Analysis of foodborne salmonellosis serotypes and drug resistance in children in Chenzhou City of China from 2017 through 2022.

Background: Salmonella is a significant pathogens of foodborne illness. The widespread use of antibiotics in clinical practice and animal husbandry has resulted in increasing drug resistance of Salmonella. In this study, we examined the serotype distribution and drug resistance of Salmonella in pediatric patients with diarrhea in Chenzhou City to provide a basis for the scientific control and rational use of antibiotics in clinical practice in relation to Salmonellosis. Methods: Stool Salmonella spp. were collected from patients younger than 18 years of age who met the definition for foodborne illness at two sentinel hospitals from 2017 through 2022 tested Salmonella, and a descriptive analysis of the epidemiologic characteristics. Salmonella strains isolated from the stool underwent serology and drug-sensitivity tests. The following 14 antibiotics were used for the drug-sensitivity tests: ampicillin (AMP), ampicillin/sulbactam (AMS), cefazolin (CFZ), cefoxitin, cefotaxime, ceftazidime, imipenem (IPM), tetracycline (TET), nalidixic acid, ciprofloxacin, chloramphenicol (CHL), gentamicin, trimethoprim/sulfamethoxazole (SXT), and azithromycin. Results: Samples from 1,263 pediatric with diarrhea, and Salmonella was detected in 221 (17.5%) of these patients. Positive test results were principally observed in the second and third quarters of each year, accounting for 21.1% and 19.6% of the cases, respectively. The infection rates of infants aged less than 12 months and toddlers aged 1-3 years with diarrhea were the highest at 21.3% and 17.8%, respectively. The 221 Salmonella strains were divided into 32 serotypes, of which Salmonella Typhimurium (S. Typhimurium) was the dominant strain (79.2%). The resistance rates to TET (86.9%), AMP (75.6%), AMS (58.4%), CFZ (55.7%), CHL (54.3%), and SXT (45.2%) predominated, and the differences in the drug-resistance rates to 1st-, 2nd-, and 3rd-generation cephalosporins were high (2.3-55.7%). Only 0.9% of the strains were resistant to IPM. The multidrug resistance (MDR) rate was 76.5% (169/221), and 48.9% (108/221) of the strains were resistant to five or more classes of antibiotics, of which the most common drug-resistance profile was AMP-AMS-TET-CHL-CFZ-SXT, accounting for 10.9% of Salmonella strains (24/221). Conclusions: Foodborne salmonellosis tended to occur during the summer and autumn in children, and infants and toddlers were more likely to develop salmonellosis than children in the other age groups. The dominant Salmonella serotype was S. Typhimurium. The drug-resistance rate of the tested strains was high, and the MDR problem was severe. We recommend that in the treatment of salmonellosis, antibiotics be selected rationally based on the drug-resistance status of local Salmonella resistance situation to ensure safety and efficacy.

Analysis of risk factors for community-acquired Clostridioides difficile diarrhea in children: a case-control study in Chenzhou, China.

Background: Most previous studies on Clostridium difficile infection (CDI) mainly focused on adults with underlying diseases or critical illnesses. However, the number of CDI cases in children has also significantly increased, especially the growth of community-acquired CDI, which has attracted attention. This study was conducted to examine the toxin gene characteristics and the risk factors associated with community-acquired CDI (CA-CDI) in children with diarrhea. Methods: Children with diarrhea before admission or within 48 hours of hospitalization were included in the study. Stool samples were collected from children with community-acquired diarrhea who were treated at the Children's Hospital of the First People's Hospital of Chenzhou, China from June of 2021 to June of 2022. Fluorescence real-time polymerase chain reaction was utilized to detect Clostridioides difficile (CD) toxins A (tcdA) and B (tcdB) genes as well as binary toxin gene A (cdtA) and B (cdtB) in the specimens cultured for CD. Each child with CA-CDI was matched with four control children of the same sex, age, and place of residence. Necessary clinical data were extracted from the hospital's electronic medical record system. Then, a multivariate conditional logistic regression analysis was applied to identify potential risk factors for CA-CDI. Results: Sixteen (8.3%) of the 193 stool specimens who tested positive for CD were selected for the case group, and their matching 64 control patients were in the study cohort. The breakdown of the CD genotypes of the 16 positive cases were follows: 14 (tcdA+ and tcdB+) (7.25%) and 2 (tcdA+ and tcdB-) (1.04%). The cdtA and cdtB binary toxin genes were negative in all. The results of multivariate conditional logistic regression analysis identified antibiotic use within the previous month [odds ratio (OR) =5.13; 95% confidence interval (CI): 1.65-15.91] and non-breastfeeding (OR =4.89; 95% CI: 1.11-21.53) as independent risk factors for CDI in pediatric patients experiencing community-acquired diarrhea. Conclusions: Children who had been treated with antibiotics and not breastfed were more susceptible to CDI. Therefore, in order to prevent and to control the spread of CD infection, being prudent to the aforementioned high-risk factors is strongly advocated in clinical practice.

