Nightingale Theory and Intentional Comfort Touch in Management of Tinea Pedis in Vulnerable Populations

Vulnerable populations, specifically migrant farm workers and persons experiencing homelessness, are often at an increased risk for foot infections. This risk is related to their working and living conditions, socioeconomic status, limited access to health care, frequent exposure to wet environments, limited access to clean and dry socks and shoes, bathing or laundry facilities, and daily routines that requires them to be on their feet for long periods of time. After years of caring for these populations and hundreds of clinical encounters, an evidence-based, effective method of foot care that incorporates intentional comfort touch has been developed. This article describes methods for mitigating the severity of fungal growth, decreasing the risk of secondary infections, and improving skin integrity by manipulating the micro-environment of the patients’ feet. This includes fundamental aspects of hygiene as described by Florence Nightingale’s Environmental Theory that suggests that direct sunlight, fresh air, and cleanliness improves health.

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Women’s health in prisons in Africa: prevalence and challenges to address HIV among women in prison in Africa

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1367 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Salah

Keyword(s):

Health Care ◽

Access To Health Care ◽

Health Care Services ◽

Prison Population ◽

International Standards ◽

Gender Based Violence ◽

Care Needs ◽

Limited Access ◽

Increased Risk ◽

Women In Prison

Abstract In Africa around 3.2% of the prison population is represented by women. People in prison are 5 times more likely to be living with HIV than adults in the general population. Moreover, women in prison have a higher HIV prevalence than men. The factors that lead to women becoming incarcerated are often also those that lead to their increased risk of acquiring HIV infection. Their situation in prison is exacerbated by stigma and discrimination, gender-based violence and inequality. Women have limited access to health care in prison settings and are less likely to receive treatment than men. This is even more the case in Africa, where the precarious and sometimes inhuman prison conditions, render the health-related interventions addressing women health particularly challenging. Their specific health care needs, such as sexual and reproductive health care, treatment of infectious diseases including STIs, as well as nutrition and hygiene requirements, are often neglected. The limited access for women (and their children) to ante- and postnatal care, labour and delivery services and antiretroviral therapy also leads to infants born in prisons being at high risk of contracting HIV. Women in prison should be able to access gender-responsive health care services which are equivalent and of the same quality as those available in the community. The presentation will present the latest available data on health status and HIV in particular among women in prison in Africa and will present the international standards in health interventions of women in prison.

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OPTIMIZATION OF DSME THROUGH INCREASED KNOWLEDGE OF PREVENTION OF COMPLICATIONS AND DIABETES EMERGENCIES IN WONOREJO VILLAGE

Darmabakti Cendekia: Journal of Community Service and Engagements ◽

10.20473/dc.v3.i1.2021.29-32 ◽

2021 ◽

Vol 3 (1) ◽

pp. 29

Author(s):

Ari Pebru Nurlaily ◽

Meri Oktariani ◽

Anestasia Pangestu Mei Tyas

Keyword(s):

Access To Health Care ◽

Diabetes Complications ◽

Clinical Manifestations ◽

The Elderly ◽

Health Care Facilities ◽

Basic Knowledge ◽

Foot Care ◽

Healthy Elderly ◽

Access To Health ◽

Prevention Of Diabetes

Background: Many elderly convey blood sugar often up and down due to lack of attention to their diet. The condition became urgent because the elderly had previously died from complications accompanied by diabetic ulcers. In the posyandu area of wonorejo healthy elderly, DM disease is one of the diseases that are quite widely suffered by its citizens. Objective: The DSME education program for cadres and the elderly at Posyandu Wonorejo aims to increase knowledge and prevent diabetes complications. Method: This DSME program was conducted in four sessions, namely, session 1 discussing basic knowledge about DM (definition, etiology, classification, etiology, clinical manifestations, diagnosis, prevention, treatment, complications), session 2 discussing DM management including nutrition/diet arrangements, and physical activities/exercises that can be done, session 3 discussing foot care and stress management; and session 4 discusses the prevention of chronic and acute complications, and the patient's access to health care facilities. Results: There was an increase in knowledge and prevention of diabetes complications up to 93,75% after this activity was conducted.. Conclusion: The program is optimally implemented.

