Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth

PURPOSE: This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). METHODS: We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. RESULTS: From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. CONCLUSIONS: Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities.

Role of cerebrospinal fluid il-8 as a marker for differentiation between acute bacterial and aseptic meningitis

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis [ABM] from aseptic meningitis [AM]. A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones [p <0.05]. The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6ng/ml with a sensitivity of 82.5% and a specificity of 85.0%

Surveillance of nosocomial infections in a Mexican community hospital: how are we doing? / Vigilancia epidemiológica de infecciones nosocomiales en un hospital comunitario de México: ¿Cómo vamos?

OBJECTIVE. To compare the nosocomial infection (NI) rate obtained from a retrospective review of clinical charts with that from the routine nosocomial infection surveillance system in a community hospital. MATERIAL AND METHODS. Retrospective review of a randomized sample of clinical charts.Results were compared to standard surveillance using crude and adjusted analyses. RESULTS. A total of 440 discharges were reviewed, there were 27 episodes of NIs among 22 patients. Cumulated incidence was 6.13 NI per 100 discharges. Diarrhea, pneumonia and peritonitis were the most common infections. Predictors of NI by Cox regression analysis included pleural catheter (HR 16.38), entry through the emergency ward, hospitalization in the intensive care unit (HR 7.19), and placement of orotracheal tube (HR 5.54). CONCLUSIONS. Frequency of NIs in this community hospital was high and underestimated. We identified urgent needs in the areas of training and monitoring.

OBJETIVO. Comparar la tasa de infecciones nosocomiales (IN) resultante de la revisión retrospectiva de expedientes clínicos con los resultados del sistema rutinario de vigilancia de IN de un hospital general. MATERIAL Y MÉTODOS. Revisión retrospectiva de una muestra seleccionada aleatoriamente de expedientes clínicos. Comparación con los resultados obtenidos por el sistema rutinario de vigilancia de IN. Análisis bivariado y multivariado de datos retrospectivos. RESULTADOS. De 440 egresos hubo 27 episodios de IN en 22 pacientes. La incidencia acumulada fue de 6.13 IN por 100 egresos. Las infecciones más frecuentes fueron diarrea, neumonía y peritonitis. Los predictores de IN fueron catéter pleural (HR 16.38), ingreso por urgencias y estancia en cuidados intensivos (HR 7.19), y colocación de tubo orotraqueal (HR 5.54). CONCLUSIONES. La frecuencia de IN fue elevada y subestimada por el sistema rutinario. Identificamos necesidades urgentes de monitoreo y entrenamiento en áreas específicas.

Pediatric hospitalizations at two different setting community hospitals in north India: Implications for regionalization of care.

Objective. To evaluate pediatric hospitalizations at two different setting community hospitals in north India, and to understand the implications for regionalization of pediatric care in heterogeneous environment of India. Methods. Retrospective review of medical records of children hospitalized at a large and a small community hospital catering to population from different social classes but in close proximity to each other was carried out. Baseline characteristics and diagnosis were recorded, and compared using appropriate statistical tests. Results. There were notable differences between the age and morbidity profiles at the two study hospitals. Smaller community hospital catered to more young, malnourished and sicker children. Morbidity profile comprised of significantly more acute gastroenteritis and communityacquired pneumonia at the small hospital. In contrast, almost a quarter (24.4%) of children was injured at the larger community hospital. Infants and newborns were more at small, while older children (>5yrs) were more at the larger community hospital (p<0.0001). Conclusion. The conclusion drawn from this study is that significant differences exist in age and morbidity profiles between different setting community hospitals in north India. There is a need to form a prospective registry of community hospitals, which would validate the observations of the present study, and has implications for regionalization of specialized pediatric services as well as postgraduate training in India.

Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: ten year data from a tertiary care center in a developing country.

