Candida auris in the burn unit: a prolonged biphasic outbreak.

Candida auris is an emerging pathogen responsible for healthcare-associated infections and outbreaks. This organism has a high tolerance to both high temperatures and high salinity. We describe our experience with a C. auris outbreak in an 8-bed inpatient burn unit at an academic medical center.

Health Characteristics and Birth Outcomes for "Starting Out Right," a Teen Pregnancy Program.

PURPOSE: To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, "Starting Out Right" (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation. DESCRIPTION: The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate. ASSESSMENT: Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began. CONCLUSION: These results suggest that participation in SOR was associated (p ≤ 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p ≤ 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens.

Barriers and perceptions of environmental cleaning: An environmental services perspective.

We examined the barriers and perceptions of using a 1-step daily disinfectant and ultraviolet light for environmental cleaning using an anonymous Likert scale survey. Results indicated that environmental services workers believe that cleaning is important for infection prevention and that ultraviolet light and 1-step daily disinfectant cleaner are effective sporicides.

Challenges to Breastfeeding Initiation and Duration for Teen Mothers.

PURPOSE: The purpose of this study was to evaluate breastfeeding practices of teen mothers in a pre- and postnatal education and support program. STUDY DESIGN AND METHODS: We studied breastfeeding practices of primarily Hispanic and non-Hispanic White teen mothers who participated in the Teen Outreach Pregnancy Services (TOPS) program, which promoted breastfeeding through prenatal programming and postpartum support. Analyses identified the most common reasons participants had not breastfed and, for those who initiated breastfeeding, the most common reasons they stopped. RESULTS: Participants (g = 314) reported on whether and for how long they breastfed. Nearly all participants reported initiating breastfeeding but few breastfed to 6 months. For the most part, reasons they reported stopping breastfeeding paralleled those previously reported for adult mothers across the first several months of motherhood. CLINICAL IMPLICATIONS: We found that teen mothers can initiate breastfeeding at high rates. Results highlight areas in which teen mothers' knowledge and skills can be supported to promote breastfeeding duration, including pain management and better recognizing infant cues. Our findings expand limited previous research investigating reasons that teen mothers who initiate breastfeeding stop before 6 months.

Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite.

We examined the perceptions and barriers to nonsurgical scrubbed hand hygiene in the operating room and endoscopy procedure room using 2 anonymous Likert-scale surveys. Results indicated poor role modeling, inconvenience, and the need to monitor hand hygiene and feedback data to providers because of poor self-awareness of hand hygiene practices.

Genus-optimized strategy for the identification of chlamydial type III secretion substrates.

Among chlamydial virulence factors are the type III secretion (T3S) system and its effectors. T3S effectors target host proteins to benefit the infecting chlamydiae. The assortment of effectors, each with a unique function, varies between species. This variation likely contributes to differences in host specificity and disease severity. A dozen effectors of Chlamydia trachomatis have been identified; however, estimates suggest that more exist. A T3S prediction algorithm, SVM-based Identification and Evaluation of Virulence Effectors (SIEVE), along with a Yersinia surrogate secretion system helped to identify a new T3S substrate, CT082, which rather than functioning as an effector associates with the chlamydial envelope after secretion. SIEVE was modified to improve/expand effector predictions to include all sequenced genomes. Additional adjustments were made to the existing surrogate system whereby the N terminus of putative effectors was fused to a known effector lacking its own N terminus and was tested for secretion. Expansion of effector predictions by cSIEVE and modification of the surrogate system have also assisted in identifying a new T3S substrate from C. psittaci. The expanded predictions along with modifications to improve the surrogate secretion system have enhanced our ability to identify novel species-specific effectors, which upon characterization should provide insight into the unique pathogenic properties of each species.

Gender bias in specialty preferences among Danish medical students: a cross-sectional study.

