Exposing the Masquerade of Nocardia otitidiscaviarum Pneumonia: A Case Report.

We present a rare case of an immunocompetent 49-year-old male agriculturalist from India diagnosed with Nocardia otitidiscaviarum pneumonia. Nocardia species are ubiquitous gram-positive, partially acid-fast bacilli that predominantly infect immunocompromised individuals. Only 0.3% to 2.9% of all nocardiosis cases are attributed to N. otitidiscaviarum. The patient presented with a 25-day history of wet cough and high-grade fever, with bilateral bronchial breath sounds on chest auscultation and findings consistent with pneumonia on chest X-ray. During hospitalization, multiple treatment revisions were made. On admission, empiric antibiotic therapy against community-acquired pneumonia was initiated. Later, GeneXpert sputum testing for Mycobacterium tuberculosis complex (MTBC) was positive for MTBC DNA. Suspected tuberculosis with a secondary infection prompted a treatment switch to antitubercular therapy (ATT) along with meropenem. Despite changes to treatment, the patient continued to deteriorate with no signs of clinical improvement. ATT with meropenem was discontinued when a repeat GeneXpert for MTBC was negative, ruling out tuberculosis. Slow-growing bronchial wash culture identified the rare pathogen N. otitidiscaviarum, prompting an urgent referral to a specialized Infectious Diseases team. Treatment was then tailored according to antibiotic resistance-sensitivity testing. Targeted multidrug antibiotic therapy with trimethoprim-sulfamethoxazole and amikacin against N. otitidiscaviarum facilitated gradual clinical improvement. This case underscores the importance of considering uncommon pathogens in differential diagnosis and highlights the critical role of microbiological diagnostics in guiding effective treatment. Drug resistance and changing bacterial pathogenicity trends must not be overlooked. The round-about antibiotic treatment changes in this case point to the necessity for faster diagnostic methods in identifying Nocardia species. Further research into rapid diagnostic methods and up-to-date treatment guidelines are warranted to optimize outcomes in nocardiosis management.

Nasal Microbiota and Sensitivity Pattern in Rhinosinusitis.

Aims: To know the microorganism causing rhinosinusitis & to study the antibiotic sensitivity pattern for the isolated nasal microbiota in this region. Background: Rhinosinusitis is inflammatory condition of nose and paranasal sinuses [1]. It is multifactorial condition, in which microorganisms play pathogenic role [2]. Interactions between microorganisms, mucosa and environmental changes influence on composition of bacterial ecosystem [2]. Though antibiotics are frequently used for medical management of rhinosinusitis, sensitivity directed antibiotics are rarely prescribed. So, this study is directed to know microbial isolate in rhinosinusitis and its antibiotic sensitivity pattern. Methodology: in this 6 months prospective study during March to September 2022, done at Department of Otorhinolaryngology, Raichur Institute of Medical Sciences, Raichur; patients attending Otorhinolaryngology outpatient department and diagnosed to have rhinosinusitis were selected. Nasal swabs were collected from the middle meatus by diagnostic nasal endoscopy and were sent for culture and sensitivity. Statistical tests were applied for results(Size = 100). Results: Out of 100 patients, 52 were males, 48 were females; 88 were adults & 12 were paediatric patients. 59 patients had acute, 32 chronic and 9 had recurrent rhinosinusitis. Most common organisms isolated in acute rhinosinusitis was Klebsiella 28%, Staphylococcus aureus 56% & 66% in chronic & recurrent rhinosinusitis respectively. Klebsiella was sensitive to beta lactams & quinolones, while Staphylococcus aureus was sensitive to beta lactams & cephalosporins. Conclusion: Increase in antibiotic use has led to antibiotic resistance. Hence judicious, sensitivity directed antibiotic usage reduces the risk of antibiotic resistance and unnecessary use of antibiotics.

Social and cultural determinants of antibiotics prescriptions: analysis from a public community health centre in North India.

