WorldWideScience

Sample records for emerging patient-driven health

  1. The barriers to patient-driven treatment in mental health: why patients may choose to follow their own path.

    Science.gov (United States)

    Greenall, Paul

    2006-01-01

    The paper aims to explore the barriers that currently exist to patient-driven treatment within the field of mental health care and reform. This study represents action learning research using grounded theory to explore a possible causal basis for recidivism related to non-compliance with medication. Interviews addressed concerns from the literature around perceived barriers to patient-driven treatment evidenced by non-compliance with medically recommended pharmaceutical treatment. Results were correlated to look for emergent themes that were used to form the basis for subsequent interview questions. An analysis of the resulting emergent themes illustrated the importance of participatory treatment and coaching rather than medically applied paternalistic care, which is seen as encouraging learned helplessness on the part of patients. Similar helplessness was also revealed in clinicians themselves. Patients' awareness of their own needs and demands for more services place clients and the caregivers at odds over appropriate care in an environment of limited resources. The research was limited to only a small number of interviewees in one institution, all of whom were closely associated with mental illness in various capacities. The grounded theory nature of the research does, however, provide a framework for more research in other institutions to test and further explore some of the findings. The study demonstrated a reinforcement of Maslow's theory of needs hierarchy. The study illustrated a step-wise approach to treatment to decrease the rate of failure and recidivism in mental health care. The provision of a stable living environment was viewed as instrumental in improving patients' compliance with pharmaceutical treatment. An action plan was therefore created to initiate the support of a transitional/emergency house by various community groups in partnership with pharmaceutical manufacturing companies. Recidivism in mental health-created by non-compliance in

  2. Forging stronger partnerships between academic health centers and patient-driven organizations.

    Science.gov (United States)

    Gallin, Elaine K; Bond, Enriqueta; Califf, Robert M; Crowley, William F; Davis, Pamela; Galbraith, Richard; Reece, E Albert

    2013-09-01

    In this article, the authors review the unique role that patient-driven organizations, such as patient advocacy groups and voluntary health organizations (PAG/VHOs), play in translational and clinical research. The importance of fostering collaborations between these organizations and U.S. academic health centers (AHCs) is also discussed. Although both the PAG/VHO community and AHCs are heterogeneous, and although not all organizations are well governed or provide independent, well-researched views, there are many outstanding, well-managed, independent PAG/VHOs in the United States whose missions overlap with those of AHCs. The characteristics of effective PAG/VHOs that would serve as excellent partners for AHCs are discussed, and examples are provided regarding their many contributions, which have included advancing research on rare diseases, recruiting patients for clinical trials, and establishing patient registries and biospecimen banks. The authors present feedback obtained from informal discussions with PAG/VHO staff, as well as a survey of a small sample of organizations, that has identified bureaucratic processes, negotiating intellectual property rights, and institutional review board (IRB) delays as the most problematic areas of interactions with AHCs. Actions are suggested for building effective partnerships between the two sectors and the activities that AHCs should undertake to facilitate their interactions with PAG/VHOs including streamlining contract review and IRB processes and finding ways to better align the incentives motivating academic clinical and translational investigators with the goals of PAG/VHOs. This article is one product of the Clinical Research Forum's Partnering with Patient Advocacy Groups Initiative.

  3. Patient-driven resource planning of a health care facility evacuation.

    Science.gov (United States)

    Petinaux, Bruno; Yadav, Kabir

    2013-04-01

    The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old. Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period. Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe. Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within

  4. Patient-Driven Innovation for Mobile Mental Health Technology: Case Report of Symptom Tracking in Schizophrenia.

    Science.gov (United States)

    Torous, John; Roux, Spencer

    2017-07-06

    This patient perspective piece presents an important case at the intersection of mobile health technology, mental health, and innovation. The potential of digital technologies to advance mental health is well known, although the challenges are being increasingly recognized. Making mobile health work for mental health will require broad collaborations. We already know that those who experience mental illness are excited by the potential technology, with many actively engaged in research, fundraising, advocacy, and entrepreneurial ventures. But we don't always hear their voice as often as others. There is a clear advantage for their voice to be heard: so we can all learn from their experiences at the direct intersection of mental health and technology innovation. The case is cowritten with an individual with schizophrenia, who openly shares his name and personal experience with mental health technology in order to educate and inspire others. This paper is the first in JMIR Mental Health's patient perspective series, and we welcome future contributions from those with lived experience. ©John Torous, Spencer Roux. Originally published in JMIR Mental Health (http://mental.jmir.org), 06.07.2017.

  5. Emergency Health Services Selected Bibliography.

    Science.gov (United States)

    Health Services and Mental Health Administration (DHEW), Bethesda, MD.

    This annotated bibliography contains books, journal articles, visual aids, and other documents pertaining to emergency health care, which are organized according to: (1) publications dealing with day-to-day health emergencies that occur at home, work, and play, (2) documents that will help communities prepare for emergencies, including natural…

  6. Public health emergencies in urban India

    Directory of Open Access Journals (Sweden)

    Bhabani Prasad Acharya

    2018-03-01

    Full Text Available Public health emergencies in urban India can be caused by natural or man-made disasters. Occurrence of a public health emergency adds to the already stretched health system. This paper looks into the public health emergency conditions in urban India, and our preparedness to tackle them. To address this composite threat to nation’s health and development, a concerted public health response is needed, that can ensure efficient delivery in emergency situations Public health emergency is an occurrence or eminent threat of an illness or health condition caused by bio-terrorism, epidemic or pandemic disease, or novel and highly fatal infectious agent or biological toxin, that possess a substantial risk of a significant number of human facilities or incidents or permanent or long–term disability (1. It is a condition that requires the government to declare a state of public health emergency. The declaration of a state of public health emergency permits the government to suspend state regulations,and change the functions of state agencies (2. Term “Urban” refers to perplexing variety of environments.  Health circumstances of small cities and town differ in many ways from larger cities and metros. Within cities, change in lifestyle of residents is observed. The urban system is often present with full array of health providers ranging from traditional healer, street drug seller to highly –trained surgeons (3.

  7. Conceptions of mobile emergency service health professionals concerning psychiatric emergency

    Directory of Open Access Journals (Sweden)

    Diego Bonfada

    2012-06-01

    Full Text Available Under the Brazilian Psychiatric Reformation, assistance to psychological seizures represents a challenge for the emergency services. Therefore, the objective of this paper is the analysis of the conceptions of health professionals who work at the Mobile Emergency Service in Natal on psychiatric emergency care. This paper is, then, a qualitative study that used interviews as tools for collecting information. By using thematic analysis, the speeches were grouped into three categories: the stigma on patients and the professionals' fear of services interventions in psychiatric emergencies; having psychiatric emergencies regarded as harmful to patients and others' security; psychiatric emergencies being taken as patients' aggressiveness or severe depression. The data collected indicate that the interviewed professionals' ideas are supported by elements associated with the ideology that insanity implies social segregation and dangerousness. Thus, the survey prompted reflection on relevant issues to the process of psychiatric reformation implementation.

  8. Developing "My Asthma Diary": a process exemplar of a patient-driven arts-based knowledge translation tool.

    Science.gov (United States)

    Archibald, Mandy M; Hartling, Lisa; Ali, Samina; Caine, Vera; Scott, Shannon D

    2018-06-05

    adapted for use with different populations and contexts. We identified specific procedural and methodological challenges that others conducting comparable work should consider, particularly as creative, patient-driven knowledge translation strategies continue to emerge across health disciplines.

  9. Mobile health systems and emergence

    NARCIS (Netherlands)

    Jones, Valerie M.; Graziosi, Barbara

    2015-01-01

    Changes in the age distribution of the population and increased prevalence of chronic illnesses, together with a shortage of health professionals and other resources, will increasingly challenge the ability of national healthcare systems to meet rising demand for services. Large-scale use of eHealth

  10. Mental health triage in emergency medicine.

    Science.gov (United States)

    Smart, D; Pollard, C; Walpole, B

    1999-02-01

    The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. A four-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health 'did not waits' showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. A systematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.

  11. Illuminating collaboration in emergency health care situations

    DEFF Research Database (Denmark)

    Sonnenwald, Diane H.; Söderholm, Hanna Maurin; Welch, Gregory F.

    2014-01-01

    reported the technology would require additional training, changes to existing financial models used in emergency health care, and increased access to physicians. Conclusions. Teaching collaboration skills and strategies to physicians and paramedics could benefit their collaboration today, and increase...

  12. One Health Perspectives on Emerging Public Health Threats

    Directory of Open Access Journals (Sweden)

    Sukhyun Ryu

    2017-11-01

    Full Text Available Antimicrobial resistance and emerging infectious diseases, including avian influenza, Ebola virus disease, and Zika virus disease have significantly affected humankind in recent years. In the premodern era, no distinction was made between animal and human medicine. However, as medical science developed, the gap between human and animal science grew deeper. Cooperation among human, animal, and environmental sciences to combat emerging public health threats has become an important issue under the One Health Initiative. Herein, we presented the history of One Health, reviewed current public health threats, and suggested opportunities for the field of public health through better understanding of the One Health paradigm.

  13. Public health implications of emerging zoonoses.

    Science.gov (United States)

    Meslin, F X; Stöhr, K; Heymann, D

    2000-04-01

    Many new, emerging and re-emerging diseases of humans are caused by pathogens which originate from animals or products of animal origin. A wide variety of animal species, both domestic and wild, act as reservoirs for these pathogens, which may be viruses, bacteria or parasites. Given the extensive distribution of the animal species affected, the effective surveillance, prevention and control of zoonotic diseases pose a significant challenge. The authors describe the direct and indirect implications for public health of emerging zoonoses. Direct implications are defined as the consequences for human health in terms of morbidity and mortality. Indirect implications are defined as the effect of the influence of emerging zoonotic disease on two groups of people, namely: health professionals and the general public. Professional assessment of the importance of these diseases influences public health practices and structures, the identification of themes for research and allocation of resources at both national and international levels. The perception of the general public regarding the risks involved considerably influences policy-making in the health field. Extensive outbreaks of zoonotic disease are not uncommon, especially as the disease is often not recognised as zoonotic at the outset and may spread undetected for some time. However, in many instances, the direct impact on health of these new, emerging or re-emerging zoonoses has been small compared to that of other infectious diseases affecting humans. To illustrate the tremendous indirect impact of emerging zoonotic diseases on public health policy and structures and on public perception of health risks, the authors provide a number of examples, including that of the Ebola virus, avian influenza, monkeypox and bovine spongiform encephalopathy. Recent epidemics of these diseases have served as a reminder of the existence of infectious diseases and of the capacity of these diseases to occur unexpectedly in new

  14. Globalisation, complex humanitarian emergencies and health.

    Science.gov (United States)

    O'Dempsey, T J D; Munslow, B

    2006-01-01

    A new political economy of conflict has emerged in the aftermath of colonialism and the Cold War. Complex political emergencies have been simmering in the post-colonial world for more than three decades. Intra-country armed conflict, often combined with natural disasters, at present contributes to the displacement of over 20 million people world-wide. The international community remains profoundly uncomfortable with the complex political emergencies of the new era, torn between the respect for national sovereignty upon which the international political system of the United Nations and other agencies is built, and the growth of concern with human rights and a burgeoning International Humanitarian Law. Globalisation may have brought many benefits to some but there are also many losers. The Word Bank and the International Monetary Fund imposed structural adjustment policies to ensure debt repayment and economic restructuring that have resulted in a net reduction in expenditure on health, education and development. A downward spiral has been created of debt, disease, malnutrition, missed education, economic entrapment, poverty, powerlessness, marginalization, migration and instability. Africa's complex political emergencies are particularly virulent and tenacious. Three examples that are among the most serious humanitarian emergencies to have faced the world in recent times--those in Angola, the Democratic Republic of Congo and Sudan--are reviewed here in detail. The political evolution of these emergencies and their impact on the health of the affected populations are also explored.

