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ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is associated with a significant risk of subsequent MRSA infection in the hospital setting. The use of decolonization as an infection control strategy remains highly controversial despite publications evaluating more than 40 different decolonization regimens over the past 60 years. The present study describes the benefits and potential drawbacks of such an approach in the patient population.
A retrospective cohort study was performed to assess the efficacy and subsequent outcome for patients with newly identified MRSA colonization at the Horizon Health Network in Moncton, New Brunswick.
A total of 241 patients with MRSA colonization or infection during the study period (2000 to 2005 inclusive) were identified. Eighty-nine MRSA-positive patients were decolonized according to a standardized regimen (hospital protocol group), and 98 received an alternative decolonization regimen (other treatment group). No attempt at decolonization was made for 54 patients (no treatment group). The hospital protocol group demonstrated superior overall successful decolonization compared with the other treatment group (67 of 84 [80%] versus 48 of 89 [54%]; OR 3.3; 95% CI 1.6 to 7.1; P=0.0004) and the no treatment group (four of 43 [9%]; OR 36.9; 95% CI 11.2 to 161.7; P<0.000001). The mean observed duration of culture negativity for the subgroup who remained MRSA culture negative over the long term was 419±398 days (range one to 1817 days). Successful decolonization occurred in 115 patients and permitted subsequent release from contact isolation for 4530 patient-days. The rate of clinical infection with MRSA was significantly lower in the hospital protocol group versus the other treatment group (16 of 89 [18%] versus 37 of 98 [38%]; OR 0.38; 95% CI 0.18 to 0.78; P=0.003).
The present study supports recent reports indicating that MRSA decolonization can be successful using a multifactorial approach (chlorhexidine soap, enhanced hygiene/housekeeping and combination oral/topical antimicrobial therapy) in hospitalized patients, both over the short and long term. Unlike previous studies, decolonization appeared to be effective in a relatively unselected population, including patients with lines and catheters. Inability to decolonize was most closely associated with failure to use a standardized decolonization protocol.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada 01/2010; 21(1):38-44. · 1.54 Impact Factor
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ABSTRACT: The goal of this study was to compare factors associated with long-term benzodiazepine use by elderly women and men (n = 1701) who participated in the Quebec Health Survey (QHS). Data from the 1998 QHS were linked with data from the administrative files of the Régie de l'assurance maladie du Québec. Results showed that elderly women were more at risk than men for long-term benzodiazepine use. Results of the multivariate logistic regression did not show a significant difference between women and men on any of the risk factors studied. Other factors such as elderly and physician attitudes deserve further study to explain differences in long-term benzodiazepine use between elderly women and men.
Journal of Women & Aging 02/2007; 19(3-4):37-52. · 0.54 Impact Factor
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ABSTRACT: Factors associated with early cessation of breastfeeding were identified and patterns of infant feeding were examined. Feeding practices were compared with the 1998 guidelines in Nutrition for Healthy Term Infants and with recent Health Canada recommendations.
To recruit participants, a letter was sent to every mother (n=424) who gave birth at Dr. Georges-L. Dumont Regional Hospital in Moncton from April 1998 to February 1999. Eighty-five mothers agreed to participate with their infants. Information on infant feeding patterns and socioeconomic background was gathered with semi-structured questionnaires. Only healthy infants from singleton pregnancies were included in this study.
At birth, almost 83% of infants were breastfed. The proportions of infants breastfed for at least four, six, and nine months were 43%, 22%, and 9%, respectively. As many as 34% of infants were introduced to baby cereals before age four months, and 21% were introduced to cow's milk before age nine months. Lower family income, lower level of parental education, and reduced postpartum hemoglobin level (below 95 g/L) were associated with discontinuation of breastfeeding before infants were four months old.
Early postpartum nutrition interventions may be effective in ensuring follow-up care for mothers with compromised iron status, in supporting breastfeeding for at least six months, and in promoting better infant feeding practices.
Canadian Journal of Dietetic Practice and Research 02/2006; 67(2):72-6. · 0.81 Impact Factor
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ABSTRACT: In Quebec, benzodiazepines are some of the most extensively used drugs by the elderly. The goal of this study was to identify factors associated with short- and long-term benzodiazepine use among 2,039 elderly persons having participated in the Quebec Health Survey conducted in 1998. Results of the multivariate, multinomial logistic regression showed that a higher number of chronic health problems, a higher number of physicians visited and general practitioners consulted were associated with short- and long-term use of benzodiazepines. Factors specifically associated with long-term use were female gender (OR = 1.84) and the presence of benzodiazepine users in the household (OR = 1.90). In this study, we were unable to show a difference between the two groups of users with regards to the risk factors studied. This result leads us to conclude that prevention of long-term use must be aimed at all new benzodiazepine users.
Canadian journal on aging = La revue canadienne du vieillissement 02/2005; 24(2):103-13. · 0.92 Impact Factor
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ABSTRACT: There have been few general population studies of the effects of psychotropic treatment on cognitive functioning in the elderly. Current evidence based on studies with numerous procedural shortenings supports the notion of the detrimental effect.
To examine changes in a wide range of specific cognitive abilities across time in a general population sample in order to establish a relationship between psychotropic drug use and cognitive performance, and to estimate to what extent such cognitive changes may be attributable to psychotropic use or other factors, notably age and co-morbidity.
We analysed the data from the Eugeria longitudinal study of cerebral ageing. Three hundred and seventy two subjects (263 female and 109 male) were visited at their place of residence and given a computerized cognitive examination. Depressive symptomatology and depressive episodes were defined according to ICD-9 criterias and medication use were established. Four categories of psychotropic consumers was differentiated. Using a logistic regression model, comparisons were made between consumers and non-consumers.
A significant positive effect in chronic consumers was found on tests of secondary memory (delayed verbal recall: Odds Ratio (OR)=1.22; 95% Confidence Intervals (CI) [1.04-1.43]; p=0.013) and this effect is principally attributable to antidepressants with significant effects being shown for both verbal (OR=1.59; 95%CI [1.18-2.14]; p=0.002) and visual recall (OR=1.51; 95%CI [1.05-2.16]; p=0.025). No effect is found for benzodiazepines.
Contrary to the common belief that psychotropic drug use has a detrimental effect on cognitive function of elderly people, even long term use is seen to be benign. We attest to the positive effects of antidepressant therapy on secondary memory.
International Journal of Geriatric Psychiatry 11/2003; 18(10):874-8. · 2.42 Impact Factor
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ABSTRACT: Inappropriate consumption of anxiolytic, sedative and hypnotic medication (ASH) in the elderly is an important public health issue. Almost 35 % of the elderly population living at home take these medications, approximately 206 days per year. According to Quebec data, people who are 65 and older take five times more ASH than people between 18 and 64. The use of ASH would not only be determined by the presence of symptoms, but also by psychosocial characteristics of the subjects. Moreover, several researchers have suggested that the family as well as the health system were environmental factors that could facilitate or inhibit consumption of these medications in the elderly. A conceptual framework is proposed to help specify more adequately the various explanatory hypotheses of this social health behavior and, consequently, better target interventions aiming at its modification.
Sante mentale au Quebec 02/2003; 28(2):165-82.
