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[PMID]: 29524774
[Au] Autor:Garcia K; Dowling D; Mettler G
[Ad] Address:Frances Payne Bolton School of Nursing, Case Western Reserve University, United States. Electronic address: ksg11@case.edu.
[Ti] Title:Teaching Guatemalan traditional birth attendants about obstetrical emergencies.
[So] Source:Midwifery;61:36-38, 2018 Feb 17.
[Is] ISSN:1532-3099
[Cp] Country of publication:Scotland
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Guatemala's Maternal Mortality Rate is 65th highest in the world at 120 deaths per 100,000 births. Contributing to the problem is traditional birth attendants (TBAs) attend most births yet lack knowledge about obstetrical emergencies. Government trainings in existence since 1955 have not changed TBA knowledge. Government trainings are culturally insensitive because they are taught in Spanish with written material, even though most TBAs are illiterate and speak Mayan dialects. The purpose of the observational study was to evaluate the effect of an oral training, that was designed to be culturally sensitive in TBAs' native language, on TBAs' knowledge of obstetrical emergencies. METHODS: one hundred ninety-one TBAs participated. The study employed a pretest-posttest design. A checklist was used to compare TBAs' knowledge of obstetrical emergencies before and after the training. FINDINGS: the mean pretest score was 5.006±SD 0.291 compared to the mean posttest score of 8.549±SD 0.201. Change in knowledge was a P value of 0.00. DISCUSSION: results suggest an oral training that was designed to be culturally sensitive in the native language improved TBAs' knowledge of obstetrical emergencies. Future trainings should follow a similar format to meet the needs of illiterate audiences in remote settings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 100242 MEDLINE  
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[PMID]: 29511602
[Au] Autor:de Lima Pereira A; Southgate R; Ahmed H; O'Connor P; Cramond V; Lenglet A
[Ad] Address:Médecins Sans Frontières (MSF), Operational Centre Amsterdam (OCA), Kobanê, Syria.
[Ti] Title:Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience.
[So] Source:PLoS Curr;10, 2018 Feb 02.
[Is] ISSN:2157-3999
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Introduction: In 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015. Methods: We implemented a pre-SIA survey in 135 randomly-selected households in Kobanê using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF 'Preventive Vaccination in Humanitarian Emergencies' guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years. Results: The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months. Discussion: As a result of the conflict in Syria, the progressive collapse of the health care system in Kobanê has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Kobanê remains high. Conclusion: We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review

  3 / 100242 MEDLINE  
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[PMID]: 28457798
[Au] Autor:Tabit CE; Coplan MJ; Spencer KT; Alcain CF; Spiegel T; Vohra AS; Adelman D; Liao JK; Sanghani RM
[Ad] Address:Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Ill.
[Ti] Title:Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.
[So] Source:Am J Med;130(9):1112.e17-1112.e31, 2017 Sep.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. RESULTS: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. CONCLUSION: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.
[Mh] MeSH terms primary: Cardiology/standards
Emergency Service, Hospital/utilization
Heart Failure/therapy
Patient Education as Topic/organization & administration
Patient Readmission/statistics & numerical data
[Mh] MeSH terms secundary: Acute Disease
Aged
Cardiology/economics
Cardiology/methods
Case-Control Studies
Chicago
Cost Control/methods
Cost Control/standards
Emergency Service, Hospital/economics
Emergency Service, Hospital/organization & administration
Female
Heart Failure/economics
Humans
Male
Middle Aged
Organizational Case Studies
Patient Discharge/economics
Patient Discharge/standards
Patient Discharge/statistics & numerical data
Patient Education as Topic/economics
Patient Education as Topic/methods
Patient Readmission/economics
Practice Guidelines as Topic
Propensity Score
Referral and Consultation/economics
Referral and Consultation/standards
Retrospective Studies
Socioeconomic Factors
Tertiary Care Centers/economics
Tertiary Care Centers/organization & administration
Urban Health/economics
Urban Health/statistics & numerical data
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:170502
[St] Status:MEDLINE

