Pulse Oximetry as an Aid to Rule Out Pneumonia among Patients with a Lower Respiratory Tract Infection in Primary Care.

Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR-) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR- of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR- (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs.

Groundwater irrigation reduces overall poverty but increases socioeconomic vulnerability in a semiarid region of southern India.

The development of irrigation is generally considered an efficient way to reduce poverty in rural areas, although its impact on the inequality between farmers is more debated. In fact, assessing the impact of water management on different categories of farmers requires resituating it within the different dimensions of the local socio-technical context. We tested this hypothesis in a semi-arid area in Karnataka, South India, where groundwater irrigation was introduced five decades ago. Using the conceptual framework of comparative agriculture, based on farmers' interviews, we built a farm typology, traced the trajectories of farm types over the last decades and assessed their current technical and economic performances. Our results show that the differentiation of farm trajectories since the 1950s has been linked with the development of groundwater irrigation, interplaying with their initial assets, and the evolution of the national and local contexts. We highlight the mechanisms by which irrigation indeed reduces poverty but engenders fragilities, particularly for poor households, whose situation was aggravated by the depletion of water resources over the last two decades. Finally, this extensive understanding of the agrarian context allowed us to formulate and assess the potential of different ways forward, including irrigation technology, change in cropping or livestock systems, land tenure, and value added distribution. As such, this analysis would be of major interest to policy makers involved in reforming the agricultural context for better agricultural water management.