Simonne S. Nouer

Molecular epidemiology and risk factors for nasal carriage of Staphylococcus aureus and methicillin-resistant S. aureus in infants attending day care centers in Brazil.

ABSTRACT Investigations regarding Staphylococcus aureus carriage among Brazilian children are scarce. We evaluated the determinants of S. aureus and methicillin-resistant S. aureus (MRSA) nasal carriage in infants attending day care centers (DCCs) and the molecular features of the MRSA strains. A total of 1,192 children aged 2 months to 5 years attending 62 DCCs were screened for S. aureus and MRSA nasal carriage. MRSA isolates were characterized by pulsed-field gel electrophoresis, multilocus sequence typing, spa typing, staphylococcal cassette chromosome (SCC) mec typing and the presence of the Panton-Valentine leukocidin gene. Logistic regression was performed to determine risk factors associated with S. aureus and MRSA colonization. S. aureus and MRSA carriage were detected in 371 (31.1%) and 14 (1.2%) children, respectively. Variables found to be independently associated with an increased risk for S. aureus carriage included being older than 24 months (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3 to 2.6) and previous DCC attendance (OR, 1.5; 95% CI, 1.0 to 2.2). Having a mother with a high level of education was a protective factor for nasal colonization (OR, 0.4; 95% CI, 0.2 to 0.8). Moreover, we observed that more children carrying MRSA had younger siblings than children not colonized by MRSA. Among the 14 MRSA strains, three SCCmec types (IIIA, IV, and V) were detected, together with a multidrug-resistant dominant MRSA lineage sharing 82.7% genetic similarity with the Brazilian clone (ST239-MRSA-IIIA; ST indicates the sequence type determined by multilocus sequence typing). Although SCCmec type V was recovered from one healthy child who had been exposed to known risk factors for hospital-associated MRSA, its genetic background was compatible with community-related MRSA. Our data suggest that DCC attendees could be contributing to MRSA cross-transmission between health care and community settings.

Pneumonia and poverty: a prospective population-based study among children in Brazil

BackgroundChildren in developing country suffer the highest burden of pneumonia. However, few studies have evaluated associations between poverty and pneumonia.MethodsA prospective population-based study on pneumonia was carried out as part of the Latin America Epidemiological Assessment of Pneumococcus (LEAP study). Chest x-rays were obtained for children one to 35 months old with suspected pneumonia presenting to emergency care centers and hospital emergency rooms in Goiania, Brazil. Chest radiographs were evaluated according to WHO guidelines. Clustering of radiologically-confirmed pneumonia were evaluated using a Poisson-based spatial scan statistic. Associations between census socioeconomic indicators and pneumonia incidence rates were analyzed using generalized linear models.ResultsFrom May, 2007 to May, 2009, chest radiographs were obtained from 11 521 children with clinical pneumonia; 3955 episodes were classified as radiologically-confirmed. Incidence rates were significantly higher in very low income areas (4825.2 per 105) compared to high income areas (1637.3 per 105). Spatial analysis identified clustering of confirmed pneumonia in Western (RR 1.78; p = 0.001) and Southeast (RR 1.46; p = 0.001) regions of the city, and clustering of hospitalized pneumonia in the Western region (RR 1.69; p = 0.001). Lower income households and illiteracy were associated with pneumonia incidence.ConclusionsIn infants the risk of developing pneumonia is inversely associated with the head of household income and with the woman educational level. Areas with deprived socioeconomic conditions had higher incidence of pneumonia and should be targeted for high vaccination coverage.

Psychometric Properties of an Intimate Partner Violence Tool for Health Care Students

Health care professionals have acknowledged intimate partner violence (IPV) as a highly prevalent public health problem necessitating the creation of standardized education programs, survey tools, and well-defined outcome measures. Testing and evaluation of these measures, however, has been limited to specific populations of health care professionals. In 2007 and 2008, psychometric properties of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) were adapted, tested, and evaluated on a group of medicine, nursing, social work, and dentistry students during their last semester of college. The adapted instrument demonstrated high reliability within some IPV constructs, and six of the eight scales described in the original PREMIS were identified. Three scales presented a Cronbach’s α ≥ .70, demonstrating acceptable reliability, and a new scale, IPV Screening, was also identified that showed good reliability (α = .74). The adapted instrument showed good stability of psychometric properties in the student population and generally good correlation within several measures.

