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To identify important risk factors for carbapenem-resistant Enterobacterales (CRE) infections among hospitalized patients.
We utilized a case–case–control design that compared patients with CRE infections to patients with carbapenem-susceptible Enterobacterales (CSE) infections and randomly selected controls during the period from January 2011 through December 2016.
The study population was selected from patients at a large metropolitan tertiary-care and instructional medical center.
Cases of CRE were defined as initial admission of adults diagnosed with a bacterial infection of an Enterobacterales species resistant clinically or through sensitivity testing to carbapenems 48 hours or more after admission. Cases of CSE were selected from the same patient population as the CRE cases within a 30-day window for admission, with diagnostic pathogens identified as susceptible to carbapenems. Controls were defined as adult patients admitted to any service within a 30-day window from a CRE case for >48 hours who did not meet either of the above case definitions during that admission.
Antibiotic exposure within 90 days prior to admission and length of hospital stay were both associated with increased odds of CRE and CSE infections compared to controls. Patients with CRE infections had >18 times greater odds of prior antibiotic exposure compared to patients with CSE infections.
Antibiotic exposure and increased length of hospital stay may result in increased patient risk of developing an infection resistant to carbapenems and other β-lactams.
OBJECTIVES/GOALS: Adolescents with congenital heart defects (CHD) have an elevated risk for future cardiovascular events, but information about their risk for e-cigarette use (“vaping”) is unknown. This study aims to present preliminary findings on gender differences in the association of impulsive behavior and vaping susceptibility from an ongoing investigation. METHODS/STUDY POPULATION: Adolescents with CHD (12-18 years; N=63) reported their vaping susceptibility and completed subjective (UPPS-P)/objective (Iowa Gambling Task; IGT) assessments of impulsive behavior previously associated with tobacco use. The UPPS-P includes 5 facets: 1) negative urgency (impulsivity under negative emotions), 2) positive urgency (impulsivity under positive emotions), 3) lack of premeditation (acting without thinking), 4) lack of perseverance (inability to focus), and 5) sensation seeking (seeking thrilling experiences). The IGT is a computerized task that creates conflict between immediate reward and delayed punishment via selections from advantageous/disadvantageous card decks. Linear regressions stratified by gender determined associations between vaping susceptibility and impulsivity. RESULTS/ANTICIPATED RESULTS: Nearly 30% (29.7%) of adolescents with CHD were susceptible to vaping. Negative urgency was associated with vaping susceptibility among females (Î² = 0.44, p = .035) but not males (Î² = 0.25, p = .128). Positive urgency was associated with vaping susceptibility among males (Î² = 0.37, p = .021) and trended toward significance among females (Î² = 0.40, p = .058). Lack of premeditation was associated with vaping susceptibility among males (Î² = 0.36, p = .025) but not females (Î² = 0.15, p = .490). The association between lack of perseverance and vaping susceptibility trended toward significance among males (Î² = 0.30, p = .064) but not females (Î² = -0.18, p = .413). IGT performance was not associated with susceptibility to vaping among either gender. UPPS-P facets and IGT performance were not significantly correlated. DISCUSSION/SIGNIFICANCE: The association of impulsivity and vaping susceptibility appears to be characterized by emotion-based rash action (positive/negative urgency) for females and by decreased conscientiousness (lack of premeditation/perseverance) for males. If replicated, the findings have implications for assessment of vaping risk and tailored intervention.
Introduction. Individuals with psychotic-spectrum disorders may smoke due to the ameliorating effect of nicotine on the cognitive deficits that accompany these illnesses. Metacognitive remediation therapy (MCR) has been shown to produce improvements in cognitive functioning among individuals with psychotic-spectrum disorders and provides a foundation for a novel smoking cessation intervention for this population. Aims. To complete an open investigation of pharmacotherapy and a modified version of MCR [MCR to Quit (MCR-Q)] in promoting smoking cessation among individuals with psychotic-spectrum disorders. Methods. Forty-nine individuals with a psychotic-spectrum disorder and who currently smoke cigarettes participated in MCR-Q while also receiving evidence-based smoking cessation pharmacotherapy. Tobacco use was assessed as follows: (i) prior to MCR-Q, (ii) immediately after completing MCR-Q, and (iii) six weeks after completion of MCR-Q. Results/Findings. During participation in MCR-Q, nearly 80% of participants made a 24-hour quit attempt. Following the completion of MCR-Q, participants experienced reductions in level of nicotine dependency and exhaled carbon monoxide, with reductions in nicotine dependency sustained six weeks after completion of MCR-Q. Over the course of their participation in MCR-Q, participants reported strong therapeutic alliance with their MCR-Q therapist and high levels of intrinsic motivation with regard to completing MCR-Q exercises. Conclusions. The results from the current study suggest cautious optimism with regard to the use of MCR-Q in combination with medication for individuals with psychotic-spectrum disorders who want to quit smoking.
This article describes a culturally and linguistically relevant, physician-led smoking cessation intervention that was delivered to the Chinese American community in New York City. Data were collected from a convenience sample of 115 participants (94% male) at a clinical site of a community health centre. The smoking intervention program included pharmacological treatments and brief cessation counselling, education and support by the physician and the health educator. Process data included the drop-out rate, number of visits completed and use of pharmacotherapy. Outcome data included self-reported and biochemically verified (expired carbon monoxide) smoking status at week 12. In the process evaluation, valuable information about the components of interventions that worked well and challenges participants faced during their quit attempts was gathered from participants, doctors and the health educator. Sixteen participants (13.9%) successfully quit smoking. Chinese male smokers face many daunting challenges that prevent them from regularly attending a smoking cessation program. Despite these challenges, they appeared to benefit from brief interventions, although the cessation rate was modest at best. This information should be incorporated into future design of smoking cessation programs to address required behavioural change in this population.
The purpose of this study was to extend research regarding the perceptions smokers have of the advantages and disadvantages of using potential reduced exposure products (PREPs). Five focus groups with female current smokers were conducted in the Appalachian region of Ohio. The semistructured discussion guide was developed to capture information on reasons why women smoke, why and how they quit smoking, and reasons why women would switch to PREPs. The results suggest that these smokers did not express enthusiasm for using PREPs as an aid to smoking cessation or as a harm reduction product. In general, the concept of harm reduction in the sense of reducing disease risks did not engage the participants. Early in the discussion the women had identified some problems caused by their smoking and later PREPs were viewed as reducing these. The results suggest that PREPs may be attractive to some smokers because they offer benefits that other products lack.
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