The Family Income Ratio of Barcelona and its impact on treatment delays and one-year mortality in 3173 cases of STEMI treated at the Codi IAM network

Introduction

STEMI networks have spread reperfusion and have decreased treatment delays.Increased treatment times have a negative impact on mortality after STEMI.The Family Income Ratio of Barcelona (FIRB) is an indicator that combines economic and socio-cultural welfare that is annually documented at the different Barcelona's neighborhoods by the Barcelona Public Health Office.

Purpose

To evaluate if FIRB has a prognostic impact on STEMI treatment times and mortality on patients of Barcelona city treated in the Codi IAM Network with primary PCI.

Methods

Analysis of all data from “Codi IAM Network” from STEMI treatment in Barcelona city from 2010 to 2016 -including treatment delays, clinical risk factors and 1-year all-cause mortality- and corresponding FIRB for each patient and episode.FIRB is divided into tertiles.Multilevel analysis is performed to obtain factors associated to EKG-opening artery time and cox-regression on 1-year all-cause mortality.

Results

3173 cases of STEMI were included with a mean age of 65±13, 25% women,21% diabetes mellitus and 42% hypertension.Characteristics of population, treatment and mortality per FIRB tertile is shown in Table 1.Multilevel analysis showed that age,diabetes mellitus,heart failure at admission,FIRB and who performed first care were associated to EKG-Opening Artery Time (all p<0.003).However,only age,heart failure at admission,who performed first care and EKG-opening artery time>120min were significantly associated to 1-year all-cause mortality (p<0.005) but not FIRB.

Conclusions

Patients at the lower FIRB treated for STEMI in Barcelona showed younger age,worse cardiovascular profile and longer treatment delays.Longer EKG-open artery time was associated to diabetes mellitus, heart failure, first assistance care and lower FIRB.One-year all-cause mortality was not associated to FIRB.

Funding Acknowledgement

Type of funding source: None

Improving tuberculosis therapy completion after jail: translation of research to practice

Inmates have high rates of latent tuberculosis infection (LTBI), but inmates are often released early and do not complete therapy in the community. This study evaluated the translation of results from a randomized trial to improve therapy completion to usual care in a county jail using Rogers' Diffusion of Innovation theory. Inmates who received a single education in the randomized trial in 1998-1999 (study group) were compared to inmates educated by Jail Discharge Planners in 2002-2003 (usual care group). Outcomes were rates of completion of a visit to the TB clinic and completion of therapy. Subjects in the usual care group were significantly less likely to go to clinic in the 30-day period after release (relative risk 0.84, 95% confidence interval 0.75-0.95). The transfer of an educational protocol did not achieve results seen under study conditions, mostly because of implementation fidelity. The educational session in the usual care period for 81.0% of inmates took 5 min, as compared to 10-15 min during the randomized trial. Differences in personnel administering the protocol, training, high turnover and time available may also account for lower rates seen. Practical clinical trials should focus on the context of care as well as the intervention and should have participation by those who will be implementing results.

Effect of directly observed preventive therapy for latent tuberculosis infection in San Francisco

SETTING

San Francisco TB Clinic instituted a directly observed preventive therapy (DOPT) program for treatment of persons with latent TB infection in 1996.

OBJECTIVE

To examine therapy completion for latent tuberculosis infection before and after implementation of the DOPT program.

DESIGN

Medical records were analyzed for patients at the San Francisco TB Clinic referred from high-risk sites for the periods 1993-1994 (n = 619) and 1997-June 1998 (n = 460). Treatment completion and time of therapy were analyzed comparing DOPT to self-administered therapy (SAT).

RESULTS

More DOPT patients completed treatment (70.3%) than SAT patients (47.9%) (P < 0.001). Controlling for sex, age, race/ethnic group and cohort, patients on DOPT were nearly twice as likely to complete therapy (OR 1.93, 95% CI 1.25-3.00).

CONCLUSION

DOPT is a successful strategy. Combined with targeted testing, DOPT can have an important impact in areas with traditionally low rates of treatment adherence.

Jail inmates and HIV care: provision of antiretroviral therapy and Pneumocystis carinii pneumonia prophylaxis

The objective of this study was to examine prescription and acceptance of antiretroviral therapy (ART) and Pneumocystis carinii pneumonia (PCP) prophylaxis in jail and at release. A retrospective cross sectional design was used, by record review, of 77 inmates receiving HIV-related care in the San Francisco City and County Jail and released to the community in 1997. Average CD4 cell count was 335/microl. Fifteen had undectable HIV RNA, and average viral load was 19,826 copies/ml. Fifty-eight per cent were put on ART in jail. Lower CD4 cell count was associated with ART (P=0.017). All inmates with CD4 cell counts less than 200/microl received PCP prophylaxis. According to 1996 guidelines, 72% of those eligible for ART were on therapy. Of 24 inmates released on ART, 71% followed medical advice and picked up medication at release. HIV care in the San Francisco Jail met high standards and exceeded levels reported in other populations.

