Socio-Cultural Challenges in Conducting Ethnographic Research among Ethiopian Street Youth

Little has been written on the personal experience of the researcher as it relates to data collection, data analysis and interpretation of results. Even more scarce has been knowledge that addresses the challenges and barriers faced by 21st century researchers engaged in ethnographic data collection amidst culturally diverse populations. The present work has addressed these gaps in the literature by detailing the personal, methodological and cultural challenges encountered by this researcher in a larger study which utilized a mixed method design to investigate homeless street youth in Addis Ababa, Ethiopia. Results indicated the need for social workers to possess an awareness of their own limitations and biases as it may relate to cultural differences

Heart Disease and African Americans

Good health depends on multiple factors, including financial status. Higher socioeconomic status correlates with a lower risk of cancer, diabetes, and heart disease. Lukachko, Hatzenbuehler, and Keyes (2014) stated that the advantages of income status make a difference with health, specifically heart disease. Another significant factor affecting heart disease is health care disparity. Kahng (2010) found that the accumulative impact of health care disparities experienced over a lifetime contributes to chronic stress and heart-related problems. Despite advancement in care, more African Americans, compared with other racial groups, die from cardiovascular disease (Centers for Disease Control and Prevention [CDC], 2016). Several risk factors are directly related to heart disease. Cardiovascular disease includes diseases of the heart and blood vessels, stroke, coronary heart diseases, high blood pressure, high cholesterol, and congestive heart failure. Atherosclerosis, hypertension, and congenital heart defects are other forms of cardiovascular disease (American Heart Association [AHA], 2016). Savitz (2012) cited disparities in cardiovascular health care as one of the most crucial public health problems in the United States

Effect of vancomycin or daptomycin with vs without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: a randomized clinical trial

Importance: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with mortality of more than 20%. Combining standard therapy with a β-lactam antibiotic has been associated with reduced mortality, although adequately powered randomized clinical trials of this intervention have not been conducted. Objective: To determine whether combining an antistaphylococcal β-lactam with standard therapy is more effective than standard therapy alone in patients with MRSA bacteremia. Design, Setting, and Participants: Open-label, randomized clinical trial conducted at 27 hospital sites in 4 countries from August 2015 to July 2018 among 352 hospitalized adults with MRSA bacteremia. Follow-up was complete on October 23, 2018. Interventions: Participants were randomized to standard therapy (intravenous vancomycin or daptomycin) plus an antistaphylococcal β-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) (n = 174) or standard therapy alone (n = 178). Total duration of therapy was determined by treating clinicians and the β-lactam was administered for 7 days. Main Outcomes and Measures: The primary end point was a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure. Secondary outcomes included mortality at days 14, 42, and 90; persistent bacteremia at days 2 and 5; acute kidney injury (AKI); microbiological relapse; microbiological treatment failure; and duration of intravenous antibiotics. Results: The data and safety monitoring board recommended early termination of the study prior to enrollment of 440 patients because of safety. Among 352 patients randomized (mean age, 62.2 [SD, 17.7] years; 121 women [34.4%]), 345 (98%) completed the trial. The primary end point was met by 59 (35%) with combination therapy and 68 (39%) with standard therapy (absolute difference, -4.2%; 95% CI, -14.3% to 6.0%). Seven of 9 prespecified secondary end points showed no significant difference. For the combination therapy vs standard therapy groups, all-cause 90-day mortality occurred in 35 (21%) vs 28 (16%) (difference, 4.5%; 95% CI, -3.7% to 12.7%); persistent bacteremia at day 5 was observed in 19 of 166 (11%) vs 35 of 172 (20%) (difference, -8.9%; 95% CI, -16.6% to -1.2%); and, excluding patients receiving dialysis at baseline, AKI occurred in 34 of 145 (23%) vs 9 of 145 (6%) (difference, 17.2%; 95% CI, 9.3%-25.2%). Conclusions and Relevance: Among patients with MRSA bacteremia, addition of an antistaphylococcal β-lactam to standard antibiotic therapy with vancomycin or daptomycin did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure. Early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favor of the intervention should be considered when interpreting the findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02365493

Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal beta-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia A Randomized Clinical Trial

10.1001/jama.2020.0103JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION3236527-53