8,814 research outputs found

    Analysis of seasonal variation of antibiotic prescribing for respiratory tract diagnoses in primary care practices

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    Abstract Objective: To determine antibiotic prescribing appropriateness for respiratory tract diagnoses (RTD) by season. Design: Retrospective cohort study. Setting: Primary care practices in a university health system. Patients: Patients who were seen at an office visit with diagnostic code for RTD. Methods: Office visits for the entire cohort were categorized based on ICD-10 codes by the likelihood that an antibiotic was indicated (tier 1: always indicated; tier 2: sometimes indicated; tier 3: rarely indicated). Medical records were reviewed for 1,200 randomly selected office visits to determine appropriateness. Based on this reference standard, metrics and prescriber characteristics associated with inappropriate antibiotic prescribing were determined. Characteristics of antibiotic prescribing were compared between winter and summer months. Results: A significantly greater proportion of RTD visits had an antibiotic prescribed in winter [20,558/51,090 (40.2%)] compared to summer months [11,728/38,537 (30.4%)][standardized difference (SD) = 0.21]. A significantly greater proportion of winter compared to summer visits was associated with tier 2 RTDs (29.4% vs 23.4%, SD = 0.14), but less tier 3 RTDs (68.4% vs 74.4%, SD = 0.13). A greater proportion of visits in winter compared to summer months had an antibiotic prescribed for tier 2 RTDs (80.2% vs 74.2%, SD = 0.14) and tier 3 RTDs (22.9% vs 16.2%, SD = 0.17). The proportion of inappropriate antibiotic prescribing was higher in winter compared to summer months (72.4% vs 62.0%, P < .01). Conclusions: Increases in antibiotic prescribing for RTD visits from summer to winter were likely driven by shifts in diagnoses as well as increases in prescribing for certain diagnoses. At least some of this increased prescribing was inappropriate

    Nivel de conocimientos de estudiantes de medicina sobre diagnóstico y manejo del infarto agudo del miocardio

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    Introduction: acute myocardial infarction is a disease with high morbidity and mortality.Objective: to determine the knowledge level of medical students about the diagnosis and management of acute myocardial infarction.Method: an observational, descriptive and cross-sectional study was carried out between January and February 2022 in medical students from the University of Medical Sciences of Pinar del Río who participated in the provincial update workshop on acute myocardial infarction. Through intentional sampling, a sample of 92 students was selected. To collect the information, a survey was used using Google Forms.Results: the female sex (65,21%), the age group from 21 to 22 years (65,21%) and the fourth-year students (50%) prevailed. Hypertension was the most identified risk factor (97,98%). 97,82% of the students identified precordial pain as the main clinical manifestation. 100% identified the presentation with complications, where sudden death was the most identified (81,52%). 100% point to the electrocardiogram as the main complementary, where ST alterations were the most identified (84,78%). 95,65% of the students indicated constant monitoring of vital parameters and cardiovascular function as the management measure.Conclusions: Medicine students belonging to the clinical area at the University of Medical Sciences of Pinar del Río have an adequate level of knowledge about the diagnosis and management of acute myocardial infarction.Introducción: el infarto agudo del miocardio constituye una enfermedad con elevada morbilidad y mortalidad.Objetivo: determinar el nivel de conocimientos de estudiantes de medicina sobre el diagnóstico y manejo del infarto agudo del miocardioMétodo: se realizó un estudio observacional, descriptivo y transversal entre enero y febrero de 2022 en estudiantes de Medicina de la Universidad de Ciencias Médicas de Pinar del Río del ciclo clínico que participaron en el Taller provincial de actualización sobre infarto agudo de miocardio. Mediante un muestreo intencional se seleccionó una muestra de 92 estudiantes. Para la recolección de la información se empleó una encuesta mediante Google Forms.Resultados: predominó el sexo femenino (65,21 %), el grupo etario de 21 a 22 años (65,21 %) y los estudiantes de cuarto año (50 %). La hipertensión fue el factor de riesgo más identificado (97,98 %). El 97,82 % de los estudiantes identificó el dolor precordial como principal manifestación clínica. El 100 % identificó la presentación con complicaciones, donde la muerte súbita fue la más identificada (81,52 %). El 100 % señala al electrocardiograma como principal complementario, donde las alteraciones del ST fueron las más identificada (84,78 %). El 95,65 % de los estudiantes indicaron la monitorización constante de los parámetros vitales y función cardiovascular como la medida de manejo.Conclusiones: los estudiantes de Medicina pertenecientes al área clínica en la Universidad de Ciencias Médicas de Pinar del Río poseen un adecuado nivel de conocimientos sobre el diagnóstico y manejo del infarto agudo del miocardio.  

