Relationship between Health Information Sharing Behavior Using Social Media and Breast Cancer Screening

Background: Despite established screening guidelines, breast cancer screening rates are below targeted goals. Pharmacists and other health care providers can promote breast cancer screening using tools such as social media. However, little is known about the use of social media among the breast cancer screening eligible population. Objective: To describe the health information sharing behavior using social media of the breast cancer screening eligible population, and to identify if sharing health information on social media was associated with breast cancer screening. Methods and materials: Data from the 2013 Health Information National Trends Survey were analyzed using descriptive statistics and bivariate logistic regression to evaluate the association between sharing health information on social media and receipt of a mammogram. Results: Women sharing health information via social media were significantly younger than those who did not. A significantly higher percentage of Hispanics (17.8%) and other races (27.0%) chose to share health information on social media compared to African Americans (8.6%) and Whites (12.9%). Mammogram rates did not differ based on social media health information sharing habits. Conclusion: Race and age differences were noted in health information sharing behavior. No association was found between health information sharing behavior and breast cancer screening. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties   Type: Original Researc

What makes the pregnant women revisit public hospitals for research? Participant engagement and retention trial in a public hospital (PERTH): an RCT protocol.

BACKGROUND: Cohort studies have public health importance as they effectively provide evidence on determinants of health from a life course perspective. Researchers often confront the poor follow-up rates as a major challenge in the successful conduct of cohort studies. We are currently recruiting in a birth cohort study, titled as "Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin" (MAASTHI) in a public hospital; with the aim of assessing maternal glycemic levels on the risk of adverse fetal outcomes. Nested within the ongoing cohort, the proposed trial aims to evaluate the effectiveness of two interventions in improving the follow-up in the cohort study in a public hospital. METHODS: A randomized trial of 795 pregnant women, with 265 women each in three arms observed through pregnancy, until their baby is 14 weeks old. The comparator group receives a standard leaflet, with details on the importance of glucose testing and regular follow up in pregnancy. Intervention arm-1 will receive the standard leaflet plus individualized messages, through an Interactive Voice Response (IVR) system; a type of computer-linked telephone intervention system to remind the participants about the lab test and follow-up dates. Intervention arm- 2 will have the opportunity to attend Mother and Baby Affairs (MBA) workshops, which will provide information on Gestational Diabetes Mellitus (GDM) screening and management to pregnant women and personalized counselling services. The outcome of interest is the difference in the proportion of participants completing follow-up at different points in time, among three arms. DISCUSSION: Between the two interventions (IVR and MBA), the study results would uncover the contextually specific, timely intervention, which can increase the proportion of pregnant women followed up in public hospitals. If effective, this study will provide information on an effective intervention, useful in ensuring the success of longitudinal follow-up in the public hospitals. TRIAL REGISTRATION: NCT03088501 , Date Registered: 16/03/2017

Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI): a prospective cohort study : Protocol of birth cohort at Bangalore, India.

BACKGROUND: India is experiencing an epidemic of obesity-hyperglycaemia, which coincides with child bearing age for women. The epidemic can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, we developed the protocol for the proposed birth cohort of 5000 women, the recruitment for which will start in April 2016. The protocol of the study documents the processes which aim at advancing the available knowledge, linking several steps in the evolution of obesity led hyperglycemia. METHODS: Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) is a cohort study in the public health facilities in Bangalore, India. The objective of MAASTHI is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases. The primary objective of the proposed study is to investigate the effect of glucose levels in pregnancy on skinfold thickness (adiposity) in infancy as a marker of future obesity and diabetes in offspring. The secondary objective is to assess the association between psychosocial environment of mothers and adverse neonatal outcomes including adiposity. The study aims to recruit 5000 pregnant women and follow them and their offspring for a period of 4 years. The institutional review board at The Indian Institute of Public Health (IIPH)-H, Bangalore, Public Health Foundation of India has approved the protocol. All participants are required to provide written informed consent. DISCUSSION: The findings from this study may help to address important questions on screening and management of high blood sugar in pregnancy. It may provide critical information on the specific determinants driving the underweight-obesity-T2DM epidemic in India. The study can inform the policy regarding the potential impact of screening and management protocols in public healthcare facilities. The public health implications include prioritising issues of maternal glycemic control and weight management and better understanding of the lifecourse determinants in the development of T2DM

Facilitating Healthy Coping in Patients With Diabetes: A Systematic Review

The purpose of this study is to summarize recent literature on approaches to supporting healthy coping in diabetes, in two specific areas: 1) impact of different approaches to diabetes treatment on healthy coping; and 2) effectiveness of interventions specifically designed to support healthy coping

Elucidation of the c-di-GMP mediated signaling mechanism in a bacterial transmembrane receptor

