To examine factors associated with blood exposure and percutaneous injury among health care workers, we assessed occupational risk factors, compliance with standard precautions, frequency of exposure, and reporting in a stratified random sample of 5123 physicians, nurses, and medical technologists working in Iowa community hospitals. Of these, 3223 (63%) participated. Mean rates of hand washing (32%-54%), avoiding needle recapping (29%-70%), and underreporting sharps injuries (22%-62%; overall, 32%) varied by occupation (P<.01). Logistic regression was used to estimate the adjusted odds of percutaneous injury (aOR(injury)), which increased 2%-3% for each sharp handled in a typical week. The overall aOR(injury) for never recapping needles was 0.74 (95% CI, 0.60-0.91). Any recent blood contact, a measure of consistent use of barrier precautions, had an overall aOR(injury) of 1.57 (95% CI, 1.32-1.86); among physicians, the aOR(injury) was 2.18 (95% CI, 1.34-3.54). Adherence to standard precautions was found to be suboptimal. Underreporting was found to be common. Percutaneous injury and mucocutaneous blood exposure are related to frequency of sharps handling and inversely related to routine standard-precaution compliance. New strategies for preventing exposures, training, and monitoring adherence are needed.

To examine the relative influence of cultural and temperamental factors on emotional response, we compared the emotional behavior, reports of emotional experience, and autonomic responses of 50 European American (EA) and 48 Chinese American (CA) college-age dating couples during conversations about conflicts in their relationships. EA couples showed more positive and less negative emotional behavior than did CA couples, despite similarities in reports of emotional experience and autonomic reactivity. Group differences in emotional behavior were mediated by cultural (values and practices) but not temperamental factors (neuroticism and extraversion). Collapsing across groups, cultural factors accounted for greater variance in emotional behavior but lesser variance in reports of emotional experience compared with temperamental factors. Together, these findings suggest that the relative influence of cultural and temperamental factors on emotion varies by response component.

A sample of committed gay and lesbian cohabiting couples engaged in two conversations after being apart for at least 8 hours: (a) an events of the day conversation and (b) a conflict resolution conversation. Physiological data were collected during the conversations and a videotape record was made. Couples viewed the videotapes and rated their affect during the interaction. The video records were coded with a system that categorized specific affects displayed. Models derived from physiology, from the perception of interaction, and from specific affective behavior were related to relationship satisfaction, and to the prediction of relationship dissolution over a 12-year period. Results supported previous findings that satisfaction and stability in gay and lesbian relationships are related to similar emotional qualities as in heterosexual relationships.

ObjectivesTo evaluate the association between longitudinal continuity of primary care and use of emergency department (ED) and inpatient care in older veterans.DesignRetrospective cohort study.SettingDepartment of Veterans Affairs (VA) primary care clinics in 15 regional health networks, ED and inpatient facilities.ParticipantsMedicare‐eligible veterans aged 65 and older with three or more VA primary care visits during fiscal year 2007–08 (baseline period) (N = 243,881).MeasurementsTwo measures of longitudinal continuity were estimated using merged VA–Centers for Medicare and Medicaid Services administrative data: Usual Provider of Continuity (UPC) and Modified Modified Continuity Index (MMCI). Negative binomial and multivariable logistic regression models were used to predict ED use and inpatient hospitalization during fiscal year 2009, controlling for sociodemographic characteristics, medical and psychiatric comorbidity, and baseline use of health services.ResultsThe incidence rate ratio (IRR) of ED visits was greater in patients with high (IRR = 1.05, 95% confidence interval (CI) = 1.02–1.07), intermediate (IRR = 1.04, 95% CI = 1.02–1.07), and low (IRR = 1.06, 95% CI = 1.03–1.09) UPC than in those with very high UPC (0.9–1.0). Patients with high (odds ratio (OR) = 1.04, 95% CI = 1.01–1.07), intermediate (OR = 1.03, 95% CI = 1.00–1.06), and low (OR = 1.04, 95% CI = 1.01–1.07) UPC were also more likely to be hospitalized during follow‐up. Results were similar for MMCI continuity scores.ConclusionEven slightly lower primary care provider (PCP) continuity was associated with modestly greater ED use and inpatient hospitalization in older veterans. Additional efforts should be made to schedule older adults with their assigned PCP whenever possible.

PTSD diagnosis is associated with an increased risk for dementia diagnosis that varied with receipt of psychotropic medications. Further research would help to delineate if these findings are due to differences in PTSD severity, psychiatric comorbidity, or independent effects of psychotropic medications on cognitive decline.

Healthcare organizations can improve staff safety by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment, and eliminating the use of blood and body fluid precautions as an isolation policy.

IntroductionEmerging evidence indicates associations between extra-central nervous system (CNS) bacterial infections and an increased risk for dementia; however, epidemiological evidence is still very limited.MethodsThis study involved a retrospective cohort of a national sample of US veterans (N = 417,172) aged ≥56 years. Extended Cox proportional hazard models adjusted for demographic characteristics and medical and psychiatric comorbidities determined the associations between systemic and localized extra-CNS bacterial infections occurring >2 years before the initial dementia diagnosis and the risk for dementia.ResultsExposure to any extra-CNS bacterial infection was associated with a significantly increased risk for dementia (hazard ratio [HR] = 1.20 [95% confidence interval = 1.16–1.24]). Independently, septicemia (HR = 1.39 [1.16–1.66]), bacteremia (HR = 1.22 [1.00–1.49]), osteomyelitis (HR = 1.20 [1.06–1.37]), pneumonia (HR = 1.10 [1.02–1.19]), urinary tract infections (HR = 1.13 [1.08–1.18]), and cellulitis (HR = 1.14 [1.09–1.20]) were associated with a significantly increased risk for dementia.DiscussionBoth systemic and localized extra-CNS bacterial infections are associated with an increased risk for developing dementia.

Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.