BACKGROUND: Retinopathy of prematurity (ROP) is an important cause of childhood blindness in developing countries. AIM: To report the spectrum of ROP and associated risk factors in babies weighing > 1250 g at birth in a developing country. SETTING AND DESIGN: Institutional, retrospective, non-randomized, observational clinical case series. MATERIALS AND METHODS : Retrospective analysis (10 years) of 275 eyes (138 babies) with ROP. STATISTICAL ANALYSIS: Qualitative data with the Chi-square test. Quantitative data using the unpaired t test or the ANOVA and further tested using multivariate logistic regression. RESULTS: The mean birth weight was 1533.9 g (range 1251 to 2750 g) and the mean period of gestation was 30.9 weeks (range 26 to 35). One hundred and twenty-four of 275 eyes (45.1%) had threshold or worse ROP. Risk factors for threshold or worse disease were, 'outborn babies' ( P P = 0.007) and exchange transfusion ( P = 0.003). The sensitivity of the American and British screening guidelines to pick up threshold or worse ROP in our study group was 82.4% and 77.4% respectively. CONCLUSIONS : Severe ROP is often encountered in babies weighing greater than 1250 g at birth in developing countries. Western screening guidelines may require modifications before application in developing countries.

Identifying the need for pre-hospital and emergency care in the developing world: a case study in Chennai, India.

OBJECTIVES: Increasing industrialization in the developing world has contributed to an epidemiological transition in disease pattern from infectious disease as a primary cause of morbidity and mortality, to more chronic illness such as heart disease and trauma. This study was done in order to assess the effectiveness of pre-hospital and emergency care as the health care needs of the population changes and to make recommendations to meet the growing need for organized emergency services in that community. METHODS: Sundaram Medical Foundation Hospital in the town of Annanagar, Chennai, India was our study site. Statistics describing the health status, demographic, and socio-ecoomic profiles of the community were obtained from a published community survey. Information regarding availability of resources in the hospitals for management of trauma and cardio-vascular emergencies was obtained from unpublished survey results of the local hospitals. Retrospective data was obtained from trauma and ambulance registries regarding trauma related admissions, death and pre-hospital assistance. RESULTS: Data analysis revealed increasing mortality from trauma and cardiovascular etiologies. Hospital statistics showed that 1/3 of the annual hospitalizations were from trauma and acute coronary syndromes. Half the trauma victims had no formal prehospital intervention. Standard of care in the emergency departments varied considerably with less than half of them carrying defibrillators and only a third of them carrying defirbillators and only a third of them carrying intubation equipment. CONCLUSION: As developing countries begin to urbanize and grow, so do their health care needs. The current system does not meet the needs of increased mortality from trauma and cardiovascular disease. We have suggested necessary changes for establishment of emergency medical services to meet the evolving health care needs.

Prevalence of dengue fever and dengue hemorrhagic fever in Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia.

Dengue fever and dengue hemorrhagic fever have been known to be endemic and reportable diseases in Malaysia since 1971. Major outbreaks occurred in 1973, 1982 and in 1998. For the past few decades until now. many studies have been performed to investigate the importance of these two diseases in Malaysia. A retrospective study was carried out in Hospital Tengku Ampuan Rahimah Klang to find the prevalence of these diseases. The data was collected from the record department of this hospital starting from the year 1999 until 2003 (5 years). A total of 6,577 cases of dengue fever and 857 cases of dengue hemorrhagic fever were reported. From the year 2000 onwards, cases of dengue fever had increased tremendously. However for the year 2001, there was a slight decrease in the reported cases. Most cases occurred in 2003, increasing from 674 in 1999 to 2,813 in 2003. Highest incidence was seen in Malay males more than 12 years of age. However, the cases of dengue hemorrhagic fever declined tremendously throughout the years. Most cases occurred in 1999 with 674 cases, then declining to only one in the year 2001 before it increased to 60 and 72 in the years 2002 and 2003, respectively. Most cases occurred in patients above 12 years old, the majority of which were Malay males.

NICU in a community level hospital.