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Effect of Attitudes, Norms, and Perception of Control of Foot Care Behavior In Patients Diabtes Melitus In Surabaya City

INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC) ◽

10.24990/injec.v4i1.232 ◽

2019 ◽

Vol 4 (1) ◽

pp. 48

Author(s):

Nuh Huda ◽

Dhian Satya R. ◽

Yohana Novitasari Sutrisno

Keyword(s):

Perceived Control ◽

Behavioral Control ◽

Cluster Sampling ◽

Perceived Behavioral Control ◽

Foot Care ◽

Validity And Reliability ◽

Chi Square ◽

Cross Sectional ◽

Increased Risk ◽

Care Behavior

Introduction:Each year the incidence of diabetes has very Significantly Increased. Increased risk of foot injuries are the caused because people have attitudes, norms, and perceptions of less control over his foot care.This study Identifies and analyzes the influence attitudes, norms, and perceived control over behavior treatment in DM Patients foot. Methods: The study used observational analytic design with cross sectional approach at a time. The study population as many as 50 241 people as calculated using the technique of Cluster Obtained 185 samples diabetics. This study uses probability sampling cluster sampling approach with analysis of the Chi Square test. Intsrument questionnaire used in this research and Foot Care Behavior TPB questionnaire the which has been tested for validity and reliability. Results: Based on statistical analysis Obtained attitude towards foot care behaviors value = 0.001 ρ (ρ <0.05), the norm of the behavior of foot care ρ value value = 0.001 (ρ <0.05), perceived behavioral control of foot care value ρ value = 0.001 (ρ <0.05) so that we can conclude the influence attitudes, norms, and perceived behavioral control in Patients with diabetic foot care. Conclusions: Foot care was right and good behavior will prevent foot ulcers in diabetic patient. Patients DM was expected to know, willing, and Able to perform behavioral treatments for further enhanced, so that people Become aware, willing and Able to do foot care behavior.

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27. Co-infections and antimicrobial use in patients hospitalized with COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.027 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S19-S20

Author(s):

Prithiv Prasad ◽

Ioannis Zacharioudakis ◽

Jordan Poles ◽

Yanina Dubrovskaya ◽

Dinuli Delpachitra ◽

...

Keyword(s):

Fungal Pathogens ◽

Hospital Admissions ◽

Teaching Hospitals ◽

Antimicrobial Use ◽

Fungal Culture ◽

Free Survival ◽

True Incidence ◽

Secondary Infections ◽

Increased Risk ◽

Duration Of Hospitalization

Abstract Background In-hospital antimicrobial use among COVID-19 patients is widespread due to perceived bacterial and fungal co-infections. We aim to describe the incidence of these co-infections and antimicrobial use in patients hospitalized with COVID-19 to elucidate data for guiding effective antimicrobial use in this population. Methods This retrospective study included all patients admitted with COVID-19 from January 1, 2020, to February 1, 2021 at any of the three teaching hospitals of the NYU Langone Health system. Variables of interest were extracted from the health system’s de-identified clinical database. The nadir of hospital admissions between the first and second peaks of hospital admissions in the dataset was used to delineate the First Wave and Late Pandemic periods of observation. A cut-off of 48 hours after admission was used to differentiate Co-infections and Secondary infections respectively among isolates of clinically relevant bacterial or fungal pathogens in blood or sputum samples. Population statistics are presented as median with interquartile range (IQR) or total numbers with percentages. Results 663 of 7,213 (9.2%) inpatients were found to have a positive bacterial or fungal culture of the respiratory tract or blood during the entire course of their initial admission at our hospitals for COVID-19. Positive respiratory cultures were found in 437 (6.1%) patients, with 94 (1.3%) being collected within 48 hours of admission. Blood culture positivity occurred in 333 patients (4.6%), with 115 (1.6%) identified within 48 hours of admission. Infection-free survival decreased with duration of hospitalization, with rate of secondary infections steadily rising after the second week of hospitalization as seen in Figure 1. 70.2% of inpatients received antimicrobials for a median duration of 6 antimicrobial days (IQR 3.0 – 12.0) per patient. A higher proportion of patients received antimicrobials in the first wave than in the late pandemic period (82.6% vs. 51.8%). Table 1. Table 2 Figure 1 Infection free survival represented as duration of admission in days on the X-axis, and proportion of admitted patients remaining infection-free in the Y-axis. The blue line represents blood cultures and the orange line represents sputum cultures. Conclusion There was a very low incidence of co-infection with SARS-CoV-2 infection at admission. A longer duration of hospitalization was associated with an increased risk of secondary infections. Antimicrobial use far exceeded the true incidence and detection of co-infections in these patients. Disclosures All Authors: No reported disclosures

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Gender Disparities in the Limited Access to Health Care and the Impact There of on Mental Health

