Filtering Down to Risks and Solutions: Risk Factors and Stratification After Pediatric Cardiac Surgery.

Acute kidney injury after cardiac surgery (CS-AKI) is common in neonatal and pediatric populations and is a risk factor for poor outcomes, such as mortality and increased hospital resource utilization. This review presents a summary of CS-AKI risk factors, integration of biomarkers, and the need to improve risk stratification for targeting future clinical trials. To date, studies examining CS-AKI risk factors cannot be generalized easily owing to variability in patient age, surgical complexity or population, AKI definition, and center-specific practices. However, certain risk associations, such as younger age at surgery, history of prematurity, cardiopulmonary bypass time, and surgical complexity, have been identified across multiple, but not all, studies. CS-AKI appears to have different severity and duration phenotypes, and serum creatinine is limited in its ability to identify CS-AKI early and predict CS-AKI course. Treatment strategies are largely supportive, and efforts are ongoing to use biomarkers and clinical features to risk-stratify patients, which in turn may facilitate differential CS-AKI phenotyping and management with supportive care bundles, clinical decision support techniques, and modulation of modifiable risk factors.

Close Together, Far Apart: an Assessment of the Public Health Needs of Three Geographically Proximate Communities in Central Haiti.

Haiti, a country marked by extreme poverty and poor health, is also an active site for thousands of non-governmental organizations. The community needs assessment is an important tool that allows aid organizations to understand better community perspectives regarding health. In this study, 84 community members were interviewed across three geographically proximate communities in the Arcahaie region of Haiti to identify similarities and differences in community needs. Overall, the most important public health-related problems included access to clean water, sanitation, health care, and education. In discussing these topics, similarities were observed in drinking water source and relative lack of water treatment. Significant differences were noted between the communities in health care source. There were no significant differences in school enrollment patterns across communities, but there were differences in gendered enrollment. This broad survey affirms the importance of understanding the needs of individual communities in order to implement effective public health interventions.