equipment were swabbed during 345 unscheduled interactive visits. We demonstrate that baseline MDRO colonization and new acquisition is common, and one in six interactive visits result in MDRO transmission. Whole genome sequencing on a subset of participants enabled us to identify sources of transmission where it was unknown using microbiologic methods alone. Our results illustrate MDRO transmission pathways and highlight the need for innovative, multidisciplinary interventions. Nursing homes are high-risk settings for transmission of infections, but risks associated with specific activities are not well understood. Here, the authors investigate transmission dynamics of multi-resistant organisms in nursing homes in the United States with a focus on out-of-room, interactive visits.

Abstract Background Wearable activity trackers may facilitate walking for chronic pain management. Objective We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity. Design Randomized controlled pilot and feasibility trial. Subjects Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls). Methods Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration. Results More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls. Conclusions With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.

Background: There are inconsistencies documenting the pain experience of Black adults and other racially minoritized populations. Often disregarded, pain among these groups is characterized by misconceptions, biases, and discriminatory practices, which may lead to inequitable pain care. Methods: To address this issue, this professional commentary provides an overview of pain reform and the need to declare chronic pain as a critical public health issue, while requiring that equity be a key focus in providing comprehensive pain screening and standardizing epidemiological surveillance to understand the prevalence and incidence of pain. Results and Conclusions: This roadmap is a call to action for all sectors of research, practice, policy, education, and advocacy. More importantly, this progressive agenda is timely for all race and other marginalized groups and reminds us that adequate treatment of pain is an obligation that cannot be the responsibility of one person, community, or institution, but rather a collective responsibility of those willing to service the needs of all individuals.

Background Older adults in disadvantaged urban communities contend with chronic psychosocial and environmental stressors that contribute to high levels of chronic pain-related disability. African American older adults are especially at risk due to the health-damaging effects of structural racism. The purpose of this study is to test the efficacy of a chronic pain self-management intervention tailored for this context. STEPS (Seniors using Technology to Engage in Pain Self-management) is a community health worker (CHW)-led chronic pain self-management program designed for older adults living in underserved communities. It is a 7-week intervention that includes (a) brief videos presenting pain self-management skills; (b) weekly telephone calls with a CHW to support the practice of new skills and goal setting; and (c) tracking daily step counts using a wearable activity tracker. CHWs also screen for social needs and make appropriate community referrals. Methods We will randomly assign 414 participants to the STEPS intervention or a control condition in a 1:1 ratio, stratifying by gender and age group. We hypothesize that participants in the STEPS intervention will have greater improvements in pain interference and pain intensity, and a more positive Global Impression of Change immediately following the intervention and at 12 months from baseline. Control group members are invited to attend a workshop covering key intervention content after the final data collection point. Discussion Growing evidence supports the effectiveness of CHWs as culturally sensitive liaisons between healthcare systems and underserved communities. If the STEPS program is shown to significantly improve pain-related outcomes, STEPS could be integrated into healthcare systems to more comprehensively treat chronic pain while reducing barriers to care and promoting non-pharmacological pain management strategies. Trial registration ClinicalTrials.gov, NCT05278234. Registered on March 3, 2022.

OBJECTIVE. This study assessed the feasibility and preliminary efficacy of an online-assisted, occupational therapist–delivered, cognitive–behavioral therapy intervention to promote physical function in patients with knee osteoarthritis (KOA). METHOD. Fifty-seven participants with KOA were randomized 2:1 to the Engage program (eight clinic-based sessions supported by online modules) or usual care. Using analysis of covariance, we estimated Engage’s effect on physical function (Western Ontario and McMaster Universities Osteoarthritis Index’s Physical Function subscale [WOMAC–PF]) at 6 mo. RESULTS. Data were analyzed on 46 completers. Engage was associated with a small effect (η2 = 0.01) on the WOMAC–PF. More Engage participants than controls reported much or very much improvement (45% vs. 13%; p = .03). Satisfaction was high, and 30 of 31 participants attended six sessions or more. CONCLUSION. An online-supported cognitive–behavioral program for people with KOA delivered by occupational therapists is feasible and may contribute to improved physical function.

Objectives/Goals: To support the growing number of clinical research professionals (CRP) working in behavioral and social science contexts, relevant formative assessments of research skills are needed. This study examines the development of an objective formative assessment designed to assess skills relevant to conducting social and behavioral research. Methods/Study Population: A multidisciplinary group at the University of Michigan was convened to develop the assessment. Case studies depicting clinical and translational research conducted in behavioral and social science contexts were used to measure proficiency in seven of the eight ECRPTQ competencies: Scientific Concepts & Research Design, Ethical & Participant Safety Concerns, Clinical Trial Operations (Good Clinical Practice), Study & Site Management, Data Management & Informatics, Leadership & Professionalism, Communication, and Teamwork & Team Science. Three difficulty levels of questions were developed: basic, intermediate, and advanced. To reinforce knowledge and skill development, the assessment was designed to give respondents formative feedback after responding to each question. Results/Anticipated Results: A preliminary “pre-pilot” test was conducted with three postdoctoral scholars to ensure that the assessment items were understandable. The assessment was then pilot tested with a larger group of 40 clinical research professionals (CRP) to test for the clarity and difficulty level of the items. A smaller group of 20 of these CRPs agreed to participate in focus groups to obtain feedback on their user experience. Data regarding years of experience as a CRP, types of studies engaged with, and information regarding professional certification were collected and used in the analyses. Demographic data collected were not connected to user responses. Results of the pilot test and focus groups were used to revise the questions on the final version of the assessment. Discussion/Significance of Impact: To our knowledge, this is the first objective assessment of research skills for CRP working in behavioral and social science contexts. We will discuss how other institutions can use this instrument to evaluate the training needs of their social and behavioral research workforce.