This paper explores the socio cultural and institutional determinants of irresponsible prescription and use of antibiotics which has implications for the rise and spread of antimicrobial resistance (AMR). This study describes the patterns of prescription of antibiotics in a public facility in India and identifies the underlying institutional, cultural and social determinants driving the irresponsible use of antibiotics. The analysis is based on an empirical investigation of patients' prescriptions that reach the in-house pharmacy following an outpatient department (OPD) encounter with the clinician. The prescription analysis describes the factors associated with use of broad-spectrum antibiotics, and a high percentage of prescriptions for dental outpatient department prescribed as a precautionary measure. This paper further highlights the need for future research insights in combining socio-cultural approach with medical rationalities, to further explore questions our analysis highlights like higher antibiotic prescription, etc., Along with the recommendations for further research.

Race and Ethnicity Reporting in Occupational Therapy Research Among Autistic Youth.

Historically marginalized racial and ethnic groups are underrepresented in autism research broadly; however, patterns of inclusion in occupational therapy research are unknown.In this secondary data analysis, we examined race and ethnicity reporting across articles included in a systematic review of evidence related to occupational therapy practice with autistic individuals <18 years (2013-2021).Two team members reached >90% interrater coding agreement in race and ethnicity reporting across articles in ADLs/IADLs, education/work, play, sleep, and social participation in clinics, homes/communities, and schools.Intervention outcomes of ADL/IADLs (66.7%) and play (66.7%) had low rates of reporting, while social participation in schools (100%) and education/work (100%) had higher rates of reporting. Sample diversity was greatest among research in schools and most limited in clinic-based settings.Systemic racism that limits individuals' participation in occupational therapy research perpetuates racial and ethnic health inequities among autistic children and adolescents.

Who is included in occupational therapy research among autistic youth?In research that guides occupational therapy practice with autistic youth, we need an understanding of the participants that were included in the research. Historically marginalized racial and ethnic groups are typically not included in the research, so we examined articles that informed occupational therapy practice for autistic youth. We found that different areas of intervention (e.g., play, education/work) had different rates of reporting. The most diverse samples were included in schools and were most limited in clinic-based settings. This is important because systemic racism can influence occupational therapy research and practice.

Reflections of Black Married Working Mothers Managing Occupational Roles and Racism.

Black married working mothers encounter forms of racism, on the job and in society. However, little attention is given to how these experiences affect their work and family lives. Qualitative thematic analysis was used to examine the narratives of 91 Black women, aged 20 to 55 years, to explore the effects of racism on their key occupational roles of wife, employee, and mother. Four major themes emerged for being a Black employee. Two themes were linked to Black mothering. Five themes were identified for being a Black wife. Also, two new culturally derived occupational roles emerged: advocate and pioneer. Findings suggest that Black married working mothers have unique transformative experiences in their occupational roles solely due to their minoritized status, which impacts their wellbeing. Occupation-based research should focus on racism's impact on the wellbeing of minoritized groups as they engage in desired and meaningful occupational roles.

Black Working Mothers Manage Racial StressorsBlack married working mothers encounter chronic forms of racism on the job and in society. However, research on how these experiences impact their work performance, family lives, and overall wellbeing remains limited. This qualitative study reviewed the interview narratives of 91 Detroit-area Black women to discover important themes about the effects of racism on their key occupational roles of wife, employee, and mother. Four major themes emerged for being a Black employee, including the need to be better than White employees while also managing discrimination. The two Black mothering themes focused on safeguarding their children and preparing them for the future. Five themes for Black wives included facing systemic stress and sustaining a marriage while preserving their autonomy. Although the results of this non-random sample cannot be generalized beyond the participants, the findings are instructive and provide a foundation for more comprehensive studies in the future.

Antibiotics resistance as a major public health concern: A pharmaco-epidemiological study to evaluate prevalence and antibiotics susceptibility-resistance pattern of bacterial isolates from multiple teaching hospitals.

