Community-acquired pneumonia with risk for drug-resistant pathogens.

BACKGROUND: Pneumonia is a leading infectious cause of morbidity and mortality in the United States. The Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) have published treatment guidelines for community-acquired pneumonia (CAP) based upon the site of acquisition and specific pathogen risk. The literature demonstrates improved outcomes with guideline-concordant empiric therapy. A subset of patients with CAP has risk factors for drug-resistant pathogens (DRPs). IDSA/ATS treatment guidelines do not provide clear recommendations for empiric treatment, and clinical studies have not provided descriptive data for this group. METHODS: A retrospective chart review of all admissions between January 1, 2008 and April 19, 2009 with an International Classification of Diseases-9 code and physician-documented diagnosis of pneumonia at two community hospitals were performed. IDSA pneumonia type and presence of risk factors for DRP were recorded for each patient, and the empiric antibiotic therapy received was evaluated. Admissions were excluded if immunosuppression or pregnancy was present. RESULTS: Of the 400 admissions reviewed, 343 patients were included. A total of 228 patients (71%) had CAP. Forty-three percent of patients with CAP had risk factors for DRP. Only 2% of this group received an antibiotic regimen with coverage of the specific DRP risk factor present. The most common DRPs not receiving coverage in this group were Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. P. aeruginosa and methicillin-resistant S. aureus occurred more commonly in culture-positive patients with CAP with DRP risk factors but did not achieve statistical significance. A larger sample size would be needed to determine whether this difference is significant. CONCLUSIONS: Risk factors for DRP occurred commonly in our CAP population. Patients with CAP with risk for DRP may be a distinct group who are without clear guidance on treatment. Future studies are needed to define the risk of DRP and the impact upon empiric therapy for patients with CAP.

Optimizing Use of Newly Approved Agents for Acute Myeloid Leukemia.

Until recently, treatment advances in acute myeloid leukemia (AML) had been slow since the 1970s. However, in the past few years, as the understanding of the pathophysiology of AML has advanced, numerous treatments have been approved by the U.S. Food & Drug Administration. This article reviews the mechanisms of action, indications, and clinical trial details for eight novel agents, as well as the current discussions surrounding monitoring minimal residual disease.

The Role of the Advanced Practitioner in Enhancing Outcomes.

Advanced practitioners (nurse practitioners, physician assistants, pharmacists, and other health-care providers) have become increasingly integral members of the oncology care team. The accelerated rate of approvals for new therapies in acute myeloid leukemia highlights the imperative of timely collaboration between the entire team.

Work-related nonfatal injuries in Alaska's aviation industry, 2000-2013.

Aviation is a critical component of life in Alaska, connecting communities off the road system across the state. Crash-related fatalities in the state are well understood and many intervention efforts have been aimed at reducing aircraft crashes and resulting fatalities; however, nonfatal injuries among workers who perform aviation-related duties have not been studied in Alaska. This study aimed to characterize hospitalized nonfatal injuries among these workers using data from the Alaska Trauma Registry. During 2000-2013, 28 crash-related and 89 non-crash injuries were identified, spanning various occupational groups. Falls were a major cause of injuries, accounting for over half of non-crash injuries. Based on the study findings, aviation stakeholders should review existing policies and procedures regarding aircraft restraint systems, fall protection, and other injury prevention strategies. To supplement these findings, further study describing injuries that did not result in hospitalization is recommended.

Local perspectives of the ability of HIA stakeholder engagement to capture and reflect factors that impact Alaska Native health.

BACKGROUND: Health impact assessment (HIA) is a process used to inform planning and decision making in a range of sectors by identifying potential positive and negative health effects of proposed projects, programs, or policies. Stakeholder engagement is an integral component of HIA and requires careful consideration of participant diversity and appropriate methodologies. Ensuring that the engagement process is able to capture and address Indigenous worldviews and definitions of health is important where Indigenous populations are impacted, particularly in northern regions experiencing increases in natural resource development activities on Indigenous lands. OBJECTIVE: Investigate local participant perspectives of an HIA of a proposed Alaska coal mine, with a focus on the ability of the HIA process to capture, reflect, and address health concerns communicated by Alaska Native participants. DESIGN: A qualitative approach guided by semi-structured interviews with purposeful sampling to select key informants who participated in the coal mine HIA stakeholder engagement process. RESULTS: QUALITATIVE DATA IDENTIFIED THREE KEY THEMES AS IMPORTANT FROM THE PERSPECTIVE OF ALASKA NATIVE PARTICIPANTS IN THE ALASKA COAL MINE HIA STAKEHOLDER ENGAGEMENT PROCESS: (i) the inability of the engagement process to recognize an Indigenous way of sharing or gathering information; (ii) the lack of recognizing traditional knowledge and its use for identifying health impacts and status; and (iii) the inability of the engagement process to register the relationship Indigenous people have with the environment in which they live. Issues of trust in the HIA process and of the HIA findings were expressed within each theme. CONCLUSIONS: Recommendations derived from the research identify the need to acknowledge and incorporate the history of colonialism and assimilation policies in an HIA when assessing health impacts of resource development on or near Indigenous lands. These historical contexts must be included in baseline conditions to understand particular vulnerabilities and potential health risks and impacts. Further, HIA practitioners should recognize the range of definitions for "health" and demonstrate this recognition throughout the stakeholder engagement process, as well as in the HIA recommendations and suggested mitigations.