OBJECTIVE: To study the clinical profile and outcome of neonates in NICU of a community hospital and highlight the importance and problems in neonatal care at a community level hospital. METHODS: Retrospective analysis of case records during the period Jan. 2001- Dec. 2003. Data regarding antenatal care, maternal morbidity, place of birth, age at admission, birth weight, gestational age, diagnosis, relevant investigations, duration of stay and outcome were recorded on a preset proforma. A cost analysis for average expenses per newborn per day for different morbidities was also done. Neonatal data was analyzed among survivors and expired using appropriate statistical tests. Probability of less than 5% was taken significant. Factors found significant on univariate analysis were subjected to logistic regression model to study independent predictor of fatality. RESULTS: A total of 168 neonates were admitted during the study period. The overall survival rate was 65%. 42(25%) neonates expired and 5.4% were referred to higher centers. The commonest morbidity in survivors was hyperbilirubinemia. Prematurity with HMD and neonatal sepsis were the commonest cause of mortality. 36(24.3%) expired within 48 hr of admission (Mean 33.2 hr). 31(17.8%) could not be referred and none survived. The difference of birth weight, gestational age and duration of stay was statistically different in survivors & expired. These variables retained their significance on multivariate analysis and thus were independent predictors of fatality. An average expense of Rs 400-500/day/newborn was charged in the NICU. CONCLUSION: In a country of limited resources, 65 % neonates requiring NICU can be managed at community level hospitals.

Prevalence of diabetic retinopathy in relation to duration of diabetes mellitus in community hospitals of Lampang.

Three thousand and forty nine patients diagnosed with diabetes mellitus were examined in 13 community (district) hospitals in Lampang from January to December 2002. Complete eye examination with standard protocol was used to determine the prevalence and severity of diabetic retinopathy. The prevalence of the background or non-proliferative diabetic retinopathy (BDR or NPDR) was 18.9% and proliferative diabetic retinopathy (PDR) was 3% in all age groups. For the relationship of the duration of diabetes, it showed that the longer the duration of diabetes the higher the prevalence of diabetic retinopathy. In BDR or NPDR, the retinopathy varied from 13.11 to 22.91% in persons having diabetes for less than 10 years and up to 42.86% in those with diabetes for up to 20 years. In the PDR group, the prevalence was 2.15 to 2.42% in persons with diabetes for less than 10 years and up to 10.20% for those with diabetes for up to 20 years. The severity of retinopathy was found to be not only related to a longer duration of diabetes but also related to higher glycosylated hemoglobin levels, higher systolic blood pressure and the presence of proteinuria.

A comparison of the antimicrobial resistance patterns of gram-positive cocci isolated from community-private and university-affiliated hospitals from Puerto Rico

The antimicrobial resistance patterns of 2,462 selected Gram-positive cocci obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: 1) to evaluate the in vitro resistance to selected standard antibiotics of Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium and Streptococcus pneumoniae clinical isolates, and 2) to compare the antimicrobial resistance patterns between community-private (CPH) and university-affiliated hospitals (UAH). Staphylococcus aureus was the most common Gram-positive isolated organism in CPH (63.3 per cent) followed by E. faecalis (31.0 per cent). In UAH, the most prevalent cocci were E. faecalis (51.7 per cent) followed by S. aureus (43.9 per cent). Enterococcus faecium represented 2.3 per cent and 4.4 per cent of CPH and UAH isolates, respectively. Streptococcus pneumoniae represented 3.4 per cent of the total Gram-positive isolates from CPH, no S. pneumoniae was reported in UAH. The antimicrobial susceptibility results showed that for Staphylococcus aureus there was a statistically significant higher resistance to methicillin and thrimethoprim sulfamethoxazole in UAH, while resistance to erythromycin was significantly higher in CPH. There was no difference in the resistance of S. aureus to other antimicrobial agents between hospitals groups. A statistically significant resistant to vancomycin was found between enterococcal isolates from UAH (43 per cent) and CPH (12.7 per cent). High-level aminoglycoside resistance (HLAR) was observed among UAH enterococcal isolates with E. faecium showing a higher resistance than E. faecalis, no data for HLAR in CPH could be obtained. For pneumococci 46 per cent of CPH isolates were resistant to penicillin. In summary, there are important differences in the prevalence and antimicrobial resistance between the Gram-positive bacteria isolated from community and teaching hospitals.

Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel / Renal trauma in childhood. Second-level hospital experience

The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.