Health Trust

Over a 2-year period, we identified Transmission from Room Environment Events (TREE) across the Johns Hopkins Health System, where the subsequent room occupant developed the same organism with the same antimicrobial susceptibilities as the patient who had previously occupied that room. Overall, the TREE rate was 50/100,000 inpatient days.

ABSTRACT Background Local and global surveillance of antibiotic resistance (ABR) has proven a challenge to implement effectively in low- and middleincome (LMI) settings. Environmental surveillance solutions are increasingly highlighted as a strategy to help overcome such problems, and thus to promote global health as well as the local management of ABR in LMI countries. While technical and scientific aspects of such solutions are being probed continuously, no study has investigated their practical feasibility. Objective Explore practical barriers for environmental surveillance of ABR in LMI countries, and pathways for surveillance experts to manage these. Methods To start charting this unknown territory, we conducted an explorative, qualitative interview study with key informants, applying a constructivist grounded theory approach to analyze the results. Results Barriers were identified across infrastructural, institutional and social dimensions, and pathways to manage them were mostly counterproductive from an ABR management perspective, including avoiding entire regions, applying substandard methods and failing to include local collaborators. Conclusion The research community as well as international agencies, organizations and states have key roles and responsibilities for improving the prospects of feasible environmental ABR surveillance in LMI-settings.

RESEARCH OBJECTIVE: Governments across the world were forced to impose social distancing and lockdown measures to prevent the spread of COVID-19, caused by coronavirus SARS-CoV-2 that emerged in December 2019. Following the declaration of COVID-19 as a pandemic, the disruptions, including restrictive measures such as school closures had severe impacts on the physical, emotional and mental health of all people, especially children with special needs. There was also scant data, particularly in low-to-middle-income countries. Existing literature stems mostly from western countries, thus the need to perform a comprehensive review on this topic. THE RESEARCH PROBLEM AND METHODS: The primary objective of the systematic review is to understand the impact of COVID-19 and restrictive measures such as school closures on the educational outcomes and physical and mental health of school-going children with special needs. THE PROCESS OF ARGUMENTATION: This systematic review used the PRISMA 2020 checklist where four databases and grey literature were searched for full text articles, peer reviewed publications in the English language that were published during January 2019–December 2021. RESEARCH RESULTS: The literature search identified 1294 publications, of which 25 key papers were selected. These studies investigate the impact on children with special needs across the globe, with a majority of papers from Europe. We found that COVID-19 and the digitalization of schooling had severe impacts on the physical and mental health of children with special needs and their parents/caregivers. CONCLUSIONS, RECOMMENDATIONS AND APPLICABLE VALUE OF RESEARCH: These studies highlight the need for an inclusive school environment to ensure that the learning outcomes for children everywhere are achieved. Further, a hybrid model that includes classroom learning with novel inventive methods would be beneficial for children with special needs.

India has reduced male-biased gender gaps in primary school enrollment and progression rates in recent years. However, patterns of early childhood education enrollment, selection of preschool, and related gender gaps remain inadequately studied. This study uses data from India’s National Family Health Survey (2019–2021), which collected preschool information for children aged 2–4 years, to examine female-male gaps in preschool enrollment. An estimated 40% of children were enrolled in preschools, and among them, 28% were enrolled in private preschools, with substantial variation across states. State, district, and household fixed-effects regressions, which accounted for a wide range of background characteristics of children, show that while preschool enrollment rates were 3.6–4.1% higher among girls than boys, girls were 9.3–16.7% less likely to be enrolled in higher quality private preschools. Using a mother fixed-effects regression, we found that while there was no gender gap in siblings’ preschool enrolment rates, girls were 18.6% less likely to be enrolled in private preschool than their brothers. The relative bias towards males in private preschool enrollment decreased with standard of living and maternal schooling levels. The findings indicate gender discrimination in enrollment in higher quality private preschool against young girls.

