Status of the Prevention of Multidrug-Resistant Organisms in International Settings: A Survey of the Society for Healthcare Epidemiology of America Research Network

2016 ◽  
Vol 38 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Nasia Safdar ◽  
Sharmila Sengupta ◽  
Jackson S. Musuuza ◽  
Manisha Juthani-Mehta ◽  
Marci Drees ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
The United States ◽  
Multidrug Resistant ◽  
High Income ◽  
Research Network ◽  
Middle Income ◽  
Stewardship Program ◽  
Multidrug Resistant Organisms ◽  
Healthcare Epidemiology

OBJECTIVETo examine self-reported practices and policies to reduce infection and transmission of multidrug-resistant organisms (MDRO) in healthcare settings outside the United States.DESIGNCross-sectional survey.PARTICIPANTSInternational members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.METHODSElectronic survey of infection control and prevention practices, capabilities, and barriers outside the United States and Canada. Participants were stratified according to their country’s economic development status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and high-income.RESULTSA total of 76 respondents (33%) of 229 SHEA members outside the United States and Canada completed the survey questionnaire, representing 30 countries. Forty (53%) were high-, 33 (43%) were middle-, and 1 (1%) was a low-income country. Country data were missing for 2 respondents (3%). Of the 76 respondents, 64 (84%) reported having a formal or informal antibiotic stewardship program at their institution. High-income countries were more likely than middle-income countries to have existing MDRO policies (39/64 [61%] vs 25/64 [39%],P=.003) and to place patients with MDRO in contact precautions (40/72 [56%] vs 31/72 [44%],P=.05). Major barriers to preventing MDRO transmission included constrained resources (infrastructure, supplies, and trained staff) and challenges in changing provider behavior.CONCLUSIONSIn this survey, a substantial proportion of institutions reported encountering barriers to implementing key MDRO prevention strategies. Interventions to address capacity building internationally are urgently needed. Data on the infection prevention practices of low income countries are needed.Infect Control Hosp Epidemiol.2016:1–8

scholarly journals Trends in Cancer Diseases Prevalence by Different Socioeconomic Strata in the United States

2021 ◽  
Author(s):  
Mingsi Wang ◽  
Yi Ma ◽  
Liangru Zhou ◽  
Yi Cheng ◽  
Yue Li ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
Family Income ◽  
Temporal Trends ◽  
The United States ◽  
High Income ◽  
Poverty Level ◽  
Middle Income ◽  
Socioeconomic Strata ◽  
Cancer Diseases

Abstract Background Income disparity among different socioeconomic strata in the United States has widened sharply in recent decades. Take into account the well-established link between income and health, this widening income gap may provide insight into the dynamics of the cancer disease burden in American adults. Assess the temporal trends of the 20-year predicted absolute cancer risk in American adults at different socioeconomic classes. Methods The cross-sectional analyses were carried out using data from adults aged 20 to 85 years between the 1999 and 2018 NHANES. Socioeconomic status was divided into three groups based on the family income to poverty ratio (PIR): high income (PIR ≥ 4), middle income (> 1 and <4), or at or below the federal poverty level (≤ 1). Results The analysis included 49 720 participants. The prevalence of lung cancer was lower in high-income participants than in middle-income participants (0.15% [n= 19] vs 0.35% [n= 92], p <0.001). For the low-income stratum, the prevalence of breast cancer was 1.12% [n = 117], but the number of adults in the middle (1.48% [n = 391], p = 0.009) and high-income levels (1.71% [n = 219], p <0.001) has increased. Conclusions The study found that the prevalence of cancer diseases was increasingly different among participants of different socioeconomic classes of NHANES from 1999 to 2018. Further research is required on the dynamics and health impact of income inequality, as well as public health policies and efforts to reduce these inequalities.

scholarly journals Investigation and Containment of New Delhi Metallo-β-Lactamase (NDM)–Producing Carbapenem-Resistant Enterobacteriaceae (CRE) in a Hospital Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s305-s305
Author(s):  
Karoline Sperling ◽  
Amy Priddy ◽  
Nila Suntharam ◽  
Adam Karlen
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Outpatient Surgery ◽  
The United States ◽  
Multidrug Resistant ◽  
New Delhi ◽  
Point Prevalence Study ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Carbapenem Resistant Enterobacteriaceae

