Previously common in Brazil, enteropathogenic Escherichia coli (EPEC) strains of serogroups O55, O111, and O119 are now rare, while enteroadherent strains other than EPEC, belonging to serogroups such as O125, were prevalent among 126 diarrheic infants less than 1 year old who were surveyed. None of these strains had the EPEC bundle-forming pilus (bfpA) gene.A number of organisms, including viral, protozoan, and bacterial agents, are associated with the etiology of infantile infectious diarrhea, a leading cause of infantile mortality and morbidity worldwide. Although representing a common species of the human intestinal microbiota, Escherichia coli is also considered an important bacterial agent of infantile infectious diarrhea, an association first described in the report of John Bray (2), when enteropathogenic E. coli (EPEC) was found as the cause of a diarrhea outbreak originating from a pediatric nursery in London, United Kingdom, in 1945. In addition to EPEC, five other diarrheagenic E. coli (DEC) pathotypes were later described: enterotoxigenic (ETEC), enteroinvasive (EIEC), enterohemorrhagic (EHEC), enteroaggregative (EAEC), and diffusely adhering (DAEC) E. coli. ETEC, EAEC, and EHEC are toxin producers; EPEC, EAEC, and DAEC express characteristic adhesion patterns (localized, aggregative, and diffuse, respectively) to epithelial cells and are thus referred to as enteroadherent E. coli; EIEC is distinguished by the capacity to invade epithelial cells and the inability to produce toxins. Serotyping, screening for pathogenicity factors, and adherence to cultured epithelial cells comprise the main laboratorial diagnosis tools for diarrhea caused by DEC. For a detailed review of DEC, see reference 12.In a recent survey carried out to investigate DEC prevalence in Botucatu, São Paulo State, Brazil, a region where some of the first epidemiological studies of enteropathogenic enterobacteria in Brazil were conducted (10), EAEC and rotavirus were found to be dominant, while traditional (EPEC, ETEC, EIEC, and EHEC) DEC pathotypes were absent from the stools of diarrheic children less than 13 years old (14). In order to better assess the role of EAEC in diarrhea and confirm the absence of EPEC in this population, we carried out the present study, restricting the survey to patients less than 1 year old, an age group more susceptible than others to EPEC-related diarrhea. The patient group consisted of 126 infants who attended the UNESP Hospital and the Medical Training Center of Botucatu between 1997 and 2000, with a record of at least two daily episodes of fluid stool evacuations, associated or not with vomiting, for 3 days or more. A total of 39 age-and geographically matched controls, randomly chosen at the same time among healthy volunteers in the community, were also surveyed. The stool collection was performed with the consent of the infant's family and the approval of the Hospital Committee on Ethics in Research. According to conventional bacteriological procedures, one to three out of five colonies randomly pi...
For seven years, the University of Rhode Island (URI) Engaging Generations Cyber-Seniors Program has utilized university student mentors through an internship format and integration within service learning courses. In 2019, community interest in the program significantly increased as did student interest in gerontology internships. This led us to develop a robust internship program focused on building age and digital inclusivity across campus and the state of RI. The program integrates a three-pronged approach where students complete field hours within the URI Cyber-Seniors program, focus on enhancing the Career Readiness Competencies employers seek in graduates today as determined by the National Association of Colleges & Employers, and complete the components necessary to earn the Geriatric Education Center Interprofessional Teamwork in Geriatrics and Gerontology Certificate. This process has enabled 350 students from different majors, including Pharmacy and Human Development & Family Science, to complete internship experiences ranging from 30 to 210 hours.
Geriatric Workforce Enhancement Programs (GWEPs) are ideally suited to develop and implement educational programs to transform the geriatric care system. They link academic programs, clinical partners, and community-based organizations to bridge care system gaps to improve the health and social care of older adults. Such a collaboration is especially important in falls prevention, where primary care assessments generate referrals to community programs that enroll older adults to reduce their risk of falling. However, exporting an evidence-based model developed in one context for implementation in another is not without its perils and pitfalls. This paper explores the challenges of applying a model developed elsewhere to the Rhode Island context, including the need to understand how structural differences in academic, primary care, and community-based systems require flexibility, innovation, and persistence in overcoming the networking challenges in these different settings. Recommendations for implementing program models in a variety of settings are explored.
Transformational efforts to redesign the care system for older adults call for the development of novel partnership models incorporating academic institutions, primary care networks, and community-based organizations. The Rhode Island Geriatric Workforce Enhancement Program (RI-GWEP) has utilized the “resource exchange model” to develop innovative, interdisciplinary, and integrated projects combining educational resources, clinical expertise, programmatic experience, and impact evaluation. With particular emphasis on the challenges of developing interprofessional education spanning the traditional gaps between disciplines and departments, this presentation emphasizes the critical conditions, components, and capacities of such a collaborative network. These include: (1) mission dominance, (2) barter exchange, (3) partnership investment, and (4) interpersonal relationships. RI-GWEP’s experience provides insights into the conceptual foundation of geriatrics networks and specific, concrete examples of projects incorporating these principles. Implications for the development of networks in other settings include consideration of particular: (1) projects, (2) people, (3) places, (4) personalities, and (5) possibilities.
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