Faculty Bibliography

Background: Heart failure (HF) is the leading cause for 30-day all-cause hospital readmission, which is targeted in the Affordable Care Act for Medicare cost reduction. Kidney function plays an important role in the pathophysiology and prognosis of HF. The objective of this analysis was to test the hypothesis that changes in admission serum creatinine (sCr) is associated with readmission in HF patients. Methods: Of the 8049 Medicare beneficiaries discharged alive from 106 U.S. hospitals during 1998-2001, data on admission, discharge, and highest sCr were available from 6854 patients. A rise in admission sCr by >0.3 mg/dL (acute kidney injury or AKI), occurred in 2179 (32%) patients and a drop in admission sCr by >0.3 mg/dL (reverse AKI) occurred in 789 (12%) patients. Patients with changes <0.3 mg/dL in admission sCr were used as reference (n=3886). Hazard ratios (HR) and 95% CIs for 30-day all-cause readmission associated with a rise and drop in sCr were estimated using multivariable (MV) Cox regression models adjusting for 41 baseline characteristics. Results: Participants had a mean (+SD) age of 76 (+11) years, 58% were women, and 25% were African American. Unadjusted 30-day all-cause readmission occurred in 24%, 25% and 19% of those in the rise, drop, and reference groups, respectively. Compared to reference group, MV-adjusted HRs (95% CIs) for 30-day all-cause readmission for those with a rise (AKI) and drop (reverse AKI) in sCr were 1.16 (1.03-1.31) and 1.20 (1.02-1.41), respectively. Conclusions: Among hospitalized older HF patients, a rise or drop in admission sCr >0.3 mg/dL has independent association with higher 30-day all-cause readmission. Future studies need to develop and test interventions to improve outcomes in these high-risk subsets of HF patients

From 2004 to 2009, the number of malaria cases reported in Haiti increased nearly fivefold. The effect of the 2010 earthquake and its aftermath on malaria transmission in Haiti is not known. Imported malaria cases in the United States acquired in Haiti tripled from 2009 to 2010, likely reflecting both the increased number of travelers arriving from Haiti and the increased risk of acquiring malaria infection in Haiti. The demographics of travelers and the proportion of severe cases are similar to those statistics reported in previous years. Non-adherence to malaria chemoprophylaxis remains a nearly universal modifiable risk factor among these cases.

Genetic discrimination may be experienced in the day-to-day lives of people at risk for Huntington disease (HD), encompassing occurrences in the workplace, when seeking insurance, within social relationships, and during other daily encounters. At -risk individuals who have tested either positive or negative for the genetic expansion that causes HD, as well as at-risk persons with a 50% chance for developing the disorder but have not had DNA testing completed the International RESPOND-HD (I-RESPOND-HD) survey. One of the study's purposes was to examine perceptions of genetic stigmatization and discrimination. A total of 412 out of 433 participants provided narrative comments, and 191 provided related codable narrative data. The core theme, Information Control, refers to organizational policies and interpersonal actions. This theme was found in narrative comments describing genetic discrimination perceptions across employment, insurance, social, and other situations. These reports were elaborated with five themes: What They Encountered, What They Felt, What Others Did, What They Did, and What Happened. Although many perceptions were coded as hurtful, this was not true in all instances. Findings document that reports of genetic discrimination are highly individual, and both policy as well as interpersonal factors contribute to the outcome of potentially discriminating events. 2010 Wiley-Liss, Inc

Genetic discrimination - defined as the denial of rights, privileges, or opportunities or other adverse treatment based solely on genetic information (including family history) - is an important concern to patients, healthcare professionals, lawmakers, and family members at risk for carrying a deleterious gene. Data from the United States, Canada, and Australia were collected from 433 individuals at risk for Huntington disease (HD) who have tested either positive or negative for the gene that causesHD and family members of affected individuals who have a 50% risk for developing the disorder but remain untested. Across all three countries, a total of 46.2% of respondents report genetic discrimination or stigma based on either their family history of HD or genetic testing for the HD gene mutation. We report on the overall incidence of discrimination and stigma in the domains of insurance (25.9%), employment (6.5%), relationships (32.9%), and other transactions (4.6%) in the United States, Canada, and Australia combined. The incidence of self-reported discrimination is less than the overall worry about the risk of discrimination, which is more prevalent in each domain. Despite a relatively low rate of perceived genetic discrimination in the areas of health insurance and employment, compared to the perception of discrimination and stigma in personal relationships, the cumulative burden of genetic discrimination across all domains of experience represents a challenge to those at risk for HD. The effect of this cumulative burden on daily life decisions remains unknown. 2010 Wiley-Liss, Inc