Nutrition Screening and Assessment in Hospitalized Patients

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141744/1/ncp0483.pd

Gene expression changes in therapeutic ultrasound-treated venous leg ulcers

IntroductionLow-frequency, low-intensity ultrasound has been previously shown to promote healing of chronic wounds in humans, but mechanisms behind these effects are poorly understood. The purpose of this study was to evaluate gene expression differences in debrided human venous ulcer tissue from patients treated with low-frequency (20 kHz), low-intensity (100 mW/cm2) ultrasound compared to a sham treatment in an effort to better understand the potential biological mechanisms.MethodsDebrided venous ulcer tissue was collected from 32 subjects one week after sham treatment or low-frequency, low-intensity ultrasound treatment. Of these samples, 7 samples (3 ultrasound treated and 4 sham treated) yielded sufficient quality total RNA for analysis by ultra-high multiplexed PCR (Ampliseq) and expression of more than 24,000 genes was analyzed. 477 genes were found to be significantly differentially expressed between the ultrasound and sham groups using cut-off values of p < 0.05 and fold change of 2.Results and DiscussionThe top differentially expressed genes included those involved in regulation of cell metabolism, proliferation, and immune cell signaling. Gene set enrichment analysis identified 20 significantly enriched gene sets from upregulated genes and 4 significantly enriched gene sets from downregulated genes. Most of the enriched gene sets from upregulated genes were related to cell-cell signaling pathways. The most significantly enriched gene set from downregulated genes was the inflammatory response gene set. These findings show that therapeutic ultrasound influences cellular behavior in chronic wounds as early as 1 week after application. Considering the well-known role of chronic inflammation in impairing wound healing in chronic wounds, these results suggest that a downregulation of inflammatory genes is a possible biological mechanism of ultrasound-mediated venous chronic wound healing. Such increased understanding may ultimately lead to the enhancement of ultrasound devices to accelerate chronic wound healing and increase patient quality of life

Influence of toilet access on antiretroviral adherence intention among pregnant and breastfeeding women who are HIV-positive and enrolled in Option B.

We investigated the influence of toilet access on intention to adhere to antiretroviral therapy (ART) among women who are HIV-positive and enrolled in Option B+. A convenience sample of 150 women residing in Lusaka (urban) and Sinazongwe (rural) Districts of Zambia were recruited. if they were seeking pre- or post-natal care and were enrolled in Option B+. Intention to adhere to ART was assessed using four questions based on the Theory of Planned Behavior; the median score was used to distinguish high intention from low intention. Descriptive statistics were used to characterize access to toilet facilities and ART adherence intention in the entire sample and by rural and urban districts in Zambia. There was no significant difference (p = .19) between rural and urban women's access to a flush toilet. After adjusting for toilet access, however, rural women were significantly less likely to be in the high adherence intention group (PR = 0.80, 95% CI 0.71-0.90, p < .001) but access to a flush toilet was associated with adherence intention (PR = 1.14, 95% CI (1.00 - 1.30). Community-led total sanitation in Zambia could increase ART adherence intention

Influence of toilet access on antiretroviral adherence intention among pregnant and breastfeeding women who are HIV-positive and enrolled in Option B.

We investigated the influence of toilet access on intention to adhere to antiretroviral therapy (ART) among women who are HIV-positive and enrolled in Option B+. A convenience sample of 150 women residing in Lusaka (urban) and Sinazongwe (rural) Districts of Zambia were recruited. if they were seeking pre- or post-natal care and were enrolled in Option B+. Intention to adhere to ART was assessed using four questions based on the Theory of Planned Behavior; the median score was used to distinguish high intention from low intention. Descriptive statistics were used to characterize access to toilet facilities and ART adherence intention in the entire sample and by rural and urban districts in Zambia. There was no significant difference (p = .19) between rural and urban women's access to a flush toilet. After adjusting for toilet access, however, rural women were significantly less likely to be in the high adherence intention group (PR = 0.80, 95% CI 0.71-0.90, p < .001) but access to a flush toilet was associated with adherence intention (PR = 1.14, 95% CI (1.00 - 1.30). Community-led total sanitation in Zambia could increase ART adherence intention

Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia.

ObjectiveThe aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia.MethodsWe recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART.ResultsIntention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67-0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76-0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality.ConclusionCompared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course

Water Access and Adherence Intention Among HIV-Positive Pregnant Women and New Mothers Receiving Antiretroviral Therapy in Zambia.

BackgroundMother-to-infant transmission of HIV is a major problem in Sub-Saharan Africa despite free or subsidized antiretroviral treatment (ART), but is significantly reduced when mothers adhere to ART. Because potable water access is limited in low-resource countries, we investigated water access and ART adherence intention among HIV-positive pregnant women and new mothers in Zambia.MethodsOur convenience sample consisted of 150 pregnant or postpartum women receiving ART. Descriptive statistics compared type of water access by low and high levels of ART adherence intention.ResultsMost (71%) had access to piped water, but 36% of the low-adherence intention group obtained water from a well, borehole, lake or stream, compared to only 22% of the high-adherence intention group. The low-adherence intention group was more rural (62%) than urban (38%) women but not statistically significant [unadjusted Prevalence Ratio (PR) 0.73, 95% CI: 0.52-1.02; adjusted PR 1.06, 95% CI: 0.78-1.45].ConclusionProviding potable water may improve ART adherence. Assessing available water sources in both rural and urban locations is critical when educating women initiating ART

Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia.

ObjectiveThe aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia.MethodsWe recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART.ResultsIntention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67-0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76-0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality.ConclusionCompared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course