  15. Radiological Emergency Response Health and Safety Manual

    Energy Technology Data Exchange (ETDEWEB)

    D. R. Bowman

    2001-05-01

    This manual was created to provide health and safety (H&S) guidance for emergency response operations. The manual is organized in sections that define each aspect of H and S Management for emergency responses. The sections are as follows: Responsibilities; Health Physics; Industrial Hygiene; Safety; Environmental Compliance; Medical; and Record Maintenance. Each section gives guidance on the types of training expected for managers and responders, safety processes and procedures to be followed when performing work, and what is expected of managers and participants. Also included are generic forms that will be used to facilitate or document activities during an emergency response. These ensure consistency in creating useful real-time and archival records and help to prevent the loss or omission of information.

  16. Enhancing crisis leadership in public health emergencies.

    Science.gov (United States)

    Deitchman, Scott

    2013-10-01

    Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.

  17. Publication ethics in public health emergencies.

    Science.gov (United States)

    Shaw, David; Elger, Bernice S

    2017-09-01

    In this article, we describe and analyse three issues in publication ethics that are raised when conducting research in emergencies and disasters. These include reluctance to share data and samples because of concerns about publications, loss of individual authorship in high high-profile multi-entity publications, and the deaths of authors during dangerous research projects. An emergency research pledge may be useful in avoiding some of these issues. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Patient-driven hand hygiene audit process at a regional cancer center.

    Science.gov (United States)

    Bow, E J; Bourrier, V; Trudel, J; Kostiuk, N; McLeod, J M

    2018-01-01

    A patient-driven hand hygiene compliance audit strategy was piloted in a Canadian provincial cancer agency during routine provision of cancer outpatient care by health care providers (physicians, nurses, and health care aides) under conditions where the deployment of an independent external auditor was not feasible. The results of the audit suggest the feasibility of this approach as a routine institutional performance metric. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  19. [Health alert management and emerging risk].

    Science.gov (United States)

    Pillonel, J

    2010-12-01

    Following health crisis that have occurred in the nineties (contaminated blood, mad cow, asbestos, etc.) and more recently those generated by the heat wave in 2003 or by emerging infectious pathogens (SARS, West Nile, Chikungunya, H5N1, H1N1…), a real health vigilance system has been progressively developed in France. After a brief historical overview of the health alert system, this article will give the guiding principles of its current organization in France and will present two examples of recent health alerts (Chikungunya in the Reunion Island in 2005-2006 and hepatitis A outbreak in the Côtes-d'Armor in August 2007), that have needed the implementation of preventive measures regarding the blood donor selection. These two examples have shown that the position of the alert in the French health vigilance system needs to be very close to the event. In that case, health alert is a very useful tool for decision making especially when measures have to be taken to prevent transfusion-transmitted pathogens. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  20. The emergent discipline of health web science.

    Science.gov (United States)

    Luciano, Joanne S; Cumming, Grant P; Wilkinson, Mark D; Kahana, Eva

    2013-08-22

    The transformative power of the Internet on all aspects of daily life, including health care, has been widely recognized both in the scientific literature and in public discourse. Viewed through the various lenses of diverse academic disciplines, these transformations reveal opportunities realized, the promise of future advances, and even potential problems created by the penetration of the World Wide Web for both individuals and for society at large. Discussions about the clinical and health research implications of the widespread adoption of information technologies, including the Internet, have been subsumed under the disciplinary label of Medicine 2.0. More recently, however, multi-disciplinary research has emerged that is focused on the achievement and promise of the Web itself, as it relates to healthcare issues. In this paper, we explore and interrogate the contributions of the burgeoning field of Web Science in relation to health maintenance, health care, and health policy. From this, we introduce Health Web Science as a subdiscipline of Web Science, distinct from but overlapping with Medicine 2.0. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed among Web-oriented investigators present at the 2012 Medicine 2.0 Conference in Boston, Massachusetts.

  1. Priority setting for health in emerging markets.

    Science.gov (United States)

    Glassman, Amanda; Giedion, Ursula; McQueston, Kate

    2013-05-01

    The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes.

  2. Emerging health issues: the widening challenge for population health promotion.

    Science.gov (United States)

    McMichael, Anthony J; Butler, Colin D

    2006-12-01

    The spectrum of tasks for health promotion has widened since the Ottawa Charter was signed. In 1986, infectious diseases still seemed in retreat, the potential extent of HIV/AIDS was unrecognized, the Green Revolution was at its height and global poverty appeared less intractable. Global climate change had not yet emerged as a major threat to development and health. Most economists forecast continuous improvement, and chronic diseases were broadly anticipated as the next major health issue. Today, although many broadly averaged measures of population health have improved, many of the determinants of global health have faltered. Many infectious diseases have emerged; others have unexpectedly reappeared. Reasons include urban crowding, environmental changes, altered sexual relations, intensified food production and increased mobility and trade. Foremost, however, is the persistence of poverty and the exacerbation of regional and global inequality. Life expectancy has unexpectedly declined in several countries. Rather than being a faint echo from an earlier time of hardship, these declines could signify the future. Relatedly, the demographic and epidemiological transitions have faltered. In some regions, declining fertility has overshot that needed for optimal age structure, whereas elsewhere mortality increases have reduced population growth rates, despite continuing high fertility. Few, if any, Millennium Development Goals (MDG), including those for health and sustainability, seem achievable. Policy-makers generally misunderstand the link between environmental sustainability (MDG #7) and health. Many health workers also fail to realize that social cohesion and sustainability--maintenance of the Earth's ecological and geophysical systems--is a necessary basis for health. In sum, these issues present an enormous challenge to health. Health promotion must address population health influences that transcend national boundaries and generations and engage with the

  3. Best practices in managing child and adolescent behavioral health emergencies.

    Science.gov (United States)

    Feuer, Vera; Rocker, Joshua; Saggu, Babar M; Andrus, Jason M

    2018-01-01

    Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies.

  4. Emerging health issues of cyanobacterial blooms

    Directory of Open Access Journals (Sweden)

    Maura Manganelli

    2012-12-01

    Full Text Available This paper describes emerging issue related to cyanobacterial dynamics and toxicity and human health risks. Data show an increasing cyanobacteria expansion and dominance in many environments. However there are still few information on the toxic species fitness, or on the effects of specific drivers on toxin production. Open research fields are related to new exposure scenario (cyanotoxins in water used for haemodialysis and in food supplements; to new patterns of co-exposure between cyanotoxins and algal toxins and/or anthropogenic chemicals; to dynamics affecting toxicity and production of different cyanotoxin variants under environmental stress; to the accumulation of cyanotoxins in the food web. In addition, many data gaps exist in the characterization of the toxicological profiles, especially about long term effects.

  5. State of emergency preparedness for US health insurance plans.

    Science.gov (United States)

    Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

    2015-01-01

    Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

  6. Zika Virus: An Emerging Global Health Threat

    Directory of Open Access Journals (Sweden)

    Rahul Mittal

    2017-12-01

    Full Text Available Zika virus (ZIKV is an emerging healthcare threat. The presence of the mosquito Aedes species across South and Central America in combination with complementary climates have incited an epidemic of locally transmitted cases of ZIKV infection in Brazil. As one of the most significant current public health concerns in the Americas, ZIKV epidemic has been a cause of alarm due to its known and unknown complications. At this point, there has been a clear association between ZIKV infection and severe clinical manifestations in both adults and neonates, including but not limited to neurological deficits such as Guillain-Barré syndrome (GBS and microcephaly, respectively. The gravity of the fetal anomalies linked to ZIKV vertical transmission from the mother has prompted a discussion on whether to include ZIKV as a formal member of the TORCH [Toxoplasma gondii, other, rubella virus, cytomegalovirus (CMV, and herpes] family of pathogens known to breach placental barriers and cause congenital disease in the fetus. The mechanisms of these complex phenotypes have yet to be fully described. As such, diagnostic tools are limited and no effective modalities are available to treat ZIKV. This article will review the recent advancements in understanding the pathogenesis of ZIKV infection as well as diagnostic tests available to detect the infection. Due to the increase in incidence of ZIKV infections, there is an immediate need to develop new diagnostic tools and novel preventive as well as therapeutic modalities based on understanding the molecular mechanisms underlying the disease.

  7. Zika Virus: An Emerging Global Health Threat

    Science.gov (United States)

    Mittal, Rahul; Nguyen, Desiree; Debs, Luca H.; Patel, Amit P.; Liu, George; Jhaveri, Vasanti M.; S. Kay, Sae-In; Mittal, Jeenu; Bandstra, Emmalee S.; Younis, Ramzi T.; Chapagain, Prem; Jayaweera, Dushyantha T.; Liu, Xue Zhong

    2017-01-01

    Zika virus (ZIKV) is an emerging healthcare threat. The presence of the mosquito Aedes species across South and Central America in combination with complementary climates have incited an epidemic of locally transmitted cases of ZIKV infection in Brazil. As one of the most significant current public health concerns in the Americas, ZIKV epidemic has been a cause of alarm due to its known and unknown complications. At this point, there has been a clear association between ZIKV infection and severe clinical manifestations in both adults and neonates, including but not limited to neurological deficits such as Guillain-Barré syndrome (GBS) and microcephaly, respectively. The gravity of the fetal anomalies linked to ZIKV vertical transmission from the mother has prompted a discussion on whether to include ZIKV as a formal member of the TORCH [Toxoplasma gondii, other, rubella virus, cytomegalovirus (CMV), and herpes] family of pathogens known to breach placental barriers and cause congenital disease in the fetus. The mechanisms of these complex phenotypes have yet to be fully described. As such, diagnostic tools are limited and no effective modalities are available to treat ZIKV. This article will review the recent advancements in understanding the pathogenesis of ZIKV infection as well as diagnostic tests available to detect the infection. Due to the increase in incidence of ZIKV infections, there is an immediate need to develop new diagnostic tools and novel preventive as well as therapeutic modalities based on understanding the molecular mechanisms underlying the disease. PMID:29276699

  8. Policy statement--emergency information forms and emergency preparedness for children with special health care needs.

    Science.gov (United States)

    2010-04-01

    Children with chronic medical conditions rely on complex management plans for problems that cause them to be at increased risk for suboptimal outcomes in emergency situations. The emergency information form (EIF) is a medical summary that describes medical condition(s), medications, and special health care needs to inform health care providers of a child's special health conditions and needs so that optimal emergency medical care can be provided. This statement describes updates to EIFs, including computerization of the EIF, expanding the potential benefits of the EIF, quality-improvement programs using the EIF, the EIF as a central repository, and facilitating emergency preparedness in disaster management and drills by using the EIF.

  9. What is a health emergency? The difference in definition and understanding between patients and health professionals.

    Science.gov (United States)

    Morgans, Amee; Burgess, Stephen J

    2011-08-01

    Investigations into 'inappropriate' use of emergency health services are limited by the lack of definition of what constitutes a health emergency. Position papers from Australian and international sources emphasise the patient's right to access emergency healthcare, and the responsibility of emergency health care workers to provide treatment to all patients. However, discordance between the two perspectives remain, with literature labelling patient use of emergency health services as 'inappropriate'. To define a 'health emergency' and compare patient and health professionals perspectives. A sample of 600 emergency department (ED) patients were surveyed about a recent health experience and asked to rate their perceived urgency. This rating was compared to their triage score allocated at the hospital ED. No significant relationship was found between the two ratings of urgency (P=0.51). CONCLUSIONS; Differing definitions of a 'health emergency' may explain patient help-seeking behaviour when accessing emergency health resources including hospital ED and ambulance services. A new definition of health emergency that encapsulates the health professional and patient perspectives is proposed. An agreed definition of when emergency health resources should be used has the potential to improve emergency health services demand and patient flow issues, and optimise emergency health resource allocation.