Spatial clusters of violent deaths in a newly urbanized region of Brazil: highlighting the social disparities

BackgroundDeaths due to homicides and traffic accidents among youth are a public health issue worldwide. Studies of the complex network of cause and effect on this topic point to both poverty and health inequalities. Different investigational approaches to intentional and unintentional deaths combined with socioeconomic variables can help create a better understanding of the association between violence and socioeconomic conditions. This study analyzed the spatial distribution and potential clusters of risk for intentional and unintentional deaths among youths aged 15-24 years in Goiânia, a newly urbanized city in central Brazil.MethodsDeath data and residential addresses were extracted from the national Mortality Information System and validated by household visits. To detect all potential cases, we prospectively investigated every death classified as a transport accident, assault, legal intervention, intentional self-harm, unknown underlying cause, and undetermined intent according to the ICD-10.The Geographical Information System was used to plot residential addresses, and cases were interactively geocoded to the residential address level using a digital map of the municipality. Spatial scan statistic was applied (Poisson model) to identify clusters of census tracts with high mortality due to intentional injuries and traffic accidents. The socioeconomic variables obtained using census data were compared between the most likely cluster and other areas of the municipality.ResultsThe most violent deaths among young people were due to intentional injuries. Between August 2005 and August 2006, 145 addresses for cases of intentional injuries and traffic accidents were located and geocoded. No significant clusters for deaths due to traffic accidents were found within the municipality. One significant cluster (RR = 4.65; p = 0.029) composed of 14 cases of intentional deaths, mostly homicides, was detected in an emergent, populated, and very poor area on the outskirts of the town. This cluster had a significantly higher proportion of people with the lowest educational status, lowest income, and poor housing conditions in comparison to the remainder of the municipality.ConclusionOur findings highlight the link between social inequalities and intentional deaths, clearly showing the need for urgent social interventions to reduce violence and premature mortality.

Outcomes of Operations Performed by Attending Surgeons after Overnight Trauma Shifts

BACKGROUND To date, work-hour restrictions have not been imposed on attending surgeons in the United States. The purpose of this study was to investigate the impact of working an overnight trauma shift on outcomes of general surgery operations performed the next day by the post-call attending physician. STUDY DESIGN Consecutive patients over a 3.5-year period undergoing elective general surgical procedures were reviewed. Procedures were limited to hernia repairs (inguinal and ventral), cholecystectomies, and intestinal operations. Any operations that were performed the day after the attending surgeon had taken an overnight trauma shift were considered post-call (PC) cases; all other cases were considered nonpost-call (NP). Outcomes from the PC operations were compared with those from the NP operations. RESULTS There were 869 patients identified; 132 operations were performed PC and 737 were NP. The majority of operations included hernia repairs (46%), followed by cholecystectomies (35%), and intestinal procedures (19%). Overall, the PC operations did not differ from the NP operations with respect to complication rate (13.7% vs 13.5%, p = 0.93) or readmission within 30 days (5% vs 6%, p = 0.84). Additionally, multivariable logistic regression failed to identify an association between PC operations and the development of adverse outcomes. Follow-up was obtained for an average of 3 months. CONCLUSIONS Performance of general surgery operations the day after an overnight in-hospital trauma shift did not affect complication rates or readmission rates. At this time, there is no compelling evidence to mandate work-hour restrictions for attending general surgeons.

Nursing Students and Intimate Partner Violence Education: Improving and Integrating Knowledge Into Health Care Curricula

This study measured intimate partner violence (IPV) curriculum content exposure; knowledge, attitudes, beliefs, and self-reported behaviors; and IPV prevalence within doctor of nursing practice and doctor of philosophy nursing programs at a university in the southern United States. The survey instrument was an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey modified with language that focused on students in the health care arena. Three summary scales-Perceived Preparedness, Perceived Knowledge, and Actual Knowledge-were also created. Mann-Whitney U tests and exploratory multivariable and logistic regression analyses were employed to analyze the data. Results indicated that nursing students who received IPV training prior to graduate school had significantly higher perceived preparation and perceived knowledge ratings than those reporting no IPV training prior to graduate school. Results also showed that 40% of nursing students surveyed had personally experienced some type of domestic violence including IPV. Identifying and responding to curricular shortcomings and ascertaining student IPV prevalence are critical steps in strategizing and implementing comprehensive curriculum revision, enabling students to enter the nursing profession with the capacity to directly impact the care and treatment of IPV victims.

