Modeling the Effects of Introducing a New Antibiotic in a Hospital Setting: A Case Study

The increase in antibiotic resistance continues to pose a public health risk as very few new antibiotics are being produced, and bacteria resis- tant to currently prescribed antibiotics is growing. Within a typical hospital setting, one may find patients colonized with bacteria resistant to a single an- tibiotic, or, of a more emergent threat, patients may be colonized with bacteria resistant to multiple antibiotics. Precautions have been implemented to try to prevent the growth and spread of antimicrobial resistance such as a reduction in the distribution of antibiotics and increased hand washing and barrier pre- ventions; however, the rise of this resistance is still evident. As a result, there is a new movement to try to re-examine the need for the development of new antibiotics. In this paper, we use mathematical models to study the possible benefits of implementing a new antibiotic in this setting; through these models, we examine the use of a new antibiotic that is distributed in various ways and how this could reduce total resistance in the hospital. We compare several dif- ferent models in which patients colonized with both single and dual-resistant bacteria are present, including a model with no additional treatment proto- cols for the population colonized with dual-resistant bacteria as well as models including isolation and/or treatment with a new antibiotic. We examine the benefits and limitations of each scenario in the simulations presented

Reasons for Pacifier Use and Non-Use in African-Americans: Does Knowledge of Reduced SIDS Risk Change Parents\u27 Minds?

OBJECTIVE: To investigate African-American parental reasons for pacifier use or non-use, and whether knowledge of the association with decreased SIDS risk changes decisions about pacifier use. METHODS: We conducted focus groups and individual interviews with mothers. Grounded theory methodology was used. RESULTS: 83 mothers participated; 72.3% of infants used pacifiers. Reasons for pacifier use included comfort/soothing, safety/SIDS, and preference over digit-sucking. Reasons for pacifier non-use included infant refusal, fear of attachment, nipple confusion, and germs. Many parents were unaware that pacifier use reduces SIDS risk; however, most parents of non-users did not think that this knowledge would have changed their decision. Reasons included skepticism about the pacifier-SIDS link. CONCLUSION: Many reasons underlie African-American parental decisions about pacifier use. Providers should provide information about the benefits of pacifiers. Establishing for parents any plausible link between the protective mechanism of pacifiers and SIDS pathophysiology may be important in promoting pacifier use

Decisions of black parents about infant bedding and sleep surfaces: A qualitative study.

OBJECTIVE: The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. METHODS: We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. RESULTS: Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted “firm sleep surface” to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. CONCLUSIONS: Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a “firm” sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices

Messaging Affects the Behavior of African American Parents with Regards to Soft Bedding in the Infant Sleep Environment: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the impact of specific health messages on the decisions of African American parents regarding soft bedding use, specifically related to the high degree of self-efficacy that African American parents have with regards to preventing infant suffocation vs low self-efficacy with regards to sudden infant death syndrome (SIDS) risk reduction. STUDY DESIGN: We conducted a randomized, controlled clinical trial of African American mothers of infants. The control group received standard messaging emphasizing safe sleep practices recommended by the American Academy of Pediatrics for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2–3 weeks, 2–3 months, and 5–6 months after the infant’s birth. RESULTS: Of 1194 mothers enrolled, 637 completed all interviews. The use of soft bedding both in the past week and last night declined with age (P < .001). Infants in the enhanced group had a lower rate of use of soft bedding in the past week (P = .006) and last night (P = .013). Mothers who received the enhanced message were more likely to state that they avoided soft bedding to protect their infant from suffocation. CONCLUSIONS: African American mothers who receive an enhanced message about SIDS risk reduction and suffocation prevention are less likely to use soft bedding in their infant’s sleep environment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01361880

Health Messaging and African-American Infant Sleep Location: A Randomized Controlled Trial.

BACKGROUND: Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African-American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African-American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. OBJECTIVES: To evaluate the impact of specific health messages on African-American parental decisions regarding infant sleep location. METHODS: We conducted a randomized, controlled trial of African-American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2–3 weeks, 2–3 months, and 5–6 months after the infant’s birth. RESULTS: 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95% CI 1.003, 1.006]) and last night (aOR 1.004 [95% CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p<0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p<0.001) and did not differ by group assignment. CONCLUSION: African-American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants

Comparison of infant sleep practices in African-American and U.S. Hispanic families: Implications for sleep-related infant death

BACKGROUND: African-American and Hispanic families share similar socioeconomic profiles. Hispanic rates of sleep-related infant death are four times lower than African-American rates. METHODS: Cross-sectional, multi-modal (surveys, qualitative interviews) study to compare infant care practices that impact risk for sleep-related infant death in African-American and Hispanic families. RESULTS: We surveyed 422 African-American and 90 Hispanic mothers. Eighty-three African-American and 6 Hispanic mothers participated in qualitative interviews. African-American infants were more likely to be placed prone (p<0.001), share the bed with the parent (p<0.001), and to be exposed to smoke (p<0.001). Hispanic women were more likely to breastfeed (p<.001), while African-American women were more knowledgeable about SIDS. Qualitative interviews indicate that, although African-American and Hispanic parents had similar concerns, behaviors differed. DISCUSSION: Although the rationale for infant care decisions was similar for African-American and Hispanic families, practices differed. This may help to explain the racial/ethnic disparity seen in sleep-related infant deaths