  10. Managing psychiatric emergencies in persons with mental health ...

    African Journals Online (AJOL)

    Background: Psychiatric emergencies are commonly encountered by the emergency room team where non-mental health specialists are often the first care providers. Materials and Methods: The study took place at the University of Ibadan Health Service, it was a descriptive cross-sectional study and participants were ...

  11. Quality improvement and emerging global health priorities

    Science.gov (United States)

    Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

    2018-01-01

    Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

  12. Emergency contraception - potential for women's health.

    Science.gov (United States)

    Mittal, Suneeta

    2014-11-01

    Emergency contraception (EC) is a safe and effective method which is used to prevent unwanted pregnancy after unprotected sexual intercourse. Many of the unwanted pregnancies end in unsafe abortions. The search for an ideal contraceptive, which does not interfere with spontaneity or pleasure of the sexual act, yet effectively controls the fertility, is still continuing. Numerous contraceptive techniques are available, yet contraceptive coverage continues to be poor in India. Thus, even when not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception. This need may also arise due to failure of contraceptive method being used (condom rupture, diaphragm slippage, forgotten oral pills) or following sexual assault. Emergency contraception is an intervention that can prevent a large number of unwanted pregnancies resulting from failure of regular contraception or unplanned sexual activity, which in turn helps in reducing the maternal mortality and morbidity due to unsafe abortions. However, a concern has been expressed regarding repeated and indiscriminate usage of e-pill, currently the rational use of emergency contraception is being promoted as it is expected to make a significant dent in reducing the number of unwanted pregnancies and unsafe abortions. In fact, since the introduction of emergency contraception, the contribution of unsafe abortion towards maternal mortality has declined from 13 to 8 per cent.

  13. Behavioral Health Emergencies Managed by School Nurses Working with Adolescents

    Science.gov (United States)

    Ramos, Mary M.; Greenberg, Cynthia; Sapien, Robert; Bauer-Creegan, Judith; Hine, Beverly; Geary, Cathy

    2013-01-01

    Background: As members of interdisciplinary teams, school nurses provide behavioral health services. Studies indicate that school nurses may lack sufficient continuing education in adolescent behavioral health and in the management of behavioral health emergencies, specifically. We conducted this study to describe the adolescent behavioral health…

  14. 21 CFR 25.16 - Public health and safety emergencies.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Public health and safety emergencies. 25.16... ENVIRONMENTAL IMPACT CONSIDERATIONS Agency Actions Requiring Environmental Consideration § 25.16 Public health... importance to the public health or safety, may make full adherence to the procedural provisions of NEPA and...

  15. The Emergence of Personalized Health Technology.

    Science.gov (United States)

    Allen, Luke Nelson; Christie, Gillian Pepall

    2016-05-10

    Personalized health technology is a noisy new entrant to the health space, yet to make a significant impact on population health but seemingly teeming with potential. Devices including wearable fitness trackers and healthy-living apps are designed to help users quantify and improve their health behaviors. Although the ethical issues surrounding data privacy have received much attention, little is being said about the impact on socioeconomic health inequalities. Populations who stand to benefit the most from these technologies are unable to afford, access, or use them. This paper outlines the negative impact that these technologies will have on inequalities unless their user base can be radically extended to include vulnerable populations. Frugal innovation and public-private partnership are discussed as the major means for reaching this end.

  16. Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

    Science.gov (United States)

    McManus, Moira C; Cramer, Robert J; Boshier, Maureen; Akpinar-Elci, Muge; Van Lunen, Bonnie

    2018-01-13

    Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. 'Other' ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal 'need', including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

  17. Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

    Science.gov (United States)

    Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

    2016-03-01

    Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  18. Bradford Hill’s criteria, emerging zoonoses, and One Health

    Directory of Open Access Journals (Sweden)

    G.V. Asokan

    2016-09-01

    Full Text Available Zoonoses constitute more than 60% of infectious diseases and 75% of emerging infectious diseases. Inappropriate overemphasis of specialization of disciplines has ignored public health. Identifying the causes of disease and determining how exposures are related to outcomes in “emerging zoonoses” affecting multiple species are considered to be the hallmarks of public health research and practice that compels the adoption of “One Health”. The interactions within and among populations of vertebrates in the causation and transmissions of emerging zoonotic diseases are inherently dynamic, interdependent, and systems based. Disease causality theories have moved from one or several agents causing disease in a single species, to one infectious agent causing disease in multiple species-emerging zoonoses. Identification of the causative pathogen components or structures, elucidating the mechanisms of species specificity, and understanding the natural conditions of emergence would facilitate better derivation of the causal mechanism. Good quality evidence on causation in emerging zoonoses affecting multiple species makes a strong recommendation under the One Health approach for disease prevention and control from diagnostic tests, treatment, antimicrobial resistance, preventive vaccines, and evidence informed health policies. In the tenets of One Health, alliances work best when the legitimate interests of the different partners combine to prevent and control emerging zoonoses.

  19. Manual on public health action in radiation emergencies

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    Over the years, the World Health Organization (WHO) has issued a series of reports and publications providing guidance on the public health aspects of nuclear power production, in line with target 11 of the European policy for health for all, which calls for the reduction of injury, disability and death from accidents. Immediately after the nuclear accident at Chernobyl in April 1986, the WHO Regional Office for Europe established an emergency operation to provide technical cooperation and communication links with Member States. A special project on the public health dimensions of radiation emergencies was subsequently established, which included a series of activities related both directly to the Chernobyl accident and to emergency planning for future accidents. This manual brings together the experience gained in the special project to improve the planning for and response to emergencies. It has been prepared to meet public health needs arising from all types of major radiation emergency in the European Region. The manual describes the guiding principles and advises on the practical application of measures to protect and inform the public in a radiation emergency. It is hoped that the manual will promote close interaction between the WHO Member States in this field. The advice given in earlier WHO publications on radiation emergencies has been examined and revised in the light of recent experience 12 refs, 4 figs, 4 tabs

  20. Manual on public health action in radiation emergencies

    International Nuclear Information System (INIS)

    1994-01-01

    Over the years, the World Health Organization (WHO) has issued a series of reports and publications providing guidance on the public health aspects of nuclear power production, in line with target 11 of the European policy for health for all, which calls for the reduction of injury, disability and death from accidents. Immediately after the nuclear accident at Chernobyl in April 1986, the WHO Regional Office for Europe established an emergency operation to provide technical cooperation and communication links with Member States. A special project on the public health dimensions of radiation emergencies was subsequently established, which included a series of activities related both directly to the Chernobyl accident and to emergency planning for future accidents. This manual brings together the experience gained in the special project to improve the planning for and response to emergencies. It has been prepared to meet public health needs arising from all types of major radiation emergency in the European Region. The manual describes the guiding principles and advises on the practical application of measures to protect and inform the public in a radiation emergency. It is hoped that the manual will promote close interaction between the WHO Member States in this field. The advice given in earlier WHO publications on radiation emergencies has been examined and revised in the light of recent experience

  1. Emerging trends in health care finance.

    Science.gov (United States)

    Sterns, J B

    1994-01-01

    Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.

  2. Bradford Hill’s criteria, emerging zoonoses, and One Health

    OpenAIRE

    G.V. Asokan; Vanitha Asokan

    2016-01-01

    Zoonoses constitute more than 60% of infectious diseases and 75% of emerging infectious diseases. Inappropriate overemphasis of specialization of disciplines has ignored public health. Identifying the causes of disease and determining how exposures are related to outcomes in “emerging zoonoses” affecting multiple species are considered to be the hallmarks of public health research and practice that compels the adoption of “One Health”. The interactions within and among populations of vertebra...

  3. E-smoking: Emerging public health problem?

    Directory of Open Access Journals (Sweden)

    Mateusz Jankowski

    2017-06-01

    Full Text Available E-cigarette use has become increasingly popular, especially among the young. Its long-term influence upon health is unknown. Aim of this review has been to present the current state of knowledge about the impact of e-cigarette use on health, with an emphasis on Central and Eastern Europe. During the preparation of this narrative review, the literature on e-cigarettes available within the network PubMed was retrieved and examined. In the final review, 64 research papers were included. We specifically assessed the construction and operation of the e-cigarette as well as the chemical composition of the e-liquid; the impact that vapor arising from the use of e-cigarette explored in experimental models in vitro; and short-term effects of use of e-cigarettes on users’ health. Among the substances inhaled by the e-smoker, there are several harmful products, such as: formaldehyde, acetaldehyde, acroleine, propanal, nicotine, acetone, o-methyl-benzaldehyde, carcinogenic nitrosamines. Results from experimental animal studies indicate the negative impact of e-cigarette exposure on test models, such as ascytotoxicity, oxidative stress, inflammation, airway hyper reactivity, airway remodeling, mucin production, apoptosis, and emphysematous changes. The short-term impact of e-cigarettes on human health has been studied mostly in experimental setting. Available evidence shows that the use of e-cigarettes may result in acute lung function responses (e.g., increase in impedance, peripheral airway flow resistance and induce oxidative stress. Based on the current available evidence, e-cigarette use is associated with harmful biologic responses, although it may be less harmful than traditional cigarettes. Int J Occup Med Environ Health 2017;30(3:329–344

  4. E-smoking: Emerging public health problem?

    Science.gov (United States)

    Jankowski, Mateusz; Brożek, Grzegorz; Lawson, Joshua; Skoczyński, Szymon; Zejda, Jan Eugeniusz

    2017-05-08

    E-cigarette use has become increasingly popular, especially among the young. Its long-term influence upon health is unknown. Aim of this review has been to present the current state of knowledge about the impact of e-cigarette use on health, with an emphasis on Central and Eastern Europe. During the preparation of this narrative review, the literature on e-cigarettes available within the network PubMed was retrieved and examined. In the final review, 64 research papers were included. We specifically assessed the construction and operation of the e-cigarette as well as the chemical composition of the e-liquid; the impact that vapor arising from the use of e-cigarette explored in experimental models in vitro; and short-term effects of use of e-cigarettes on users' health. Among the substances inhaled by the e-smoker, there are several harmful products, such as: formaldehyde, acetaldehyde, acroleine, propanal, nicotine, acetone, o-methyl-benzaldehyde, carcinogenic nitrosamines. Results from experimental animal studies indicate the negative impact of e-cigarette exposure on test models, such as ascytotoxicity, oxidative stress, inflammation, airway hyper reactivity, airway remodeling, mucin production, apoptosis, and emphysematous changes. The short-term impact of e-cigarettes on human health has been studied mostly in experimental setting. Available evidence shows that the use of e-cigarettes may result in acute lung function responses (e.g., increase in impedance, peripheral airway flow resistance) and induce oxidative stress. Based on the current available evidence, e-cigarette use is associated with harmful biologic responses, although it may be less harmful than traditional cigarettes. Int J Occup Med Environ Health 2017;30(3):329-344. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  5. Health Services Utilization Patterns Associated with Emergency Department Closure

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders

    2011-01-01

    , 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...

  6. Emerging issues in occupational safety and health.

    Science.gov (United States)

    Schulte, Paul A

    2006-01-01

    In developed countries, changes in the nature of work and the workforce may necessitate recalibrating the vision of occupational safety and health (OSH) researchers, practitioners, and policymakers to increase the focus on the most important issues. New methods of organizing the workplace, extensive labor contracting, expansion of service and knowledge sectors, increase in small business, aging and immigrant workers, and the continued existence of traditional hazards in high-risk sectors such as construction, mining, agriculture, health care, and transportation support the need to address: 1) broader consideration of the role and impact of work, 2) relationship between work and psychological dysfunction, 3) increased surveillance basis for research and intervention, 4) overcoming barriers to the conduct and use of epidemiologic research, 5) information and knowledge transfer and application, 6) economic issues in prevention, and 7) the global interconnectedness of OSH. These issues are offered to spur thinking as new national research agendas for OSH are considered for developed countries.

