Lactoferrin intake from maternal milk during the neonatal hospitalization and early brain development among preterm infants.

BACKGROUND: Lactoferrin is an immuno-modulatory nutrient in human milk that may be neuroprotective. METHODS: In 36 infants born <32 weeks' gestation, we sampled human milk at 14 and 28 days of chronologic age and measured lactoferrin by electrochemiluminescence multiplex immunoassay. Using 3T quantitative brain magnetic resonance imaging scans obtained at term equivalent, we estimated total and regional brain volumes. We compared outcomes between infants exposed to low (bottom tertile, range 0.06-0.13 mg/mL) vs. high (top tertile, range 0.22-0.35 mg/mL) lactoferrin using median regression in models adjusted for gestational age, birth weight z-score, sex, and postmenstrual age. RESULTS: Compared to infants exposed to low lactoferrin, infants exposed to high lactoferrin had 43.9 cc (95% CI: 7.6, 80.4) larger total brain volume, 48.3 cc (95% CI: 12.1, 84.6) larger cortical gray matter, and 3.8 cc (95% CI: 0.7, 7.0) larger deep gray matter volume at term equivalent age. Other regional brain volumes were not statistically different between groups. CONCLUSION: Higher lactoferrin exposure during the neonatal hospitalization was associated with larger total brain and gray matter volumes, suggesting that lactoferrin may have potential as a dietary supplement to enhance brain growth in the neonatal intensive care unit setting. IMPACT: This study suggests that lactoferrin, a whey protein found in human milk, may be beneficial for preterm infant brain development, and therefore has potential as a dietary supplement in the neonatal intensive care unit setting.

Antibiotic Prescribing Patterns Among U.S. Ophthalmologists and Optometrists from 2018 to 2021 in the Medicare Part D Database.

Purpose: To assess antibiotic prescribing patterns among ophthalmologists and optometrists from 2018 to 2021. Methods: This is an observational, retrospective cohort study of the Medicare Part D prescriber public use files from 2018 to 2020. Prescription trends were analyzed with analysis of variance and negative binomial regression tests based on specialty, region, and types of antibiotics. Results: From 2018 to 2021, the number of ophthalmologists in the Medicare Part D database decreased from 18,452 to 18,285, and the number of optometrists increased from 23,071 to 24,734. Throughout the study period, the total number and proportion of antibiotic prescriptions by ophthalmologists and optometrists stayed almost constant with a dip in 2020, likely reflecting the effects of the COVID-19 pandemic. Both ophthalmologists and optometrists demonstrated geographic regional differences in prescribing patterns. The South consistently had the highest average number of claims per provider. Of the antibiotics prescribed by ophthalmologists in 2021, 48.6% are from the fluoroquinolone class, 20.5% are from the aminoglycoside class, and 18.2% are from the macrolide class. Optometrists were found to be more likely to prescribe antibiotics in a formulation combined with a corticosteroid throughout the study period. Conclusions: Our results have shown that prescribing patterns among ophthalmologists and optometrists have demonstrated significant changes in prescriptions of microbial resistance-promoting antibiotics. These patterns persist despite nation-wide attempts to control antimicrobial resistance.

A Cross-Sectional Survey Analyzing Community Perception and Utilization of Village Health Workers Stratified by the Urban-Rural Divide Within the Kingdom of Bhutan.

Village health workers (VHWs) serve as an integral health resource for many resource limited nations, including the Kingdom of Bhutan. As such, we aimed to identify community perceptions as well as utilization rates and types with relation to VHWs based on the urban-rural divide. Our team conducted a randomized survey of 429 community members in 14 villages within the Western region of Bhutan. Our findings indicate VHWs in rural communities are requested for their services twice as much as their urban counterparts. More specifically, urban VHWs are utilized 2.5 times more for general community services, while rural VHWs are utilized more for accessing medications. Additionally, our research indicates a need to increase training of VHWs as well as overall program promotion relating to the specific services that VHWs can provide. These investigations indicate the importance of differentially allocating resources, programming, and training based on the urban-rural divide.

Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan.

BACKGROUND: Village health workers (VHWs) in Bhutan play an all-encompassing role in supporting the health of their communities. Recent reports from the Bhutan Ministry of Health have indicated a sharp reduction in the number of working VHWs. As such, our work attempts to estimate the cost saved and the number of averted hospital admissions onto the Bhutanese healthcare system and the individuals who are served by these health workers. METHODS: We utilized a dataset from the Bhutan Ministry of Health which encompassed over 95% of all reported disease cases within the nation. We examined the impact that VHWs have on hospital admission rates for eight diseases of interest by using multiple multivariate logistic regression models. Our model allowed us to estimate the potential disease cases averted when the average number of VHWs per health center is increased by one unit. Lastly, we utilized the 2011 "A Costing of Healthcare Services in Bhutan" to estimate the cost saved attributed to VHWs. RESULTS: An average one unit increase of VHWs per health center is associated with a decrease in hospital and clinic admission for diarrhea, dysentery, wound care, depression/anxiety, dental caries, and skin infection, while a non-significant increase was observed for scabies and conjunctivitis. These findings translate to 4604 outpatient visits averted, with $28,637 saved, and 78 inpatient visits averted, with $10,711 saved. These values sum to a total of 4682 yearly averted admissions at health centers, with a total cost savings of $39,348 yearly. Additionally, we estimated a yearly savings of $13,348 in transportation costs and a total of $20,960 saved in wages to the community members that VHWs serve. CONCLUSIONS: VHWs serve as a source of cost-savings for the Kingdom of Bhutan and also act as an economic buffer for more vulnerable communities. The cost-savings associated with these health workers is likely to become more pertinent as the nation begins to develop and healthcare costs increase. It is imperative that proper action be taken to retain these health workers as every VHW who leaves the program increases healthcare costs onto the Bhutanese government.