Even with antiretroviral therapy, children born to HIV-infected (HI) mothers are at a higher risk of early-life infections and morbidities including dental disease. The increased risk of dental caries in HI children suggest immune-mediated changes in oral bacterial communities, however, the impact of perinatal HIV exposure on the oral microbiota remains unclear. We hypothesized that the oral microbiota of HI and perinatally HIV-exposed-but-uninfected (HEU) children will significantly differ from HIV-unexposed-and-uninfected (HUU) children. Saliva samples from 286 child-participants in Nigeria, aged ≤ 6 years, were analyzed using 16S rRNA gene sequencing. Perinatal HIV infection was significantly associated with community composition (HI vs. HUU—p = 0.04; HEU vs. HUU—p = 0.11) however, immune status had stronger impacts on bacterial profiles (p < 0.001). We observed age-stratified associations of perinatal HIV exposure on community composition, with HEU children differing from HUU children in early life but HEU children becoming more similar to HUU children with age. Our findings suggest that, regardless of age, HIV infection or exposure, low CD4 levels persistently alter the oral microbiota during this critical developmental period. Data also indicates that, while HIV infection clearly shapes the developing infant oral microbiome, the effect of perinatal exposure (without infection) appears transient.

BACKGROUND:Depression is common in patients with inflammatory bowel disease (IBD) and contributes to poor quality of life (QoL). The use of information technology for the remote management of patients with IBD is growing, but little is known about its impact on depressive symptoms (DS) and QoL. We aimed to evaluate the impact of telemedicine on DS and generic QoL in IBD patients.METHODS:We analyzed data from the Telemedicine for Patients with IBD (TELE-IBD) study. During this 12-month clinical trial, patients were randomized to receive text message-based telemedicine weekly (TELE-IBD W), every other week (TELE-IBD EOW), or to standard care. Depressive symptoms and QoL were assessed over time with the Mental Health Inventory 5 (MHI-5) and the Short Form 12 (SF-12), respectively. We compared the change in MHI-5 and SF-12 (with separate physical (PCS) and mental component summary (MCS) scores) between the study arms.RESULTS:A total of 217 participants were included in this analysis. After 1 year, there was no significant difference in the change in MHI-5 (TELE-IBD W +3.0 vs TELE-IBD EOW +0.7 vs standard care +3.4; P = 0.70), MCS (TELE-IBD W +1.4 vs TELE-IBD EOW +1.0 vs standard care +2.5; P = 0.89), and PCS scores (TELE-IBD W +0.4 vs TELE-IBD EOW +0.6 vs standard care +3.7; P = 0.06) between the groups.CONCLUSIONS:Text message-based telemedicine does not improve DS or QoL when compared with standard care in IBD patients treated at tertiary referral centers. Further studies are needed to determine whether telemedicine improves DS or QoL in settings with few resources.

This manuscript is a secondary analysis of a large multicenter randomized controlled trial. The primary study is Cross RK et al., A Randomized Controlled Trial of TELEmedicine for patients with Inflammatory Bowel Disease (TELE-IBD). Am J Gastroenterol, 2019 Mar.

Inflammatory bowel disease (IBD) is a chronic debilitating condition involving the gastrointestinal (GI) tract that has a negative impact on quality of life (QoL). Depressive symptoms (DS) are common in affected patients and contribute to decreased QoL. Telemedicine is the use of information technology to remotely deliver health care; it is poised to gain widespread use in the care of IBD patients. However, its effect on DS and QoL is unknown in IBD. We investigated the impact of telemedicine on DS and QoL over time. This was a one-year, multicenter, randomized, controlled trial evaluating disease activity and QoL in IBD patients using text message-based telemedicine. Participants were randomized to three groups: standard of care and telemedicine weekly or every other week (EOW). Using mobile phones, telemedicine participants relayed information on their clinical symptoms and treatment plans were similarly conveyed to them. DS and QoL were measured using the Mental Health Inventory (MHI-5) and Short Form (SF-12) respectively. The SF-12 score has a physical component score (PCS) and a mental component score (MCS). Change in MHI-5 and SF-12 scores from baseline to 12 months was assessed, and comparison was made between the intervention and control groups. Of the 217 study participants, 59% were woman and 69% had Crohn’s disease. The number of participants in the control, telemedicine weekly and EOW groups were 72, 71, and 74 respectively. The baseline PCS, MCS, and MHI-5 scores were 46.9, 48.6, and 74.9 for all participants. Increase in mean PCS (p=0.0003) and MCS (p=0.04) was significant in the standard of care group over the study period. After controlling for confounding variables, there was no significant difference in the mean change in PCS (p=0.06), MCS (p=0.89), and MHI-5 (p=0.70) scores among the standard of care, weekly and EOW telemedicine groups. Text message-based telemedicine does not lead to improvement of DS or QoL when compared to standard of care in IBD patients. Although telemedicine has been shown to reduce healthcare utilization and improve access to care, caution should be exercised in overstating its benefits with regards to outcomes such as DS and QoL. Future studies should explore the impact of telemedicine on DS and QoL in other settings such as community practices.