An Innovative Evaluation in Fundamental Nursing Curriculum for Novice Nursing Students: An Observational Research.

BACKGROUND: is the first specialized curriculum for nursing students, laying a foundation for nursing education. includes many important basic nursing skills, which suggests the traditional examination could not evaluate how well students learn. Since the OSCE (objective structured clinical examination) developed, it has been used among newly graduated nurses, postgraduate nursing students and achieved some success. OSCE might be a better way to evaluate and reflect students' fundamental nursing skills and comprehensive abilities, although few studies have put it into practice. OBJECTIVES: To build an examination model relating to based on OSCE, and put this examination model into practice, and then evaluate the reliability and validity of this examination model. DESIGN: This study is to design an examination model based on literature and teaching purposes of . A quantitative descriptive survey methodology was used to obtain the students' outcome and the views of the students on the process and outcome. SETTINGS: This study was conducted in the nursing school of one comprehensive university in Beijing, China. PARTICIPANTS: 99 undergraduate nursing students in second year participated in this study. METHODS: The OSCE consisted of 4 interactive simulated patient stations, 2 operating stations without standard patients, 2 theoretical stations. We designed 4 standardized process-based case scenarios and corresponding scripts pertinent to each station. 4 standard patients and 8 teachers of were recruited, trained and evaluated before the implementation of objective structured clinical examination. RESULTS: The average score of overall fundamental nursing skills was 90.51 ±â€¯4.00. The Cronbach alpha was 0.665, demonstrating the OSCE is reliable. The content validity of each station varies from 0.90-1, and the criterion validity was promising (R = 0.661, p = 0.000). Also, most students were in favor of OSCE to evaluate in . CONCLUSIONS: The OSCE is a reliable and valid assessment tool in . Meanwhile, it could inspire students' critical thinking and promote students' communication skills. Through successive application of OSCE in nursing education from the very beginning, it might also have some potential effect on the clinical performance.

Negative effects of artemisinin on phosphorus solubilizing bacteria in vitro.

The anti-malarial drug artemisinin is extracted from the leaves of Artemisia annua L. Due to toxicity to some microorganisms, the release of artemisinin from this medicinal plant in commercial cultivation might produce a potential risk for phosphorus (P) solubilizing bacteria (PSB). Therefore, the growth, P mobilization, and proton and organic acid efflux by two PSB isolates, Bacillus subtilis and Pseudomonas fluorescens, obtained from the soil without growing A. annua L. in history in the region for growing A. annua L., Chongqing, China, were studied through soil and solution incubations with different nominal concentrations of artemisinin (0, 2.5, 5.0, and 10.0 mg/kg or mg/L). Addition of artemisinin into soil and culture solutions decreased significantly the number of PSB except P. fluorescens at a low artemisinin concentration (2.5 mg/L) in culture solution which remained unchanged in comparison with the control (without artemisinin). This suggests high artemisinin inhibited the cell division or led to the death of PSB, and the different species responded differently to artemisinin. Compared with original soil, PSB inoculation significantly increased Olsen P, whilst the addition of artemisinin decreased this P form in soil. There was a positive correlation between the number of PSB and Olsen P content in soils (r2 = 0.824, n = 8), indicating the involvement of PSB in P mobilization of insoluble minerals. Oxalate and acetate were commonly found in the bacterial culture solutions, which accounted for 73.6-84.4% of all organic acids in the culture medium without artemisinin. Malate was detected in the culture solution of B. subtilis, and citrate and succinate in P. fluorescens. The percentage of tricalcium phosphate solubilization (PTPS) positively correlated to the concentrations of protons and all organic acids (r2proton＝0.901, n＝8, P＜0.01; r2organic acids＝0.923, n＝8, P＜0.01). The concentrations of protons, organic acids and soluble inorganic P in culture solutions, and PTPS were decreased simultaneously as nominal artemisinin concentrations increased. For these decreases it implies the metabolic inhibition and the death of PSB caused by artemisinin could be the main reasons for the less efflux of protons and organic acids, presumably resulting in the decreased ability of PSB to mobilize inorganic P. Therefore, artemisinin released from A. annua L. in commercial and continual cultivation could adversely affect the community structure and inorganic P mobilization of PSB in soils.

A simulation model approach to analysis of the business case for eliminating health care disparities.

BACKGROUND: Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. METHODS: To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. RESULTS: The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. CONCLUSIONS: For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.

Long-term projections for diabetes-related work loss and limitations among U.S. adults.

We used data from the U.S. National Health Interview Survey to estimate the effect of diabetes on labor market outcomes. In the year 2050 an estimated 1.46 million U.S. adults will not be working; 597,000 will be work disabled; and 780,000 will have work limitations as a result of diabetes.