Patient-Centered Outcomes for GoStrong: A Self-Management Diabetes Program in Savannah, GA

Background: To advance the goal of health improvement for diverse populations with diabetes, a patient-centered approach is foundational. Methods: Innovative methods were used to initiate and advance an approach to diabetes engagement and self-management. We began with a strategy to understand how patients with diabetes view and interact with the disease via the medical community and moved to program development through patient-centered design and to the development of strategic partnerships and continuous learning from patients, stakeholders, and academic research partners. Results: The mean age of the participants in the GoStrong™ program (n=106) was 51 ±9.2 (SD) years. There were significant differences in the HbA1c levels over time compared to the Control group (n=100). The mean HbA1c level from baseline to 36 months decreased from 7.49% to 6.89%, with the largest decline (to 6.28%, p\u3c0.01) at 12 months. The mean HbA1c level for the control group increased from 8.38% to 8.49% from baseline to 36 months, with the largest increase (to 8.89%, p\u3c0.01) at 18 months. There were significant differences for total medical costs at 12 months prior to and 12 months after starting the GoStrong program, a difference in total prescription drug costs at 12 months, and differences within the total group in number of emergency room (ER) visits. Claims information showed that GoStrong produced significantly lower total medical costs and ER visits. There was also an increase in total prescription drug costs that may be due to better medication adherence. Conclusions: For diabetics, the GoStrong program results in reduced HbA1c levels, reduced costs, and reduced ER visits

Long-term cellular immunity of vaccines for Zaire Ebola Virus Diseases

Recent Ebola outbreaks underscore the importance of continuous prevention and disease control efforts. Authorized vaccines include Merck’s Ervebo (rVSV-ZEBOV) and Johnson & Johnson’s two-dose combination (Ad26.ZEBOV/MVA-BN-Filo). Here, in a five-year follow-up of the PREVAC randomized trial (NCT02876328), we report the results of the immunology ancillary study of the trial. The primary endpoint is to evaluate long-term memory T-cell responses induced by three vaccine regimens: Ad26–MVA, rVSV, and rVSV–booster. Polyfunctional EBOV-specific CD4+ T-cell responses increase after Ad26 priming and are further boosted by MVA, whereas minimal responses are observed in the rVSV groups, declining after one year. In-vitro expansion for eight days show sustained EBOV-specific T-cell responses for up to 60 months post-prime vaccination with both Ad26-MVA and rVSV, with no decline. Cytokine production analysis identify shared biomarkers between the Ad26-MVA and rVSV groups. In secondary endpoint, we observed an elevation of pro-inflammatory cytokines at Day 7 in the rVSV group. Finally, we establish a correlation between EBOV-specific T-cell responses and anti-EBOV IgG responses. Our findings can guide booster vaccination recommendations and help identify populations likely to benefit from revaccination

Knowledge about and Exposure to Tick-borne Diseases in Georgia, USA

Background: Vector-borne diseases including tick-borne diseases (TBD) contribute significant morbidity and mortality in the US and worldwide. Ticks have been known to transmit pathogens to humans and their occurrence and distribution ranges are increasing due to climate changes and deforestation. However, the general public may not be aware of the growing prevalence of TBD in the state of Georgia. The purpose of this study was to assess the risk of tick exposure and to evaluate awareness of TBD among students attending college in south-eastern Georgia. Methods: Information about recent tick exposure and knowledge about vectors and TBD was obtained from 257 healthy individuals visiting a university health center. Blood was collected and sera tested using the indirect microimmunofluorescence (IFA) test and Rickettsa rickettsii antigen (RR-AG). Results: Sixty percent (n=257) of the participants tested positive for IgG antibody reacting with RR-AG (titer of \u3e128, 64 as the positive cutoff). Of the 154 participants who tested positive, only 4% reported that they had a tick bite or tick contact during the previous summer, but only 57% of responders could correctly recognize ticks. Only 35% and 15% had prior knowledge about TBD and tick prevention guidelines, respectively. Most of the participants spent their summer in Georgia (78%) and were engaged in a variety of recreational activities (94%) typically associated with enhanced risk of exposure to ticks. Conclusions: We determined there was a significant gap between the low awareness about TBD of young adults in Georgia and their significant antibody evidence of exposure to tick-borne rickettsiae. In order to increase awareness of potential TBD, further steps should be taken to increase public awareness of TBD in Georgia and to educate individuals about arthropod vectors, the significant risk of tick exposure due to various recreational activities, and techniques for prevention and avoidance of tick bites

Impact of a Prevention Bundle on Clostridium difficile Infection Rate in a Hospital in Southeastern US

We sought to assess the impact of a multicomponent prevention program on hospital-acquired Clostridium difficile infections in a hospital in the Southeastern United States. We collected retrospective data of 140 patients from years 2009-2014 and applied the Poisson regression model for analysis. We did not find any significant associations of increased risk of Clostridium difficile infections for the preintervention group. Further studies are needed to test multifaceted bundles in hospitals with high infection rates