INTRODUCTION: Telemedicine has shown promise in inflammatory bowel disease (IBD). The objective of this study was to compare disease activity and quality of life (QoL) in a 1-year randomized trial of IBD patients receiving telemedicine vs. standard care. METHODS: Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine (monitoring via texts EOW or weekly) or standard care. The primary outcomes were the differences in change in disease activity and QoL between the groups; change in healthcare utilization among groups was a secondary aim. RESULTS: 348 participants were enrolled (117 control group, 115 TELE-IBD EOW, and 116 TELE-IBD weekly). 259 (74.4%) completed the study. Age was 38.9 ± 12.3 years, 56.6% were women, 91.9% were Caucasian, 67.9% had Crohn’s disease (CD) and 42.5% had active disease at baseline. In CD, all groups experienced a decrease in disease activity (control −5.2 ± 5.0 to 3.7 ± 3.6, TELE-IBD EOW 4.7 ± 4.1 to 4.2 ± 3.9, and TELE-IBD weekly 4.2 ± 4.2 to 3.2 ± 3.4, p < 0.0001 for each of the groups) In UC, only controls had a significant decrease in disease activity (control 2.9 ± 3.1 to 1.4 ± 1.4, p = 0.01, TELE-IBD EOW 2.7 ± 3.1 to 1.7 ± 1.9, p = 0.35, and TELE-IBD Weekly 2.5 ± 2.5 to 2.0 ± 1.8, p = 0.31). QoL increased in all groups; the increase was significant only in TELE-IBD EOW (control 168.1 ± 34.0 to 179.3 ± 28.2, p = 0.06, TELE-IBD EOW 172.3 ± 33.1 to 181.5 ± 28.2, p = 0.03, and TELE-IBD Weekly 172.3 ± 34.5 to 179.2 ± 32.8, p = 0.10). Unadjusted and adjusted changes in disease activity and QoL were not significantly different among groups. Healthcare utilization increased in all groups. TELE-IBD weekly were less likely to have IBD-related hospitalizations and more likely to have non-invasive diagnostic tests and electronic encounters compared to controls; both TELE-IBD groups had decreased non-IBD related hospitalizations and increased telephone calls compared to controls. DISCUSSION: Disease activity and QoL, although improved in all participants, were not improved further through use of the TELE-IBD system. TELE-IBD participants experienced a decrease in hospitalizations with an associated increase in non-invasive diagnostic tests, telephone calls and electronic encounters. Research is needed to determine if TELE-IBD can be improved through patient engagement and whether it can decrease healthcare utilization by replacing standard care.

Background: Depression is common in patients with inflammatory bowel disease (IBD) and is known to be associated with poor adherence in the usual care setting. In the last decade, there has been an increase in the use of information technology (IT) for the delivery of IBD care, but the association between depressive symptoms (DS) and adherence to self-testing in this context is not known. We aimed to investigate this association among IBD patients managed via a text messaging-based telemedicine system. Methods: This was a prospective study of participants in the 2 intervention arms of the Telemedicine for Patients with IBD (TELE-IBD) trial. Depressive symptoms were measured at baseline, and then participants received periodic text messages to initiate IBD-specific self-testing. Treatment plans were similarly conveyed, and adherence to self-testing was evaluated at the end of 1 year. Regression analyses were performed, and age-stratified models were constructed to evaluate for effect modification. Results: Of the 193 study participants, 48% had DS at baseline. Overall, there was no significant association between DS and adherence to self-testing. However, upon stratification by age, adherence increased with depressive symptoms in those that were 40 years and younger (P = 0.02), but there was no association between depressive symptoms and adherence in the older group (P = 0.53). Conclusions: Younger IBD patients with DS have high adherence when managed in a text messaging-based telemedicine program. Telemedicine interventions have the potential to improve health outcomes in this demographic-a group that is often thought to be difficult to manage due to nonadherence.