Examining DNA fingerprinting as an epidemiology tool in the tuberculosis program in the Northwest Territories, Canada.

BACKGROUND: Tuberculosis (TB) is an important public health problem in the Northwest Territories (NWT), particularly among Canadian Aboriginal people. OBJECTIVE: To analyse the transmission patterns of tuberculosis among the population living in the NWT, a territorial jurisdiction located within Northern Canada. METHODS: This population-based retrospective study examined the DNA fingerprints of all laboratory confirmed cases of TB in the NWT, Canada, between 1990 and 2009. An isolate of each lab-confirmed case had genotyping done using IS6110 Restriction Fragment Length Polymorphism. DNA patterns were assigned to each DNA fingerprint, and indistinguishable fingerprints patterns were assigned a cluster. Social network analysis (SNA) was used to examine direct linkages among cases determined through conventional contact tracing (CCT), their DNA fingerprint and home community. RESULTS: Of the 225 lab-confirmed cases identified, the study was limited to 195 subjects due to DNA fingerprinting data availability. The mean age of the cases was 43.8 years (±22.6) and 120 (61.5%) males. The Dene (First Nations) encompassed 120 of the cases (87.7%), 8 cases (4.1%) were Inuit, 2 cases (1.0%) were Metis, 7 cases (3.6%) were Immigrants and 1 case had unknown ethnicity. One hundred and eighty six (95.4%) subjects were clustered, resulting in 8 clusters. Trend analysis showed significant relationships between with risk factors for unemployment (p=0.020), geographic location (p≤0.001) and homelessness (p≤0.001). Other significant risk factors included excessive alcohol consumption, prior infection with Mycobacterium tuberculosis and prior contact with a case of TB. CONCLUSIONS: This study demonstrates how DNA fingerprinting and SNA can be additional epidemiological tools, along with CCT method, to determine transmission patterns of TB.

Seroprevalence of Trypanosoma cruzi infection in three rural communities in Guatemala

A systematic, house-based serological survey for Trypanosoma cruzi seroreactivity was conducted in three contiguous communities in Olopa municipality, Chiquimula Department, Guatemala. Blood samples from a total of 292 individuals in 63 households were examined by enzyme-linked immunosorbent assay. The seropositive rate ranged from 0 x cent to 20.8 x cent for the three communities, with a mean of 15.1 x cent. Log-linear models showed that seroprevalence was significantly related to age (P0.005) but not to sex. However, when the age group with the lowest prevalence (1-9 years) was excluded from the analysis, age was not a significant factor (P=0.55). Data from a stratified sample collected at the same time were combined with those of the systematic sample to analyze the relationship between seropositivity and possible explanatory variables. Log-linear models, based on 586 individuals in 129 households from the two surveys, revealed a significant positive association between seropositivity and thatched roofs (P=0.01)

Seroprevalence of Trypanosoma cruzi infection in three rural communities in Guatemala / Seroprevalencia de infección por Trypanosoma cruzi en tres comunidades rurales de Guatemala

A systematic, house-based serological survey for Trypanosoma cruzi seroreactivity was conducted in three contiguous communities in Olopa municipality, Chiquimula Department, Guatemala. Blood samples from a total of 292 individuals in 63 households were examined by enzyme-linked immunosorbent assay. The seropositive rate ranged from 0 x cent to 20.8 x cent for the three communities, with a mean of 15.1 x cent. Log-linear models showed that seroprevalence was significantly related to age (P<0.005) but not to sex. However, when the age group with the lowest prevalence (1-9 years) was excluded from the analysis, age was not a significant factor (P=0.55). Data from a stratified sample collected at the same time were combined with those of the systematic sample to analyze the relationship between seropositivity and possible explanatory variables. Log-linear models, based on 586 individuals in 129 households from the two surveys, revealed a significant positive association between seropositivity and thatched roofs (P=0.01)

Una encuesta serológica sistemática y domiciliaria para detectar serorreactividad a Trypanosoma cruzi se llevó a cabo en tres comunidades contiguas de la municipalidad de Olapa, en el departamento de Chiquimula, Guatemala. Se examinaron mediante inmunoadsorción enzimática muestras de sangre obtenidas de un total de 292 habitantes que residían en 63 viviendas. La tasa de seropositividad varió de 0 a 20,8% en las tres comunidades y tuvo una media de 15,1%. Los modelos logarítmico-lineales mostraron una asociación significativa entre la seroprevalencia y la edad (P < 0,05), pero no entre aquella y el sexo. No obstante, cuando el grupo de edad que tuvo la seroprevalencia más baja (el de 1 a 9 años) se excluyó del análisis, la edad dejó de ser un factor significativo (P = 0,55). Datos obtenidos de una muestra estratificada recogida simultáneamente se combinaron con los de la muestra sistemática con el fin de analizar la relación entre la seropositividad y algunas variables que podrían ser explicativas. Los modelos logarítmico-lineales, aplicados en 586 habitantes de 129 viviendas incluidas en ambas encuestas, revelaron una asociación positiva significativa entre la seropositividad y la presencia de techo de paja (P = 0,01)