BACKGROUND: Multi Drugs Resistance (MDR) is among the most worrisome healthcare issues resulting from inappropriate and indiscriminate utilization of antimicrobial agents which has compromised the efficacy and reliability of antimicrobial agents (AMAs). This has not only put a huge burden on the health care system but also is a major cause of morbidity and mortality. This project was designed to evaluate the prevalence of various microbial strains among patients admitted to various teaching hospitals and to assess their susceptibility and resistance towards clinically approved antibiotics. METHODS: The study was conducted during August 2021-February 2022 to determine the prevalence of common resistant strains of bacteria and to analyze their susceptibility pattern to the commonly prescribed antibiotics using standard procedures. One hundred and thirty biological samples including urine, blood, cerebrospinal fluid (CSF), wound swabs, pus and sputum were collected from the site of infection from the patients admitted at different wards of North West General Hospital (NWGH), Peshawar, Pakistan, Khyber Teaching Hospital (KTH), Peshawar Pakistan, and Hayat Abad Medical Complex (HMC) Peshawar Pakistan. Samples were collected and cultured following standard hospital procedures. The cultured samples were subjected to identification procedures including Gram staining, morphological characterization of bacterial colonies and biochemical assessments. The identified bacteria were tested for their susceptibility using Kirby-Bauer disc diffusion method. The diameter of Inhibitory Zones (DIZ) was analyzed following Clinical and Laboratory Standards Institute (CLSI) criteria. Minimum Inhibitory Concentrations (MICs) were evaluated using agar dilution method. Antimicrobials sensitivity were presented as antibiogram following CLSI M39 standard. RESULTS: A total of one hundred and thirty biological samples were collected, out of which one hundred and nine samples were positive for bacterial growth and were further processed for detailed analysis. The frequency and type of bacteria isolated from various cultures indicated that Gram negative bacteria (n = 92/109) were more dominant than Gram-positive (n = 17/109) pathogens. The most prevalent bacteria isolated was Escherichia coli (29.35 %), followed by Staphylococcus aureus (15.59 %), and Klebsiella spp, (12.84 %). In addition, other pathogens including, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. showed a prevalence of 9.175 %, 8.25 %, and 5.50 % respectively. As indicated in the antbiogram, several organisms exhibited considerble decline in the sensitivies towards various antibiotics. A high percentage of resistance was observed against some antibiotics including trimethoprim, co-trimoxazole, amoxicillin/clavulanate, ciprofloxacin, piperacillin/tazobactam, cefotaxime and ceftazidime. CONCLUSION: The prevalence of resistant strains of pathogens is increasing day by day, while the antibiotics commonly prescribed against them are losing their efficacy, which is pushing the world to the era of pre-antibiotics. Unfortunately, the discovery of novel antibiotics is limited and researchers speculate that the is pushing towards pre-antibiotics era. Subsequently, efforts must be directed towards ensuring rational antibiotics use to prevent emergence of MDR pathogens. Our findings indicated that Gram negative bacteria including Escherichia coli was most prevalent. Other bacterial strains including S. aureus, Klebsiella spp, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. were found among the causative agents. Unfortunately, considerable decline in the sensitivities of various bacterial isolated were observed towards the tested antibiotics. Previous studies reported the high prevalence of E. coli and S. aureus in clinical samples of Pakistani hospitals including hospitals in Peshawar and thus our findings are in agreement with the previous reports. Pharmacists being experts can play their role by promoting the optimal use of antimicrobial agents and educating healthcare professionals, patients and the public.

Unraveling the "Greener Pastures" Concept: The Phenomenology of Internationally Educated Occupational Therapists.

The Philippines is one of the major labor exporters for health care workers in the world and occupational therapists are the second most likely professionals behind nurses to work in "greener pastures" overseas. This phenomenological study describes the migration experiences of Philippine-trained occupational therapists working in high-income, Anglophone countries. Researchers conducted online interview for 15 participants who were previously/currently unemployed/underemployed. Following an inductive approach to qualitative data analysis, themes were drawn from the migrant therapists' lived experiences. Four themes describe the migration experiences of Filipino occupational therapists: (a) realities of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) when the pastures overseas are not greener, and (d) when the pastures overseas are indeed greener. The study contributes to the labor migration discourse in occupational therapy and the critical examination of the idea of "greener pastures."