Background: African Americans (AA) experience higher incidence and mortality of lung cancer as compared with European Americans (EA). Inflammation is associated with lung cancer, many aspects of which differ between AA and EA. We investigated whether use, frequency, and duration of the anti-inflammatory drug aspirin were associated with lung cancer risk and survival, separately among AA and EA populations. Methods: Using data from the Maryland Non–Small Cell Lung Cancer (NSCLC) Case–Control Study (1,220 cases [404 AA and 816 EA] and 1,634 controls [1,004 EA and 630 AA]), we estimated the adjusted odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) of the associations between aspirin use and NSCLC risk and survival, respectively. Results: Any aspirin use (OR: 0.66; 95% CI, 0.49–0.89), daily use of ≥ 1 tablet (OR: 0.68; 95% CI, 0.50–0.90), and use for ≥ 3 years (OR: 0.61; 95% CI, 0.44–0.85) was associated with lower NSCLC risk only among men, even after adjustment for covariates including body mass index and global genetic ancestry. These variables were also associated with improved survival, but only among AA (HR: 0.64; 95% CI, 0.46–0.91; HR: 0.61; 95% CI, 0.42–0.90; and HR: 0.60; 95% CI, 0.39–0.92, respectively). Tylenol and other NSAIDs were either associated with elevated or no NSCLC risk. Conclusions: Aspirin use is associated with lower risk of NSCLC among men and improved survival among AA. Impact: Preventive regular aspirin use could be considered among men and AA.

IBD affects 1.6 million people in the US and is associated with increased healthcare utilization. Telemedicine is an alternative healthcare delivery system which could improve outcomes and decrease costs. The objective of this study was to compare healthcare utilization 1 year before and after randomization among participants receiving TELE-IBD and standard care.

Background:Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients' limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge.Methods:TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups.Results:This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms.Conclusions:Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.

Background: Although HIV infection is associated with well-known oral pathologies, there remains a dearth of comparative studies aimed at determining the association between HIV infection/exposure and early childhood caries. Methods: This is a cross-sectional study using a convenience sample of 3 groups of children receiving care at a tertiary care hospital in Nigeria. The groups include HIV infected (HI), HIV exposed but uninfected and HIV-unexposed and -uninfected children 6 through 72 months of age. Medical records were reviewed, and caregivers were interviewed for sociodemographic, maternal and birth factors as well as early feeding and dietary information. Oral examinations were performed by trained dentist examiners. Results: Of 335 children enrolled, 33 (9.9%) presented with caries. In an adjusted analysis, compared with HIV-unexposed and -uninfected children, HI children had significantly greater odds of having caries (odds ratio = 2.58; 95% confidence interval: 1.04–6.40; P = 0.04), but there was no statistically significant difference in HIV exposed but uninfected children (odds ratio = 2.01; 95% confidence interval: 0.56–7.23; P = 0.28). Factors significantly associated with higher caries prevalence include low CD4 counts and percentage, older age, longer duration of breastfeeding and spontaneous membrane rupture during delivery. Conclusions: Caries was more prevalent in HI children. These findings support the need to target HI children for oral health prevention and treatment services particularly in Nigeria and other developing countries.