Locating study subjects: predictors and successful search strategies with inmates released from a U.S. county jail

Minimizing loss to follow-up in longitudinal studies is critical. The purpose of this study was to examine the ability to locate subjects recently released from jail, identify predictors of being able to find a subject, and describe effective search strategies for this unique population. The sample for this cohort study included study subjects who were sought for interview after release from jail. Inmates in the San Francisco City and County Jail were enrolled in a randomized trial of incentives to improve follow-up for tuberculosis therapy after release from jail. Sociodemographic, health-related, and extensive locating information was collected during baseline interviews in jail. The main outcome was successful location of the subject. Study personnel recorded data on the number and nature of attempts made to find subjects in order to describe successful search strategies. Of 254 persons sought for the postrelease interview, 188 (74.0%) were found. Primary English speakers were more likely than Spanish speakers to be found (relative risk: 3.2, 95% confidence interval: 1.5-6.7, p = 0.002). Nearly one quarter of subjects (24%) were found back in jail, and the remainder were found in the community. Phone calls and letters to the subjects, and personal contacts to family and friends were successful strategies for 53% of the subjects. Seeking persons in programs, such as shelters and drug and alcohol programs, was successful in finding 18% of English-speaking subjects. Outreach efforts in sections of the city where Latinos spent time, including popular restaurants and community gathering places, were successful in finding 13% of Spanish-speaking subjects. We conclude that study subjects released from jails can be successfully located using well-defined search protocols tailored to the ethnicity of the sample and including a variety of strategies. Employment of bilingual personnel is important when a large proportion of subjects is monolingual and non-English speaking.

Tuberculosis prevalence in an urban jail: 1994 and 1998

SETTING

Despite a continuing decline in tuberculosis (TB) in the US, jails remain a high-risk setting for the identification of active and latent TB infection (LTBI).

OBJECTIVE

The purpose of this study was to document the change in TB prevalence in the San Francisco City and County Jail.

DESIGN

Two period prevalence analyses were done, for 1994 and 1998. The sample included all persons booked into jail during the two years. The rates of inmates screened and the prevalence of active TB and LTBI by sex and ethnicity were compared using computerized records.

RESULTS

Prevalence of active TB was 72.1 per 100000 jail population for 1998, and did not change significantly from 1994. In 1998 one third of active TB cases were found through jail screening. Latinos represented respectively 20.1% and 17.7% of those booked in 1994 and 1998, but 43.0% and 41.7% of inmates with LTBI. In 1998, being Latino (odds ratio 2.9) and male (odds ratio 1.6) were most strongly associated with LTBI.

CONCLUSION

Screening for TB among jail inmates is an increasingly valuable clinical and epidemiological tool for case-finding and for identifying persons who would benefit from preventive therapy.

Distribution of lutein and zeaxanthin stereoisomers in the human retina

The distribution of macular pigment stereoisomers in the human retina has been mapped and a pathway to account for the presence of the non-dietary carotenoid, meso-zeaxanthin, is proposed. Adult neural retinas were cut into three concentric areas centered on the fovea, and the extracted carotenoids were analysed and purified by high-performance liquid chromatography. The dicarbamate or dibenzoate derivatives of the collected zeaxanthin fractions for each tissue sample were further analysed by HPLC to determine their stereoisomer composition. Whole retinas from infant eyes were similarly analysed. The results show that, relative to zeaxanthin, the concentration of lutein in the adult neural retina increases with radial distance from the fovea while that of meso-zeaxanthin decreases. Infant retinas were found to have more lutein and less meso-zeaxanthin, relative to zeaxanthin, than adult retinas. Small quantities of (3S, 3'S)-zeaxanthin were also found in the adult retina, particularly in the macula. It is proposed that lutein and zeaxanthin are transported into an individual's retina in the same proportions found in his or her blood serum. Some of the lutein is then converted into meso-zeaxanthin, primarily in the macula, by a mechanism which is less developed in infants than adults.

Influence of undernutrition during gestation and suckling on development and sexual maturity in the rat

The effects of undernourishment during gestation and suckling on rats subsequently fed ad libitum for 4 mo after weaning are explored. We measured the following: weight at birth and over a 5-mo period; sexual behavior of adult males; curiosity; basal physical activity; morphometric measures; organ weights (absolute and relative) including brain, testicles and seminal vesicles in males 5 mo of age; and the O2 uptake of some brain and glandular structures in males at 5 mo of age. Body weight of the malnourished animals was consistently lower than that of the controls. Compared to controls sexual behavior in undernourished males was significantly reduced, while curiosity test and basal physical activity were increased. The absolute weights of all organs (except the pituitary gland) were significantly lower in malnourished males at 5 mo than in controls. Compared to controls, relative weight of brain was greater and that of seminal vesicles was less in the male rats. Oxygen uptake was significantly lower in the pituitary gland and testicles of malnourished males than of controls. In view of these results, it can be concluded that malnutrition in utero and while suckling affects fundamental parameters of both development and reproductive function in the male offspring 4 mo after feeding ad libitum is begun at weaning.

Blockade of the antiadrenergic action of Bretylium by an aqueous extract of the leaves of Rhoeo spathacea

In isolated rabbit ileum, bretylium-induced blockade of the inhibitory response to stimulation of the adrenergic nerve supply is prevented by an aqueous extract of the leaves of Rhoeo spathacea, apparently as a result of its dopamine content.