The Migration and Deskilling of Filipino Occupational TherapistsThis study provides stories of Filipino occupational therapists who were underemployed as they migrated to developed and English-speaking countries. We interviewed 15 people online to explore their experiences of migration, being underemployed, and working in a foreign country with a different culture of working. Results of the study revealed four ideas: (a) reality of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) barriers faced by migrant occupational therapists, and (d) successes experienced by migrant occupational therapists. This study contributes to the ongoing research on occupational therapy, labor migration, and overseas Filipino workers.

Classification of Chemotherapy-Induced Febrile Neutropenic Episodes Into One of the Three Febrile Neutropenic Syndromes.

Introduction Febrile neutropenia is a commonly encountered medical emergency in patients undergoing cancer treatment and can delay and modify the course of treatment and even lead to dire outcomes, including death. The cause of fever in a post-chemotherapy-induced neutropenic patient can be confusing to treating physicians. A review of the literature demonstrated that blood culture results could determine the cause of febrile neutropenia in only approximately 10% to 25% of patients. The objective of our study was to measure the incidence of positive blood cultures, urine cultures, and other body fluid cultures resulting in chemotherapy-induced neutropenia and further classify fever episodes into three neutropenic fever syndromes, such as microbiologically documented, clinically suspected, or unknown causes of fever, respectively. Methods We conducted a prospective observational study on 399 chemotherapy-induced neutropenic fever episodes with the aim of classifying them into one of the three neutropenic syndromes. We tried to document the cause of the fever in these patients. We also noted the type of cancer treatment regimen they were on and correlated their clinical profile with their body fluid cultures, including blood cultures, urine cultures, and other body fluid cultures. We then categorized each fever episode into one of three neutropenic syndromes. Results We studied 399 febrile neutropenic episodes. We were able to microbiologically document the cause of fever in 39% of the cases, and we obtained growth in 51 out of 399 blood cultures (13%), which was comparable to the available literature, and urine culture showed growth in 62 out of 399 cultures (16%), while other body cultures such as pus culture, bile culture, and bronchioalveolar lavage cultures collectively showed growth in 42 out of 399 episodes (10%). The most common bacteria isolated in both blood and urine cultures were Escherichia coli. Cumulatively, including blood, urine, and body fluid cultures, we were able to classify 39% (155 out of 399 cases) of febrile neutropenic episodes as microbiologically documented. The cause of fever was clinically suspected by means of careful history taking and an extensive physical examination in 31% (125 out of 399) without growth evidence in blood cultures, urine cultures, or any other body fluid culture. The cause of fever remained unknown in 119 cases (30%) of patients and was classified under the unknown cause of fever. Conclusions We conclude by stating that the study of fever in a neutropenic patient should include a thorough history and clinical evaluation of blood, urine, and other body fluid cultures instead of solely relying on blood culture results. We recommend further classifying patients into one of the three neutropenic fever syndromes, such as those that are microbiologically documented, clinically suspected, or unknown. Our blood cultures were able to give us a 13% positivity rate, whereas microbiologically, we were able to isolate an organism likely causing fever in 39% of patients. The cause of fever was suspected clinically in 31% of patients, but we were unsuccessful in microbiologically documenting any culture growth in blood, urine, or any other body fluid culture. The cause of fever remained a mystery and unknown to us without any microbiological or clinical cues in 119 cases (30%) of febrile neutropenic episodes.

Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan.

Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient's medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization's Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.

Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications.

Background: Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. Methods: This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Results: Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Conclusion: Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.

Narrative Theater to Examine and Mitigate Anti-Black Racism Within Occupational Therapy.

Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire-Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational therapists to engage in anti-Black racism.

A prospective study of the clinical profile of hemoptysis and its correlation with radiological and microbiological findings.