  7. International health law : an emerging field of public international law

    NARCIS (Netherlands)

    Toebes, Brigit

    This article discusses the nature and scope of international health law as an emerging field of public international law. It is argued that the protection of health reflects a pressing social need that should now be spoken of in the vocabulary of international law. Furthermore, there is an urgent

  8. Ebola disease: an international public health emergency

    Directory of Open Access Journals (Sweden)

    Saurabh RamBihariLal Shrivastava

    2015-04-01

    Full Text Available Ebola virus disease (EVD, previously known as Ebola hemorrhagic fever, is a severe illness caused by Ebola filovirus, and is often fatal if left untreated. The first case of the current EVD was diagnosed in Guinea in March 2014, and since then it has spread to Sierra Leone, Liberia, Nigeria, and Senegal. The current review has been performed with an objective to explore the magnitude of the current Ebola virus epidemic and identify the multiple determinants that have resulted in the exponential growth of the epidemic. An extensive search of all materials related to the topic was done for almost two months (August-October in Pubmed, Medline, World Health Organization website and Google Scholar search engines. Relevant documents, reports, recommendations, guidelines and research articles focusing on the different aspects of Ebola virus and its current outbreak, published in the period 2002-2014 were included in the review. Keywords used in the search include Ebola virus, Ebola virus disease, Ebola hemorrhagic fever, Ebola vaccine, and Ebola treatment. The current EVD epidemic has turned out to be extensive, severe, and uncontrollable because of a delayed response and ineffective public health care delivery system. In fact, multiple challenges have also been identified and thus a range of interventions have been proposed to control the epidemic. In conclusion, the 2014 epidemic of EVD has shown to the world that in absence of a strong public health care delivery system even a rare disease can risk the lives of millions of people. The crux of this epidemic is that a large scale and coordinated international response is the need of the hour to support affected and at-risk nations in intensifying their response activities and strengthening of national capacities.

  9. Health Departments’ Engagement in Emergency Preparedness Activities: The Influence of Health Informatics Capacity

    OpenAIRE

    Gulzar H. Shah; Bobbie Newell; Ruth E. Whitworth

    2016-01-01

    Background: Local health departments (LHDs) operate in a complex and dynamic public health landscape, with changing demands on their emergency response capacities. Informatics capacities might play an instrumental role in aiding LHDs emergency preparedness. This study aimed to explore the extent to which LHDs’ informatics capacities are associated with their activity level in emergency preparedness and to identify which health informatics capacities are associated with improved em...

  10. Emerging Radiation Health-Risk Mitigation Technologies

    International Nuclear Information System (INIS)

    Wilson, J.W.; Cucinotta, F.A.; Schimmerling, W.

    2004-01-01

    Past space missions beyond the confines of the Earth's protective magnetic field have been of short duration and protection from the effects of solar particle events was of primary concern. The extension of operational infrastructure beyond low-Earth orbit to enable routine access to more interesting regions of space will require protection from the hazards of the accumulated exposures of Galactic Cosmic Rays (GCR). There are significant challenges in providing protection from the long-duration exposure to GCR: the human risks to the exposures are highly uncertain and safety requirements places unreasonable demands in supplying sufficient shielding materials in the design. A vigorous approach to future radiation health-risk mitigation requires a triage of techniques (using biological and technical factors) and reduction of the uncertainty in radiation risk models. The present paper discusses the triage of factors for risk mitigation with associated materials issues and engineering design methods

  11. Emerging role of Vitamin D in health

    Directory of Open Access Journals (Sweden)

    Deepanjali Lomte

    2014-03-01

    Full Text Available Vit. D is a steroid prohormone. It is synthesized in the skin under ultra –violet light exposure. Traditionally, Vit.D3, cholecalciferol and calcitriol were known to have a role only in calcium and bone mineral metabolism. This article takes an account of the current view on the impact of Vit D deficiency on human health. Research has now shown the indisputable role of Vit D in prevention/treatment of some cancers, osteoporosis, rheumatoid arthritis, multiple sclerosis, tuberculosis, hypertension, and diabetes mellitus. In addition lower maternal Vit. D levels are associated with Pregnancy Induced Hypertension (PIH, suggesting that Vit. D deficiency may be a modifiable risk factor for PIH. Greater awareness of the problem of a high prevalence of vitamin D inadequacy is required among researchers, clinicians, and patients. Special efforts on the medical and social fronts are nec­essary to combat this preventable epidemic of vitamin D deficiency.

  12. Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

    Science.gov (United States)

    Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

    2017-12-01

    Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  13. Exploring mHealth Participation for Emergency Response Communities

    Directory of Open Access Journals (Sweden)

    David G. Schwartz

    2017-03-01

    Full Text Available We explore the challenges of participation by members of emergency response communities who share a similar condition and treatment, and are called upon to participate in emergency events experienced by fellow members. Smartphones and location-based social networking technologies present an opportunity to re-engineer certain aspects of emergency medical response. Life-saving prescription medication extended in an emergency by one individual to another occurs on a micro level, anecdotally documented. We illustrate the issues and our approach through the example of an app to support patients prone to anaphylaxis and prescribed to carry epinephrine auto-injectors. We address unique participation challenges in an mHealth environment in which interventions are primarily short-term interactions which require clear and precise decision-making and constant tracking of potential participants in responding to an emergency medical event. The conflicting effects of diffused responsibility and shared identity are identified as key factors in modeling participation.

  14. UC3M Emergencies : health center search, first aid, defibrillators, emergency exits, last warnings and torch (iOS platform)

    OpenAIRE

    Martín Civiac, María

    2013-01-01

    This document contains Maria Martin’s bachelor thesis. The issues that this project wants to solve are emergencies-related: health centersand emergency exits location,emergency call, first aid instructions and information and latest emergency alerts at Carlos III University. It has been detected that members of Carlos III University currently have difficulties to find health centers, emergency exits and first aid information. Furthermore, the University itself did not have any mechanism to pu...

  15. National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

    Science.gov (United States)

    Love, Jennifer S; Karp, David; Delgado, M Kit; Margolis, Gregg; Wiebe, Douglas J; Carr, Brendan G

    2016-08-01

    Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies. A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering. A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times. Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576-582).

  16. Health, Health Care, and Systems Science: Emerging Paradigm.

    Science.gov (United States)

    Janecka, Ivo

    2017-02-15

    Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

  17. Integrating Social Media Monitoring Into Public Health Emergency Response Operations.

    Science.gov (United States)

    Hadi, Tamer A; Fleshler, Keren

    2016-10-01

    Social media monitoring for public health emergency response and recovery is an essential response capability for any health department. The value of social media for emergency response lies not only in the capacity to rapidly communicate official and critical incident information, but as a rich source of incoming data that can be gathered to inform leadership decision-making. Social media monitoring is a function that can be formally integrated into the Incident Command System of any response agency. The approach to planning and required resources, such as staffing, logistics, and technology, is flexible and adaptable based on the needs of the agency and size and scope of the emergency. The New York City Department of Health and Mental Hygiene has successfully used its Social Media Monitoring Team during public health emergency responses and planned events including major Ebola and Legionnaires' disease responses. The concepts and implementations described can be applied by any agency, large or small, interested in building a social media monitoring capacity. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

  18. Privacy Attitudes among Early Adopters of Emerging Health Technologies.

    Directory of Open Access Journals (Sweden)

    Cynthia Cheung

    Full Text Available Advances in health technology such as genome sequencing and wearable sensors now allow for the collection of highly granular personal health data from individuals. It is unclear how people think about privacy in the context of these emerging health technologies. An open question is whether early adopters of these advances conceptualize privacy in different ways than non-early adopters.This study sought to understand privacy attitudes of early adopters of emerging health technologies.Transcripts from in-depth, semi-structured interviews with early adopters of genome sequencing and health devices and apps were analyzed with a focus on participant attitudes and perceptions of privacy. Themes were extracted using inductive content analysis.Although interviewees were willing to share personal data to support scientific advancements, they still expressed concerns, as well as uncertainty about who has access to their data, and for what purpose. In short, they were not dismissive of privacy risks. Key privacy-related findings are organized into four themes as follows: first, personal data privacy; second, control over personal information; third, concerns about discrimination; and fourth, contributing personal data to science.Early adopters of emerging health technologies appear to have more complex and nuanced conceptions of privacy than might be expected based on their adoption of personal health technologies and participation in open science. Early adopters also voiced uncertainty about the privacy implications of their decisions to use new technologies and share their data for research. Though not representative of the general public, studies of early adopters can provide important insights into evolving attitudes toward privacy in the context of emerging health technologies and personal health data research.

  19. Privacy Attitudes among Early Adopters of Emerging Health Technologies.

    Science.gov (United States)

    Cheung, Cynthia; Bietz, Matthew J; Patrick, Kevin; Bloss, Cinnamon S

    2016-01-01

    Advances in health technology such as genome sequencing and wearable sensors now allow for the collection of highly granular personal health data from individuals. It is unclear how people think about privacy in the context of these emerging health technologies. An open question is whether early adopters of these advances conceptualize privacy in different ways than non-early adopters. This study sought to understand privacy attitudes of early adopters of emerging health technologies. Transcripts from in-depth, semi-structured interviews with early adopters of genome sequencing and health devices and apps were analyzed with a focus on participant attitudes and perceptions of privacy. Themes were extracted using inductive content analysis. Although interviewees were willing to share personal data to support scientific advancements, they still expressed concerns, as well as uncertainty about who has access to their data, and for what purpose. In short, they were not dismissive of privacy risks. Key privacy-related findings are organized into four themes as follows: first, personal data privacy; second, control over personal information; third, concerns about discrimination; and fourth, contributing personal data to science. Early adopters of emerging health technologies appear to have more complex and nuanced conceptions of privacy than might be expected based on their adoption of personal health technologies and participation in open science. Early adopters also voiced uncertainty about the privacy implications of their decisions to use new technologies and share their data for research. Though not representative of the general public, studies of early adopters can provide important insights into evolving attitudes toward privacy in the context of emerging health technologies and personal health data research.

  20. Mental Health of General Practitioners in Emergency Wards

    Directory of Open Access Journals (Sweden)

    Sepehrmanesh Z.1 PhD,

    2015-01-01

    Full Text Available Aims General practitioners have an essential role in patient care and are exposed to high levels of job stress. General practitioners’ mental health has effects on their functional abilities and medical managements.This study was carried out to evaluate the mental health of general practitioners in emergency wards in KashanUniversity of Medical Sciences, Iran. Materials & Methods In this cross-sectional study, all of General practitioners in emergency wards (n=87 were studied. The survey instruments includedtwo questionnaires: 1-demographic variables and 2- General Health Questionnaire (GHQ-28. Data were analyzed using SPSS 16 software and Chi square, Fisher exactand Mann-Whitney statistical tests. Findings The mean age of general practitioners was 36.11±5.67 years; 89.7% of them were married; 60.3% were male. 41% of the total general practitioners had mental health problems. The mean score of GHQ was 22.56±9.24. There were significant relationships between mental health and each age, employment situation, and number of children (p0.05. Conclusion The majority of employed general practitioners in emergency rooms do not have proper mental health statuses.

  1. Hantaviruses: an emerging public health threat in India? A review

    Indian Academy of Sciences (India)

    PRAKASH KUMAR

    is to increase awareness of these emerging pathogens and the threats they pose to the public health system. [Chandy S, Abraham P and ..... distribution of the hosts through international shipping routes. The majority of SEOV-related .... Dalrymple J M 1994 Serological relationships among viruses in the Hantavirus genus, ...