Objective Immune-mediated inflammatory diseases (IMID) are characterized by systemic inflammation affecting the joints and bodily organs. Studies examining the association between individual IMIDs and the risk of Alzheimer’s disease (AD) have yielded inconsistent findings. This study examines AD risk across a group of IMIDs in a large population-based sample of older adults. Methods Data on a national sample of US adults over age 50 was drawn from the Health and Retirement Study (HRS) and linked Medicare claims from 2006 to 2014. IMIDs include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, and related conditions. We identified IMIDs from 2006 to 2009 Medicare claims using International Classification of Diseases (ICD9-CM) codes. The date of incident AD was derived from Chronic Conditions Warehouse (CCW) identifiers. We examined the risk of AD from 2009 to 2014 using Cox proportional hazards models, both unadjusted and adjusted for age, gender, education, race, and the genetic risk factor APOE-e4. Results One hundred seventy-one (6.02%) of the 2842 total HRS respondents with Medicare coverage and genetic data were classified with IMIDs. Over the subsequent 6 years, 9.36% of IMID patients developed AD compared to 8.57% of controls (unadjusted hazard ratio (HR): 1.09, 95% CI .66–1.81, p  = 0.74). Adjusted HR 1.27 (95% CI 0.76–2.12, p  = 0.35). Age (HR for 10-year increment 3.56, p  < .001), less than high school education (HR 1.70, p  = .007), and APOE-e4 (HR 2.61, p  < .001 for one or two copies), were also statistically significant predictors of AD. Conclusion HRS respondents with common IMIDs do not have increased risk of Alzheimer’s disease over a 6-year period.

The clinical and translational research workforce involved in social and behavioral research (SBR) needs to keep pace with clinical research guidance and regulations. Updated information and a new module on community and stakeholder engagement were added to an existing SBR training course. This article presents evaluation findings of the updated course for the Social and Behavioral Workforce. Participants working across one university were recruited. Course completers were sent an online survey to evaluate the training. Some participants were invited to join in a focus group to discuss the application of the training to their work. We performed descriptive statistics and conducted a qualitative analysis on focus group data. There were 99 participants from diverse backgrounds who completed the survey. Most reported the training was relevant to their work or that of the study teams they worked with. Almost half (46%) indicated they would work differently after participating. Respondents with community or stakeholder engaged research experience vs. those without were more likely to report that the new module was relevant to study teams they worked with ( = 5.61, = 0.001), and that they would work differently following the training ( = 2.63, = 0.01). Open-ended survey responses ( = 99) and focus group ( = 12) data showed how participants felt their work would be affected by the training. The updated course was rated highly, particularly by those whose work was related to the new course content. This course provides an up-to-date resource for the training and development for the Social and Behavioral Workforce.

Objective To determine the validity of self‐reported physician diagnosis of rheumatoid arthritis (RA) using multiple gold‐standard measures based on Medicare claims in a nationally representative sample of older adults and to verify whether additional questions about taking medication and having seen a physician in the past two years for arthritis can improve the positive predictive value (PPV) and other measures of the validity of self‐reported RA. Methods A total of 3768 Medicare‐eligible respondents with and without incident self‐reported RA were identified from the 2004, 2008, and 2012 waves of the United States Health and Retirement Study. Self‐reported RA was validated using the following three claims‐based algorithms: 1) a single International Classification of Diseases, ninth edition, Clinical Modification claim for RA, 2) two or more claims no greater than 2 years apart, and 3) two or more claims with at least one diagnosis by a rheumatologist. Additional self‐report questions of medication use and having seen a doctor for arthritis in the past two years were validated against the same criteria. Results A total of 345 respondents self‐reported a physician diagnosis of RA. Across all three RA algorithms, the PPV of self‐report ranged from 0.05 to 0.16., the sensitivity ranged from 0.23 to 0.55., and the κ statistic ranged from 0.07 to 0.15. Additional self‐report data regarding arthritis care improved the PPV and other validity measures of self‐report; however, the values remained low. Conclusion Most older adults who self‐report RA do not have a Medicare claims history consistent with that diagnosis. Revisions to current self‐reported RA questions may yield more valid identification of RA in national health surveys.

Background Studies suggest an increased prevalence of cognitive impairment (CI) among people with rheumatoid arthritis (RA). However, most prior studies have used convenience samples which are subject to selection biases or have failed to adjust for key confounding variables. We thus examined the association between CI and RA in a large national probability sample of older US adults. Methods Data were from interviews with 4462 participants in the 2016 wave of the nationally representative U.S. Health and Retirement Study with linked Medicare claims. RA diagnoses were identified via a minimum of two ICD-9CM or ICD-10 codes in Medicare billing records during the prior 2 years. The Langa-Weir Classification was used to classify cognitive status as normal, cognitively impaired non-dementia (CIND), or dementia based on a brief neuropsychological battery for self-respondents and informant reports for proxy respondents. We compared the odds of CI between older adults with and without RA using logistic regression, adjusted for age, education, gender, and race. Results Medicare records identified a 3.36% prevalence of RA (150/4462). While age, gender, education, and race independently predicted CI status, controlling for these covariates we found no difference in CI prevalence according to RA status (prevalent CI in 36.7% of older adults with RA vs. 34.0% without RA; adjusted OR = 1.08, 95% CI 0.74–1.59, p  = .69). Conclusion There was no association between RA and CI in this national sample of older U.S. adults.