Background: The etiological pattern of hemoptysis has evolved, with pulmonary tuberculosis (PTB) becoming less prevalent as a cause. There is a paucity of literature regarding the spectrum of diseases that present as hemoptysis and the data related to detailed clinical profile are lacking. Hence, this study is taken up to determine the clinical profile of hemoptysis and its correlation with radiological and microbiological findings. Methods: This was a 3-year observational prospective study of a total of 50 patients who presented with active hemoptysis. Data were recorded from these patients for assessing the clinical characteristics, radiological, and microbiological correlation. Results: The most common etiologies of hemoptysis identified in this study were PTB in 60% of the patients, aspergilloma in 14%, followed by bronchiectasis in 8%, pneumonia in 8%, carcinoma lung in 4%, and lung abscess in 1 (2%). Mild hemoptysis was present in 8% of patients, whereas 42% had moderate hemoptysis, 18% of patients had severe, and 32% had massive hemoptysis. Sixty percent of patients had recurrent hemoptysis, and the majority of the patients, i.e., 68% tested negative on sputum smear examination for acid-fast bacillus. In 60% of patients, no growth was obtained in the sputum cultures. The most common organisms isolated from sputum cultures of the rest of the patients were Pseudomonas in 14%, Klebsiella in 10%, Escherichia coli in 4%, Staphylococci in 4%, and Streptococcus pneumoniae in 4% of the cases. The majority of the patients were having consolidation and cavitary disease. A highly significant correlation was noted between the radiological findings of consolidation, mycetoma, cystic shadows, lung mass, and lung abscess and the etiology of hemoptysis (P = 0.000). Conclusion: Hemoptysis of any volume implies a life-threatening process, which mandates immediate evaluation and treatment. It is evident that the etiological spectrum of hemoptysis is continuously changing, and more sophisticated investigations, better imaging techniques, bronchoscopic tools, availability of newer techniques in the developing world, and changing patterns of diseases, all contribute to these changes. Identification of the etiology, and localization of the bleeding site, is essential for the efficient management of hemoptysis.

Case Report: Urinary Tract Infection in a Diabetic Postmenopausal Woman With Multiple Episodes of Recurrence: An Antimicrobial Susceptibility dispute.

Urinary tract infection (UTI) is caused by bacteria growing in urine and affect kidneys, bladder, ureters, and urethra. Women with diabetes are at high risk of developing UTI. This is a case of a 60-year-old postmenopausal woman with uncontrolled type-I diabetes mellitus and hypertension, who presented with an acute onset of dysuria, burning micturition, and increased frequency. This case highlights the shortfall in the preliminary management plan of performing imperative clinical laboratory investigations including urine detailed report (DR), urine culture and sensitivity(C/S), and plasma glucose testing to initiate antimicrobial treatment. UTI requires to be treated precisely in diabetic patients with the help of a comprehensive diagnosis for signs of dysuria, frequent urination, and pelvic pain. The treatment of UTIs should always begin with culture and sensitivity analysis while the patient is symptomatic, to initiate antimicrobial treatment. Comorbidities should be managed appropriately during treatment to achieve desired therapeutic outcomes.

A nationwide survey of Italian Centers for Cognitive Disorders and Dementia on the provision of care for international migrants.

BACKGROUND: More than 500,000 dementia cases can be estimated among migrants living in Europe. There is the need to collect "real world" data on the preparedness of healthcare services to support the inclusion of migrants in the public health response to dementia. The present study aimed (i) to estimate the number of migrants referred to Italian memory clinics (Centers for Cognitive Disorders and Dementia [CCDDs]) and (ii) to identify possible barriers and resources for the provision of diversity-sensitive care. METHODS: A survey of all Italian CCDDs was conducted between December 2020 and April 2021. An online questionnaire was developed to obtain information on the number of migrants referred to Italian CCDDs in 2019, the challenges encountered in the diagnostic approach, and possible facilitators in the provision of care. RESULTS: Overall, 343 of the 570 contacted CCDDs completed the survey questionnaire (response rate: 60.2%). Nearly 4527 migrants were referred to these services in 2019. Migrants accounted for a median 1.1% (IQR: 0.9%-2.8%) of overall CCDD referrals. More than one-third of respondents reported that the number of migrants referred to their facilities had increased in the last 5 years. The overall quality of the migrants' cognitive assessment was deemed to be very poor or insufficient in most cases. A minority of CCDDs had translated information material on dementia and reported the possibility to contact cultural mediators and interpreters. CONCLUSIONS: A relevant number of migrants are being referred to Italian CCDDs that are still not adequately prepared to deliver diversity-sensitive care and support.