  2. Occupational health surveillance: Pulmonary function testing in emergency responders

    Directory of Open Access Journals (Sweden)

    James D McCluskey

    2014-01-01

    Full Text Available Emergency responders may be exposed to a variety of fumes, gases, and particulates during the course of their job that can affect pulmonary function (PF and require the use of respiratory protection. This investigation used occupational health monitoring examination data to characterize PF in a population currently employed as emergency responders. PF tests for workers who required health examinations to ensure fitness for continued respirator use were compared to the National Health and Nutrition Examination Survey (NHANES III Raw Spirometry database to determine if decreased PF was associated with employment as an emergency responder. The results of this research indicated that the emergency responders experienced a modest, but statistically significant, increase in forced expiratory volume in 1 second (FEV1 and forced vital capacity (FVC mean values over the NHANES III population in both total and stratified analyses, including stratification by age, gender, height, and smoking history. Results are likely due to a combination of effectively controlled exposures in the workplace, and the healthy worker effect among long-term workers. PF testing required by the Occupational and Safety Health Administration (OSHA has substantial utility for conducting occupational surveillance at the population level. In this investigation, we were able to quickly evaluate if abnormal PF existed in an industrial sector known to have exposures that, when uncontrolled, can lead to PF impairment.

  3. Air Quality and Heart Health: An Emerging Topic for Heart ...

    Science.gov (United States)

    Air Quality and Heart Health: An Emerging Topic for Heart Month: Ambient air particle pollution increases short- and long-term cardiovascular morbidity and mortality. Older-people, those with pre-existing heart disease and lung disease and diabetes are at higher risk. Mechanisms are under investigation and are likely related to oxidative stress, inflammation and effects on autonomic control. Improvements in air pollution levels reduce health impacts and increase life expectancy. Reductions of short-term exposure in those at highest risk are predicted to mitigate adverse health effects. EPA regularly evaluates the standards, health risks and issues improved standards when needed. Public health action is needed along with EPA standards to reduce the public health burden of short- and long-term adverse health effects of air pollution. Health risks remain and need to be addressed through integrated efforts of public health, health care, environmental health, individuals and communities. Presented at Webinar for the National Association of Clean Air Agencies, February 2, 2017, Chapel Hill, NC- This webinar provided an update of environmental health information related to the effects of air pollution and heart and blood vessel disease. Such information is critically important for the Clean Air Agencies to understand as it provides the justification of their actions.

  4. The health of healthcare: Emergency department physician well-being

    Directory of Open Access Journals (Sweden)

    Martin Gagne

    2017-07-01

    Full Text Available Introduction: Physician health and well-being is an important issue that ultimately affects job performance. We compared the self-reported incidence of known medical issues, physical and mental health symptoms, and health behaviors of Emergency Physicians (EPs with the general public in the United States. Methods: Questions selected from a national survey conducted by the Center for Disease Control (CDC about public health trends were distributed to via Facebook to a private group of 12,917 EPs. Responses were compared between EPs and the general population using Chi-square tests of independence. Results: Our results demonstrated that EPs suffer less from chronic diseases, especially those related to the cardiopulmonary system; however, they suff er from a higher incidence of musculoskeletal pain and infectious disease complaints. EPs also exhibit higher rates of mental health symptoms, sleep-related complications, and alcohol consumption. Conclusions: Awareness, education, and advocacy may help improve physician health and ultimately job performance.

  5. Physician's emerging roles relating to trends in health information technology.

    Science.gov (United States)

    David Johnson, J

    2014-08-12

    Objective: To determine the new roles that physicians will adopt in the near future to adjust to accelerating trends from managed care to outcome-based practice to health care reform to health information technology to the evolving role of health consumers. Methods: Trends and related developments concerning the changing roles of physicians based on prior literature reviews. Results: Six possible roles, traditional, gatekeeper, coach, navigator, informatician and one voice among many, are discussed in terms of physician's centrality, patient autonomy, decision-making and uncertainty, information seeking, satisfaction and outcomes, particularly those related to compliance. Conclusion: A greater understanding of these emerging roles could lead to more efficacious outcomes in our ever changing, increasingly complex medical system. Patients often have little understanding of emerging trends that lead to the development of specialized roles such as hospitalist and navigators and, relatedly, the evolving roles of physicians.

  6. Cloud based emergency health care information service in India.

    Science.gov (United States)

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  7. The World Health Organization Global Health Emergency Workforce: What Role Will the United States Play?

    Science.gov (United States)

    Burkle, Frederick M

    2016-08-01

    During the May 2016 World Health Assembly of 194 member states, the World Health Organization (WHO) announced the process of developing and launching emergency medical teams as a critical component of the global health workforce concept. Over 64 countries have either launched or are in the development stages of vetting accredited teams, both international and national, to provide surge support to national health systems through WHO Regional Organizations and the delivery of emergency clinical care to sudden-onset disasters and outbreak-affected populations. To date, the United States has not yet committed to adopting the emergency medical team concept in funding and registering an international field hospital level team. This article discusses future options available for health-related nongovernmental organizations and the required educational and training requirements for health care provider accreditation. (Disaster Med Public Health Preparedness. 2016;10:531-535).

  8. Anthropology in public health emergencies: what is anthropology good for?

    Science.gov (United States)

    Stellmach, Darryl; Beshar, Isabel; Bedford, Juliet; du Cros, Philipp; Stringer, Beverley

    2018-01-01

    Recent outbreaks of Ebola virus disease (2013-2016) and Zika virus (2015-2016) bring renewed recognition of the need to understand social pathways of disease transmission and barriers to care. Social scientists, anthropologists in particular, have been recognised as important players in disease outbreak response because of their ability to assess social, economic and political factors in local contexts. However, in emergency public health response, as with any interdisciplinary setting, different professions may disagree over methods, ethics and the nature of evidence itself. A disease outbreak is no place to begin to negotiate disciplinary differences. Given increasing demand for anthropologists to work alongside epidemiologists, clinicians and public health professionals in health crises, this paper gives a basic introduction to anthropological methods and seeks to bridge the gap in disciplinary expectations within emergencies. It asks: 'What can anthropologists do in a public health crisis and how do they do it?' It argues for an interdisciplinary conception of emergency and the recognition that social, psychological and institutional factors influence all aspects of care.

  9. The politics of emergency health powers and the isolation of public health.

    Science.gov (United States)

    Colmers, John M; Fox, Daniel M

    2003-03-01

    The Model State Emergency Health Powers Act became a contentious document in more than 30 states in 2001 and 2002. Controversy has focused on recommendations by the authors of the Model Act that seemed to accord higher priority to collective action in emergencies than to protecting privacy and property. This situation has several causes that derive from the characteristics of public health emergencies during the past half century and the relative isolation of public health officials from both their colleagues in government and many members of the public.

  10. The Relationship between Health Locus of Control and Health Behaviors in Emergency Medicine Personnel.

    Science.gov (United States)

    Pourhoseinzadeh, Mansour; Gheibizadeh, Mahin; Moradikalboland, Mehrnaz

    2017-10-01

    Health locus of control defined as individual beliefs based on past experiences in health issues and having external or internal control over them, could affect health. Health locus of control plays a role in health behaviors. We aimed to investigate the relationship between health locus of control and health behavior in emergency medical personnel in Ahvaz during 2016. This is a cross-sectional descriptive study, which began in August 2016 for a period of six months on 215 emergency medical personnel in Ahvaz who were selected randomly. The data were collected by a demographic questionnaire, Rotter's locus of control questionnaire, and health behavior questionnaire and analyzed using SPSS software, version 22. The correlation between variables was estimated by Pearson's correlation coefficient and independent t test. The level of significance for all statistical tests was set at 0.05. We found no significant relationship between health locus of control (external and internal) and health behavior (P>0.05).Health behaviors were very good in terms of personal health (86.5%), nutrition (53%), and sleep and rest (48.4%), and poor in terms of physical activity (52.6%) and stress management (79.5%). Furthermore, 79.5% of the emergency personnel, in general, had poor heath behaviors. Leaders and officials in the field of health must necessarily design programs in relation to health locus of control and the factors developing and affecting it as well as the role of health locus of control in doing correct behaviors.

  11. Overview of Emerging Contaminants and Associated Human Health Effects

    Directory of Open Access Journals (Sweden)

    Meng Lei

    2015-01-01

    Full Text Available In recent decades, because of significant progress in the analysis and detection of trace pollutants, emerging contaminants have been discovered and quantified in living beings and diverse environmental substances; however, the adverse effects of environmental exposure on the general population are largely unknown. This review summarizes the conclusions of the comprehensive epidemic literature and representative case reports relevant to emerging contaminants and the human body to address concerns about potential harmful health effects in the general population. The most prevalent emerging contaminants include perfluorinated compounds, water disinfection byproducts, gasoline additives, manufactured nanomaterials, human and veterinary pharmaceuticals, and UV-filters. Rare but statistically meaningful connections have been reported for a number of contaminants and cancer and reproductive risks. Because of contradictions in the outcomes of some investigations and the limited number of articles, no significant conclusions regarding the relationship between adverse effects on humans and extents of exposure can be drawn at this time. Here, we report that the current evidence is not conclusive and comprehensive and suggest prospective cohort studies in the future to evaluate the associations between human health outcomes and emerging environmental contaminants.

  12. Overview of Emerging Contaminants and Associated Human Health Effects

    Science.gov (United States)

    Lei, Meng; Zhang, Lun; Lei, Jianjun; Zong, Liang; Li, Jiahui; Wu, Zheng; Wang, Zheng

    2015-01-01

    In recent decades, because of significant progress in the analysis and detection of trace pollutants, emerging contaminants have been discovered and quantified in living beings and diverse environmental substances; however, the adverse effects of environmental exposure on the general population are largely unknown. This review summarizes the conclusions of the comprehensive epidemic literature and representative case reports relevant to emerging contaminants and the human body to address concerns about potential harmful health effects in the general population. The most prevalent emerging contaminants include perfluorinated compounds, water disinfection byproducts, gasoline additives, manufactured nanomaterials, human and veterinary pharmaceuticals, and UV-filters. Rare but statistically meaningful connections have been reported for a number of contaminants and cancer and reproductive risks. Because of contradictions in the outcomes of some investigations and the limited number of articles, no significant conclusions regarding the relationship between adverse effects on humans and extents of exposure can be drawn at this time. Here, we report that the current evidence is not conclusive and comprehensive and suggest prospective cohort studies in the future to evaluate the associations between human health outcomes and emerging environmental contaminants. PMID:26713315

  13. Emergency contraception in a public health emergency: exploring pharmacy availability in Brazil.

    Science.gov (United States)

    Tavares, Marilia P; Foster, Angel M

    2016-08-01

    Dedicated progestin-only emergency contraceptive pills (ECPs) have been available with a prescription in Brazil since 1999. However, utilization of emergency contraception has been limited. We conducted a mystery client study at retail pharmacies in three regions to assess current availability. Using a predetermined client profile, we approached a random sample of chain and independent pharmacies in urban areas in the southeastern, northeastern and central-west regions. We documented product availability, price and the client-pharmacy representative interaction at each site. We analyzed these data with descriptive statistics and for content and themes. We visited 122 pharmacies in early 2016. All but three pharmacies (97.5%) had ECPs in stock at the time of the interaction and offered our client the medication without a prescription. In general, pharmacy representatives did not ask questions or provide our client with information about emergency contraception. When prompted, over one third of the pharmacy representatives (37.7%) inaccurately reported that levonorgestrel ECPs could only be used immediately or within 12, 24 or 48h from the time of intercourse. Despite the current regulatory status, our findings suggest that progestin-only ECPs are widely available without a prescription. Additional efforts to ensure that women have up-to-date and medically accurate information about progestin-only ECPs appear warranted. Our findings suggest that more work needs to be done to align national regulatory policies with international standards and evidence-based practices. The Zika virus epidemic has shined a spotlight on the importance of providing timely access to emergency contraception in Latin America. This public health emergency offers a window of opportunity to advance national policies and practices to ensure that Brazilian women have access to a full range of reproductive health services. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Emerging arboviruses and public health challenges in Brazil

    OpenAIRE

    Lima-Camara,Tamara Nunes

    2016-01-01

    ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by th...

