One health: a guiding imperative

Public-Private Partnerships for One Health PanelGiven the large proportion of households that include pets, this is perhaps a most important time to consider human-companion animal interaction as a vehicle to facilitate One Health (human-animal health). The potential benefits of this interaction is worthy of exploration for a number of health problems, such as obesity. The presentation will describe a program of research aimed at testing dog walking as an intervention aimed at improving physical activity and health for humans and dogs. The implications for public private partnerships will be discussed

Walk A Hound, Lose A Pound, & Stay Fit for Seniors

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionBackground: Obesity rates in older adults are linked with the national problem of limited physical activity (PA), resulting in chronic illness. Obesity-related illness and functional loss require innovative interventions. Older adult dog walkers maintained physical functioning over a 3 year period (Thorpe 2006). Dog walking may improve long-term PA by improving readiness and physical function. Purpose: The study aimed to test the association between dog walking and physical functioning. Methods: A three-group, repeated measures design tested efficacy of a 12-week (5 days/week) shelter dog walking program for community-dwelling adults over age 65. Three retirement facilities were assigned to the shelter dog walking (DW), human walking companion (HWC), or no-treatment control (C) group. DW group members selected a dog matching their walking capability & walked on a paved road at the animal shelter. HWC group members walked with a friend or spouse on a paved road at their residence. Both groups were accompanied by study staff. Pretest, mid-trial & posttest findings included 6-minute walk, weight, physical activity during the previous week, physical activity stage of change, mood & social support. Findings: Fifty-four adults participated {DW n=12, HWC n=23 & C n=19}. Fourteen males & 40 females, ranged in age from 67-97 years (Mean=85). The 6-minute walk compared pre and post for the DW group increased 28% (p=0.012), the HWC had a 4% increase (p=0.32) and the C group a 6% increase (p=0.18). Conclusions: DW group participants expressed affinity for the shelter dogs. The DW group's walking ability improved significantly. They stated that their balance & walking confidence improved. They stated that they liked the program because it “gets me out,” “is helping me to feel more confident,” & “is fun.” Dog walking may be beneficial to improve or maintain functioning in older adults. Walking speed is an important indicator of balance

Shelter Dog Behavior Improvement: Dog Walking as Enrichment

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionBackground: Several million dogs are euthanized in animal shelters annually after multiple relinquishment reasons (Scarlett, 2002; Salman, 1998; New, 2000 & Kass, 2001). Gains in pet adoptions are happening via shelter enrichment programs. We hypothesized that shelter dogs participating in a daily dog walking program involving elderly citizens, would have better behavior, higher adoption rates, and decreased euthanasia rates than dogs in a control group not in the walking program. Methods: All participant dogs were pre-qualified for walking through the standard shelter behavioral assessment for adoption. The dogs, at least one year of age were matched with a control dog for size (small, medium and large). The experimental group walked with an older adult five days a week. The control group of dogs did not walk. Pre-test and daily behavior scores were assigned. The length of time each dog spent in the shelter was recorded as were adoption, move to foster care, release to a breed rescue group or euthanasia outcomes. Results: There were 84 dog pairs. Outcomes for the experimental (walking) group: adoption n=58, to foster/rescue n=13, euthanized n=7. For the control group: adoption n=26, to foster/rescue n=28, and euthanized n=20. A chi-square test showed that the experimental group had significantly more adoptions (p<0.0001) and fewer euthanasias (p=.0063) than the control group. The control group had significantly more dogs that went to breed rescue networks (p=.00071) than did the experimental group. The control group had a higher total behavior score (exhibited more negative behavior). The Wilcoxon rank sum test was used to compare the experimental and control groups in terms of total behavior scores. Dogs in the experimental group had significantly better behavior than dogs in the control group (p=<0.0001). Conclusions: The dog walking program was associated with desired dog behavior outcomes, better adoption rates and lower euthanasia rates

Enrollment of adolescents and young adults onto SWOG cancer research network clinical trials: A comparative analysis by treatment site and era.

