Basic Prevention Strategies Research Articles

Infection Prevention Measures for Service Recipients in Postpartum Care Homes

<p>產後護理之家服務對象，包括產後未滿二個月產婦及出生未滿二個月嬰兒。又嬰兒出生後來自母親的抗體逐漸消退，且免疫力尚未達到成熟階段，感染疾病風險高及可能嚴重併發症，因此對於服務對象入住機構內健康管理、包括疾病監測、疑似感染及適當隔離等，防範於未然及有效感染控制措施至為重要，各項感染管制訂定如：陪住家屬及訪客管理，遵守政府規範防疫政策；服務對象之配膳、飲食衛生、哺餵、哺育器材清消，飲用水衛生安全、供水設施等措施並落實執行，維護產婦、嬰兒及工作人員等之健康，建構優質安全環境，提升照護品質。機構管理者及工作人員應瞭解基本的感染預防及管制策略，確實執行應用，避免機構內感染及群聚事件，且配合衛生主管機關評鑑及感染管制查核督導，強化各項感染管制措施，共築完善防疫網。</p> <p> </p><p>Postpartum care homes provide services to mothers and infants in the first 2 months after birth. During this time, antibodies from the mother gradually diminish in infants, whose immunity is insufficiently mature, placing them at high risk of contracting diseases and developing serious complications. Therefore, adhering to and implementing strict infection control measures is crucial. For service recipients of health management in postpartum homes, infectious disease monitoring, isolation precautions, rules for managing family members and visitors, disease control regulations, meal preparation and feeding hygiene, access to cleaning and disinfection equipment, and regular cleaning and disinfection of water supplies are all critical measures for improving service quality and creating a high-quality and safe care environment. Institutional managers and staff must understand basic infection prevention and control strategies and carefully implement them to avoid infections and cluster incidents in postpartum homes. They must also cooperate with health authorities for institution accreditation, infection control inspection, and supervision to strengthen infection control measures and create comprehensive epidemic prevention strategies.</p> <p> </p>

Effect of fourth hourly oropharyngeal suctioning on ventilator-associated events in patients requiring mechanical ventilation in intensive care units of a tertiary care center in South India: a randomized controlled trial.

Mechanical ventilation (MV) is a necessary life-saving measure for critically ill patients. Ventilator-associated events (VAEs) are potentially avoidable complications associated with MV that can double the rate of death. Oral care and oropharyngeal suctioning, although neglected procedures, play a vital role in the prevention of VAE. A randomized controlled trial was conducted in the intensive care units to compare the effect of fourth hourly oropharyngeal suctioning with the standard oral care protocol on VAE among patients on MV. One hundred twenty mechanically ventilated patients who were freshly intubated and expected to be on ventilator support for the next 72 hours were randomly allocated to the control or intervention groups. The intervention was fourth hourly oropharyngeal suctioning along with the standard oral care procedure. The control group received standard oral care (i.e., thrice a day) and on-demand oral suctioning. On the 3rd and 7th days following the intervention, endotracheal aspirates were sent to rule out ventilator-associated pneumonia. Both groups were homogenous at baseline with respect to their clinical characteristics. The intervention group had fewer VAEs (56.7%) than the control group (78.3%) which was significant at P<0.01. A significant reduction in the status of "positive culture" on ET aspirate also been observed following the 3rd day of the intervention (P<0.001). One of the most basic preventive strategies is providing oral care. Oropharyngeal suctioning is also an important component of oral care that prevents microaspiration. Hence, fourth-hourly oropharyngeal suctioning with standard oral care significantly reduces the incidence of VAE.

Unmet Need for School-Based Substance Use Prevention Strategies Among Secondary Schools in Orlu, Imo State

Abstract: Background. In Nigeria, the use of psychoactive substances has reached an epidemic proportion while substance use prevention remains inadequate or unavailable. Methods. Cross-sectional data from 300 Junior Secondary School students in Imo state were analyzed to evaluate the unmet need for school-based substance use prevention strategies among secondary school students in Orlu, Imo state. Information was collected using a structured questionnaire. Results. Substance use was common with easy access to psychoactive substances for young people. There was a perceived need for substance use prevention strategies in their school with most students lacking access to basic preventive strategies. Conclusion. Though there was a high need for preventive strategies for substance abuse among secondary school students in Orlu, few strategies were in place to meet the needs of the students.

