Cognitive Impairment in the Primary Care Clinic.

Cognitive impairment is a common problem in the geriatric population and is characterized by variable symptoms of memory difficulties, executive dysfunction, language or visuospatial problems, and behavioral changes. It is imperative that primary care clinicians recognize and differentiate the variable symptoms associated with cognitive impairment from changes attributable to normal aging or secondary to other medical conditions. A thorough evaluation for potentially reversible causes of dementia is required before diagnosis with a neurodegenerative dementia. Other abnormal neurologic findings, rapid progression, or early age of onset are red flags that merit referral to neurology for more specialized evaluation and treatment.

Longitudinal observation of meticillin-resistant Staphylococcus pseudintermedius pulsotypes in six veterinary hospitals in the north-western United States.

Background: Meticillin-resistant Staphylococcus pseudintermedius (MRSP) infections in companion animals are increasing and are difficult to treat. Environmental contamination with MRSP in small animal primary care hospitals may pose an exposure risk to animal patients. Methods: This longitudinal study assessed the genotypic relationships of MRSP isolated from 39 environmental samples collected from six private small animal primary care hospitals, in the north-eastern United States, between August 2018 and April 2019. Results: Of the 39 bacterial isolates, 18 unique pulsotypes were identified based on pulsed-field gel electrophoresis, including six clusters of two or more indistinguishable isolates. Single pulsotypes were frequently detected from multiple hand-contact and animal-contact surfaces within a hospital during a single sampling event, but detection of a single pulsotype within the same hospital on subsequent visits was infrequent. However, one pulsotype was recovered from three separate hospitals, which suggests that either MRSP transmission between hospitals may have occurred via people, animals, or fomites or that there was a dominant community strain. Conclusions: Single strains of MRSP were isolated from various hand-contact and animal-contact surfaces within hospitals, indicating the important role of humans, animals and the environment in MRSP transmission. Additionally, the detection of a single strain between hospitals and over time suggests that either MRSP transmission between hospitals may have occurred via people, animals or fomites or that there was a dominant community strain.

Observed Face Mask Use at Six Universities - United States, September-November 2020.

Approximately 41% of adults aged 18-24 years in the United States are enrolled in a college or university (1). Wearing a face mask can reduce transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2), and many colleges and universities mandate mask use in public locations and outdoors when within six feet of others. Studies based on self-report have described mask use ranging from 69.1% to 86.1% among adults aged 18-29 years (3); however, more objective measures are needed. Direct observation by trained observers is the accepted standard for monitoring behaviors such as hand hygiene (4). In this investigation, direct observation was used to estimate the proportion of persons wearing masks and the proportion of persons wearing masks correctly (i.e., covering the nose and mouth and secured under the chin*) on campus and at nearby off-campus locations at six rural and suburban universities with mask mandates in the southern and western United States. Trained student observers recorded mask use for up to 8 weeks from fixed sites on campus and nearby. Among 17,200 observed persons, 85.5% wore masks, with 89.7% of those persons wearing the mask correctly (overall correct mask use: 76.7%). Among persons observed indoors, 91.7% wore masks correctly. The proportion correctly wearing masks indoors varied by mask type, from 96.8% for N95-type masks and 92.2% for cloth masks to 78.9% for bandanas, scarves, and similar face coverings. Observed indoor mask use was high at these six universities with mask mandates. Colleges and universities can use direct observation findings to tailor training and messaging toward increasing correct mask use.

Prevalence of methicillin-resistant Staphylococcus pseudintermedius on hand-contact and animal-contact surfaces in companion animal community hospitals.

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is an important companion animal pathogen, but few published studies have evaluated its epidemiology in primary care settings. This study determined MRSP prevalence on hand- and animal-contact surfaces in 11 small animal primary care hospitals in Washington and Idaho, USA. Overall, MRSP was isolated from at least 1 sample from 7 of 11 hospitals (64%) and from 36 of 374 total samples (10%) with no difference in prevalence between hand- and animal-contact surfaces (P = 0.51). Strain typing by pulsed-field gel electrophoresis indicated high within-hospital similarity of MRSP strains, but minimal similarity between strains from different hospitals. Indistinguishable MRSP strains were present on handand animal-contact surfaces within individual hospitals. A questionnaire was administered to a representative from each hospital. Respondents reported that animal-contact surfaces were cleaned and disinfected more frequently than hand-contact surfaces (P < 0.001). Improving hand hygiene and disinfection of hand-contact surfaces may decrease exposure of veterinary patients to MSRP.

Prévalence de Staphylococcus pseudintermedius résistant à la méthicilline sur des surfaces en contact avec les mains et des surfaces en contact avec les animaux dans des hôpitaux de première ligne pour animaux de compagnie. Staphylococcus pseudintermedius résistant à la méthicilline (MRSP) est un agent pathogène important chez les animaux de compagnie, mais peu d'études publiées ont évalué son épidémiologie dans les sites de soins de première ligne. Dans la présente étude on détermina la prévalence de MRSP sur les surfaces de contact avec les mains et les surfaces de contact avec les animaux dans 11 hôpitaux de première ligne pour animaux de compagnie dans les états de Washington et de l'Idaho, USA. De manière globale, le MRSP fut isolé à partir d'au moins un échantillon dans 7 des 11 hôpitaux (64 %) et de 36 des 374 échantillons (10 %) sans noter de différence dans la prévalence entre les contacts main-surface ou animal-surface (P = 0,51). Le typage des souches par électrophorèse en champs pulsés indiqua une similarité intra-hôpital élevée des souches de MRSP, mais une similarité minimale entre les souches provenant d'hôpitaux différents. Des souches indistinguables de MRSP étaient présentes sur les surfaces de contact avec les mains et les animaux dans un même hôpital. Un questionnaire fut soumis à un représentant de chaque hôpital. Les répondants rapportèrent que les surfaces de contact avec l'animal étaient nettoyées et désinfectées plus fréquemment que les surfaces de contact avec les mains (P < 0,001). Une amélioration de l'hygiène des mains et de la désinfection des surfaces en contacts avec les mains pourraient diminuer l'exposition de patients vétérinaires au MSRP.(Traduit par Dr Serge Messier).