Becoming Anti-Racist Occupational Therapy Practitioners: A Scoping Study.

The ongoing racism pandemic in the United States negatively impacts the health, safety, and occupations of Black, Indigenous, and/or People of Color. Although occupational therapy (OT) practitioners have a pressing obligation to actively address racism's causes and consequences, they lack guidance on what to do. This scoping study sought to identify and synthesize existing knowledge on ways OT practitioners and the profession can engage in anti-racist actions. Six databases were searched for content related to OT and anti-racism. The 31 included articles indicated that OT practitioners should: engage in reflexivity on ways their power and privilege impact therapeutic relationships, use inclusive models, consider how racism can impact client occupations and health care access, and address structural racism through advocacy and occupations as means. Although being anti-racist is a lifelong process, strategies within this study can support OT practitioners and the profession to initiate concrete anti-racist actions.

Magnitude of post-urethroplasty urinary tract infections in children with hypospadias at a tertiary hospital in Kenya.

INTRODUCTION: Children who have undergone urethroplasty procedure for hypospadias are at a higher risk of getting urinary tract infections (UTI). This may be due to urethral scarring following urethroplasty that acts as a nidus for UTI. The risk is also attributed to urine stasis due to complications of urethroplasty such as urethral diverticulum, urethral stricture, meatal stenosis or breakdown of urethroplasty. Hypospadias is associated with mullerian duct remnants such as mullerian duct cysts and enlarged prostatic duct utricle which may lead to recurrent UTI. OBJECTIVE: To determine the magnitude of urinary tract infections after urethroplasty for hypospadias in children at Kenyatta National Hospital (KNH), a tertiary hospital in Kenya. DESIGN: This was a prospective descriptive cross-sectional study of male children with hypospadias who had undergone urethroplasty between January 2014 to December 2018 (5years) at KNH with age range from 6 months to 18 years. Appropriate urine collection method was used to obtain the urine specimen for microscopy, culture and sensitivity tests. Data collected was analyzed using STATA 15. Significance of the results was considered at 95% confidence interval. RESULTS: The total number of patients seen and urine samples collected was 83 boys. The prevalence of UTI following urethroplasty for children with hypospadias was 6% (5/83). They all had UTI symptoms. Of the patients who had UTI, 60% was due to Enterobacter coli, 20% Pseudomonas aeruginosa and 20% Enterobacter cloaca complex. E.coli was 100% sensitive to nitrofurantoin, amoxicillin/clavulanic acid and cefazolin while 33% resistant to ciprofloxacin and Trimethoprim/sulfamethoxazole. Majority of the patients with UTI (80%) had penoscrotal hypospadias and 60% of them developed complications post-operatively. CONCLUSION: Urinary tract infections is not a common finding in children who have undergone urethroplasty for hypospadias at KNH. Patients with penoscrotal hypospadias appears to be at a higher risk of developing UTI in our institution with E. Coli being the commonest bacteria implicated. Antibiotic protocol should be based on local culture and sensitivity pattern.

Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi.

