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Vancomycin-resistant Enterococcus (VRE) is a major nosocomial pathogen. We collected clinical and laboratory data on 93 hospitalized adults with VRE bacteremia and 101 adults with vancomycin-susceptible enterococcal (VSE) bacteremia. Risk factors for VRE bacteremia included central venous catheterization, hyperalimentation, and prolonged hospitalization prior to the initial blood culture. VRE-infected patients were less likely to have undergone recent surgery or have polymicrobial bacteremia, suggesting a pathogenesis distinct from traditional VSE bacteremia. Prior exposure to metronidazole was the only significant pharmacologic risk factor for VRE bacteremia. Animal studies suggest metronidazole potentiates enterococcal overgrowth in the gastrointestinal tract and translocation into the bloodstream. An increasing APACHE II score was the major risk factor for death in a multivariate analysis, with VRE status being of only borderline significance.

Objectives: The purpose of this paper is to provide background information on the epidemic proportions of hand injuries related to computer use. It offers a solution of early health education in prevention of cumulative trauma disorders (CTDs) through specially designed instruction in elementary schools., Study Design: The current literature is reviewed. Some physical impairments caused by poor biomechanics and computer overuse are identified. Disability factors are highlighted in relation to how the physical impairment affects an individual's performance in the domain of work. Handicapping factors that are the result of the individual's decline in performance roles of worker are noted. These factors impact our society in dollars spent on medical insurance and worker's compensation claims. A review of a pilot project aimed at early education in hand health basics is introduced, as a proactive ergonomic solution to the present epidemic of cumulative trauma disorders., Results: A positive response was displayed by the 950 elementary students and their staff to a 20-min program that introduced concepts of posture at the keyboard and basic upper body stretches. Children were instructed in their individual classes during their computer lab time. Daily follow-up, particularly for the forearm and hand stretches, was fostered by the computer lab coordinator, teachers, and wall posters. Parents were informed through a summary article printed in the monthly school newsletter., Conclusions: Wellness thinking and living can be learned at an early age to assure that basic principles of work practice such as posture and upper body stretches become a life skill. Review of the literature supports programs to educate individuals at an early age to develop life skills that would minimize the occurrence of cumulative trauma disorders, especially in relation to the use of computers.