Phylogenetic analysis of feline infectious peritonitis virus, feline enteric coronavirus, and severe acute respiratory syndrome coronavirus 2 of cats in Surabaya, Indonesia.

Questions about the origin of coronavirus and its introduction to human beings have persisted. The detection of a variety of coronavirus related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in bats and pangolins led to the widespread belief that SARS-CoV-2 originated from wild ani-mals and was introduced to humans through an inter-mediate animal. Thus, coronaviruses from animals, especially those in close contact with humans, have attracted particular attention. This study aimed to phylogenetically analyze feline enteric coronavirus (FECV), feline infectious peritonitis virus (FIPV), and SARS-CoV-2 found in cats in Surabaya amid the COVID-19 pandemic. The results will provide a basis for developing basic preventive and pet healthcare strategies. Samples were collected on physical examinations of domestic and Persian cats (males and females) from March 2020 to March 2022. Samples were collected if there were clinical signs of FECV and FIP based on a veterinarian's diagnosis in several clinics in Surabaya. Laboratory examinations in this study were performed by reverse-transcription-polymerase chain reaction (RT-PCR) with primers for conserved regions of FIP and FECV, DNA sequencing was performed with Applied Biosystem Genetic Analyzer protocol, homology analysis was performed using Basic Local Alignment Search Tool NCBI, phylogenetic analysis was carried out with BioEdit 7.2 software, and sequences were compared with references from GenBank. Samples were collected from ten cats showing clinical signs of FECV and FIP, based on a veterinarian's diagnosis. On RT-PCR examinations performed with specifically designed primers for detecting FIPV in blood, peritoneal fluid, and feces, only one sample showed positivity for FIPV (1/10), namely, a peritoneal sample from a domestic cat in Surabaya. Homology analysis of the FIPV Surabaya isolate showed 98% similarity with FECV and FIPV reported in GenBank (MT444152 and DQ010921, respectively). In phylogenetic analysis, the FIPV Surabaya isolate was clustered together with SARS-CoV-2 of Clade A (MT198653) from Spain, SARS-CoV-2 Clade A (MT192765) from the USA, SARS-CoV-2 Clade D (039888) from the USA, and SARS-CoV-2 Clade F (MT020781) from Finland. This study revealed a relationship between the SARS-CoV-2 viruses that infect humans and cats (FECV), which is an important finding for those keeping cats at home. However, this finding requires further comprehensive support from laboratory studies.

Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey.

PURPOSE:The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey.DESIGN:Observational, cohort study with cross-sectional data collection and retrospective data analysis.SUBJECTS AND SETTING:The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years.METHODS:Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units.RESULTS:Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups.CONCLUSION:Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.

Vaccination in Pediatric Patients with Sickle-Cell Disease: Uptake Report and Mini-Review

Brazil has one of the highest numbers of births with sickle-cell disease (SCD) in the Americas. Despite the risk of severe illnesses and death due to both vaccine-preventable infections, vaccination uptake in pediatric patients with SCD is unknown. Children under 18 years with SCD presenting to routine medical consultations had their vaccination status evaluated according to the national recommendations. Data obtained were classified as 'Adequate', 'Delayed' or 'Missing' vaccination and compared among age groups. From 117 children screened, 100 had their vaccination card available. Vaccination coverage of routine vaccines was above 95% for all primary series and both age groups, with varied rates of delays and low missing doses. Among SCD extended vaccination, the most frequently delayed and missed vaccines were those specifically recommended to individuals with SCD as per national guidelines-and particularly those against encapsulated bacteria. Significant and varied rates of missing doses occurred in primary series and booster doses for PPSV23, Hib, menC, hepatitis A and varicella. The average influenza vaccination rate was 69.5%, with higher rates among younger children. Children with SCD have alarming under-vaccination rates. Basic prevention strategies in Brazil should be reassessed in this specific population.