  4 / 100242 MEDLINE  
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[PMID]: 29522616
[Au] Autor:Armus M; Factorovich M; Woscoboinik N
[Ad] Address:Programa "Mirar y Prevenir", Ministerio de Salud, Ciudad Autónoma de Buenos Aires. marcela.armus@gmail.com.
[Ti] Title:Tiempos de la infancia. Clínica de la urgencia y del desamparo. [Times of childhood. Clinic of urgency and helplessness].
[So] Source:Vertex;XXVIII(131):55-60, 2017 Jan.
[Is] ISSN:0327-6139
[Cp] Country of publication:Argentina
[La] Language:spa
[Ab] Abstract:In this paper we discuss the "times of childhood", the relevance of what is "urgent" in the construction of psychological subjectivity, the symptoms leading to the identifcation of an early distress in children up to the age of 2, and some other mental health emergencies, such as abuse, violence and Münchausen syndrome. We consider the infant-mother relationship the cornerstone of this clinic of helplessness. We discuss the notion of emergency beyond the classic psychiatric emergency. We conclude there is an urgent need to build work teams (health care professionals, education professionals, professionals in the judicial feld) trained in the early detection of warning signs and early intervention.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  5 / 100242 MEDLINE  
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[PMID]: 29522615
[Au] Autor:Novas SV; García-Barthe M
[Ad] Address:Unidad de Salud Mental, Hospital de Niños "Dr. Ricardo Gutiérrez". doc.sandranovas@gmail.com.
[Ti] Title:El hospital y las urgencias de la época. Salud Mental de niños y adolescentes. [The hospital and the emergencies in our time. Child and adolescents mental health].
[So] Source:Vertex;XXVIII(131):48-54, 2017 Jan.
[Is] ISSN:0327-6139
[Cp] Country of publication:Argentina
[La] Language:spa
[Ab] Abstract:In the last decade, the Emergency Department of "Dr. Ricardo Gutiérrez" Children's Hospital in the city of Buenos Aires, Argentina, registered a signifcant increase in mental health consultations of children and adolescents. The increase in the demand for assistance was mainly due to self-injurious behavior, suicide attempts and situations of violence and abandonment. We analyze the variables that determine the characteristics of the current consultation and the change in the profile of the institutions called to respond to this demand. Finally, we reflect on the place of childhood and adolescence, considering the influence of cultural and socioeconomic changes of contemporary society.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  6 / 100242 MEDLINE  
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[PMID]: 29522614
[Au] Autor:Coronel PA
[Ad] Address:Dispositivo Ambulatorio para la Niñez y la Adolescencia, Hospital Nacional en Red especializado en Salud Mental y Adicciones "Lic. Laura Bonaparte". Hospital General de Niños "Dr. Pedro de Elizalde" (GCABA). pacoronel74@yahoo.com.
[Ti] Title:Manejo de las urgencias psiquiátricas en población infantojuvenil con consumo de sustancias psicoactivas. [Clinical management of child and adolescent psychiatric emergencies in patients with substance abuse disorders].
[So] Source:Vertex;XXVIII(131):40-47, 2017 Jan.
[Is] ISSN:0327-6139
[Cp] Country of publication:Argentina
[La] Language:spa
[Ab] Abstract:This paper addresses the problem of substance abuse disorders in child and adolescent patients within its frequent psychiatric emergency setting. It describes the clinical features that defne the high complexity of these cases, the current state of knowledge regarding clinical management of child and adolescent psychiatric emergencies in patients with substance abuse disorders, and the available treatment strategies in the metropolitan area of Buenos Aires, Argentina. Finally, this article delves into the existence of a metropolitan addiction treatment network, its community outreach and the obstacles it has to conquer in order to attain the international standards for the treatment of substance abuse disorders.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  7 / 100242 MEDLINE  
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[PMID]: 29522612
[Au] Autor:Costa J; Stagnaro JC
[Ti] Title:Urgencias en psiquiatría infanto-juvenil. [Emergencies in child and adolescent psychiatry].
[So] Source:Vertex;XXVIII(131):30-32, 2017 Jan.
[Is] ISSN:0327-6139
[Cp] Country of publication:Argentina
[La] Language:spa
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  8 / 100242 MEDLINE  
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[PMID]: 29474397
[Au] Autor:Cranmer JN; Dettinger J; Calkins K; Kibore M; Gachuno O; Walker D
[Ad] Address:Emory University, Atlanta, Georgia, United States of America.
[Ti] Title:Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness.
[So] Source:PLoS One;13(2):e0184252, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. OBJECTIVE-METHOD: We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. FINDINGS: Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. SIGNIFICANCE: Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade's intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted.
[Mh] MeSH terms primary: Delivery, Obstetric
Maternal Health Services/organization & administration
[Mh] MeSH terms secundary: Child, Preschool
Female
Humans
Infant
Infant Mortality
Infant, Newborn
Kenya/epidemiology
Pregnancy
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180224
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184252