Indian Journal of Science and Technology ◽

10.17485/ijst/2015/v8is7/69990 ◽

2015 ◽

Vol 8 (S7) ◽

pp. 352

Author(s):

Sunju Sohn

Keyword(s):

Mental Health ◽

Health Care ◽

Access To Health Care ◽

Gender Disparities ◽

Limited Access ◽

Access To Health ◽

The Impact

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Protecting the vulnerable during COVID-19: Treating and preventing chronic disease disparities

Gates Open Research ◽

10.12688/gatesopenres.13181.1 ◽

2020 ◽

Vol 4 ◽

pp. 125

Author(s):

Linda M. Mobula ◽

David J. Heller ◽

Yvonne Commodore-Mensah ◽

Vanessa Walker Harris ◽

Lisa A. Cooper

Keyword(s):

Vulnerable Populations ◽

Communicable Diseases ◽

Non Communicable Diseases ◽

Socioeconomic Groups ◽

Policy Interventions ◽

Vulnerable Patients ◽

Increased Risk ◽

Care Models ◽

Key Policy ◽

Poor Outcomes

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases – are key drivers of this widening gap, because they disproportionately afflict vulnerable populations. Vulnerable populations with non-communicable diseases, in turn, are disproportionately affected by COVID-19 itself – but also at increased risk of poor outcomes from those underlying conditions. Proven strategies for NCD control must be adapted to help vulnerable patients react to these dual threats. We detail six key policy interventions – task shifting, workforce protection, telehealth and mobile services, insurance restructuring and increased funding for NCDs, prescription policies for NCDs and community partnerships - to bridge this care gap. Long-term integration of these care models post-COVID-19 may prevent care shocks during future pandemics, bolstering emerging universal primary care models.

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The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

International Journal of Endocrinology ◽

10.1155/2015/920124 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Julia Lowe ◽

R. Gary Sibbald ◽

Nashwah Y. Taha ◽

Gerald Lebovic ◽

Madan Rambaran ◽

...

Keyword(s):

Diabetic Foot ◽

Health Care Professionals ◽

Phase 1 ◽

Major Amputation ◽

Foot Ulcers ◽

Quality Improvement Intervention ◽

Foot Care ◽

Middle Income ◽

Increased Risk ◽

Two Phases

Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases.Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P<0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented.Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.

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Carbapenemase-producing Enterobacterales causing secondary infections during the COVID-19 crisis at a New York City hospital

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa466 ◽

2020 ◽

Author(s):

Angela Gomez-Simmonds ◽

Medini K Annavajhala ◽

Thomas H McConville ◽

Donald E Dietz ◽

Sherif M Shoucri ◽

...

Keyword(s):

New York ◽

New York City ◽

York City ◽

Bacterial Infections ◽

Antibiotic Resistance Gene ◽

City Hospital ◽

Nanopore Sequencing ◽

Sequencing Data ◽

Secondary Infections ◽

Increased Risk

Abstract Background Patients with COVID-19 may be at increased risk for secondary bacterial infections with MDR pathogens, including carbapenemase-producing Enterobacterales (CPE). Objectives We sought to rapidly investigate the clinical characteristics, population structure and mechanisms of resistance of CPE causing secondary infections in patients with COVID-19. Methods We retrospectively identified CPE clinical isolates collected from patients testing positive for SARS-CoV-2 between March and April 2020 at our medical centre in New York City. Available isolates underwent nanopore sequencing for rapid genotyping, antibiotic resistance gene detection and phylogenetic analysis. Results We identified 31 CPE isolates from 13 patients, including 27 Klebsiella pneumoniae and 4 Enterobacter cloacae complex isolates. Most patients (11/13) had a positive respiratory culture and 7/13 developed bacteraemia; treatment failure was common. Twenty isolates were available for WGS. Most K. pneumoniae (16/17) belonged to ST258 and encoded KPC (15 KPC-2; 1 KPC-3); one ST70 isolate encoded KPC-2. E. cloacae isolates belonged to ST270 and encoded NDM-1. Nanopore sequencing enabled identification of at least four distinct ST258 lineages in COVID-19 patients, which were validated by Illumina sequencing data. Conclusions While CPE prevalence has declined substantially in New York City in recent years, increased detection in patients with COVID-19 may signal a re-emergence of these highly resistant pathogens in the wake of the global pandemic. Increased surveillance and antimicrobial stewardship efforts, as well as identification of optimal treatment approaches for CPE, will be needed to mitigate their future impact.

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