Cardioembolic stroke: classification of causes and prevention strategies

This literature review covers the diversity of cardioembolic stroke (CES), the heterogeneity of the embolism sources and the morphological characteristics of the embolic substrate. It is emphasized that the determination of the individual tactics of secondary prevention is based on the verification of specific cardiac causes of stroke, for convenience, stratified as pathology of chambers, heart valves and variants of paradoxical embolism (PE). It has been shown that the leading pathology of the heart chambers associated with CES is nonvalvular atrial fibrillation and left ventricular thrombosis, and the main basis for the prevention of stroke in this pathology is oral anticoagulant therapy with direct oral anticoagulants or vitamin K antagonists (warfarin). The main types of heart valve pathology are prosthetic valves and rheumatic mitral stenosis. In this case, oral anticoagulant therapy also serves as the basis for secondary prevention. In the absence of the need to prescribe anticoagulants (mainly in the pathology of natural heart valves) acetylsalicylic acid is the drug of choice. In infective endocarditis (IE), the basic prevention strategies are antibiotic therapy and surgery. Surgical tactics also remain the main one for the prevention of CES in tumors of the left heart. Transcatheter closure of the patent foramen ovale and occlusion of the left atrial appendage are being introduced into the daily practice of interventional medicine in order to prevent ischemic stroke. A balanced individual approach to the patient, a targeted cardiological examination, a comprehensive analysis of clinical and instrumental data and the reasonable use of funds that have proven their effectiveness and safety in the main strategies for stroke prevention, are essential in effective prevention of CES.

Utilization of growth monitoring and promotion services and associated factors among children aged 0-23 months in Banja District, Northwest Ethiopia 2020: A cross-sectional study.

BackgroundGrowth monitoring and promotion are the basic malnutrition preventive strategies usually used to assess the growth of children using anthropometric measurements in comparison with world health organization standards. However, the utilization of growth monitoring and promotion services is inadequate in most developing countries. Therefore, this study aimed to assess the utilization of growth monitoring and promotion service and associated factors among children aged 0-23-month in Banja District, Northwest Ethiopia, 2020.MethodsA community-based cross-sectional study was conducted from February 2 to April 1, 2020. A total of 572 children were selected using a simple random sampling technique. Data were collected using structured and pre-tested interviewer-administered questionnaires. Data were entered into Epi data version 4.6 and analyzed using the statistical package for social science (SPSS) version 25. Both binary and multivariable logistic regression analyses with a 95% confidence level were used to identify the associated factors. Statistical significance was set at p <0.05.ResultsThis finding revealed that the proportion of growth monitoring and promotion services utilization was 38.9% [95%CI: 34.8%, 43.0%]. Child age from 0-11 months [AOR = 4.98 (95% CI: 2.75,8.37)], mothers who can read and write Amharic language [AOR = 2.04 (95%CI: 1.02,4.08)], know the benefits of weighing their child monthly [AOR = 2.9 (95%CI: 1.23, 6.94)], presence of growth monitoring service nearby [AOR = 3.2 (95%CI: 1.59,6.31)] and monthly income ≥2000 Ethiopian birr [AOR = 1.75(95% CI = 1.08, 3.02)] were some of the factors significantly associated with utilization of growth monitoring and promotion services.Conclusion and recommendationThe findings indicate that utilization of growth monitoring and promotion services is mainly affected by child age, mother/caregiver ability to read and write Amharic language, having maternal information on the benefit of the weighing child, presence of service nearby health facility, and mother/caregiver monthly income. Preparation of growth monitoring charts in local language (Awigna) and creating awareness on the proper utilization of growth monitoring and promotion services is strongly recommended.

Bridging the gap: introduction of an antimicrobial peripherally inserted central catheter (PICC) in response to high PICC central line-associated bloodstream infection incidence.

To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. A 582-bed community teaching hospital in Northwest Indiana. Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred inpatients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P=0.0002). Combined with continued compliance with basic prevention strategies (ie use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

Bridging the Gap: Introduction of an Antimicrobial Peripherally Inserted Central Catheter (PICC) in Response to High PICC Central Line-Associated Bloodstream Infection Incidence

Highlights Abstract Objective: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Design: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. Setting: A 582-bed community teaching hospital in Northwest Indiana. Methods: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred in patients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. Results: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P = 0.0002). Conclusion: Combined with continued compliance with basic prevention strategies (i.e., use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

The COVID-19 Pandemic-an Epidemiological Perspective.