  15. Commercial products that convey personal health information in emergencies.

    Science.gov (United States)

    Potini, Vishnu C; Weerasuriya, Dilani N; Lowery-North, Douglas W; Kellermann, Arthur L

    2011-12-01

    Describe commercially available products and services designed to convey personal health information in emergencies. The search engine Google®, supplemented by print ads, was used to identify companies and organizations that offer relevant products and services to the general market. Disease-specific, health system, and health plan-specific offerings were excluded. Vendor web sites were the primary sources of information, supplemented by telephone and e-mail queries to sales representatives. Perfect inter-rater agreement was achieved. Thirty-nine unique vendors were identified. Eight sell engraved jewelry. Three offer an embossed card or pamphlet. Twelve supply USB drives with various features. Eleven support password-protected web sites. Five maintain national call centers. Available media differed markedly with respect to capacity and accessibility. Quoted prices ranged from a one-time expenditure of $3.50 to an annual fee of $200. Associated features and annual fees varied widely. A wide range of products and services exist to help patients convey personal health information. Health care providers should be familiar with their features, so they can access the information in a disaster or emergency.

  16. The public health aspects of complex emergencies and refugee situations.

    Science.gov (United States)

    Toole, M J; Waldman, R J

    1997-01-01

    Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated.

  17. Emerging health isues in Asia and the Pacific: implications for public health policy

    OpenAIRE

    Amarakoon Bandara

    2005-01-01

    The Asia-Pacific region is confronted with several emerging healthrelated issues. The prevalence of diseases causing high rates of mortality and morbidity, and the lack of skilled health personnel, infrastructure, financial resources and health systems that are responsive to the needs of society, are among them. A pragmatic approach with a focus on issues of major health and socio-economic concern is vital for the development of successful public health services. Striking a balance between di...

  18. Public health implications of complex emergencies and natural disasters.

    Science.gov (United States)

    Culver, Amanda; Rochat, Roger; Cookson, Susan T

    2017-01-01

    During the last decade, conflict or natural disasters have displaced unprecedented numbers of persons. This leads to conditions prone to outbreaks that imperil the health of displaced persons and threaten global health security. Past literature has minimally examined the association of communicable disease outbreaks with complex emergencies (CEs) and natural disasters (NDs). To examine this association, we identified CEs and NDs using publicly available datasets from the Center for Research on the Epidemiology of Disasters and United Nations Flash and Consolidated Appeals archive for 2005-2014. We identified outbreaks from World Health Organization archives. We compared findings to identify overlap of outbreaks, including their types (whether or not of a vaccine-preventable disease), and emergency event types (CE, ND, or Both) by country and year using descriptive statistics and measure of association. There were 167 CEs, 912 NDs, 118 events linked to 'Both' types of emergencies, and 384 outbreaks. Of CEs, 43% were associated with an outbreak; 24% NDs were associated with an outbreak; and 36% of 'Both' types of emergencies were associated with an outbreak. Africa was disproportionately affected, where 67% of total CEs, 67% of 'Both' events (CE and ND), and 46% of all outbreaks occurred for the study period. The odds ratio of a vaccine-preventable outbreak occurring in a CE versus an ND was 4.14 (95% confidence limits 1.9, 9.4). CEs had greater odds of being associated with outbreaks compared with NDs. Moreover, CEs had high odds of a vaccine-preventable disease causing that outbreak. Focusing on better vaccine coverage could reduce CE-associated morbidity and mortality by preventing outbreaks from spreading.

  19. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    Energy Technology Data Exchange (ETDEWEB)

    HCTT-CHE

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.

  20. Emergency planning and management in health care: priority research topics.

    Science.gov (United States)

    Boyd, Alan; Chambers, Naomi; French, Simon; Shaw, Duncan; King, Russell; Whitehead, Alison

    2014-06-01

    Many major incidents have significant impacts on people's health, placing additional demands on health-care organisations. The main aim of this paper is to suggest a prioritised agenda for organisational and management research on emergency planning and management relevant to U.K. health care, based on a scoping study. A secondary aim is to enhance knowledge and understanding of health-care emergency planning among the wider research community, by highlighting key issues and perspectives on the subject and presenting a conceptual model. The study findings have much in common with those of previous U.S.-focused scoping reviews, and with a recent U.K.-based review, confirming the relative paucity of U.K.-based research. No individual research topic scored highly on all of the key measures identified, with communities and organisations appearing to differ about which topics are the most important. Four broad research priorities are suggested: the affected public; inter- and intra-organisational collaboration; preparing responders and their organisations; and prioritisation and decision making.

  1. [Characteristics of the emergency health service demand in Southern Brazil].

    Science.gov (United States)

    Carret, Maria Laura Vidal; Fassa, Anaclaudia Gastal; Paniz, Vera Maria Vieira; Soares, Patrícia Carret

    2011-01-01

    This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.

  2. Designing smartphone mental health applications for emergency service workers.

    Science.gov (United States)

    Deady, M; Peters, D; Lang, H; Calvo, R; Glozier, N; Christensen, H; Harvey, S B

    2017-08-01

    Emergency service workers are often exposed to trauma and have increased risk of a range of mental health (MH) conditions. Smartphone applications have the potential to provide this group with effective psychological interventions; however, little is known about the acceptability and preferences regarding such initiatives. To describe the preferences and opinions of emergency service workers regarding the use of smartphone MH applications and to examine the impact of age on these preferences. Participants were recruited from four metropolitan Fire and Rescue NSW stations and responded to questionnaire items covering three key domains: current smartphone use, potential future use and preferences for design and content as well as therapeutic techniques. Overall, approximately half the sample (n = 106) claimed they would be interested in trying a tailored emergency-worker MH smartphone application. There were few differences between age groups on preferences. The majority of respondents claimed they would use an app for mental well-being daily and preferred terms such as 'well-being' and 'mental fitness' for referring to MH. Confidentiality, along with a focus on stress, sleep, exercise and resiliency were all considered key features. Behavioural therapeutic techniques were regarded most favourably, compared with other therapies. Emergency workers were interested in utilizing smartphone applications focused on MH, but expressed clear preferences regarding language used in promotion, features required and therapeutic techniques preferred. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  3. Innovation in Graduate Education for Health Professionals in Humanitarian Emergencies.

    Science.gov (United States)

    Evans, Dabney P; Anderson, Mark; Shahpar, Cyrus; Del Rio, Carlos; Curran, James W

    2016-10-01

    The objective of this report was to show how the Center for Humanitarian Emergencies (the Center) at Emory University (Atlanta, Georgia USA) has trained graduate students to respond to complex humanitarian emergencies (CHEs) through innovative educational programs, with the goal of increasing the number of trained humanitarian workers. Natural disasters are on the rise with more than twice as many occurring from 2000-2009 as there were from 1980-1989. In 2012 alone, 144 million people were affected by a natural disaster or displaced by conflict worldwide. This has created an immense need for trained humanitarian workers to respond effectively to such disasters. The Center has developed a model for educational programming that targets learners along an educational continuum ranging from the undergraduate level through continuing professional education. These programs, based in the Rollins School of Public Health (RSPH) of Emory University, include: a competency-based graduate certificate program (the Certificate) in humanitarian emergencies; a fellowship program for mid-career professionals; and funded field practica. The competency-based Certificate program began in 2010 with a cohort of 14 students. Since then, 101 students have received the Certificate with 50 more due for completion in 2016 and 2017 combined. The fellowship program for mid-career professionals has hosted four fellows from conflict-affected or resource-poor countries, who have then gone on to assume leadership positions with humanitarian organizations. From 2009-2015, the field practicum program supported 34 students in international summer practicum experiences related to emergency response or preparedness. Students have participated in summer field experiences on every continent but Australia. Together the Certificate, funded field practicum opportunities, and the fellowship comprise current efforts in providing innovative education and training for graduate and post-graduate students of public

  4. Foundational workplace safety and health competencies for the emerging workforce☆

    Science.gov (United States)

    Okun, Andrea H.; Guerin, Rebecca J.; Schulte, Paul A.

    2016-01-01

    Introduction Young workers (aged 15–24) suffer disproportionately from workplace injuries, with a nonfatal injury rate estimated to be two times higher than among workers age 25 or over. These workers make up approximately 9% of the U.S. workforce and studies have shown that nearly 80% of high school students work at some point during high school. Although young worker injuries are a pressing public health problem, the critical knowledge and skills needed to prepare youth for safe and healthy work are missing from most frameworks used to prepare the emerging U.S. workforce. Methods A framework of foundational workplace safety and health knowledge and skills (the NIOSH 8 Core Competencies)was developed based on the Health Belief Model (HBM). Results The proposed NIOSH Core Competencies utilize the HBM to provide a framework for foundational workplace safety and health knowledge and skills. An examination of how these competencies and the HBM apply to actions that workers take to protect themselves is provided. The social and physical environments that influence these actions are also discussed. Conclusions The NIOSH 8 Core Competencies, grounded in one of the most widely used health behavior theories, fill a critical gap in preparing the emerging U.S. workforce to be cognizant of workplace risks. Practical applications Integration of the NIOSH 8 Core Competencies into school curricula is one way to ensure that every young person has the foundational workplace safety and health knowledge and skills to participate in, and benefit from, safe and healthy work. National Safety Council and Elsevier Ltd. All rights reserved. PMID:27846998

  5. Developing an Emergency Physician Productivity Index Using Descriptive Health Analytics.

    Science.gov (United States)

    Khalifa, Mohamed

    2015-01-01

    Emergency department (ED) crowding became a major barrier to receiving timely emergency care. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, we identified variables and factors affecting crowding and performance to develop indicators to help evaluation and improvement. Measuring efficiency of work and activity of throughput processes; it was important to develop an ED physician productivity index. Data on all ED patients' encounters over the last six months of 2014 were retrieved and descriptive health analytics methods were used. Three variables were identified for their influence on productivity and performance; Number of Treated Patients per Physician, Patient Acuity Level and Treatment Time. The study suggested a formula to calculate the productivity index of each physician through dividing the Number of Treated Patients by Patient Acuity Level squared and Treatment Time to identify physicians with low productivity index and investigate causes and factors.

  6. Internet Gaming Disorder: An Emergent Health Issue for Men.

    Science.gov (United States)

    Chen, Kevin H; Oliffe, John L; Kelly, Mary T

    2018-03-01

    Internet gaming is a legitimate leisure activity worldwide; however, there are emerging concerns that vast numbers of gamers are becoming addicted. In 2013, the American Psychiatric Association (APA) classified Internet Gaming Disorder (IGD) as a condition warranting more clinical research ahead of formalizing it as a mental disorder. Proposed as a behavioral addiction, IGD shares many similarities in both physical and psychosocial manifestations with substance use disorder, including cerebral changes on functional magnetic resonance imaging (fMRI). Among the gaming population, compared to females, adolescent and adult males demonstrate far more addictive internet gaming use in terms of screen hours, craving, and negative impacts on health, which have, in isolated incidents, also caused death. The current article draws findings from a scoping review of literature related to IGD as a means to raising awareness about an emergent men's health issue. Included are three themes: (a) unveiling the nature, impacts and symptoms of IGD; (b) conceptualizing IGD through neuroscience; and (c) treatment approaches to IGD. Afforded by these themes is an overview and synthesis of the existing literature regarding IGD as a means of providing direction for much needed research on gaming addiction and orientating primary care providers (PCPs) to the specificities of IGD in men's health. The findings are applied to a discussion of the connections between IGD and masculinity and the importance of recognizing how behaviors such as social isolation and game immersion can be maladaptive coping strategies for males.

  7. Assessing Emergency Preparedness and Response Capacity Using Community Assessment for Public Health Emergency Response Methodology: Portsmouth, Virginia, 2013.

