Community Readiness Assessment of the "Take TIME for Your Child's Health" Intervention.

Take TIME (Tobacco-free, Injury-free, Moving daily, Eating healthy) was an early intervention strategy targeting community readiness to support healthy lifestyles for young children in Uxbridge, Canada. This study aimed to assess the effectiveness of Take TIME using the Community Readiness Model adapted for childhood obesity prevention. Six interviews were completed in Uxbridge, before and after the intervention, with purposively selected community leaders in education, political, business, religious, not-for-profit, and healthcare fields. Each interview was rated independently by two scorers. Interview content was scored (scale from 1 to 9, with 1 being no awareness and 9 being a high level of community ownership) according to the Community Readiness Model criteria on six dimensions, with overall readiness calculated as the mean score of all dimensions. T-tests compared readiness by time-point and between communities. Overall community readiness significantly improved (p = 0.03) in Uxbridge from pre-intervention (3.63 ± 1.14 vague awareness) to post-intervention (5.21 ± 0.97 preparation). Seven interviews were also completed with leaders in the matched town of Rockwood, Canada which served as the control community. Rockwood readiness was close to the Uxbridge post-intervention score (5.35 ± 1.11). Results indicated increased awareness and leadership support post-intervention in Uxbridge, but further improvements in community knowledge, formalized efforts, and additional leadership support are desired. Take TIME increased community readiness to support healthy lifestyles for young children and may be useful to other communities at similar stages, given its theoretical alignment with the community readiness model. Future research should investigate the impact of Take TIME in demographically diverse communities and appropriate interventions to move communities from the preparation to the action stage.

Risk factors for respiratory depression in patients undergoing retrobulbar block for vitreoretinal surgery.

BACKGROUND AND OBJECTIVE: To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery. PATIENTS AND METHODS: Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center. RESULTS: Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.1%), nine (8%), and six (5.3%) patients, respectively. No patients required intubation. Age, sex, body mass index, history of obstructive sleep apnea, American Society of Anesthesiologists physical status level, and baseline oxygen saturation were not predictive of airway intervention. Of the four anesthetic agents utilized (midazolam, fentanyl, alfentanil, and propofol), only propofol and fentanyl were associated with an increased risk for clinically significant apnea. Use of three medications for sedation was associated with a 5.4-fold increase in the relative risk of requiring a respiratory rescue intervention. CONCLUSION: During preoperative sedation for retrobulbar block administration, the use of propofol, fentanyl, or a combination of three anesthetics is associated with a statistically significant increase in the risk for respiratory depression requiring resuscitation.

Application of 10% povidone iodine reduces conjunctival bacterial contamination rate in patients undergoing cataract surgery.

PURPOSE: To determine the efficacy of 10% povidone iodine (PVI) drops given before cataract extraction in addition to routine irrigation of the conjunctival sac with 1% PVI. METHODS: This prospective, randomized, single-center study at the Department of Ophthalmology, Ludwig-Maximilians-University, Munich, includes 263 eyes of 242 patients undergoing cataract surgery. Patients were randomized to receive 3 drops of 10% PVI into the conjunctival sac (study group) or no PVI drops (control group). All patients underwent periorbital disinfection with 10% PVI followed by irrigation of the conjunctiva with 10 mL of 1% PVI. Specimens were obtained prior to the application of PVI, after antibiotic administration (T1), after irrigation with PVI but before surgery (T2), and at the conclusion of surgery (T3). RESULTS: After PVI disinfection, the number of positive cultures was significantly reduced in all groups (p<0.0001) from 69%-93% at T1 to 1%-16% at T3. In outpatients, the study group showed significantly fewer positive cultures at the conclusion of surgery compared to the control group (4% vs 16%; p=0.03). Also in inpatients significant fewer positive cultures were found in the study group compared to the control group at T2 (12% vs 28%; p=0.03) and at T3 (1% vs 10%; p=0.03). CONCLUSIONS: Three additional drops of 10% PVI prior to surgery provided additional benefit by reducing the conjunctival bacterial contamination rate even in the setting of preoperative irrigation of the conjunctiva with 1% PVI.

A prospective study determining the efficacy of topical 0.5% levofloxacin on bacterial flora of patients with chronic blepharoconjunctivitis.

BACKGROUND: To determine the efficacy of conjunctival bacterial eradication following a 1-day, 3-day and 7-day application of topical 0.5% levofloxacin, with and without eyelid scrub, in patients with chronic blepharoconjunctivitis (CBC). METHODS: Patients with CBC (n = 60) were prospectively randomized to three groups (n = 20 in each group): no antibiotic treatment, topical levofloxacin four times per day in both eyes, and eyelid scrub in addition to topical levovofloxacin four times a day in both eyes. Patients without CBC (n = 40) were enrolled as the negative control group. Cultures of the conjunctiva were obtained from both eyes at baseline, 1 day, 3 days, and 7 days following treatment. RESULTS: The most common bacteria isolated for all groups at baseline were coagulase-negative Staphylococcus. Eight patients did not complete the study. The remaining 52 patients with CBC had a significantly higher rate of positive thioglycolate broth cultures (94%) compared to a 58% positive culture rate in patient without CBC (P < 0.0001). Treatment with at least 3 days of topical antibiotic in patient with CBC resulted in a significant reduction (P < 0.05) in the number of thioglycolate positive cultures (or= 88%). Following a minimum of a 1-day application of antibiotic, the median colony-forming unit was 0-1 compared to 3-8 for eyes without antibiotic treatment (P < 0.05). Scrubbing of the eyelids did not provide further benefit compared to antibiotic treatment alone. CONCLUSIONS: CBC eyes have a significantly higher number of positive cultures than eyes without CBC. The application of topical 0.5% levofloxacin for at least 3 days provided a significant reduction in the number of positive cultures as well as the number of bacteria harbored on the conjunctival surface.