Purpose of ReviewThe ongoing COVID-19 pandemic is a matter of great concern worldwide. After the first wave, several countries, notably in the European Union, are suffering a very rapid increase in the number of cases in the pandemic second wave. Health systems are under stress; hospital beds and ICU beds are increasingly occupied by COVID-19 patients, and hospitals are struggling to keep their normal operations. We review some basic epidemiological data of this new disease, regarding its appearance, reproductive rate, ways of transmission, number of cases, death rate, usefulness of diagnostic tests, basic treatment options, and prevention and control strategies, including vaccines.Recent FindingsThe basic control strategy falls into two well established categories: active attack (control) or organized defense (mitigation). The control strategy relies on classic testing, tracing, and tracking possible cases of COVID-19. Those actions draw from classical epidemiology: to actively find and detect cases, isolate if positive for 10 days and treat when needed. At the same time, the search for close contacts, test them when needed and quarantine and monitor for 10 to 14 days in order to break chains of transmission. The mitigation strategy include basic measures to protect people at increased risk of severe illness, like social distancing, wearing a mask when social distancing is not possible, avoiding crowds, avoiding indoor crowded spaces, increase ventilation indoors and washing or sanitizing hands often. They include also targeted restrictions in people’s mobility, and lock-downs, widely used during the first wave in order to spare the health system, become overwhelmed and increasingly used in Europe once more in the current strong second wave.SummaryWaiting for effective and safe vaccines and treatments, stopping the ongoing COVID-19 transmission is our only defense wall. We do not know yet which strategy or strategies worked best. We all must work as a team to give an adequate response to this pandemic. We have just one world and one health. Nobody will be safe until everybody is safe.

Association between Silica Exposure and Cardiovascular Disease Mortality: A Meta-Analysis.

Background: Silica exposure is detrimental to health and has, thus, been a global health concern. We performed a systematic review and meta-analysis of existing articles to assess the involvement of silica exposure in cardiovascular disease (CVD) mortality. Methods: Electronic databases including Web of Sciences, Scopus, PubMed, and Google Scholar were searched for eligible publication until December 2019. The pooled standard mortality ratio (SMR) and the 95% confidence interval (CI) were used to detect the association between silica exposure and CVD mortality. Results: The pooled estimates of SMR indicated a nonsignificant association between silica exposure and CVD mortality (SMR: 1.26; 95% CI: 0.88-1.63). The subgroup analysis based on the type of CVD indicated a significant positive association between silica exposure and mortality from hypertensive heart disease (SMR: 2.45; 95% CI: 2.16 -2.74) and pulmonary heart disease (SMR: 4.03; 95% CI: 3.87-4.20). Conclusion: This study confirmed that silica exposure is associated with an enhanced risk of mortality of hypertensive and pulmonary heart diseases. The verification of these results may have important effects on basic preventive strategies for health-care providers. Because of the mismatch in the silica exposure classification, some works in the literature were excluded. Also, the years of silica exposure may be important in CVD mortality. We suggest that these potential confounders be considered in future research.