INTRODUCTION: Female medical students tend to prefer person-oriented specialties characterized by close doctor-patient contact and aspects of care. Conversely, male medical students tend to seek towards specialties with elements of autonomy, technology and "action" . Furthermore, female doctors will outnumber male doctors in Denmark by 2017 and this may have implications for the availability of specialized doctors. MATERIAL AND METHODS: Data derives from a baseline questionnaire pertaining to a Danish follow-up study. A total of 561 first year medical students enrolled in 2006 and 2007 answered the questionnaire. Binary logistic regression analysis was used to calculate odds ratio estimates of the relationship between gender and specialty preference. Variables measuring self-image were included in the analysis as potential mediators. RESULTS: 47% female and 19% male students pursued personoriented specialties and 46% female and 68% male students pursued technique-oriented specialties. More female students pursued technique-oriented specialties than in 1992. Female students have 69% less probability of choosing a technique-oriented specialty than males. This association is mediated by lack of self-confidence. CONCLUSION: If specialty preferences are persistent during medical school, the results suggest that we will face more difficulties recruiting males to person-oriented specialties than females to technique-oriented specialties in the future. Furthermore, when addressing students' specialty preferences, we should consider both self confidence and gender. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Female medical students are estimated to have a higher risk for developing eating disorders than male medical students.

INTRODUCTION: Studies show that university students are at risk for eating disorders. However, risk behaviour has not been studied among Danish medical students, nor have the gender differences in risk behaviour been described in a Danish context. MATERIAL AND METHODS: All first-year medical students (n = 979) received a questionnaire related to body perception, exercise habits, eating habits, height and weight in the fall of 2006 and 2007. The response rate was 57% (n = 561). The gender distribution of the study population was 71.8% females and 28.2% males and the average age was 21.5 years. RESULTS: More males (89.8%) than females (73.1%) were satisfied with their body and more females (34.8%) than males (10.9%) felt too fat. More females (42.7%) than males (19.9%) felt guilty when eating unhealthy food. 2.3% (all females) claimed to feel anxiety when they were about to eat. More males (48.4%) than females (28.6%) stated that they could not keep themselves from exercising. 13.5% of the underweight females (body mass index < 20 kg/m²) felt too fat, while none of the underweight males had this perception. In average, females and males displayed 2.8 and 2.1 risk behaviours, respectively. CONCLUSION: Female medical students have a drive for thinness and male medical students want to be muscular. More female than male students have a negative body perception. Female medical students are estimated to have a higher risk for developing eating disorders than male students. Future research in this area should address the causes of such behaviour.

[Gender differences in the social relations of students]. / Kønsforskelle i studerendes sociale relationer.

INTRODUCTION: The aim of this study is to study gender differences in social network and social support among university students with a special view to social relations as a coping strategy for dealing with personal problems. MATERIAL AND METHODS: A total of 1,126 (48%) medical, psychology and liberal arts students who initiated their studies in 2006 or 2007 participated in the study. Data derives from a student register and a questionnaire on social network and social support. RESULTS: Approximately 85% of the students visit friends weekly, and about 40% spend time with their family weekly. Nearly half of the students have a partner. More female than male medical students have a partner when initiating their studies. More than 80% of the students have experienced mental health or social problems in the past, more female than male medical and liberal arts students. More than half of the male students handle their personal problems by themselves, whereas female students receive more social support. Significant gender differences in social support are mostly found among medical and liberal arts students. CONCLUSION: The results suggest that male and female students use different coping strategies when dealing with social and mental health problems, and gender differences in social relations seem to be most widespread among medical and liberal arts students - why and how should be investigated further.

[The social recruitment of medical students in year group 2006 and 2007 at the University of Copenhagen]. / Den sociale baggrund hos medicinstuderende ved Københavns Universitet.

AIMS: To study the social recruitment of medical students at the University of Copenhagen in 2006 and 2007 and compare it to the social recruitment in 1992, the Danish population and other study programmes. MATERIAL AND METHODS: Questionnaire survey of first-year medical students from year 2006-2007. The population comprised 446 students, of whom 71% were women. They were categorised according to parents' social class, parents' education and presence of doctors in the family. RESULTS: 81% of the students belonged to social class I and II, 41% of the students' parents had a higher education and 17% had at least one parent who was a trained physician. For the Danish population and for students at Psychology and the Humanities, the numbers were significantly lower. Fewer students were recruited from the higher social classes in 1992, but more students had parents with higher education. In 1992, the quota system had an equalizing effect on the distribution across social classes; this effect did not seem to be present in 2006-07. CONCLUSION: The distribution of medical students across social classes is less equal than in the rest of the Danish population and has remained close to unchanged in the period 1992 to 2007. Furthermore, the medical school recruits more students from higher socioeconomic backgrounds than other fields of study at the University of Copenhagen. There is a need for an increased focus on the social recruitment and an intensified effort to recruit a more differentiated segment of students, among others through an increase in quota 2 admission rates.

