Few studies have examined whether infant dietary diversity is prospectively associated with malnutrition risk in young children. We sought to assess whether dietary diversity and animal-source food consumption were associated with malnutrition and body composition among children younger than 2 years at high risk of malnutrition.

Longitudinal cohort of HIV-exposed uninfected (HEU) or HIV-unexposed children with repeated measures of weight, length, circumferences, and skinfold thicknesses from age 9 to 23 months from which WHO z-scores were calculated. Food frequency questionnaire assessed infants’ dietary diversity, flesh foods and egg intake. Cox proportional hazards were used to examine whether minimum dietary diversity (MDD, dietary diversity scores ≥5) and consumption of animal-source foods were associated with malnutrition, defined as z-score <-2.

western Kenya

Infants (n=232; 48% female; 49% HEU; growth z-scores above -2 at 9 months).

At 9 months, 42% of infants met MDD, and mean z-scores were above -1 SD. Meeting MDD at 9 months was associated with a lower risk of stunting from 9 to 23 months (HR 0.51; 95% CI:0.33,0.80) but not wasting or underweight. MDD at 9 months was associated with 86% (95%CI 0.11,0.51) lower risk of low subscapular skinfolds; similar trends were observed for flesh foods.

In a cohort of Kenyan infants, MDD at 9 months was associated with reduced risk of stunting through the second year of life. Flesh food intake was associated with lower risk of low trunk adiposity. Improving dietary diversity during infancy may protect against early-life stunting.

To evaluate clinical outcomes in patients with uncomplicated β-hemolytic Streptococcus spp. bloodstream infections (BSI) transitioned to oral antimicrobial therapy (OAT) compared with those that remain on intravenous antimicrobial therapy.

Retrospective cohort study.

Tertiary academic hospital.

This retrospective cohort study included adult patients hospitalized between 1/1/2013 and 12/31/2019 diagnosed with uBSI due to β-hemolytic streptococci. Patients were excluded if BSI was due to endovascular, central nervous system, or bone/joint infection or patient was immunosuppressed or died within 72 hours of identification of BSI. We compared outcomes including: 30-day mortality, antimicrobial therapy, BSI relapse, 30-day rehospitalization, adverse drug events, and reversion to IV therapy. Fisher’s exact test was used for categorical variables; Mann – Whitney test and Independent T-test for continuous variables.

232 BSIs were included. OAT was used in 152 (65%). Cohort demographics were similar. Mortality was also similar between cohorts (2% vs 6% P = .13). Hospital length of stay was shorter in the OAT cohort with a median of 5 days (interquartile range 4.00, 8.00) versus 8 (5.00, 16.00) in the IV group (P < .0001). Patients transitioned to OAT were more likely to finish antibiotics outpatient (93% vs 62% P < .001).

For β-hemolytic Streptococcus uBSI, OAT was associated with decreased length of stay without adverse clinical outcomes. Opportunities exist to modify clinical management of uBSI.

Natural disasters can cause widespread death and extensive physical devastation, but also harmfully impact individual and community health following a disaster event. Nature-based recovery approach can positively influence the mental health of people and community’s post-natural disasters. In response to the Australian bushfire season of 2019-2020, Zoos Victoria, in partnership with the Arthur Rylah Institute, worked with local communities in East Gippsland to support people’s recovery through experiencing, supporting, and witnessing nature’s recovery.

This mixed-method study explored how nature improved the recovery of remote and rural communities affected by the Black Summer bushfires in East Gippsland. The research studied the individuals’ feelings about being involved in nature-based community events and their lived experiences. Data were collected from June to September 2023 through a nature-based community recovery project survey and community interviews.

The findings demonstrated that engagement with natural environments promotes positive psychological, mental, and general well-being of people from bushfire-affected communities. Positive feedback from participants indicated the success of the Nature-Based Community Recovery Project in East Gippsland after the Black Summer bushfire.

This research provides insights for future recovery projects and ensures that sustainable nature-based recovery solutions for bushfire-impacted communities can be established.

Black and Latino individuals are underrepresented in COVID-19 treatment and vaccine clinical trials, calling for an examination of factors that may predict willingness to participate in trials.

We administered the Common Survey 2.0 developed by the Community Engagement Alliance (CEAL) Against COVID-19 Disparities to 600 Black and Latino adults in Baltimore City, Prince George’s County, Maryland, Montgomery County, Maryland, and Washington, DC, between October and December 2021. We examined the relationship between awareness of clinical trials, social determinants of health challenges, trust in COVID-19 clinical trial information sources, and willingness to participate in COVID-19 treatment and vaccine trials using multinomial regression analysis.

Approximately half of Black and Latino respondents were unwilling to participate in COVID-19 treatment or vaccine clinical trials. Results showed that increased trust in COVID-19 clinical trial information sources and trial awareness were associated with greater willingness to participate in COVID-19 treatment and vaccine trials among Black and Latino individuals. For Latino respondents, having recently experienced more challenges related to social determinants of health was associated with a decreased likelihood of willingness to participate in COVID-19 vaccine trials.

The willingness of Black and Latino adults to participate in COVID-19 treatment and vaccine clinical trials is influenced by trial awareness and trust in trial information sources. Ensuring the inclusion of these communities in clinical trials will require approaches that build greater awareness and trust.

Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers’ perceptions, with specific focus on personal challenges, worries, coping skills, and resilience.

Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers.

Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult’s greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey.

This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers’ perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.

BrighT STAR was a diagnostic stewardship collaborative of 14 pediatric intensive care units (PICUs) across the United States designed to standardize and reduce unnecessary blood cultures and study the impact on patient outcomes and broad-spectrum antibiotic use. We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs.

A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR.

14 PICUs enrolled in BrighT STAR.

Site leads at each enrolled site.

An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative.

10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. Strategies used in top-performing sites were distinct from those used in lower-performing sites. Certain strategies may link to drivers of culture overuse and represent key targets for changing clinician behavior.

BrighT STAR offers important insights into the tasks and strategies used to facilitate successful diagnostic stewardship in the PICU. More work is needed to compare specific strategies and optimize stewardship outcomes in this complex environment.

Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR). NCT03441126. https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1