CDC Releases Suicide Prevention Guide for States, Communities

Back to table of contents Previous article Next article Professional NewsFull AccessCDC Releases Suicide Prevention Guide for States, CommunitiesMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Oct 2018https://doi.org/10.1176/appi.pn.2018.10b9AbstractPsychiatrists and mental health clinicians may have an especially important role in counseling patients and family members about safe storage of medications, firearms, and other household items that may be used in suicide.The Centers for Disease Control and Prevention (CDC) has published a “technical package” of suicide-prevention strategies that can be used at the state and community levels as well as by psychiatrists and mental health professionals.Christine Moutier, M.D., urges psychiatrists to seek extra training in suicide risk assessment and treatment.The 67-page document, titled “Preventing Suicide: A Technical Package of Policies, Programs and Practices,” describes a select group of strategies based on the best available evidence. These strategies are described in seven chapters that cover the topics of strengthening economic supports, strengthening access and delivery of suicide prevention care, creating protective environments, promoting connectedness, teaching coping and problem-solving skills, identifying and supporting people at risk, and lessening harms and preventing future risk.“States and communities already engaged in suicide prevention can use this technical package to assess their activities and see if there are areas in which to expand their efforts,” said Deb Stone, Sc.D., M.S.W., M.P.H., in comments to Psychiatric News. She is a behavioral scientist in the Division of Violence Prevention at the CDC’s National Center for Injury Prevention and Control. “For states and communities who have not begun work in the area of suicide prevention, this technical package can help guide decision making and prevention planning.”The strategies in the package include those with a focus on preventing suicide and reducing risk as well as approaches to lessen the immediate and long-term harms of suicidal behavior for individuals, families, communities, and society at large.Although primarily intended for policymakers, the technical package can be used by psychiatrists and mental health clinicians. “Psychiatrists may be able to use the package in several ways—by working with their local community organizations to make sure that evidence-based programs are being implemented and helping to raise awareness about the programs and policies described in the technical package,” Stone said. “The broad range of strategies in the technical package requires collaboration across community sectors. Psychiatrists and other health and mental health professionals are critical to the implementation of evidence-based treatments and practices such as Collaborative Assessment and Management of Suicidality, dialectical behavior therapy, and other forms of cognitive-behavioral therapy.” Among the experts who reviewed the CDC document was APA member Christine Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention (AFSP).In comments to Psychiatric News, Moutier said the technical package builds on a similar document produced by the AFSP’s Action Alliance, “Transforming Communities: Key Elements for the Implementation of Comprehensive Community-Based Suicide Prevention.” The latter outlined very broad public health strategies—planning, communication with stakeholders in the community, aligning activities to the local culture, and ensuring sustainability for long-lasting change.She said the CDC technical package is a more detailed “toolkit” describing specific strategies that have been shown to reduce suicide.Moutier highlighted the need to reduce access to lethal means among people at risk for suicide. In the chapter titled “Create Protective Environments,” the technical package outlines the importance of safe storage of medications, firearms, and other household products that can be used in suicide.“Such practices may include education and counseling around storing firearms locked in a secure place (e.g., in a gun safe or lock box), unloaded and separate from the ammunition; and keeping medicines in a locked cabinet or other secure location away from people who may be at risk or who have made prior attempts,” according to the technical package.Moutier said psychiatrists and other physicians have a critical role in providing such counseling. “If we educate all gun owners that the presence of a gun in the home increases the risk of suicide and we also teach them basic prevention strategies such as safe storage, we have a logical reason to believe it will reduce suicide in the population,” she said.She urged psychiatrists to seek out extra training in suicide risk assessment and evidence-based treatments and to familiarize themselves with the CDC technical package.“It really represents how far we have advanced in community-based suicide prevention,” Moutier said. ■“Preventing Suicide: A Technical Package of Policies, Programs, and Practices” can be accessed here. “Transforming Communities: Key Elements for the Implementation of Comprehensive Community-Based Suicide Prevention” is available here. ISSUES NewArchived

Insight and judgment on recurrence of hepatocellular carcinoma after liver transplantation

Hepatocellular carcinoma (HCC) is the most important cause of adult liver transplantation in China. HCC recurrence after liver transplantation is a common clinical problem. It is imperative to explore its metastasis and recurrence mechanism and to develop effective prevention and treatment strategies. This article describes the basic prevention and treatment strategies for recurrent HCC after liver transplantation. During the pre-transplant period, the clinical and pathological information of HCC, such as tumor staging, general morphology, pathological features, tumor markers and tumor molecular biological characteristics, should be collected and analyzed carefully in order to determine the risk of recurrent HCC; Design and implement a comprehensive program of prevention and treatment. Currently, sorafenib and capecitabine are common candidate drugs for prevention and control of recurrence of HCC after liver transplantation. Substitution of m-TOR inhibitors for CNI-like drugs can be used as an immunosuppressive drug to prevent and control recurrence of HCC. HCC recurrence after liver transplantation will significantly reduce the cure rate, but active treatment often can effectively control the progression of the disease and improve the prognosis. However, available effective measures to prevent the progress of HCC can also be used to treat HCC recurrence after liver transplantation. Surgical treatment is preferred for recurrent lesions that can be resected, and local treatment is available for recurrent lesions that cannot be resected. Drug treatment can inhibit tumor growth to a certain extent, but it is difficult to achieve a satisfying prognosis by single drug, commonly used as adjuvant therapy.

