Rural Mobile Health Unit: Outcomes

Abstract The Mobile Health Unit was implemented to increase access to nursing services, to improve and/or maintain functional status and health status, and to increase health promotion behaviors of rural elderly residents experiencing difficulty obtaining health care due to illness, transportation problems, or financial factors. For 222 project participants 1,773 encounters were completed, with a mean number of visits per individual of 7.9. Participants in the project demonstrated increased breast and cervical cancer screenings, increased immunization rates for influenza, pneumonia and tetanus, and decreased utilization of the emergency room. This project represents an alternative model of health care delivery in a rural area with limited resources and health care providers.     

Breastfeeding: Perceived Barriers and Benefits/Enhancers in a Rural and Urban Setting

Abstract This study investigated differences in perceived benefits/enhancers and barriers between women who planned to breastfeed, those who were uncertain, and those who did not plan to breastfeed. The volunteers were obtained from rural (60) and urban (82) public health department prenatal clinics. Fifty-three percent of the women were married, the average age was 23 years, 25% had not graduated from high school, 38% were black, and 46% were planning to return to work. The breastfeeding inventory consisted of 13 items to measure benefits and enhancers, 15 to measure barriers, and an openended question. Cronbach's alphas for internal consistency for benefits and enhancers and barriers were 0.88 and 0.83 respectively. Analysis of variance found significant differences among the three groups on perceived benefits and barriers. Rural and urban differences existed in perceived benefits/ enhancers, but not in perceived barriers. In a multiple discriminant function analysis that included demographic characteristics, the most important predictor of breastfeeding decision was perceived benefits.     

Neoadjuvant Doxorubicin/Cyclophosphamide Followed by Ixabepilone or Paclitaxel in Early Stage Breast Cancer and Evaluation of βIII‐Tubulin Expression as a Predictive Marker

Background.

This randomized phase II trial was designed to compare the rate of pathologic complete response (pCR) induced by neoadjuvant cyclophosphamide plus doxorubicin (AC) followed by ixabepilone or paclitaxel in women with early stage breast cancer (BC). Expression of βIII-tubulin as a predictive marker was also evaluated.

Patients and Methods.

Women with untreated, histologically confirmed primary invasive breast adenocarcinoma received four cycles of AC followed by 1:1 randomization to either ixabepilone 40 mg/m² (3-hour infusion) every 3 weeks for four cycles (n = 148) or weekly paclitaxel 80 mg/m² (1-hour infusion) for 12 weeks (n = 147). All patients underwent a core needle biopsy of the primary cancer for molecular marker analysis prior to chemotherapy. βIII-Tubulin expression was assessed using immunohistochemistry.

Results.

There was no significant difference in the rate of pCR in the ixabepilone treatment arm (24.3%; 90% confidence interval [CI], 18.6–30.8) and the paclitaxel treatment arm (25.2%; 90% CI, 19.4–31.7). βIII-Tubulin-positive patients obtained higher pCR rates compared with βIII-tubulin-negative patients in both treatment arms; however, βIII-tubulin expression was not significantly associated with a differential response to ixabepilone or paclitaxel. The safety profiles of both regimens were generally similar, although neutropenia occurred more frequently in the ixabepilone arm (grade 3/4: 41.3% vs. 8.4%). The most common nonhematologic toxicity was peripheral neuropathy.

Conclusions.

Neoadjuvant treatment of early stage BC with AC followed by ixabepilone every 3 weeks or weekly paclitaxel was well tolerated with no significant difference in efficacy. Higher response rates were observed among βIII-tubulin-positive patients.     

Rachitis- und Kariesprophylaxe in der Praxis

Background

In Germany the recommended intake of vitamin D to prevent rickets is 10?C12.5???g (400?C500?IE)/day in the first year of life. To prevent caries 0.25?C0.5?mg of fluoride/day is recommended in the first 4 years of life. The aim of this study was to examine to what extent these recommendations are realized in German children aged 10?C36 months.

Method

The 7-day estimated dietary records of 530 children from the German Representative Study of Toddler Alimentation (GRETA) were analyzed in terms of intake of nutrient preparations. The percentage of children receiving vitamin D and/or fluoride and the dosages were evaluated.

Results

In total 42% of the children received nutrient preparations and 96% of these received vitamin D and/or fluoride. Of the infants in the age group 10?C11 months 6% received vitamin D and fluoride as recommended. After the first year of life the percentage of toddlers receiving vitamin D and fluoride declined abruptly.

Conclusion

In practice parents should be made aware of the importance of rickets and caries prophylaxis in the first year of life. After the first year of life there also should be an anamnesis of vitamin D intake and synthesis by the skin due to UV radiation as well as fluoride intake.     

Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

ObjectivesTo describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19).MethodsWe performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records.ResultsOf a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes.ConclusionsCo-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.