    Sylvatic infestation of Oklahoma reptiles with immature Ixodes scapularis (Acari: Ixodidae)

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    Reptiles were collected in nine counties in Oklahoma from September 2002 to May 2004 and examined for Ixodes scapularis (Say) larvae and nymphs to determine seasonal incidence and prevalence of these ticks. In total, 209 reptile specimens consisting of nine species of lizards and seven species of snakes were collected. Plestiodon fasciatus (L.) was the most numerous species collected (55%) followed by Sceloporus undulatus (Latreille) (17%) and Scincella lateralis (Say) (11%). Less than 10 individuals were collected for all remaining reptile species. The infestation prevalence of I. scapularis on all reptile specimens collected was 14% for larvae and 25% for nymphs. Larvae were found on lizards from April until September and peaked in May, while nymphs were found from March until September and peaked in April. I. scapularis larvae (84%) and nymphs (73%) preferentially attached to the axillae/front leg of P. fasciatus. Two chigger species, Eutrombicula splendens (Ewing) and Eutrombicula cinnabaris (Ewing), were found on 2% of the reptiles collected. No ectoparasites, including ticks, were obtained from the seven species of snakes collected.Peer reviewedEntomology and Plant Patholog

    Etiological and epidemiological features of acute meningitis or encephalitis in China: a nationwide active surveillance study

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    Background: Acute meningitis or encephalitis (AME) results from a neurological infection causing high case fatality and severe sequelae. AME lacked comprehensive surveillance in China. Methods: Nation-wide surveillance of all-age patients with AME syndromes was conducted in 144 sentinel hospitals of 29 provinces in China. Eleven AME-causative viral and bacterial pathogens were tested with multiple diagnostic methods. Findings: Between 2009 and 2018, 20,454 AME patients were recruited for tests. Based on 9,079 patients with all-four-virus tested, 28.43% (95% CI: 27.50%‒29.36%) of them had at least one virus-positive detection. Enterovirus was the most frequently determined virus in children &lt;18 years, herpes simplex virus and Japanese encephalitis virus were the most frequently determined in 18−59 and ≥60 years age groups, respectively. Based on 6,802 patients with all-seven-bacteria tested, 4.43% (95% CI: 3.94%‒4.91%) had at least one bacteria-positive detection, Streptococcus pneumoniae and Neisseria meningitidis were the leading bacterium in children aged &lt;5 years and 5−17 years, respectively. Staphylococcus aureus was the most frequently detected in adults aged 18−59 and ≥60 years. The pathogen spectrum also differed statistically significantly between northern and southern China. Joinpoint analysis revealed age-specific positive rates, with enterovirus, herpes simplex virus and mumps virus peaking at 3−6 years old, while Japanese encephalitis virus peaked in the ≥60 years old. As age increased, the positive rate for Streptococcus pneumoniae and Escherichia coli statistically significantly decreased, while for Staphylococcus aureus and Streptococcus suis it increased. Interpretation: The current findings allow enhanced identification of the predominant AME-related pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures in China, and a possible reassessment of vaccination strategy. Funding: China Mega-Project on Infectious Disease Prevention and the National Natural Science Funds</p

    Effects of a Comprehensive School Health Program on Elementary Student Academic Achievement

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    BACKGROUND: Improving the academic achievement of youth in the U.S. has been an area of interest for many decades and has been a critical indicator of future success of youth. The purpose of this study was to examine the impact of a comprehensive school physical activity and healthy eating program on 5th grade students’ academic achievement, specifically reading and math. METHODS: In total, 628 (intervention: 377, 54% female; comparison: 251, 49% female) 5th grade children participated across the six schools in a yearlong comprehensive health intervention, completing curriculum-based academic achievement measures at two-time points. RESULTS: Results showed that even after controlling for class clustering, age, sex, race, and T1 reading and math variables, students’ T2 reading and math achievement were significantly higher in the intervention group than the comparison group. CONCLUSIONS: Comprehensive health programming can enhance the health and academic achievement of youth. BACKGROUND: Improving the academic achievement of youth in the U.S. has been an area of interest for many decades and has been a critical indicator of future success of youth. The purpose of this study was to examine the impact of a comprehensive school physical activity and healthy eating program on 5th grade students’ academic achievement, specifically reading and math. METHODS: In total, 628 (intervention: 377, 54% female; comparison: 251, 49% female) 5th grade children participated across the six schools in a yearlong comprehensive health intervention, completing curriculum-based academic achievement measures at two-time points. RESULTS: Results showed that even after controlling for class clustering, age, sex, race, and T1 reading and math variables, students’ T2 reading and math achievement were significantly higher in the intervention group than the comparison group. CONCLUSIONS: Comprehensive health programming can enhance the health and academic achievement of youth
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