Chapter 20 - Cerebral palsy

Cerebral palsy (CP) is a lifespan motor disorder arising from damage to the developing brain before or shortly after birth. People with CP may experience problems with muscle coordination and difficulties with the organization and processing of sensory information. Functional mobility is impaired and commonly influenced by spasticity and musculoskeletal system problems such as contractures or bony torsion. Around 60% of individuals with CP are able to walk independently or with aids when entering adulthood. However, many adults with CP experience increasing balance and mobility dysfunction associated with premature aging. Falls and reduced falls efficacy are commonly experienced, with associated physical and psychosocial consequences. There is evidence that ambulant adults with CP may be able to enhance their functional balance and mobility as a result of an individualized exercise program of sufficient duration and intensity. However, whether such programs result in a reduction in falls is unknown. Given the high number of falls with injury experienced by this population, attention to fall risk factors and provision of basic fall prevention strategies are warranted.

Epidemiology and Outcome Determinants of Pedestrian Injuries in a Level I Trauma Center in Southern Iran; A Cross-Sectional Study

To epidemiologically assess the accidents and incidents in the injured pedestrians referred to Shahid Rajaee Hospital, Shiraz in order to provide basic preventive strategies and reduce injuries and fatalities caused by traffic accidents in pedestrians.This cross-sectional study was conducted on 5840 injured pedestrians referred to Shahid Rajaee Hospital, Shiraz from 2009 to 2014. The baseline characteristic including the demographic and clinical information, the mechanism of injury, injury severity score (ISS) and outcome determinants. We also recorded the outcome measures and the mortality. Multivariate logistic regression analysis was performed to investigate the factors related to mortality rate and Length of Stay (LOS) in hospital.In our study, the history of 5840 injured pedestrians was analyzed. The mean age of the patients was 41.32 ± 19.21 years. Multivariate logistic regression indicated that mortality increased with age. Moreover, the odds of mortality was more in patients with Injury Severity Score (ISS) between 16 and 24 [OR: 12.94, 95% CI (3.78-32.66), p=0.001] and injuries in the head and neck [OR: 7.92, 95% CI (4.18-14.99), p=0.020]. LOS in hospital was also higher in patients with ISS > 25 [OR: 16.65, 95%CI (10.68-25.96), p=0.001].Pedestrians have always been one of the most vulnerable road users. Our study indicated that the adverse consequences and mortalities in pedestrians increased with age. Hence, approaches are required to improve primary prevention programs and reduce deaths and injuries due to this major public health problem.

Epidemiology and Outcome Determinants of Pedestrian Injuries in a Level I Trauma Center in Southern Iran; A Cross-Sectional Study.

To epidemiologically assess the accidents and incidents in the injured pedestrians referred to Shahid Rajaee Hospital, Shiraz in order to provide basic preventive strategies and reduce injuries and fatalities caused by traffic accidents in pedestrians. This cross-sectional study was conducted on 5840 injured pedestrians referred to Shahid Rajaee Hospital, Shiraz from 2009 to 2014. The baseline characteristic including the demographic and clinical information, the mechanism of injury, injury severity score (ISS) and outcome determinants. We also recorded the outcome measures and the mortality. Multivariate logistic regression analysis was performed to investigate the factors related to mortality rate and Length of Stay (LOS) in hospital. In our study, the history of 5840 injured pedestrians was analyzed. The mean age of the patients was 41.32 ± 19.21 years. Multivariate logistic regression indicated that mortality increased with age. Moreover, the odds of mortality was more in patients with Injury Severity Score (ISS) between 16 and 24 [OR: 12.94, 95% CI (3.78-32.66), p=0.001] and injuries in the head and neck [OR: 7.92, 95% CI (4.18-14.99), p=0.020]. LOS in hospital was also higher in patients with ISS > 25 [OR: 16.65, 95%CI (10.68-25.96), p=0.001]. Pedestrians have always been one of the most vulnerable road users. Our study indicated that the adverse consequences and mortalities in pedestrians increased with age. Hence, approaches are required to improve primary prevention programs and reduce deaths and injuries due to this major public health problem.