Purpose: Lung cancer is a multifactorial malignancy for which some risk factors, such as chronic lung diseases, their interactions with smoking, and how they differ by race and sex, are not fully understood. We investigated the associations between chronic inflammatory lung disease and non small cell lung carcinoma (NSCLC) and how sex and race may affect such associations. Methods: Using logistic regression, we analyzed 1660 lung cancer cases and 1959 population controls and estimated adjusted odds ratios (AORs) and 95% confidence intervals (Os). Results: Chronic lung disease was significantly associated with higher odds of having NSCLC in never (AOR = 1.99; 95% CI = 1.19-334), former (AOR = 1.68; 95% CI = 1.29-2.20), and current smokers (AOR = 2.40; 95% CI = 1.62-3.57), after adjustment for relevant covariates. For each 5-year increment in chronic lung disease duration, the risk of lung cancer increased only among females (AOR = 1.07; 95% CI = 1.02-1.13). Females, but not males, with asthma were at risk for NSCLC (AOR = 2.08; 95% CI = 1.40-3.10). Conclusions: This study provides support for chronic lung inflammation as a potential contributing factor to lung cancer risk and possible sex difference in the inflammatory events underlying disease mechanisms. (C) 2018 Elsevier Inc. All rights reserved.

Background The effect of treating comorbid depression to achieve optimal management of chronic obstructive pulmonary disease (COPD) has not yet empirically tested. We examined the association between antidepressant treatment and use of and adherence to COPD maintenance medications among patients with new‐onset COPD and comorbid depression. Methods Using 2006‐2012 Medicare data, this retrospective cohort study identified patients with newly diagnosed COPD and new‐onset major depression. Two exposures—antidepressant use (versus non‐use) and adherence measured by proportion of days covered (PDC) (PDC ≥0.8 versus <0.8)—were assessed quarterly. We used marginal structural models to estimate the effects of prior antidepressant use and adherence on subsequent COPD maintenance inhaler use and adherence outcomes, accounting for time‐varying confounders. Results A total of 25 458 COPD‐depression patients, 82% with antidepressant treatment, were followed for a median of 2.5 years. Nearly half (48%) used at least 1 COPD maintenance inhaler in any given quarter; among users, 3 in 5 (61%) had a PDC of <0.8. Compared to patients with no antidepressant treatment, those with antidepressant use were more likely to use (relative ratio [RR] = 1.15, 95% confidence interval [CI] = 1.12‐ 1.17) and adhere to (RR = 1.08, 95% = 1.03‐1.14) their COPD maintenance inhalers. Patients who adhered to antidepressant treatment were more likely to use and adhere to COPD maintenance inhalers. Conclusion Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication‐taking behaviors among COPD patients comorbid with depression.

Introduction: While effective treatments are available for patients with inflammatory bowel disease (IBD), suboptimal outcomes continue to occur and have been linked to many factors including patients' limited knowledge of their disease. Telemedicine has been used to educate IBD patients with some success. The aim of our study was to determine if delivery of educational messages through a novel telemedicine system can improve patients' disease knowledge. Methods: Our study was a sub-study of the TELEmedicine for Patients with IBD (TELE-IBD) study. Patients from 3 IBD referral centers were randomized to receive TELE-IBD EOW, TELE-IBD weekly or standard of care. Participants in the TELE-IBD weekly and EOW arms received 2 and 1 educational messages per week respectively; controls received educational materials at the discretion of their provider. Participants had visits at baseline, 6 and 12 months; disease knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year between the TELE-IBD and control arms. Results: 348 patients were enrolled and 74% (n=259) completed the final study visit; however 40 had missing CCKNOW scores and were excluded from the analysis. Thus, 219 participants were included in the analysis. Mean age was 38.5±12.3 years, 92% were white, and 58% were female. Participants had similar baseline CCKNOW scores across each study arm. Participants in the TELE-IBD EOW arm had a significant improvement in CCKNOW scores compared to the standard care arm (TELE-IBD EOW +2.4 vs. standard care +1.8, p=0.03). TELE-IBD Weekly participants improved compared to standard care; however the difference was not significant (TELE-IBD Weekly +2.0 vs. standard care +1.8, p=0.35). Participants with lower baseline CCKNOW scores, higher self-efficacy scores, and lower depression scores had a greater change in their score over time (p < 0.01, p=0.05, and p < 0.01 respectively). Conclusion: Telemedicine interventions can improve patients' disease-specific knowledge of IBD through weekly text messaging, although the improvement is not additive with additional text messages. Patients who are not depressed, have high self-efficacy, and have lower baseline knowledge about their disease derive the greatest benefit from this intervention.