The LapA/LapG/LapD system is a common biofilm effector system found in over 1000 bacterial genomes and is mediated by the bacterial second messenger, cyclic-di-GMP or c-di-GMP. C-di-GMP along with the proteins that synthesize it (diguanylate cyclases or DGCs with GGDEF domains) and degrade it (phosphodiesterases or PDEs with EAL or HD-GYP domains) are important regulators of biofilm formation. Although some aspects of the biofilm formation process are fairly well understood, much still remains to be elucidated at the molecular level, especially the signaling mechanisms and the associated conformational changes in these proteins that are crucial for cell adhesion in a wide variety of bacteria, including several human pathogens. This study was undertaken to fill some of these gaps in our knowledge, focusing on the molecular mechanism of the transmembrane c-di-GMP receptor LapD, the main signaling switch in this pathway in Pseudomonas fluorescens. In this study, we introduced single amino acid cysteine mutations spanning the entire HAMP domain and the S-helix in a LapD-green fluorescent protein-fusion protein. As LapD exists as a homodimer as its smallest functional unit, a single amino acid substitution is represented once in each monomeric unit and the intra-dimer crosslinking of these residues was reported. Four distinct states/conformations of LapD were studied: 1) apo, 2) in the presence of c-di-GMP, 3) in the presence of LapG, and 4) in the presence of both c-di-GMP and LapG. Cysteine crosslinking experiments were performed on these four states of LapD by mildly oxidizing the protein in the presence of the catalyst copper phenanthroline [Cu(Phen)2]. The presence of disulfide dimer formation was detected using in-gel fluorescence by monitoring electrophoretic mobility shifts of the msfGFP-fusion protein on SDS-PAGE gels. Most of the 68-cysteine mutants generated spanning the HAMP domain and the S-helix displayed a significant level of intra-dimer crosslinking irrespective of whether they were proximally or distally located in the helices, or whether they were buried or surface-exposed. LapD thus appears to exist in multiple conformations in solution such that even more distal residues in the helices could come into close contact with each other. Periplasmic domain mutants located closer to the LapG binding site showed the highest levels of crosslinking for the partially activated LapG-LapD bound protein. Less crosslinking was observed whenever c-di-GMP was also available for binding. However, mutants located closer to the transmembrane domain showed higher crosslinking rates in the presence of c-di-GMP. Cysteine substitutions made on helix α1-H crosslinked readily in the absence of oxidant, whereas residues on helix α2-H showed little crosslinking under similar experimental conditions. In partially and fully activated states of LapD, consecutive residues on α2-H helix showed large differences in disulfide bond formation, whereas it tended to be similar for residues belonging to the α1-H. Cysteine mutations in residues located on α2-H also revealed the presence of an additional cross-linked species in conditions where LapD was able to form dimer-of-dimers. The fact that crosslinks were observed in different states of LapD activation and that the rates of disulfide bond formation differed across different activation states implies that LapD may operate by oscillating between different bundle conformations. Our results, therefore, suggest that LapD’s signaling mechanism appears to be more consistent with a dynamic bundle model rather than a conventional two-state signaling model such as the gearbox model

Estimation of Annual Health Care Costs for Adults with Type 1 Diabetes in the United States.

BACKGROUND: Diabetes health care resource utilization (HCRU) studies tend to focus on patients with type 2 diabetes (T2D) or pool patients with T2D and type 1 diabetes (T1D). There is a paucity of recent data on the cost of treating patients with T1D in the United States. OBJECTIVES: To (a) estimate the per-patient per-year (PPPY) HCRU and costs, from a payer perspective, associated with treating U.S. adults with T1D and (b) compare these with the HCRU and costs for patients with T2D. METHODS: This retrospective cohort study used claims data from the Optum Clinformatics database between January 2015 and December 2017. Adults (aged ≥ 18 years) with a diagnosis of T1D were propensity score-matched to adults with T2D. Overall and nondiabetes-related HCRU and costs were assessed for T1D and T2D and compared between the 2 groups. RESULTS: Propensity scores were used to match 10,103 patient pairs from T1D and T2D cohorts (mean ages 54.4 and 56.9 years, respectively). In the T1D cohort, inpatient, emergency department (ED), outpatient, and prescription claims occurred in 14.0%, 17.3%, 85.5%, and 100% of patients, respectively, resulting in a mean total cost of U.S. $18,817 PPPY (diabetes-related =$11,002; nondiabetes-related = $7,816). The T1D cohort had significantly higher mean total costs than the T2D cohort ($18,817 vs. 14,148 PPPY; P < 0.001). When extrapolating these findings to a commercial health plan with 1 million covered lives, the estimated total direct medical costs of T1D would be 103.4 million. CONCLUSIONS: This study showed that the total annual cost of managing an adult with T1D is significantly higher than that of an adult with T2D. Nondiabetes costs accounted for 40% of the total per-patient cost, similar to patients with T2D, confirming that as patients with T1D live longer lives, they may also be at greater risk for cardiometabolic complications. DISCLOSURES: This study was funded by Sanofi U.S. and Lexicon Pharmaceuticals as part of a business partnership in a diabetes program at the time this study was conducted. Joish and Davies are employees and stockholders of Lexicon Pharmaceuticals. Zhou, Preblick, and Paranjape are employees and stockholders of Sanofi. Lin was a postdoctoral fellow at Sanofi through Rutgers University during this project. Deshpande provided consulting services through Communication Symmetry. Verma is an employee of Evidera, which was contracted by Sanofi for work on this study. Pettus is a consultant for Diasome, Insulet, Lexicon, Lilly, Mannkind, Novo Nordisk, Sanofi, and Senseonics