BackgroundFew adolescents and young adults (AYAs, 15-39 years old) enroll onto cancer clinical trials, which hinders research otherwise having the potential to improve outcomes in this unique population. Prior studies have reported that AYAs are more likely to receive cancer care in community settings. The National Cancer Institute (NCI) has led efforts to increase trial enrollment through its network of NCI-designated cancer centers (NCICC) combined with community outreach through its Community Clinical Oncology Program (CCOP; replaced by the NCI Community Oncology Research Program in 2014).MethodsUsing AYA proportional enrollment (the proportion of total enrollments who were AYAs) as the primary outcome, we examined enrollment of AYAs onto SWOG therapeutic trials at NCICC, CCOP, and non-NCICC/non-CCOP sites from 2004 to 2013 by type of site, study period (2004-08 vs 2009-13), and patient demographics.ResultsOverall, AYA proportional enrollment was 10.1%. AYA proportional enrollment decreased between 2004-2008 and 2009-2013 (13.1% vs 8.5%, P &lt; .001), and was higher at NCICCs than at CCOPs and non-NCICC/non-CCOPs (14.1% vs 8.3% and 9.2%, respectively; P &lt; .001). AYA proportional enrollment declined significantly at all three site types. Proportional enrollment of AYAs who were Black or Hispanic was significantly higher at NCICCs compared with CCOPs or non-NCICC/non-CCOPs (11.5% vs 8.8, P = .048 and 11.5% vs 8.6%, P = .03, respectively).ConclusionNot only did community sites enroll a lower proportion of AYAs onto cancer clinical trials, but AYA enrollment decreased in all study settings. Initiatives aimed at increasing AYA enrollment, particularly in the community setting with attention to minority status, are needed

TigerPlace, a State-Academic-Private Project to Revolutionize Traditional Long Term Care

This is a preprint of an article whose final and definitive form has been published in the Journal of Housing for the Elderly 2008, copyright Taylor & Francis. Journal of Housing for the Elderly is available online at: http://www.informaworld.com/openurl?genre=article&issn=0276-3893&volume=22&issue=1&spage=66 DOI:10.1080/02763890802097045The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.The authors wish to acknowledge the organizations and staff who made the AIP project possible: Americare of Sikeston, MO; TigerPlace staff; Sinclair Home Care staff; MU Sinclair School of Nursing faculty and deans; MU administration; Missouri Department of Health and Senior Services staff; Missouri state legislature (in particular, Tim Harlan of Columbia, MO); and all the friends and families who have supported those who implemented this pioneering effort

Factors associated with attendance at screening for breast cancer : a systematic review and meta-analysis

Objective: Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance. Design: CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987–June 2019, and reporting attendance in relation to at least one patient-level factor. Data synthesis: Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible. Results: Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence. Conclusions: Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated. Trial registration number: CRD42016051597

Preclinical Alzheimer's disease and longitudinal driving decline

Introduction: Links between preclinical Alzheimer's disease (AD) and driving difficulty onset would support the use of driving performance as an outcome in primary and secondary prevention trials among older adults (OAs). We examined whether AD biomarkers predicted the onset of driving difficulties among OAs. Methods: One hundred four OAs (65+ years) with normal cognition took part in biomarker measurements, a road test, clinical and psychometric batteries, and self-reported their driving habits. Results: Higher values of cerebrospinal fluid (CSF) tau/Aβ42 and phosphorylated tau (ptau181)/Aβ42 ratios, but not uptake on Pittsburgh compound B amyloid imaging (P = .12), predicted time to a rating of marginal or fail on the driving test using Cox proportional hazards models. Hazards ratios (95% confidence interval) were 5.75 (1.70–19.53), P = .005 for CSF tau/Aβ42; 6.19 (1.75–21.88), and P = .005 for CSF ptau181/Aβ42. Discussion Preclinical AD predicted time to receiving a marginal or fail rating on an on-road driving test. Driving performance shows promise as a functional outcome in AD prevention trials

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization.

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy