scholarly journals 1681. Assessment of the Impact of Infectious Events in a Cohort of Pediatric Leukemia Patients in the Dominican Republic

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S615-S616
Author(s):  
Julianne E Burns ◽  
Dominga Reyes Pérez ◽  
Yimei Li ◽  
Wendy Gómez García ◽  
F Jay Garcia ◽  
...  
Keyword(s):  
Dominican Republic ◽  
Poisson Regression ◽  
Hospital Admissions ◽  
Lymphoblastic Leukemia ◽  
Invasive Infection ◽  
Pediatric Leukemia ◽  
Middle Income ◽  
Effective Interventions ◽  
Invasive Infections ◽  
The Impact

Abstract Background Infections are a leading cause of morbidity and mortality in children with cancer. Although data are limited, the impact of infection in this population appears to be amplified in low- and middle-income countries. Defining the epidemiology of infection in a specific region is paramount to developing effective interventions. This study aims to define the epidemiology of and outcomes from infection in children with leukemia in the Dominican Republic. Methods A retrospective cohort was assembled of children newly diagnosed with leukemia between July 1, 2015 and June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child’s home to the hospital was determined using ArcGIS 10.5.1. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using Poisson regression. Results The cohort included 68 patients; 54 (79.4%) with acute lymphoblastic leukemia and 14 (20.6%) with acute myeloblastic leukemia. The cohort was 48.5% female, had a median age at diagnosis of 7.3 years (range 1.1–16.6), and a median weight-for-age of 45.5 percentile (range 0–99.9). There were 1.2 invasive infections per 100 days at risk in the first 60 days after diagnosis, 0.8 from > 60–100 days, and 0.4 from > 100–180 days. Gastroenteritis, skin/soft-tissue infection, and pneumonia were most frequent, with bacteremia most common in the first 60 days. In a multivariate Poisson regression model, age ≥10 years (IRR 0.49, 95% CI 0.28–0.85) and distance from the hospital >100 km (IRR 0.34, 95% CI 0.14 – 0.81) were each protective against infection in the first 180 days after diagnosis. During the 2-year period, 8 of 22 (36%) patient deaths were related to infection. Conclusion Invasive infections were common and a prominent source of death in this cohort. Interventions aimed at reducing infection should target the first 60 days after diagnosis. Decreased infection incidence among children of older age and farther distance from the hospital were unexpected and warrant further investigation. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of the impact of inpatient infectious events in pediatric patients with newly diagnosed acute leukemia at Dr. Robert Reid Cabral Children’s Hospital, Dominican Republic

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243795
Author(s):  
Julianne E. Burns ◽  
Dominga Reyes Pérez ◽  
Yimei Li ◽  
Wendy Gómez García ◽  
F. Jay Garcia ◽  
...  
Keyword(s):  
Dominican Republic ◽  
Acute Leukemia ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Infection Prevention And Control ◽  
Invasive Infection ◽  
Newly Diagnosed ◽  
Binomial Regression ◽  
Invasive Infections ◽  
The Impact

Survival rates for pediatric acute leukemia vary dramatically worldwide. Infections are a leading cause of morbidity and mortality, and the impact is amplified in low and middle-income countries. Defining the epidemiology of infection in a specific health care setting is paramount to developing effective interventions. This study aimed to define the epidemiology of and outcomes from infection in children with acute leukemia treated in a large public pediatric hospital in the Dominican Republic. A retrospective cohort was assembled of children newly diagnosed with acute leukemia between July 1, 2015 to June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database (PONDTM) and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child’s home to the hospital was determined using ArcGIS by Esri. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using negative binomial regression. Overall, invasive infections were common and a prominent source of death in this cohort. Rates were highest in the first 60 days after diagnosis. Gastroenteritis/colitis, cellulitis, and pneumonia were most frequent, with bacteremia common early on. Multidrug resistant bacteria were prevalent among a small number of positive cultures. In a multivariate negative binomial regression model, age ≥ 10 years and distance from the hospital > 100 km were each protective against invasive infection in the first 180 days after diagnosis, findings that were unexpected and warrant further investigation. Over one-third of patient deaths were related to infection. Interventions aimed at reducing infection should target the first 60 days after diagnosis, improved supportive care inside and outside the hospital, and increased antimicrobial stewardship and infection prevention and control measures.

scholarly journals Incidence and Effects of Acquisition of the Phage-Encoded ssa Superantigen Gene in Invasive Group A Streptococcus

2021 ◽  
Vol 12 ◽  
Author(s):  
Chuan Chiang-Ni ◽  
Yen-Shan Liu ◽  
Chieh-Yu Lin ◽  
Chih-Yun Hsu ◽  
Yong-An Shi ◽  
...  
Keyword(s):  
Wild Type Strain ◽  
Group A Streptococcus ◽  
Invasive Infection ◽  
Invasive Group ◽  
North Asia ◽  
Invasive Infections ◽  
Group A ◽  
The Impact ◽  
Northern Taiwan

The acquisition of the phage-encoded superantigen ssa by scarlet fever-associated group A Streptococcus (Streptococcus pyogenes, GAS) is found in North Asia. Nonetheless, the impact of acquiring ssa by GAS in invasive infections is unclear. This study initially analyzed the prevalence of ssa+ GAS among isolates from sterile tissues and blood. Among 220 isolates in northern Taiwan, the prevalence of ssa+ isolates increased from 1.5% in 2008–2010 to 40% in 2017–2019. Spontaneous mutations in covR/covS, which result in the functional loss of capacity to phosphorylate CovR, are frequently recovered from GAS invasive infection cases. Consistent with this, Phostag western blot results indicated that among the invasive infection isolates studied, 10% of the ssa+ isolates lacked detectable phosphorylated CovR. Transcription of ssa is upregulated in the covS mutant. Furthermore, in emm1 and emm12 covS mutants, ssa deletion significantly reduced their capacity to grow in human whole blood. Finally, this study showed that the ssa gene could be transferred from emm12-type isolates to the emm1-type wild-type strain and covS mutants through phage infection and lysogenic conversion. As the prevalence of ssa+ isolates increased significantly, the role of streptococcal superantigen in GAS pathogenesis, particularly in invasive covR/covS mutants, should be further analyzed.

scholarly journals The Impacts of Family Physician Plan and Health Transformation Plan on Hospitalization Rates in Iran: An Interrupted Time Series

2020 ◽  
Author(s):  
Samad Rouhani ◽  
Reza Esmaeili ◽  
Jamshid YazdaniCharati ◽  
Masoud Khandehroo
Keyword(s):  
Time Series ◽  
Family Physician ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
Hospitalization Rate ◽  
Public Hospitals ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Impact ◽  
Low And Middle Income

Abstract Background : Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran.Methods: We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1.Results: A decreasing trend by -0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P<0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P<0.001).Conclusions: Family physician created a decreasing trend for hospitalization. Development of FPP to urban area of Iran will lead to health system efficiency. HTP with lower user fee in public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.

Scaling Up Public Health Interventions: Engaging Partners Across Multiple Levels

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Jennifer Leeman ◽  
Alix Boisson ◽  
Vivian Go
Keyword(s):  
Public Health ◽  
Scale Up ◽  
Lessons Learned ◽  
Annual Review ◽  
Publication Date ◽  
Illustrative Case ◽  
Middle Income ◽  
Effective Interventions ◽  
Illustrative Case Study ◽  
The Impact

Advancing the science of intervention scale-up is essential to increasing the impact of effective interventions at the regional and national levels. In contrast with work in high-income countries (HICs), where scale-up research has been limited, researchers in low- and middle-income countries (LMICs) have conducted numerous studies on the regional and national scale-up of interventions. In this article, we review the state of the science on intervention scale-up in both HICs and LMICs. We provide an introduction to the elements of scale-up followed by a description of the scale-up process, with an illustrative case study from our own research. We then present findings from a scoping review comparing scale-up studies in LMIC and HIC settings. We conclude with lessons learned and recommendations for improving scale-up research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

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