Overcoming Barriers in Intimate Partner Violence Education and Training of Graduate Social Work Students.

Intimate partner violence (IPV) is a highly prevalent problem detected frequently in the social work field, and also extends to the personal lives of social workers and students, with compelling evidence that professionals and students are often victims of IPV. However, students continue to lack substantive knowledge of IPV. This article addresses the need for increased IPV education and training for social work students and professionals by measuring IPV education, knowledge, and attitudes among students, while also examining the incidence of student personal experience with IPV and exploring the role this experience plays in identifying and safely intervening in IPV situations.

Improving diabetes care via telemedicine: lessons from the Addressing Diabetes in Tennessee (ADT) project.

The prevalence of diabetes continues to escalate around the world, with an estimated 24 million people affected in the U.S. (1). Its prevalence has more than doubled in Tennessee the last decade from 5.0% in 1997 to 11.0% in 2007 (2), with estimated diabetes related mortality of 31 per 100,000 population (2). Rising prevalence and shortage of physicians, especially in rural areas, contribute to poor outcome in diabetic patients (3). Telemedicine, the transfer of electronic medical data to a remote location utilizing telecommunications technology, may be beneficial in improving access, care, and outcome in diabetic patients. Therefore, we investigated the impact of telemedicine on the quality of care in diabetic patients in five health professional shortage areas with diabetes related mortality rates of 41.5–84.7 per …

Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study

Background. Intussusception is uncommon in children older than 3 years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted. Methods. The Pediatric Health Information System database was reviewed from January 1, 2009–June 30, 2014. Patients were followed for 6 months from initial presentation or until bowel resection occurred. Successful enema reduction was defined as having radiologic reduction without additional procedures. Results. A total of 7,412 patients were identified: 6,681 were <3 years old, 731 patients were >3 years old. In those >3 years old, 450 (62%) were treated successfully with enema reduction; the rate of patients with a tumor diagnosis was similar in patients <3 years old and patients >3 years old (5% vs 6%, P = .07). The rate of a Meckels diagnosis was greater in patients >3 years old (2% vs 14%, P < .0001). In patients >3 years old, duration of stay between patients who underwent primary operative therapy versus those who underwent operative therapy after enema reduction was similar (4 days vs 4 days, P = .06). Older age was not associated with increased risk of recurrent admission for intussusception (P = .45). Conclusion. Pediatric Health Information System data suggest that enema reduction may be safe and effective for a majority of children even if older than 3 years.

Changes in breastfeeding attitudes in a metropolitan community in Tennessee

Background: The Southern United States has low breastfeeding rates, particularly among African Americans. Breastfeeding rates are influenced by community attitudes and norms. Objective: This study aimed to examine changes in breastfeeding attitudes and demographic factors related to these attitudes. Methods: Cross-sectional data from a community-based survey, repeated annually from 2004 to 2008, were analyzed. Univariable analysis examined trends over time and log binomial regression estimated the strength of the association between year of the survey, demographic factors, and outcome responses related to the survey questions. Results: After adjusting for sex, race, marital status, age, and education, compared to 2004, 2008 respondents were 26% more likely to rate breastfeeding as extremely important compared to formula feeding (prevalence ratio [PR] = 1.26; 95% confidence interval [CI], 1.10-1.43). Similarly, 2008 respondents were 29% more likely to rate the importance of breastfeeding for long-term health as extremely important (PR = 1.29; 95% CI, 1.14-1.46). Comfort levels with breastfeeding outside the home also increased. Respondents to the 2008 survey were more likely to report that they were comfortable with a mother breastfeeding in their workplace (PR = 1.20; 95% CI, 1.11-1.31) and in a mall or restaurant (PR = 1.15; 95% CI, 1.06-1.26). After controlling for demographic factors, there were no significant differences in responses between African Americans and other races. Conclusion: Despite significantly lower breastfeeding rates among African Americans, this analysis revealed significant positive changes in attitudes regarding breastfeeding between 2004 and 2008, regardless of race. These changes in attitude coincided with increased breastfeeding initiation rates, suggesting that federal, state, and local breastfeeding promotion efforts had an effect.