Contrast-induced nephropathy: Basic concepts, pathophysiological implications and prevention strategies.

Contrast-induced nephropathy (CIN) is reversible acute renal failure observed following administration of iodinated contrast media (CM) during angiographic or other medical procedures such as urography. There are various mechanisms through which CM develop their nephrotoxic effects, including oxidative stress and apoptosis. CIN is a real-life, albeit not very rare, entity. Exact pathophysiology remains obscure and no standard diagnostic criteria apply. The Acute Kidney Injury Network criteria was recently employed but its incidence/clinical significance warrants further clarification based on recent methodological advancements, because most published studies to date were contaminated by bias. The current study is a comprehensive review conducted to provide an overview of the basic concepts of CIN and summarize recent knowledge on its pathophysiology and the evidence supporting potential prevention strategies. CIN is expected to increase morbidity, hospital stay and mortality, while all patients scheduled to receive CM should undergo risk assessment for CIN and high-risk patients may be considered candidates for prevention strategies. The value of using compounds with antioxidant properties other than sodium bicarbonate, remains controversial, warranting further clinical investigation.

Body Site Distribution and Relative Tumor Density of Different Human Cutaneous Malignancies with Emphasis on Sunlight Exposure: A Single Institution Experience

Backround: Different skin cancer types display disparate body site distribution, particularly related to sunlight exposure pattern. We evaluated topographic distribution and relative tumor density (RTD) in a set of human cutaneous malignant melanoma (MM), basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) cases. Material and methods: A total of 186 MMs from 182 subjects, 1184 BCCs from 899 subjects, and 146 SCCs from 114 subjects were analyzed. Results: MMs occured most commonly on the trunk (46.8%) and upper limbs (25.3%). While the back, and the trunk in particular were sites with the most frequent MM development in males (64.3% and 45.9%), the upper limbs were the most common location in females (34.1%). BCCs and SCCs occured predominantly on the head and neck, comprising a total of 69.0% and 81.5% of the cases. The face was a region with by far the highest RTDs in BCC and SCC patients. Men had more frequently affected extra-facial sites of the head and neck compared to women in both, the BCC (46% vs 31.9%) and SCC (62.5% vs 48.3%) cases. In BCC, the second most frequent anatomic site included the back in both genders (25.1% in males, 18.2% in females), but in SCC, it represented the trunk as a whole in males (13.6%), and the lower limbs in females (14.3%). The greatest differences in RTDs between BCC and SCC were on the back (BCC:SCC ratio, 7.5:1), especially in men (BCC:SCC ratio, 9:1). Conclusion: We have observed striking heterogeneity for skin cancers risk by anatomic site with apparent gender-related disparities. Knowledge about spatial density and body site predilection of cutaneous malignancies may provide better insight into their pathogenesis and help to improve basic preventive strategies.

Effect of daily chlorhexidine bathing on the acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit with methicillin-resistant S aureus endemicity.

Universal decolonization is recommended in intensive care units (ICUs) that have unacceptably high rates of methicillin-resistant Staphylococcus aureus (MRSA) despite implementation of basic prevention strategies. An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of MRSA in a medical ICU with MRSA endemicity. There was a 14-month control period and a 16-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of daily chlorhexidine bathing on the incidence density of MRSA. Also, chlorhexidine susceptibility testing with polymerase chain reaction for the qacA/B gene was performed on MRSA isolates collected during the chlorhexidine bathing period. There was a significant reduction in trend (-0.056; 95% confidence interval, -0.095 to -0.017; P = .005) of incidence density of MRSA despite a significant increase in both level and trend of MRSA prevalence rates during the chlorhexidine bathing period. However, there was no significant reduction in level of incidence density of MRSA during the interventional period. Minimum inhibitory concentration of chlorhexidine and the detection rates of the qacA/B gene for a total of 174 MRSA isolates did not increase during the chlorhexidine bathing period. Daily chlorhexidine bathing resulted in a significantly decreasing trend of MRSA acquisition rates irrespective of increased MRSA prevalence rates in the medical ICU. There was no shift of chlorhexidine-resistant MRSA strains.