RESUMEN
BACKGROUND: Livestock-associated Staphylococcus aureus (LA-SA) has been documented worldwide. However, much remains unknown about LA-SA colonization and infection, especially in rural environments. METHODS: We conducted a large-scale prospective study of 1342 Iowans, including individuals with livestock contact and a community-based comparison group. Nasal and throat swabs were collected to determine colonization at enrollment, and skin infection swabs over 17 months were assessed for S. aureus. Outcomes included carriage of S. aureus, methicillin-resistant S. aureus (MRSA), tetracycline-resistant S. aureus (TRSA), multidrug-resistant S. aureus (MDRSA), and LA-SA. RESULTS: Of 1342 participants, 351 (26.2%; 95% confidence interval [CI], 23.8%-28.6%) carried S. aureus. MRSA was isolated from 34 (2.5%; 95% CI, 1.8%-3.5%) and LA-SA from 131 (9.8%; 95% CI, 8.3%-11.5%) of the 1342 participants. Individuals with current swine exposure were significantly more likely to carry S. aureus (prevalence ratio [PR], 1.8; 95% CI, 1.4-2.2), TRSA (PR, 8.4; 95% CI, 5.6-12.6), MDRSA (PR, 6.1; 95% CI, 3.8-10.0), and LA-SA (PR, 5.8; 95% CI, 3.9-8.4) than those lacking exposure. Skin infections (n = 103) were reported from 67 individuals, yielding an incidence rate of 6.6 (95% CI, 4.9-8.9) per 1000 person-months. CONCLUSIONS: Current swine workers are 6 times more likely to carry MDRSA than those without current swine exposure. We observed active infections caused by LA-SA. This finding suggests that individuals with livestock contact may have a high prevalence of exposure to, and potentially infection with, antibiotic-resistant S. aureus strains, including LA-SA strains.
Asunto(s)
Agricultura , Portador Sano/epidemiología , Farmacorresistencia Bacteriana Múltiple , Exposición a Riesgos Ambientales , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/efectos de los fármacos , Porcinos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Portador Sano/microbiología , Niño , Preescolar , Femenino , Humanos , Lactante , Iowa/epidemiología , Masculino , Persona de Mediana Edad , Cavidad Nasal/microbiología , Exposición Profesional , Faringe/microbiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Piel/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Adulto JovenRESUMEN
Cancer has become a prevalent disease, affecting millions of new patients globally each year. The COVID-19 pandemic is having far-reaching impacts around the world, causing substantial disruptions to health and health care systems that are likely to last for a prolonged period. Early data have suggested that having cancer is a significant risk factor for mortality from severe COVID-19. A diverse group of medical oncologists met to formulate detailed practical advice on systemic anticancer treatments during this crisis. In the context of broad principles, issues including risks of treatment, principles of prioritizing resources, treatment of elderly patients, and psychosocial impact are discussed. Detailed treatment advice and options are given at a tumor stream level. We must maintain care for patients with cancer as best we can and recognize that COVID-19 poses a significant competing risk for death that changes conventional treatment paradigms.
Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/mortalidad , Oncología Médica , Neoplasias/mortalidad , Neumonía Viral/mortalidad , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Atención a la Salud , Humanos , Neoplasias/complicaciones , Neoplasias/terapia , Neoplasias/virología , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Neumonía Viral/virología , Factores de Riesgo , SARS-CoV-2 , TelemedicinaRESUMEN
A pilot study was conducted to compare gauze with silicone foam that may be left in place for as long as seven days. Adult patients who were receiving treatment via peripherally inserted central catheters were recruited and alternately assigned to either the gauze or silicone foam group. Patient-reported itch and discomfort, nurse-reported ease of removal, and skin status were recorded for four weeks at each weekly dressing change.
Asunto(s)
Cateterismo Periférico/instrumentación , Cateterismo Periférico/enfermería , Catéteres de Permanencia , Adulto , Anciano , Anciano de 80 o más Años , Vendajes , Dermatitis Irritante/etiología , Dermatitis Irritante/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prurito/etiología , Prurito/prevención & control , SiliconasRESUMEN
CONTEXT: The Agricultural Health Study (AHS) is a large, prospective cohort study in the states of Iowa and North Carolina that has been developed to better understand how pesticides and other agricultural exposures relate to the occurrence of cancer and other diseases. PURPOSE: This report compares the characteristics of AHS farmers to the Census of Agriculture to evaluate the generalizability of AHS findings. METHODS: We restricted the AHS to private pesticide applicators who enrolled in Iowa (n = 31,065) and in North Carolina (n = 17,239) between 1993 and 1997, and who identified themselves as living or working on a farm. We compared their self-reported data with data from the 1992 and 1997 Censuses of Agriculture. FINDINGS: AHS farmers in Iowa are younger; live or work on larger farms; more frequently apply herbicides, insecticides, and fungicides; and are more likely to raise beef cattle and swine, and grow corn, soybeans, hay, and oats. AHS farmers in North Carolina are also younger, live or work on larger farms, more frequently reported growing crops commonly seen in the state, and are more frequent pesticide users. However, animals raised are similar to those in the North Carolina Census of Agriculture. CONCLUSIONS: AHS farmers likely represent the higher end of pesticide usage in both states in part because AHS farmers have larger farms. Since the health effects of pesticides are best ascertained among pesticide users with the greatest exposure, the AHS cohort should prove to be a valuable resource for health effects research.