  9 / 100242 MEDLINE  
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[PMID]: 29447192
[Au] Autor:Abbasi A; Sadeghi-Niaraki A; Jalili M; Choi SM
[Ad] Address:School of Engineering and IT, University of New South Wales (UNSW), Canberra, ACT, Australia.
[Ti] Title:Enhancing response coordination through the assessment of response network structural dynamics.
[So] Source:PLoS One;13(2):e0191130, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Preparing for intensifying threats of emergencies in unexpected, dangerous, and serious natural or man-made events, and consequent management of the situation, is highly demanding in terms of coordinating the personnel and resources to support human lives and the environment. This necessitates prompt action to manage the uncertainties and risks imposed by such extreme events, which requires collaborative operation among different stakeholders (i.e., the personnel from both the state and local communities). This research aims to find a way to enhance the coordination of multi-organizational response operations. To do so, this manuscript investigates the role of participants in the formed coordination response network and also the emergence and temporal dynamics of the network. By analyzing an inter-personal response coordination operation to an extreme bushfire event, the networks' and participants' structural change is evaluated during the evolution of the operation network over four time durations. The results reveal that the coordination response network becomes more decentralized over time due to the high volume of communication required to exchange information. New emerging communication structures often do not fit the developed plans, which stress the need for coordination by feedback in addition to by plan. In addition, we find that the participant's brokering role in the response operation network identifies a formal and informal coordination role. This is useful for comparison of network structures to examine whether what really happens during response operations complies with the initial policy.
[Mh] MeSH terms primary: Personnel Management/methods
Resource Allocation/methods
[Mh] MeSH terms secundary: Australia
Communication
Emergency Responders
Firefighters
Humans
Organizations/organization & administration
Wildfires
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191130

  10 / 100242 MEDLINE  
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[PMID]: 29447174
[Au] Autor:Lee S; You CY; Kim J; Jo YH; Ro YS; Kang SH; Lee H
[Ad] Address:Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
[Ti] Title:Long-term cardiovascular risk of hypertensive events in emergency department: A population-based 10-year follow-up study.
[So] Source:PLoS One;13(2):e0191738, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Hypertension-related visits to the emergency department (ED) are increasing every year. Thus, ED could play a significant role in detecting hypertension and providing necessary interventions. However, it is not known whether a hypertensive event observed in the ED is an independent risk factor for future major adverse cardiovascular events (MACE). METHODS: A population-based observational study was conducted using a nationally representative cohort that contained the claim data of 1 million individuals from 2002 to 2013. We included non-critical ED visits without any history of MACE, and compared the new occurrences of MACE according to the presence of hypertensive events using extended Cox regression model. The disease-modifying effect of a follow-up visit was assessed by analyzing the interaction between hypertensive event and follow-up visit. RESULTS: Among 262,927 first non-critical ED visits during the study period (from 2004 to 2013), 6,243 (2.4%) visits were accompanied by a hypertensive event. The hypertensive event group had a higher risk of having a first MACE at 3 pre-specified intervals: 0-3 years (HR, 4.25; 95% CI, 3.83-4.71; P<0.001), 4-6 years (HR, 3.65; 95% CI, 3.14-4.24; P<0.001), and 7-10 years (HR, 3.20; 95% CI, 2.50-4.11; P<0.001). Follow-up visits showed significant disease-modifying effect at 2 intervals: 0-3 years (HR 0.65, 95% CI, 0.50-0.83) and 4-7 years (HR 0.68, 95% CI, 0.48-0.95). CONCLUSIONS: A hypertensive event in the ED is an independent risk factor for MACE, and follow-up visits after the event can significantly modify the risk.
[Mh] MeSH terms primary: Cardiovascular Diseases/etiology
Emergency Service, Hospital
Hypertension/complications
[Mh] MeSH terms secundary: Cohort Studies
Follow-Up Studies
Humans
Risk Factors
[Pt] Publication type:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191738


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