1,25-dihydroxyvitamin D3 reverses experimental autoimmune encephalomyelitis by inhibiting chemokine synthesis and monocyte trafficking.

Multiple sclerosis (MS) is a complex neurodegenerative disease whose pathogenesis involves genetic and environmental risk factors leading to an aberrant, neuroantigen-specific, CD4+ T cell-mediated autoimmune response. In support of the hypothesis that vitamin D3 may reduce MS risk and severity, we found that vitamin D3 and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) inhibited induction of experimental autoimmune encephalomyelitis (EAE), an MS model. To investigate how 1,25-(OH)2D3 could carry out anti-inflammatory functions, we administered 1,25-(OH)2D3 or a placebo to mice with EAE, and subsequently analyzed clinical disease, chemokines, inducible nitric oxide synthase (iNOS), and recruitment of dye-labeled monocytes. The 1,25-(OH)2D3 treatment significantly reduced clinical EAE severity within 3 days. Sharp declines in chemokines, inducible iNOS, and CD11b+ monocyte recruitment into the central nervous system (CNS) preceded this clinical disease abatement in the 1,25-(OH)2D3-treated animals. The 1,25-(OH)2D3 did not directly and rapidly inhibit chemokine synthesis in vivo or in vitro. Rather, the 1,25-(OH)2D3 rapidly stimulated activated CD4+ T cell apoptosis in the CNS and spleen. Collectively, these results support a model wherein inflammation stimulates a natural anti-inflammatory feedback loop. The activated inflammatory cells produce 1,25-(OH)2D3, and this hormone subsequently enhances the apoptotic death of inflammatory CD4+ T cells, removing the driving force for continued inflammation. In this way, the sunlight-derived hormone could reduce the risk of chronic CNS inflammation and autoimmune-mediated neurodegenerative disease.

Gene expression analysis suggests that 1,25-dihydroxyvitamin D3 reverses experimental autoimmune encephalomyelitis by stimulating inflammatory cell apoptosis.

Multiple sclerosis (MS) is a debilitating autoimmune disease of the central nervous system (CNS) that develops in genetically susceptible individuals who are exposed to undefined environmental risk factors. Epidemiological, genetic, and biological evidence suggests that insufficient vitamin D may be an MS risk factor. However, little is known about how vitamin D might be protective in MS. We hypothesized that 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] might regulate gene expression patterns in a manner that would resolve inflammation. To test this hypothesis, experimental autoimmune encephalomyelitis (EAE) was induced in mice, 1,25-(OH)2D3 or a placebo was administered, and 6 h later, DNA microarray hybridization was performed with spinal cord RNA to analyze the gene expression patterns. At this time, clinical, histopathological, and biological studies showed that the two groups did not differ in EAE disease, but changes in several 1,25-(OH)2D3-responsive genes indicated that the 1,25-(OH)2D3 had reached the CNS. Compared with normal mice, placebo-treated mice with EAE showed increased expression of many immune system genes, confirming the acute inflammation. When 1,25-(OH)2D3 was administered, several genes like glial fibrillary acidic protein and eukaryotic initiation factor 2alpha kinase 4, whose expression increased or decreased with EAE, returned to homeostatic levels. Also, two genes with pro-apoptotic functions, calpain-2 and caspase-8-associated protein, increased significantly. A terminal deoxynucleotidyl transferase-mediated dUTP nicked end labeling study detected increased nuclear fragmentation in the 1,25-(OH)2D3-treated samples, confirming increased apoptosis. Together, these results suggest that sensitization of inflammatory cells to apoptotic signals may be one mechanism by which the 1,25-(OH)2D3 resolved EAE.