Silent Risk of Tick-borne Diseases in Georgia, USA

Background: Vector-borne diseases, including tick-borne diseases (TBD) are on the rise in the USA and worldwide, possibly due in part to changes in climate and meteorological conditions. There have been few studies in the state of Georgia addressing the prevalence of TBD. The purpose of this study was to assess the contemporary risk of TBD exposure in a rural population in South-Eastern Georgia. Methods: A self-assessment survey of symptoms of recent exposure and knowledge of TBD was administered to 258 healthy individuals visiting a university health center. Blood was drawn and serological testing was performed using the indirect microimmunofluorescence (IFA) test and Rickettsia rickettsii antigen (RR-AG). Results: Of the 258 responders, 244 reported their participation in regular recreational activities potentially associated with tick exposure; however, only 11 individuals (4%) experienced a self-reported tick bite during the previous summer or fall. Most participants acknowledged their ability to recognize ticks, but only 48% (n=169) were able to correctly identify them when provided with pictures of a variety of arthropods. Similarly, only 38% and 18% of participants (n=257) were knowledgeable about proper practices of tick avoidance and prevention of tick bites, respectively. Fifty-six percent of the participants tested positive for IgG antibody reacting with RR-AG (titer of \u3e128, 64 as the positive cutoff). Conclusions: The assessment survey identified a significant knowledge gap regarding TBD among adults in Georgia. The significant level of TBD exposure we detected may affect the serological diagnosis of clinical rickettsial diseases in Georgia, USA because preexisting antibody may be interpreted as false positives. Continuous education about TBD is needed to improve awareness of the risks of exposure to ticks, to promote proper methods of tick protection and removal, and to disseminate current knowledge about these commonplace arthropods. Progra

Authors’ Response: Health Benefits/Hazards Associated with Companion Animal-Exposure Might be Endpoint- and Animal-Specific

This response was in regards to comments made in Pet Ownership and the Risk of Dying (Letter to the Editor) by Gillum, R. F. in High Blood Pressure and Cardiovascular Prevention

Pet Ownership and the Risk of Dying from Cardiovascular Disease Among Adults Without Major Chronic Medical Conditions

Introduction: In a recent statement, the American Heart Association stated “There are scant data on pet ownership and survival in people without established cardiovascular disease (CVD)”. This study sought to fill this gap. Methods: We analyzed nationally representative data of 3964 adults aged ≥50 who were free from major physical illnesses. Pet ownership was assessed at baseline between 1988 and 1994. Vital status was followed through December 31st 2006. Results: With dogs being most popular pets owned by 22.0 (standard error 0.34) % of the participants, 34.6 % of the study population owned a pet. Pet ownership was associated with low rates of CVD deaths [hazard ratio (HR) = 0.69 (95 % CI 0.45–1.07)] and stroke [0.54 (0.28–1.01)] at borderline significant levels among women. These associations were adjusted for physical activity and largely attributed to having a cat rather than a dog. Among cat owners, the HR of all CVD deaths was 0.62 (0.36–1.05) and the HR of dying from stroke was 0.22 (0.07–0.68) compared with non-cat owners. The corresponding HRs among dog owners were 0.82 (0.51–1.34) and 0.76 (0.34–1.71) respectively. No similar associations were observed among men. The hazard of dying from hypertension was not associated with pet ownership for both men and women. Conclusions: Owning a cat rather than a dog was significantly associated with a reduced hazard of dying from CVD events, in particular, stroke. The protection pets confer may not be from physical activities, but possibly due to personality of the pet owners or stress-relieving effects of animal companionship

Long-Term Decrease in Intraocular Pressure in Survivors of Ebola Virus Disease in the Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III Study

Objective: Survivors of Ebola virus disease (EVD) experience decreased intraocular pressure (IOP) relative to unaffected close contacts during the first year of convalescence. Whether this effect persists over time and its relationship to intraocular pathology are unclear. We sought to determine whether IOP remained lower in survivors of EVD over 4 years of follow-up and to identify associated risk factors. Design: Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III is a 5-year, longitudinal cohort study of survivors of EVD and their close contacts and is a collaboration between the Liberian Ministry of Health and the United States National Institutes of Health. Participants: Participants who enrolled in PREVAIL III at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 who underwent comprehensive ophthalmic evaluation annually for 5 consecutive visits. Methods: Intraocular pressure was measured at each visit by a handheld rebound tonometer using sterile tips. Comparisons are made between antibody-positive survivors and antibody-negative close contacts. Main Outcome Measures: Intraocular pressure, measured in mmHg, at each study visit. Results: Of 565 antibody-positive survivors and 644 antibody-negative close contacts enrolled in the study at baseline, the majority of participants returned annually, with 383 (67.8%) and 407 (63.2%) participants, respectively, presenting for the final study visit at a median of 60 months after symptom onset. A sustained, relative decrease in IOP was observed in survivors relative to close contacts, with mean difference of −0.72 mmHg (95% confidence interval [CI] −1.18 to −0.27) at the final study visit. This difference remained constant throughout the study period (P = 0.4 for interaction over time). Among survivors, physical examination findings of vitreous cell and OCT findings of vitreous opacities both demonstrated a significant association with decreased IOP at baseline (P < 0.05 for both). After adjusting for such factors, the difference throughout the follow-up (−0.93 mmHg, 95% CI, −1.23 to −0.63) remained significant. Conclusions: Survivors of EVD experienced a sustained decrease in IOP relative to close contacts over a 5-year period after EVD. The results highlight the importance of considering long-term sequelae of emerging infectious diseases within a population. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references