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Background: The number of methicillin-resistant STaphylococcus aureus (MRSA) infections in the hospital setting is increasing but little is known of its prevalence in the community. In a 1986-1987 study, the prevalence in dermatology outpatient clinics was <0.9%. This study reports changes in the same facilities from 1988 through 1996.Methods: Culture results and antimicrobial susceptibility patterns were reviewed for the population for the period 1988 through 1996.Results: We report a gradual increase of MRSA from 1.5% of all strains of Staphylococcus aureus in 1988 to 11.9% in 1996 in these outpatient facilities. Susceptibility data indicate that the MRSA strains isolated in 1996 are more resistant to oral agents such as ciprofloxacin and tetracycline, while all strains remain susceptible to the intravenous agent vancomycin.Conclusion: The prevalence of MRSA in the community is increasing and should be considered when selecting a treatment regimen for staphylococcal infections. [ABSTRACT FROM AUTHOR]

Unlabelled: Disasters can have wide-ranging effects on individuals and their communities. Loss of specific resources (e.g., household contents, job) following a disaster has not been well studied, despite the implications for preparedness efforts and postdisaster interventions., Objective: To provide information about the effects of loss on postdisaster distress, the present study assessed associations between disaster-related variables, including the loss of specific resources, and postdisaster distress., Method: Random-digit dialing methodology was used to recruit hurricane-affected adults from Galveston and Chambers, TX, counties one year after Hurricane Ike. Data from 1,249 survivors were analyzed to identify predictors of distress., Results: Variables that were significantly associated with posttraumatic stress disorder symptoms included sustained losses, hurricane exposure, and sociodemographic characteristics; similar results were obtained for depressive symptoms., Conclusions: Together, these findings suggest risk factors that may be associated with the development of posthurricane distress that can inform preparedness efforts and posthurricane interventions., (© 2013 Wiley Periodicals, Inc.)

Objective: We examined the association between disaster exposure, community support, and mental health outcomes in urban and nonurban participants of Galveston and Chambers counties after Hurricane Ike. The moderating effect of community support was evaluated as a protective factor relative to postdisaster mental health., Methods: A representative population-based sample of 157 urban and 714 nonurban adults were interviewed 12 to 17 months after the hurricane about their mental health functioning, disaster exposure, and perceptions of community support., Results: A series of multiple regressions demonstrated that disaster exposure was associated with mental health outcomes for both groups. The strength of the association varied across population samples.Community support moderated the association between interpersonal effects of the disaster and posttraumatic stress disorder (PTSD) and depression outcomes in nonurban participants and the association between property damage and PTSD in urban participants., Conclusions: Community support played a larger role in reducing PTSD and depression symptoms associated with the interpersonal effects of a disaster in the nonurban sample only. Communities may play a more beneficial role in the recovery process in nonurban areas that have elevated levels of injury or death attributed to a disaster.

The current study extends knowledge regarding the differential impact of natural disasters among White, African American, and Latino survivors of Hurricane Ike through its use of a large, regional sample recruited via representative sampling procedures to examine the associations between cultural identification and disaster impact, including loss, damage, and negative mental health outcomes. Consistent with previous research, results indicated disparities between cultural groups with regard to disaster exposure. Additionally, type of disaster impact was differentially associated with PTSD and depression status dependent on cultural group. Specifically, the extent of personal disaster exposure, property damage, and loss of services made significant contributions to PTSD status among White survivors. African-Americans were more likely than White and Latino Ike survivors to endorse post-disaster PTSD and depression and endorsement of depression was predicted by severity of property damage. With respect to Latino respondents, only the extent of personal disaster exposure significantly contributed to both PTSD and depression status. Implications of the current findings are discussed with regard to future disaster preparedness and response efforts and the implementation and evaluation of community-based disaster resources.

Identification of a population at high risk for Clostridium difficile infection (CDI) would enable CDI prevention strategies to be designed. The purpose of this study was to create a clinical risk index that would predict those at risk for CDI. A CDI risk index was therefore developed, based on a cohort of hospital patients given broad-spectrum antibiotics, and divided into a development and validation cohort. Logistic regression equations helped identify significant predictors of CDI. A scoring algorithm for CDI risk was created using identified risk factors and collapsed to create four categories of CDI risk. The area under the receiver operating characteristic (aROC) curve was used to measure goodness-of-fit. Among 54 226 patients, 392 tested positive for C. difficile. Age 50-80 years [odds ratio (OR: 0.5; P<0.0116)], age >80 years (OR: 2.5; P<0.0001), haemodialysis (OR: 1.5; P=0.0227), non-surgical admission (OR: 2.2; P<0.0001) and increasing length of stay in the intensive care unit (OR: 2.1; P<0.0001) were significantly associated with CDI. A simple risk index using presence of significant variables was significantly associated with increasing risk for CDI in both development (OR: 3.57; P<0.001; aROC: 0.733) and validation (OR: 3.31; P<0.001; aROC: 0.712) cohorts. An OR-derived risk index did not perform as well as the simple risk index. This easily implemented risk index should allow stratification of patients into risk group categories for development of CDI and help fashion preventive strategies.

Patients with Clostridium difficile-associated diarrhoea (CDAD) may initially develop symptoms in the community and be subsequently diagnosed at hospital admission. At the present time there is no national surveillance system and no standardized case definition of CDAD in the USA, and baseline data on the incidence and epidemiology of CDAD are scarce. The objective of this study was to report the incidence of CDAD at a tertiary care hospital, and to determine the epidemiology of cases diagnosed within 48h of hospital admission, compared with cases of nosocomial CDAD diagnosed 48h or more after hospitalization. The average incidence was 4.0 cases/10 000 patient-days for CDAD on admission and 7.0 cases/10 000 patient-days for nosocomial CDAD. A significant difference was observed in CDAD rates on admission compared with nosocomial CDAD rates (P=0.017), but no differences were observed over time for either rate. Overall, 44% of cases had CDAD on admission and 56% of cases had nosocomial CDAD. Fifty-six (62%) patients with CDAD on admission had been admitted to the same hospital and 24 (27%) had been admitted to another hospital within the previous 90 days. Only eight (9%) patients had not been exposed to any healthcare services in the 90 days preceding hospital admission. A standardized case definition of healthcare-associated CDAD should include previous hospitalizations. Admitting physicians should consider C. difficile in the differential diagnosis of patients admitted with diarrhoea, with or without a history of admission to healthcare facilities.

The Sam and Ann Barshop Center for Longevity and Aging Studies is a focal point for advanced research designed exclusively to study the genes involved in aging and the diseases of aging. The research performed at the Barshop Center is based on a solid foundation of nearly twenty-five years of aging research at The University of Texas Health Science Center at San Antonio. Internationally recognized scientists in aging are now leading innovative research programs using state-of-the-art technologies in molecular and cellular biology to explore aging processes at the gene level in the four major programs that comprise the research at the Barshop Center: the Cellular Aging Program, the Invertebrate Aging Program, the Rodent Models of Aging Program, and the Human Genetics of Aging Program. The researchers involved in these programs share a common purpose in an atmosphere of collaboration to gain the scientific insights necessary to understand the molecular basis of aging. Their long-term goal is to gain the knowledge that will give rise to the development of interventions that retard or arrest the debilitating conditions associated with aging. February or March 2003 marks the groundbreaking for the first building of Barshop Center's new stand-alone facility. This is the initial step toward a $70 million, world-class research complex dedicated to the study of aging and healthy longevity.