BACKGROUND:We tested the hypothesis that the early improvement in mood after the first hour of bright light treatment compared to control dim-red light would predict the outcome at six weeks of bright light treatment for depressed mood in patients with Seasonal Affective Disorder (SAD). We also analyzed the value of Body Mass Index (BMI) and atypical symptoms of depression at baseline in predicting treatment outcome.METHODS:Seventy-eight adult participants were enrolled. The first treatment was controlled crossover, with randomized order, and included one hour of active bright light treatment and one hour of control dim-red light, with one-hour washout. Depression was measured on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD version (SIGH-SAD). The predictive association of depression scores changes after the first session. BMI and atypical score balance with treatment outcomes at endpoint were assessed using multivariable linear and logistic regressions.RESULTS:No significant prediction by changes in depression scores after the first session was found. However, higher atypical balance scores and BMI positively predicted treatment outcome.LIMITATIONS:Absence of a control intervention for the six-weeks of treatment (only the first session in the laboratory was controlled). Exclusion of patients with comorbid substance abuse, suicidality and bipolar I disorder, and patients on antidepressant medications, reducing the generalizability of the study.CONCLUSION:Prediction of outcome by early response to light treatment was not replicated, and the previously reported prediction of baseline atypical balance was confirmed. BMI, a parameter routinely calculated in primary care, was identified as a novel predictor, and calls for replication and then exploration of possible mediating mechanisms.

Introduction: Telemedicine is increasingly utilized in the care of patients with inflammatory bowel disease (IBD). However, telemedicine requires active patient engagement as symptom monitoring, self-assessment and periodic reporting are needed for optimal health outcomes. Our aim was to identify the socio-demographic and clinical predictors of adherence to self-testing in patients with IBD enrolled in the Telemedicine for Patients with IBD (TELE-IBD) study. Methods: This was a prospective cohort study of participants in the 2 intervention arms of the TELE-IBD study. Data were collected at baseline and participants received adjunctive care with TELE-IBD for 1 year. Depending on group assignment, weekly or every other week (EOW) messages were sent to participants to initiate self-testing sessions. During the sessions, participants were prompted to respond to a series of simple text messages regarding disease symptoms, medication side-effects, and body weight. Based on responses, an assessment of disease severity and action plans were generated and communicated via text. Adherence was defined as completion of ≥80% of self-testing sessions at the end of the study period. Multivariate logistic regression were used to assess predictors of adherence. Results: Among 191 total participants, mean age was 39.2 +/- 12.4 years, 56% were women, and 94% were Caucasian. 127 (66%) had Crohn's disease (CD) and mean disease duration was 12.5 +/- 9.0 years. 110 (58%) were adherent to self-testing. In bivariate analysis for those with CD, female gender (P=0.005), Crohn's and Colitis Knowledge (CCKNOW) score > 14 (P= 0.037), perforating disease (P= 0.047), c reactive protein (CRP) >3 (P= 0.043) and perianal involvement (P= 0.05) were associated with adherence. For those with ulcerative colitis (UC), a history of immune suppressant use (P= 0.05) and testing EOW (P= 0.009) were associated with adherence. On multivariate analysis in CD, female gender (OR 2.59, 95% CI 1.05-6.36, p= 0.03) and CRP > 3 (OR 2.97, 95% CI 1.16-7.58, p= 0.02) remained independently associated with adherence while testing EOW (OR 3.32, 95% CI 1.11-9.89) was a significant predictor in UC. Conclusion: Female gender and inflammatory disease activity in CD, and testing EOW in UC are significant predictors of adherence to self-testing. This suggests a role for targeted selection of IBD patients for participation in telemedicine to improve adherence and patient engagement.Table: Table. Baseline Demographic, Clinical and Psychosocial Characteristics of Study Population by Inflammatory Bowel Disease Type