OBJECTIVE: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. METHODS: The prospective cohort study was conducted from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised eyes of patients with corneal ulcer. Corneal scrapes were sent for microbiological assessment. Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity, treatment and complications. Data was analysed using SPSS 20. RESULTS: Of the 65 eyes of as many patients, 40(61.5%) were from female patients and 25(38.4%) from males. The most common local risk factor was ocular surgery 19(29.2%), followed by ocular trauma 15(23.1%). Diabetes was present in 29(44.6%) cases. Culture results after corneal scrapings were positive for 39(60%) samples, while 26(40%) had no growth. Bacterial growth was present in 20(51.3%) eyes, fungal in 11(28.2%) and polymicrobial organisms were present in 8(20.5%). The most common pathogens were pseudomonas 10(25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up, 40(61.5%) cases showed improvement. CONCLUSIONS: Isolated pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are needed in developing countries to avoid blindness due to infective corneal ulcers.

User-Involvement in the Development of a Culturally Sensitive Intervention in the Safe Pregnancy Study to Prevent Intimate Partner Violence.

Intimate partner violence (IPV) during pregnancy has negative health impacts on the woman and the fetus. There is a lack of evidence supporting effective interventions to prevent IPV during pregnancy. This user-involvement study was conducted to get feedback on a culturally sensitive, tablet intervention containing questions about violence and safety-behaviors and a video promoting safety behaviors. This resulted in important feedback on the intervention content. Our findings show that women are in favor of disclosing IPV via a tablet. They suggested ways to address barriers for disclosure, such as safeguarding anonymity and creating a trustful relationship with the midwife.

The Feasibility and Efficacy of an Israeli Lifestyle Redesign®-Based Program for Well Older Adults: A Pilot Study.

The Israeli Lifestyle Program (ILP) was adapted from the original Lifestyle Redesign® intervention, aiming to enhance health, functioning, and quality of life (QoL) of older adults. The purpose of this study was to examine the feasibility and effectiveness of the ILP. The design of the study entailed a non-randomized trial with a 3-month follow-up including 18 women aged 65 to 81 recruited from a community center. The research group (n = 9) participated in 15 weekly group meetings and three individual sessions. The control group (n = 9) received an information booklet based on the ILP content. Between-group comparisons revealed significant differences in change scores in favor of the research group for occupational performance (U = 19.0, p = .03), environmental (U = 21.5, p = .04), and social (U = 20.5, p = .03) QoL factors. Findings also revealed reduction in depressive symptoms (U = 24.0, p = .07). These findings suggest community group programs for improving occupational performance and QoL.

The Safe Pregnancy study - promoting safety behaviours in antenatal care among Norwegian, Pakistani and Somali pregnant women: a study protocol for a randomized controlled trial.

BACKGROUND: Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem with damaging consequences. However, little is known about the effect of violence assessment and intervention during pregnancy. We hypothesise that routine enquiry about IPV during pregnancy, in combination with information about IPV and safety behaviours, has the potential to increase the use of these behaviours and prevent and reduce IPV. METHODS: The Safe Pregnancy study is a randomised controlled trial (RCT) to test the effectiveness of a tablet-based intervention to promote safety behaviours among pregnant women. Midwives include women who attend routine antenatal care. The intervention consists of a screening questionnaire for violence and information about violence and safety behaviours through a short video shown on a tablet. The materials are available in different languages to ensure participation of Norwegian, Urdu, Somali and English-speaking women. Eligible women answer baseline questions on the tablet including the Abuse Assessment Scale (AAS). Women who screen positive on the AAS will be randomized to an intervention video that contains information about violence and safety behaviours and women in the control group to a video with general information about a healthy and a safe pregnancy. All women receive information about referral resources. Follow up will be at three months post-partum, when the woman attends the maternal and child health centre (MCHC) for the baby's check-up. Outcome measures are: Use of safety behaviours and quality of life (primary outcomes), prevalence of violence, mental health measures and birth outcomes (secondary outcomes). Intention to treat analysis will be performed. DISCUSSION: The project will provide evidence on whether enquiry about violence and a short video intervention on a tablet is effective and feasible to prevent or reduce harm from IPV among women who attend antenatal care. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov. Identifier: NCT03397277 (Registered 11th January 2018).