The use of point of care ultrasound (POCUS) to aid diagnosis of tuberculosis has been investigated in countries where concomitant endemic prevalence of HIV increases the incidence of extrapulmonary tuberculosis (EPTB). In such cases, using a focused assessment with sonography for HIV-associated tuberculosis (FASH) scan has found to be immensely advantageous as a rapid diagnostic tool in low resource settings where other imaging modalities are scarce. The prevalence of EPTB in immunocompetent patients in industrialised countries is growing. Since EPTB can manifest itself in almost any part of the human body, symptomatic patients present with constitutional and non-specific symptoms. In our case, a 44-year-old male presented to the emergency department (ED) with a 3-month history of left-sided chest pain and swelling of the chest wall. Clinical examination revealed a swollen and tender lump above the left first rib. Palpation of the thoracic (T7) vertebral body demonstrated localised pain. POCUS showed a collection of heterogenous material with fluid content and specks of hyperechoic ‘ring-like’ structures. Further investigations led to the diagnosis of EPTB. The patient was admitted and treated for EPTB where he went on to make a full recovery. This case report highlights the role of integrating POCUS in clinical examination of patients with suspected EPTB, which can expedite its diagnosis and management.

Antimicrobial resistance (AMR) is a pressing, holistic, and multisectoral challenge facing contemporary global health. In this study we assessed the associations between socioeconomic, anthropogenic, and environmental indicators and country-level rates of AMR in humans and food-producing animals. In this modelling study, we obtained data on Carbapenem-resistant Acinetobacter baumanii and Pseudomonas aeruginosa, third generation cephalosporins-resistant Escherichia coli and Klebsiella pneumoniae, oxacillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium AMR in humans and food-producing animals from publicly available sources, including WHO, World Bank, and Center for Disease Dynamics Economics and Policy. AMR in food-producing animals presented a combined prevalence of AMR exposure in cattle, pigs, and chickens. We used multivariable β regression models to determine the adjusted association between human and food-producing animal AMR rates and an array of ecological country-level indicators. Human AMR rates were classified according to the WHO priority pathogens list and antibiotic-bacterium pairs. Significant associations were identified between animal antimicrobial consumption and AMR in food-producing animals (OR 1·05 [95% CI 1·01-1·10]; p=0·013), and between human antimicrobial consumption and AMR specifically in WHO critical priority (1·06 [1·00-1·12]; p=0·035) and high priority (1·22 [1·09-1·37]; p<0·0001) pathogens. Bidirectional associations were also found: animal antibiotic consumption was positively linked with resistance in critical priority human pathogens (1·07 [1·01-1·13]; p=0·020) and human antibiotic consumption was positively linked with animal AMR (1·05 [1·01-1·09]; p=0·010). Carbapenem-resistant Acinetobacter baumanii, third generation cephalosporins-resistant Escherichia coli, and oxacillin-resistant Staphylococcus aureus all had significant associations with animal antibiotic consumption. Analyses also suggested significant roles of socioeconomics, including governance on AMR rates in humans and animals. Reduced rates of antibiotic consumption alone will not be sufficient to combat the rising worldwide prevalence of AMR. Control methods should focus on poverty reduction and aim to prevent AMR transmission across different One Health domains while accounting for domain-specific risk factors. The levelling up of livestock surveillance systems to better match those reporting on human AMR, and, strengthening all surveillance efforts, particularly in low-income and middle-income countries, are pressing priorities. None.

Food insecurity disproportionately affects rural communities and people living with HIV (PLHIV). The Food Access Pilot Project (FAPP) was a California state-funded program that provided home-delivered, medically supportive meals via online meal vendors to food-insecure PLHIV in three rural counties. We performed longitudinal, retrospective analyses of FAPP participant data (n = 158; 504 and 460 person-time observations for viral load and CD4 count, respectively) over 36 months from a Ryan White client management database. Pre-post analyses demonstrated increased prevalence of food security and CD4 ≥ 500 between baseline and 12 months. Population-averaged trends using generalized estimating equations adjusted for participant demographics demonstrated increased odds of viral suppression and CD4 ≥ 500, and increased CD4 count (cells/mm3) for every six months of program enrollment. Home-delivered, medically supportive meals may improve food security status, HIV viral suppression, and immune health for low-income PLHIV in rural settings.