    Science.gov (United States)

    Kurkjian, Katie M; Winz, Michelle; Yang, Jun; Corvese, Kate; Colón, Ana; Levine, Seth J; Mullen, Jessica; Ruth, Donna; Anson-Dwamena, Rexford; Bayleyegn, Tesfaye; Chang, David S

    2016-04-01

    For the past decade, emergency preparedness campaigns have encouraged households to meet preparedness metrics, such as having a household evacuation plan and emergency supplies of food, water, and medication. To estimate current household preparedness levels and to enhance disaster response planning, the Virginia Department of Health with remote technical assistance from the Centers for Disease Control and Prevention conducted a community health assessment in 2013 in Portsmouth, Virginia. Using the Community Assessment for Public Health Emergency Response (CASPER) methodology with 2-stage cluster sampling, we randomly selected 210 households for in-person interviews. Households were questioned about emergency planning and supplies, information sources during emergencies, and chronic health conditions. Interview teams completed 180 interviews (86%). Interviews revealed that 70% of households had an emergency evacuation plan, 67% had a 3-day supply of water for each member, and 77% had a first aid kit. Most households (65%) reported that the television was the primary source of information during an emergency. Heart disease (54%) and obesity (40%) were the most frequently reported chronic conditions. The Virginia Department of Health identified important gaps in local household preparedness. Data from the assessment have been used to inform community health partners, enhance disaster response planning, set community health priorities, and influence Portsmouth's Community Health Improvement Plan.

  8. Blended learning: emerging best practices in allied health workforce development.

    Science.gov (United States)

    Brandt, Barbara F; Quake-Rapp, Cindee; Shanedling, Janet; Spannaus-Martin, Donna; Martin, Peggy

    2010-01-01

    To remain dynamic and viable, academic institutions preparing the future workforce need to convert to a more accessible and convenient pathway for students. The need for responsiveness is especially true when considering strategies to prepare an allied health workforce in areas of shortages and to meet the needs of the underserved. A blended or hybrid learning model that strategically uses web-based and face-to-face teaching/learning methods is an innovative and strategic way that promotes learner-centered higher education and facilitates a higher learning experience. A model and emerging best practices for implementation are presented from our experience at the Center for Allied Health Programs at the University of Minnesota.

  9. Women's mental health research: the emergence of a biomedical field.

    Science.gov (United States)

    Blehar, Mary C

    2006-01-01

    This review surveys the field of women's mental health, with particular emphasis on its evolution into a distinct area of biomedical research. The field employs a biomedical disease model but it also emphasizes social and cultural influences on health outcomes. In recent years, its scope has expanded beyond studies of disorders occurring in women at times of reproductive transitions and it now encompasses a broader study of sex and gender differences. Historical and conceptual influences on the field are discussed. The review also surveys gender differences in the prevalence and clinical manifestations of mental disorders. Epidemiological findings have provided a rich resource for theory development, but without research tools to test theories adequately, findings of gender differences have begged the question of their biological, social, and cultural origins. Clinical depression is used to exemplify the usefulness of a sex/gender perspective in understanding mental illness; and major theories proposed to account for gender differences are critically evaluated. The National Institutes of Health (NIH) is the primary federal funding source for biomedical women's mental health research. The review surveys areas of emphasis in women's mental health research at the NIH as well as some collaborative activities that represent efforts to translate research findings into the public health and services arenas. As new analytic methods become available, it is anticipated that a more fundamental understanding of the biological and behavioral mechanisms underlying sex and gender differences in mental illness will emerge. Nonetheless, it is also likely that integration of findings predicated on different conceptual models of the nature and causes of mental illness will remain a challenge. These issues are discussed with reference to their impact on the field of women's mental health research.

  10. Improvement of Emergency Management Mechanism of Public Health Crisis in Rural China: A Review Article.

    Science.gov (United States)

    Hu, Jiaxiang; Chen, Chao; Kuai, Tingting

    2018-02-01

    With the rapid development of social economy in China, various public health emergencies frequently occur. Such emergencies cause a serious threat to human health and public safety, especially in rural China. Owing to flaws in emergency management mechanism and policy, the government is not capable to effectively deal with public health emergencies. Therefore, this study aimed to discuss the path to improve the emergency management mechanism for public health emergency in rural China. This study was conducted in 2017 to detect the emergency management mechanism of public health crisis (EMMPHC) in Rural China. Data were collected using the following keywords: Rural China, public health emergency, emergency management mechanism, organization mechanism, operation mechanism in the databases of PubMed, Scopus, Web of Science, and CNKI. EMMPHC in rural China can be enhanced from the following three aspects. First, a permanent institution for rural emergency management with public health management function is established. Second, the entire process of emergency management mechanism, including the stages of pre-disaster, disaster, and post-disaster, is improved. Finally, investment in rural public health is increased, and an adequate reserve system for emergency resources is formed. The new path of EMMPHC in rural China can effectively help the local government accomplish the dispatch capability in public health emergency, and it has important research significance for the protection of public health and social stability of residents in rural China.

  11. Public health emergencies and the public health/managed care challenge.

    Science.gov (United States)

    Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

    2002-01-01

    The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

  12. Health Information Technology Adoption in the Emergency Department.

    Science.gov (United States)

    Selck, Frederic W; Decker, Sandra L

    2016-02-01

    To describe the trend in health information technology (IT) systems adoption in hospital emergency departments (EDs) and its effect on ED efficiency and resource use. 2007-2010 National Hospital Ambulatory Medical Care Survey - ED Component. We assessed changes in the percent of visits to EDs with health IT capability and the estimated effect on waiting time to see a provider, visit length, and resource use. The percent of ED visits that took place in an ED with at least a basic health IT or an advanced IT system increased from 25.2 and 3.1 percent in 2007 to 69.1 and 30.6 percent in 2010, respectively (p < .05). Controlling for ED fixed effects, waiting times were reduced by 6.0 minutes in advanced IT-equipped EDs (p < .05), and the number of tests ordered increased by 9 percent (p < .01). In models using a 1-year lag, advanced systems also showed an increase in the number of medications and images ordered per visit. Almost a third of visits now occur in EDs with advanced IT capability. While advanced IT adoption may decrease wait times, resource use during ED visits may also increase depending on how long the system has been in place. We were not able to determine if these changes indicated more appropriate care. © Health Research and Educational Trust.

  13. Incentivizing health care behaviors in emerging adults: a systematic review

    Directory of Open Access Journals (Sweden)

    Yu CH

    2016-03-01

    Full Text Available Catherine H Yu,1,2 Giuliana Guarna,1 Pamela Tsao,3 Jude R Jesuthasan,1 Adrian NC Lau,3,4 Ferhan S Siddiqi,1 Julie Anne Gilmour,3 Danyal Ladha,1 Henry Halapy,5 Andrew Advani1–3 1Li Ka Shing Knowledge Institute, St Michael’s Hospital, 2Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, University of Toronto, 3Department of Medicine, Faculty of Medicine, University of Toronto, 4Division of Endocrinology, Department of Medicine, University Health Network, 5Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada Purpose: For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases.Methods: The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years with chronic medical conditions including addictions, were included.Results: A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated.Conclusion: While the majority of

  14. Ethics, health policy, and Zika: From emergency to global epidemic?

    Science.gov (United States)

    Jamrozik, Euzebiusz; Selgelid, Michael J

    2018-05-01

    Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation (PAHO), with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Global health risks and cosmopolitisation: from emergence to interference.

    Science.gov (United States)

    Figuié, Muriel

    2013-02-01

    According to Beck's 'World at Risk' theory, global risks push nations towards a cosmopolitisation of their health policy and open opportunities for a democratic turn. This article provides an empirical analysis of Beck's theory, based on the experience of Vietnamese authorities from 2003 to 2007 in managing the emerging avian flu virus. It shows how Vietnam's framing of avian flu has shifted, under the pressure from international organisations and the US administration, from an epizootic and zoonotic risk (or a classic risk) to a pandemic threat (or a late modern risk). Vietnam's response was part of its overall strategy to join the World Trade Organization and it was limited by Vietnam's defence of its sovereignty. This strategy has been successful for Vietnam but has limited the possibility of cosmopolitan and democratic transformations. The case study highlights the constructed dimension of risks of late modernity and their possible instrumentalisation: it minimises the role of a community of fear relative to a community of trade. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  16. EMERGENCE OF "DRIVERS" FOR THE IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT.

    Science.gov (United States)

    Castro Jaramillo, Hector Eduardo; Moreno-Mattar, Ornella; Osorio-Cuevas, Diana

    2016-01-01

    Health technology assessment (HTA) examines the consequences of the application of health technologies and is aimed at better informing decision-makers. Over the past 30 years, different countries have implemented HTA organizations. Colombia established by law its own HTA agency (IETS) in 2011 which started operations in November 2012. The aim of this study was to assess the feasibility of conducting and using HTA to inform decision-making in this context. Through a qualitative approach, ten "drivers" emerged with the ability to help or hinder HTA development in this context: availability and quality of data, implementation strategy, cultural aspects, local capacity, financial support, policy/political support, globalization, stakeholder pressure, health system context, and usefulness perception. Semi-structured interviews were conducted with key HTA researchers, after following rigorous transcription, and thematic content analysis, those aspects that may be barriers or facilitator for HTA development and use in Colombia were identified. Although HTA has become a tool to inform decision-making around the world, its use may vary according to setting. Determining those aspects which may enable or interfere with HTA development and use in Colombia may be useful for other countries when considering the establishment of HTA systems. The conceptual transferability of concepts like "drivers" with caveats may be of interest for similar settings trying to incorporate HTA processes and institutions into systematic decision-making.

  17. Health impact assessment in China: Emergence, progress and challenges

    Energy Technology Data Exchange (ETDEWEB)

    Huang Zheng, E-mail: huangzhg@mails.tjmu.edu.cn

    2012-01-15

    The values, concepts and approaches of health impact assessment (HIA) were outlined in the Gothenburg consensus paper and some industrialized countries have implemented HIA for many years. HIA has played an important role in environmental protection in China, however, the emergence, progress and challenges of HIA in China have not been well described. In this paper, the evolution of HIA in China was analyzed and the challenges of HIA were presented based on the author's experiences. HIA contributed to decision-making for large capital construction projects, such as the Three Gorges Dam project, in its emergence stage. Increasing attention has been given to HIA in recent years due to supportive policies underpinning development of the draft HIA guidelines in 2008. However enormous challenges lie ahead in ensuring the institutionalization of HIA into project, program and policy decision-making process due to limited scope, immature tools and insufficient professionals in HIA practice. HIA should broaden its horizons by encompassing physical, chemical, biological and socio-economic aspects and constant attempts should be made to integrate HIA into the decision-making process, not only for projects and programs but also for policies as well.

  18. The emergency of concept global health: perspectives for the field of public health

    Directory of Open Access Journals (Sweden)

    João Roberto Cavalcante Sampaio

    2016-12-01

    Full Text Available In recent years, we have witnessed the emergence of new terms in the academic and political debate of public health, such as ‘’global health’’, ‘’global public goods’’, ‘’global health governance’’, ‘’global public health’’, ‘’health diplomacy’’, 'international cooperation’’. In this study, we aimed to analyze the historical development of the concept of ‘global health’, as well as the prospects of this new concept in the research and public health practice. A comprehensive literature review was performed in Pubmed, Scielo, Scopus, and BVS. We also analyzed documents obtained from the websites of international health organizations. 514 publications were retrieved and 36 were selected for this study. In general, the concept of "global health" refers to health as a transnational phenomenon linked to globalization, which has as main challenge to think public health beyond international relations between countries. International health organizations are particularly important in the development of the concept of "global health" and its new application prospects in the field of public health are health diplomacy, international cooperation and global health governance.

  19. Emerging arboviruses and public health challenges in Brazil

    Directory of Open Access Journals (Sweden)

    Tamara Nunes Lima-Camara

    2016-01-01

    Full Text Available ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country.

  20. Phytosterols: natural compounds with established and emerging health benefits

    Directory of Open Access Journals (Sweden)

    Trautwein Elke A.