Background: With increasing medical tourism and international healthcare, emerging multidrug resistant organisms (MDROs) or “superbugs” are becoming more prevalent. These MDROs are unique because they are resistant to antibiotics and can carry special resistance mechanisms. In April 2019, our hospital was notified that a superbug, New Delhi Metallo-β-lactamase(NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE), was identified in a patient who had been transferred to another hospital after being at our hospital for 3 weeks. Our facility had a CRE admission screening protocol in place since 2013, but this patient did not meet the criteria to be screened on admission. Methods: The infection prevention (IP) team consulted with the Minnesota Department of Health (MDH) and gathered stakeholders to discuss containment strategies using the updated 2019 CDC Interim Guidance for Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs) to determine whether transmission to other patients had occurred. NDM CRE was classified under tier 2 organisms, meaning those primarily associated with healthcare settings and not commonly identified in the region, and we used this framework to conduct an investigation. A point-prevalence study was done in an intensive care unit that consisted of rectal screening of 7 patients for both CRE and Candida auris, another emerging MDRO. These swabs were sent to the Antibiotic Resistance Laboratory Network (ARLN) Central Regional Lab at MDH for testing. An on-site infection control risk assessment was done by the MDH Infection Control Assessment and Response (ICAR) team. Results: All 7 patients were negative for both CRE and C. auris, and no further screening was done. During the investigation, it was discovered that the patient had had elective ambulatory surgery outside the United States in March 2019. The ICAR team assessment provided overall positive feedback to the nursing unit about isolation procedures, cleaning products, and hand hygiene product accessibility. Opportunities included set-up of soiled utility room and updating our process to the 2019 MDH recommendation to screen patients for CRE and C. auris on admission who have been hospitalized, had outpatient surgery, or hemodialysis outside the United States in the previous year. Conclusions: Point-prevalence study results showed no transmission of CRE and highlighted the importance of standard precautions. This event supports the MDH recommendation to screen for CRE any patients who have been hospitalized, had outpatient surgery, or had hemodialysis outside the United States in the previous year.Funding: NoneDisclosures: None

Exporting Forest Loss? A Cross-National Analysis of the United States Export–Import Bank Financing in Low- and Middle-Income Nations

2020 ◽  
Vol 29 (2) ◽  
pp. 245-269
Author(s):  
Michael Restivo ◽  
John M. Shandra ◽  
Jamie M. Sommer
Keyword(s):  
United States ◽  
The United States ◽  
High Income ◽  
Forest Loss ◽  
Dependency Theory ◽  
Middle Income ◽  
Forestry Sector ◽  
States Export ◽  
Cross National ◽  
Low And Middle Income

Dependency theory argues that due to unequal economic relationships, including exports, multinational corporations, and loans from multilateral lending institutions, high-income nations exploit the labor and resources of low- and middle-income nations. We extend this line of reasoning to the United States Export–Import Bank, as it has recently come under scrutiny for its lending in the forestry sector of low- and middle-income nations. Although this concern has been raised, we are not aware of any cross-national research that empirically evaluates if their investments adversely impact forests. Therefore, we examine the impact of the United States Export–Import Bank lending in the forestry sector on forest loss. Using a two-stage instrumental variable regression model to account for possible donor selection bias as well as ordinary least squares regression to analyze data for 78 low- and middle-income nations, we find that export credit agency financing is related to increased forest loss from 2001 to 2014. Our findings are consistent with dependency theory ideas that economic linkages with high-income nations increase forest loss in low- and middle-income nations.

