Background: Urinary tract infection is a common pediatric bacterial infection associated with significant morbidity and increasing antimicrobial resistance, particularly in low- and middle-income countries. Updated local data regarding microbiological patterns and antibiotic susceptibility in children with UTI remain limited in Bangladesh. Methods: This cross-sectional study was conducted in the Department of Pediatric Nephrology, Bangladesh Medical University, from August 2023 to January 2026. Among 242 children aged <18 years with symptoms suggestive of UTI, 188 fulfilled criteria for presumptive UTI based on pyuria and/or positive dipstick findings. Urine culture and antibiotic susceptibility testing were performed for all presumptive cases. Children with asymptomatic bacteriuria, recent antibiotic exposure, prophylactic antibiotics, or contaminated cultures were excluded. Confirmed UTI was defined by significant growth of a single organism in urine culture. Demographic, clinical, microbiological, and antimicrobial susceptibility data were analyzed using SPSS version 26.0. Results: Culture-positive UTI was identified in 78 children (41.5%). Females predominated (55.9%), and most patients were below five years of age. Fever (67.0%) and dysuria (39.4%) were the most common presenting symptoms. Associated renal disease was present in 60.1% of cases, most commonly nephrotic syndrome and hydronephrosis. Klebsiella species (38.5%) were the predominant uropathogens, followed by Escherichia coli (21.8%). Gram-negative isolates demonstrated high susceptibility to carbapenems, aminoglycosides, nitrofurantoin, and colistin, while resistance to commonly used antibiotics was substantial. Female sex, uncircumcised male infants, high-grade fever, and associated kidney disease were independent predictors of culture-positive UTI. Conclusion: Pediatric UTIs in this tertiary nephrology setting were frequently associated with underlying renal abnormalities and multidrug-resistant non–E. coli organisms. Early urine culture, culture-guided therapy, and strengthened antimicrobial stewardship are essential to improve outcomes and limit antimicrobial resistance.
Aims: This study explored rural disparities in eyecare utilization among adult patients with diabetes with mild/moderate and severe diabetic retinopathy in the rural state of West Virginia, United States. Methods: Demographic characteristics, clinical and vision/eye care utilization data were collected from electronic health records at West Virginia University Eye Institute and affiliated teleophthalmology clinics. A manual review identified patients who received eye care services between October 2015 and March 2024 (n=11,633). Patient’s residence was categorized using the rural-urban commuting area codes. Unadjusted and adjusted logistic regression of eye-care visits by diagnosis (diabetes, mild/moderate diabetic retinopathy, severe diabetic retinopathy and rural residence were conducted adjusting for sociodemographic, behavioral, clinical factors and comorbidities. Results: The mean age and HbA1c was 59.7 ± 14.2 years and 7.8 ± 1.9%, respectively. In the adjusted multivariable logistic regression controlling for established risk factors, rural residence was associated with higher visits (OR = 1.47, 95% confidence interval [CI] = 1.04 to 2.08), P<.001. Higher visits were also noted among rural (vs. urban) patients with severe DR complications (aOR=1.70; 95% CI = 1.48 to 1.96) and mild/moderate DR (aOR= 1.34; 95% CI = 1.18 to 1.52), P<.001. Conclusions: A clear rural disadvantage was noted in eyecare utilization among rural patients with severe diabetic retinopathy. Teleophthalmology may provide opportunities for timely screening and treatment to reduce preventable blindness.
Importance Shared decision-making (SDM) improves patient adherence and may reduce costs, yet its adoption remains limited. A brief, valid, and practical measure of clinicians’ willingness to adopt SDM is needed to support implementation efforts and research. Objective To refine and improve the incorpoRATE measure of clinician willingness to incorporate shared decision-making. Design, Setting, and Participants Cognitive interview study conducted via video conference with physicians, nurse practitioners, and physician assistants working in primary care in rural New Hampshire, recruited through the Northern New England Practice and Community-Based Research Network (NNE CO-OP), October to December 2024. Main Outcomes and Measures Item-level feedback on clarity, interpretability, and social desirability of measure items; participant-rated willingness scores (0–10 scale) for each item. Results Cognitive interviews across two rounds with 16 health professionals (9 physicians, 6 nurse practitioners, 1 physician assistant) confirmed that further modifications were required to the measure. Changes reduced potential social desirability introduced by certain word choices and modified the question stems and response scale. Conclusions and Relevance Refinements improved incorpoRATE's clarity and applicability, with slightly higher and similar-more variable mean willingness scores (8.33, SD = 1.3) than earlier versions. A further version of the measure is now available for clinical validation.
Background: Medical education in Paraguay faces a structural paradox. Graduate profiles have progressively aligned with competency-based medical education (CBME), social accountability, and Primary Health Care (PHC), yet the competencies expected of the medical educators who must enact these reforms remain undefined, unregulated, and unevaluated. This asymmetry is intensified by the rapid expansion of undergraduate medical programmes, which has increased the demand for faculty without guaranteeing their pedagogical preparation. Aim: To analyze the implicit and explicit competencies required of medical educators in Paraguay and to propose an integrative competency profile and a policy pathway for their professionalization, aligned with national frameworks and international standards. Methods: A qualitative, interpretative, and integrative documentary study compared national reference documents from the National Agency for the Evaluation and Accreditation of Higher Education, the Model for Medical Education in Paraguay, and the competency framework of the Ministry of Public Health and Social Welfare against international references, including global standards for medical education, the CanMEDS framework, and faculty development guides from the Association for Medical Education in Europe. Analysis proceeded through four phases: thematic extraction, comparison of convergences and divergences, international alignment, and integrative conceptual synthesis. Results: National frameworks converge in describing an ethical, socially accountable, communicative, and community-oriented physician, yet none specifies educator competencies. A structural gap was identified between the sophistication of graduate profiles and the absence of formalized faculty standards, compounded by educational expansion and the lack of specific faculty regulation. Ten interconnected competency domains were synthesized into an integrative educator profile spanning pedagogy, competency-based assessment, updated clinical competence, professionalism and ethical leadership, communication and mentorship, educational scholarship, social accountability and Primary Health Care orientation, academic leadership and innovation, interprofessional education, and continuous faculty development. Conclusion: Professionalizing medical educators is both an educational and a public health priority. The proposed integrative competency profile and phased policy pathway offer a conceptual basis for faculty development, quality assurance, and future national standards, requiring empirical validation in subsequent research.