Introduction: To evaluate enrollment, characteristics, and attrition in patients enrolled in the TELEmedicine for patients with inflammatory bowel disease study (TELE-IBD). Methods: Adults with IBD from the University of Maryland (UMB), University of Pittsburgh (UP), and Vanderbilt (VU) from June 2013 to June 2014 were recruited. Patients were randomized 1:1:1 to standard care, TELE-IBD every other week, or TELE-IBD weekly. Visits were conducted at baseline, 6, and 12 months. Participants in the TELE-IBD arms respond to texts about symptoms, side effects, and weight and receive medication prompts and educational messages. Based on responses, they are assigned into a disease activity zone: Green (none to mild), Yellow (mild to moderate), and Red (moderate to severe). Participants receive action plans and alerts are generated based on activity zone. Results: Two hundred patients enrolled (UMB=139, UP=50, VU=11); 32%, 35%, and 33% received standard care, TELE-IBD every other week, and TELE-IBD weekly respectively. Seventy-one percent of participants had Crohn’s disease (CD) and 29% had ulcerative colitis (UC) or IBD-type undetermined. Forty-one percent had active disease. Fifty-eight percent were women and 90% were white. Mean age and disease duration were 39±12 years and 12±10 years respectively. Fifty-five percent of patients had extraintestinal manifestations of disease. Thirty-one, 20, 37, and 62% were currently using 5-ASA, steroids, immune suppressants, and anti-TNFs respectively. Of patients with CD, 30, 43, and 27% had ileal, Ileocolonic, and colonic disease and 46, 28, and 26% had inflammatory, stricturing, and penetrating disease. Forty-one percent had perianal involvement. Fifty percent of UC patients had extensive or pancolonic involvement. Mean CD activity index at was 112.5±116.5; mean Seo index was 108.5±26.0. See Table 1 for SF-36 scores. Mean patient knowledge scores were 13.5±4.8. Fifty-four out of 60 completed the 6 month visit and 1 out of 1 completed 1 year visit. Only 10 participants withdrew: 3 technical issues, 3 pregnancies, 1 relocation, 1 non-adherence, 1 personal reason, and 1 breast cancer.Table 1: SF-36Scores at Baseline the TELE-IBD TrialConclusion: Recruitment of IBD patients for TELE-IBD is feasible and attrition is low. Recruitment and follow up are ongoing. Additional analyses will determine the impact of TELE-IBD on disease activity, quality of life, and health care utilization.

BACKGROUND:This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies. METHODS:Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA. RESULTS:There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P < .01). Transmission varied greatly by type of care from 0%-19% for gowns and 7%-37% for gloves. High-risk care activities (odds ratio [OR] > 1.0, P < .05) for gown contamination included changing dressings (eg, wound), dressing, providing hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR < 1.0, P < .05 or no transmission) for gown contamination included glucose monitoring, giving medications, and feeding. CONCLUSIONS:MRSA transmission from colonized residents to gloves was higher than transmission to gowns. Transmission to gloves varies by type of care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environment.

Introduction: The 2011 Maryland alcohol sales tax increase from 6% to 9% provided an opportunity to evaluate the impact on rates of alcohol-positive drivers involved in injury crashes.Methods: Maryland police crash reports from 2001 to 2013 were analyzed using an interrupted time series design and a multivariable analysis employing generalized estimating equations models with a negative binomial distribution. Data were analyzed in 2014-2015.Results: There was a significant gradual annual reduction of 6% in the population-based rate of all alcohol-positive drivers (p<0.03), and a 12% reduction for drivers aged 15-20 years (p<0.007), and 21-34 years (p<0.001) following the alcohol sales tax increase. There were no significant changes in rates of alcohol-positive drivers aged 35-54 years (rate ratio, 0.98; 95% CI=0.89, 1.09). Drivers aged >= 55 years had a significant immediate 10% increase in the rate of alcohol-positive drivers (rate ratio, 1.10; 95% CI=1.04, 1.16) and a gradual increase of 4.8% per year after the intervention. Models using different denominators and controlling for multiple factors including a proxy for unmeasured factors found similar results overall.Conclusions: The 2011 Maryland alcohol sales tax increase led to a significant reduction in the rate of all alcohol-positive drivers involved in injury crashes especially among drivers aged 15-34 years. This is the first study to examine the impact of alcohol sales taxes on crashes; previous research focused on excise tax. Increasing alcohol taxes is an important but often neglected intervention to reduce alcohol-impaired driving. (C) 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.