Universal Basic Income in the United States and Advanced Countries

2019 ◽  
Vol 11 (1) ◽  
pp. 929-958 ◽  
Author(s):  
Hilary Hoynes ◽  
Jesse Rothstein
Keyword(s):  
United States ◽  
Low Income ◽  
The United States ◽  
Pilot Studies ◽  
Middle Income ◽  
Transfer Programs ◽  
Poor Households ◽  
Advanced Economies ◽  
Low Income Families

We discuss the potential role of universal basic incomes (UBIs) in advanced countries. A feature of advanced economies that distinguishes them from developing countries is the existence of well-developed, if often incomplete, safety nets. We develop a framework for describing transfer programs that is flexible enough to encompass most existing programs as well as UBIs, and we use this framework to compare various UBIs to the existing constellation of programs in the United States. A UBI would direct much larger shares of transfers to childless, nonelderly, nondisabled households than existing programs, and much more to middle-income rather than poor households. A UBI large enough to increase transfers to low-income families would be enormously expensive. We review the labor supply literature for evidence on the likely impacts of a UBI. We argue that the ongoing UBI pilot studies will do little to resolve the major outstanding questions.

scholarly journals Global Health Equity: Cancer Care Outcome Disparities in High-, Middle-, and Low-Income Countries

2016 ◽  
Vol 34 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Jonas A. de Souza ◽  
Bijou Hunt ◽  
Fredrick Chite Asirwa ◽  
Clement Adebamowo ◽  
Gilberto Lopes
Keyword(s):  
Low Income ◽  
Cancer Care ◽  
Task Force ◽  
Cancer Control ◽  
The United States ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in global cancer control, especially in low- and middle-income countries.

scholarly journals Migration of International Medical Graduates: Implications for the Brain-Drain

2015 ◽  
Vol 2 (1) ◽  
pp. 17-24 ◽  
Author(s):  
O.C. Nwagwu Emeka
Keyword(s):  
United States ◽  
New Zealand ◽  
Intellectual Capital ◽  
Brain Drain ◽  
Low Income ◽  
Health Workers ◽  
The United States ◽  
High Income ◽  
Low Income Countries ◽  
The Brain

Studies indicate that about 23 percent to 28 percent of the physicians working and residing in the United States, Canada, Australia, the UK and New Zealand were born and trained in the low-income countries, areas suffering from critical shortages of physicians and other health workers. In the US alone, the preponderance of the foreign physicians hails from South Africa, Philippines, India, Pakistan, and Nigeria. From Africa alone where the burden of disease, poverty, deprivation and death are greatest, around 23,000 qualified physicians emigrate annually. From the perspectives of the low-income countries, significant amounts of resources are, by necessity, committed into turning their nationals into vital intellectual capital for their own desperately needed health needs and crumbling healthcare systems. Thus, the migration of these physicians to other nations to help strengthen their already stable health care systems is not only ethically deplorable but poses moral hazards for both the physicians and the high-income countries. That is, high-income countries such as the United States, Canada, UK, Australia and New Zealand are draining the scarce recourses of the low-income countries through the loss of intellectual capital, a phenomenon that socio-economic and developmental experts have dubbed “the brain drain”.

Assisted Housing and Income Segregation among Neighborhoods in U.S. Metropolitan Areas

2015 ◽  
Vol 660 (1) ◽  
pp. 98-116 ◽  
Author(s):  
Ann Owens
Keyword(s):  
United States ◽  
Economic Integration ◽  
Low Income ◽  
Metropolitan Areas ◽  
The United States ◽  
High Income ◽  
Housing Policies ◽  
Income Segregation ◽  
The Past ◽  
Low Income Families

Over the past 40 years, assisted housing in the United States has undergone a dramatic geographic deconcentration, with at least one unit of assisted housing now located in most metropolitan neighborhoods. The location of assisted housing shapes where low-income assisted renters live, and it may also affect the residential choices of nonassisted residents. This article examines whether the deconcentration of assisted housing has reduced the segregation of families by income among neighborhoods in metropolitan areas from 1980 to 2005–9. I find that the deconcentration of assisted housing resulted in modest economic residential integration for very low-income families. However, high-income families became even more segregated, as assisted housing was deconcentrated, potentially offsetting the economic integration gains and ensuring that very low-income families are living in neighborhoods with only slightly higher-income neighbors. I conclude by discussing features of housing policies that might promote greater income integration among neighborhoods.

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