Objective
To investigate risk factors for multi-drug resistant organism (MDRO) infection within a hospital population in northern India.
Design
This case-control study examined MDRO infection risk factors including diet, health history and medical device use. We administered a diet questionnaire to collect data on usual diet and collected data on other risk factors from chart review.
Setting
Patients were recruited from a tertiary care hospital in northern India
Patients
All participants were inpatients identified through hospital microbiology reports. A total of 39 MDRO-patient cases and 91 controls were included.
Methods
Descriptive statistics, univariate analysis, and multivariate logistic regression were performed to evaluate the association between risk factors and MDRO infection.
Results
All cases had gram-negative MDRO infections. Univariate analyses found length of hospital stay, connective tissue disease, hospitalization in the last 12 months, hospitalization of a family member, in-hospital antibiotic use, antibiotic use in the last 12 months, and feeding tube, central venous line, and urinary catheter use to be significantly different between cases and controls. Logistic regression showed a more than three-fold increase in the odds of infection with antibiotic use in the last twelve months (OR 3.30, 95% CI 1.22–8.91) and urinary catheter use (OR 3.63, 95% CI 1.14–11.58). Differences in dietary preferences and fruit, vegetable, and fiber consumption were not significantly associated with infection.
Conclusions
Antibiotic use is a major driver of MDRO infections. Our findings suggest that interventions optimizing antibiotic stewardship and reducing device use should be a priority to prevent MDRO infections.
Introduction
Despite global improvements in maternal health, disparities in maternal mortality rates in the United States have worsened in recent years. Community health workers (CHWs) as maternal health educators have previously been studied in low‐ and middle‐income countries, however their use in the United States has been limited.
Methodology
To address the ongoing disparities in maternal mortality, we conducted a mixed methods pilot study consisting of discussion groups and a written survey with CHWs in two boroughs in NYC. The study's goal was to identify and explore CHW professional training, their daily tasks, and roles as well as their insights and perspectives regarding the needs of their pregnant clients.
Results
Eighteen CHWs participated in the discussion groups and 11 participated in the survey. Participants were predominantly Black and/or Latina. Key themes were very consistent across group discussion and survey data. Major themes were a lack of standardized training for CHWs on basic maternal health topics, the existence of racism and bias in the provision of care for Black and other minority individuals, along with pregnant peoples’ needs for support to better advocate to overcome systemic barriers.
Conclusion
This study suggests that targeted maternal health training of CHWs is needed to better enable them to identify pregnancy risks and advance health literacy and promote self‐advocacy among their pregnant clients. This will ultimately yield a more effective CHW workforce and better health outcomes for pregnant people.
T-test was used to compare continuous and dependent variables as appropriate.RESULTS: A total of 2062 oocytes from 182 cycles of 173 patients were included. The mean age was 36.8 AE4.2 (range 25-45) years old. The main infertility diagnoses were diminished ovarian reserve (40%) and Male factor (33%). Overall, the rate of MII oocytes retrieved was 45% (926/2062). The majority of both MIs (83%; 264/319), and GVs (67%; 251/375) subjected to RIVM, achieved MII status. Fertilization rates did not differ between either RIVM MIs and GVs, compared to their MII siblings (68 AE27% vs. 65 AE37%, p¼0.2; 63 AE27% vs. 63 AE28%, p¼0.8; respectively). RIVM MIs and GVs showed significantly lower blastulation rates compared to their MIIs siblings (32 AE40% vs. 59 AE36%, p<0.01; 23 AE38% vs. 56 AE36%, p<0.01; respectively). While the rate of good quality blastocysts did not significantly differ between RIVM MIs and retrieved MIIs blastocysts (40 AE47% vs. 47% AE40%, p¼0.39), RIVM GVs blastocysts quality was significantly lower compared to their MIIs siblings' blastocysts (19 AE36% vs 50AE 39%, p<0.01). 17/39 and 9/27 tested RIVM MIs and GVs blastocysts were euploid. No significant difference was observed in euploidy rates of RIVM MIs and GVs blastocysts compared to their MIIs sibling blastocysts (39 AE47% vs 38 AE32%, p¼0.96; 25 AE42% vs. 42 AE31% p¼0.17, respectively).CONCLUSIONS: To our knowledge, this is the largest series of RIVM blastocysts with PGT-A analysis. RIVM oocytes overall displayed lower developmental competence, demonstrated by lower blastulation rates. While RIVM MI blastocysts show similar quality, as well as similar euploidy rates compared to MII blastocysts, RIVM GVs blastocysts have lower quality and there is a trend toward lower euploidy rates.IMPACT STATEMENT: RIVM can yield genetically normal blastocysts, hence increase the number of embryos available for transfer.
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