    2007-09-01

    Full Text Available Phytosterols (plant sterols and stanols are naturally occurring compounds which are found in all foods of plant origin. The term phytosterols refers to more than 200 different compounds. The most abundant ones in the human diet are sitosterol and campesterol. Their saturated counterparts, sitostanol and campestanol, are found in much lower amounts. Good food sources of phytosterols include vegetable oils, cereal grains, nuts, legumes, and fruits and vegetables. Phytosterols are structurally similar to cholesterol. Despite this structural similarity, they are not absorbed in significant quantities. Absorption is less than 2% for phytosterols, while it is 30-60% for cholesterol. Phytosterols are known to have various bioactive properties, which may have an impact on human health, and as such boosted interest in phytosterols in the past decade. The most important benefit is their blood cholesterol-lowering effect via partial inhibition of intestinal cholesterol absorption. The recommended daily intake of 2 g of phytosterols reduces cholesterol absorption by 30-40% and LDL-cholesterol by 10% on average. Other claimed benefits of phytosterols are possible anti-atherogenic effects as well as, particularly for beta-sitosterol, immune stimulating and anti-inflammatory activities. Furthermore, there is emerging evidence suggesting that particularly plant sterols may have beneficial effects against the development of different types of cancers, like colorectal, breast and prostate cancers. It is not clear whether mechanisms other than the established cholesterol-lowering action of phytosterols as such also contribute to these potential health benefits.

  1. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    Energy Technology Data Exchange (ETDEWEB)

    ORAU' s Oak Ridge Institute for Science Education (HCTT-CHE)

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.

  2. Can public health registry data improve Emergency Medical Dispatch?

    DEFF Research Database (Denmark)

    Andersen, M S; Christensen, E F; Jepsen, S B

    2016-01-01

    BACKGROUND: Emergency Medical Dispatchers make decisions based on limited information. We aimed to investigate if adding demographic and hospitalization history information to the dispatch process improved precision. METHODS: This 30-day follow-up study evaluated time-critical emergencies...

  3. Best practices in managing child and adolescent behavioral health emergencies [digest].

    Science.gov (United States)

    Feuer, Vera; Rocker, Joshua; Saggu, Babar M; Andrus, Jason M; Wormley, Molly

    2018-01-22

    Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  4. [Blood transfusion in emergency settings: French military health service experience].

    Science.gov (United States)

    Sailliol, A; Ausset, S; Peytel, E

    2010-12-01

    Blood transfusion is required in a number of emergency settings and the French military health service (FMHS) has issued specific guidelines for the treatment of war casualties. These guidelines take into account European standards and laws, NATO standards, and also public sentiment regarding transfusion. These guidelines reflect a determination to control the process and to avoid the improvisation frequently associated with wartime transfusion. The evolution in warfare (terrorism and bombing more frequent than gunshot) and the wide use of body armor have deeply changed the clinical presentation of war injuries. These now involve the extremities in 80% of cases, with extensive tissue damage and heavy blood loss. The FMHS recommends that war casualties with hemorrhagic shock be brought quickly to a medical treatment facility (MTF) after first-line treatment applied through buddy aid or by medics. In the MTF, before an early Medevac, a damage control surgery will be performed, with resuscitation using freeze-dried plasma, red blood cells and fresh whole blood. The French military blood bank is responsible for blood product supply, training and medical advice regarding transfusion therapy during wartime, as well as hemovigilance. All transfusion therapy practices are periodically assessed but research on whole blood pathogen reduction is being conducted in order to reduce the residual infectious risk associated with this product. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  5. Health promoting attitudes and behaviors of emergency physicians: exploring gender differences.

    Science.gov (United States)

    Rondeau, Kent V; Francescutti, Louis H; Cummings, Garnet E

    2006-01-01

    The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention. A mail survey of 325 male and 97 female Canadian emergency physicians. Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts. The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.

  6. Development of a Work Climate Scale in Emergency Health Services.

    Science.gov (United States)

    Sanduvete-Chaves, Susana; Lozano-Lozano, José A; Chacón-Moscoso, Salvador; Holgado-Tello, Francisco P

    2018-01-01

    An adequate work climate fosters productivity in organizations and increases employee satisfaction. Workers in emergency health services (EHS) have an extremely high degree of responsibility and consequent stress. Therefore, it is essential to foster a good work climate in this context. Despite this, scales with a full study of their psychometric properties (i.e., validity evidence based on test content, internal structure and relations to other variables, and reliability) are not available to measure work climate in EHS specifically. For this reason, our objective was to develop a scale to measure the quality of work climates in EHS. We carried out three studies. In Study 1, we used a mixed-method approach to identify the latent conceptual structure of the construct work climate . Thus, we integrated the results found in (a) a previous study, where a content analysis of seven in-depth interviews obtained from EHS professionals in two hospitals in Gibraltar Countryside County was carried out; and (b) the factor analysis of the responses given by 113 EHS professionals from these same centers to 18 items that measured the work climate in health organizations. As a result, we obtained 56 items grouped into four factors (work satisfaction, productivity/achievement of aims, interpersonal relationships, and performance at work). In Study 2, we presented validity evidence based on test content through experts' judgment. Fourteen experts from the methodology and health fields evaluated the representativeness, utility, and feasibility of each of the 56 items with respect to their factor (theoretical dimension). Forty items met the inclusion criterion, which was to obtain an Osterlind index value greater than or equal to 0.5 in the three aspects assessed. In Study 3, 201 EHS professionals from the same centers completed the resulting 40-item scale. This new instrument produced validity evidence based on the internal structure in a second-order factor model with four

  7. Development of a Work Climate Scale in Emergency Health Services

    Directory of Open Access Journals (Sweden)

    Susana Sanduvete-Chaves

    2018-01-01

    Full Text Available An adequate work climate fosters productivity in organizations and increases employee satisfaction. Workers in emergency health services (EHS have an extremely high degree of responsibility and consequent stress. Therefore, it is essential to foster a good work climate in this context. Despite this, scales with a full study of their psychometric properties (i.e., validity evidence based on test content, internal structure and relations to other variables, and reliability are not available to measure work climate in EHS specifically. For this reason, our objective was to develop a scale to measure the quality of work climates in EHS. We carried out three studies. In Study 1, we used a mixed-method approach to identify the latent conceptual structure of the construct work climate. Thus, we integrated the results found in (a a previous study, where a content analysis of seven in-depth interviews obtained from EHS professionals in two hospitals in Gibraltar Countryside County was carried out; and (b the factor analysis of the responses given by 113 EHS professionals from these same centers to 18 items that measured the work climate in health organizations. As a result, we obtained 56 items grouped into four factors (work satisfaction, productivity/achievement of aims, interpersonal relationships, and performance at work. In Study 2, we presented validity evidence based on test content through experts' judgment. Fourteen experts from the methodology and health fields evaluated the representativeness, utility, and feasibility of each of the 56 items with respect to their factor (theoretical dimension. Forty items met the inclusion criterion, which was to obtain an Osterlind index value greater than or equal to 0.5 in the three aspects assessed. In Study 3, 201 EHS professionals from the same centers completed the resulting 40-item scale. This new instrument produced validity evidence based on the internal structure in a second-order factor model with

  8. Emerging arboviruses and public health challenges in Brazil.

    Science.gov (United States)

    Lima-Camara, Tamara Nunes

    2016-06-27

    Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country's public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. RESUMO A modificação do ambiente por ações antrópicas, o crescimento urbano desordenado, o processo de globalização do intercâmbio internacional e as mudanças climáticas são alguns fatores que vêm facilitando a emergência e disseminação de doenças infecciosas humanas transmitidas por vetores. Este comentário aborda a recente entrada de três arbovírus no Brasil, Chikungunya (CHIKV), West Nile (WNV) e Zika (ZIKV), com enfoque nos desafios para a Saúde Pública do País. Transmitidos por mosquitos vetores amplamente distribuídos no território nacional e associados ao homem, a população brasileira encontra-se exposta à infecção por esses três arbovírus. Na ausência de vacina eficaz e tratamento específico, são importantes a manutenção e integração de uma vigilância entomológica e epidemiológica contínua, a fim de direcionarmos métodos de controle e prevenção contra essas arboviroses no País.

  9. Planning for a radiological emergency in health care institutions

    International Nuclear Information System (INIS)

    Jerez Vegueria, S.F.; Jerez Vegueria, P.F.

    1998-01-01

    The possible occurrence of accidents involving sources of ionizing radiation calls for response plans to mitigate the consequences of radiological accidents. An emergency planning framework is suggested for institutions which use medical applications of ionizing radiation. Bearing in mind that the prevention of accidents is of prime importance in dealing with radioactive materials and other sources of ionizing radiation, it is recommended that emergency instructions and procedures address certain aspects of the causes of these radiological events. Issues such as identification of radiological events in medical practices and their consequences, protective measures, planning for an emergency response and maintenance of emergency capacity are considered. (author)

  10. Integrating authorities and disciplines into the preparedness-planning process: a study of mental health, public health, and emergency management.

    Science.gov (United States)

    Robertson, Madeline; Pfefferbaum, Betty; Codispoti, Catherine R; Montgomery, Juliann M

    2007-01-01

    The process of integrating all necessary authorities and disciplines into an organized preparedness plan is complex, and the inclusion of disaster mental health poses specific challenges. The goals of this project were (1) to identify whether state mental health preparedness was included in state public health and emergency management preparedness plans, (2) to document barriers to entry and strategies reportedly used by state authorities in efforts to incorporate reasonable mental health preparedness into existing public health and emergency management preparedness planning, (3) to employ a theory for organizational change to organize and synthesize this information, and (4) to stimulate further discussion and research supporting coordinated preparedness efforts at the state level, particularly those inclusive of mental health. To accomplish these goals we (1) counted the number of state public health preparedness and emergency management plans that either included, mentioned, or omitted a mental health preparedness plan; (2) interviewed key officials from nine representative states for their reports on strategies used in seeking greater inclusion of mental health preparedness in public health and emergency management preparedness planning; and (3) synthesized these results to contribute to the national dialogue on coordinating disaster preparedness, particularly with respect to mental health preparedness. We found that 15 out of 29 publicly available public health preparedness plans (52 percent) included mental health preparedness, and eight of 43 publicly available emergency management plans (18 percent) incorporated mental health. Interviewees reported numerous barriers and strategies, which we cataloged according to a well-accepted eight-step plan for transforming organizations.

  11. A "one health" approach to address emerging zoonoses: the HALI project in Tanzania.

    OpenAIRE

    Jonna A K Mazet; Deana L Clifford; Peter B Coppolillo; Anil B Deolalikar; Jon D Erickson; Rudovick R Kazwala

    2009-01-01

    Jonna Mazet and colleagues describe their work in the Tanzania-based HALI Project, which adopts the ?One Health? approach to address emerging zoonoses and that recognizes the interconnectedness of human, animal, and environmental health.

  12. [Survey on a public health emergency event caused by norovirus].

    Science.gov (United States)

    Xing, Y; Jiang, C; Hua, W Y; Liu, F; Zhao, Z; Ding, Y J; Wang, L; Li, J

    2017-09-10

    Objective: To study the epidemiological characteristics of an outbreak caused by norovirus infection in a school in Haidian district, Beijing. Methods: Basic information of the school and data related to patients in the fields survey were collected and analyzed descriptively. Laboratory tests were performed to test the stool and anal swab specimens of both patients and cooks as well as the environmental specimens. Risk factors related to the incidence were analyzed through a case-control study. Results: A total number of 119 patients were identified in the school. Clinical symptoms were mild, mainly involving vomiting (94.1 % , 112/119), abdominal pain (46.2 % , 55/119), but no need of hospitalization. The average age of the student patients was 6.38, with minimum and maximum between 5 and 11. Patients were found in 22 classes, but mainly in grade 1 and class 7 where 35 patients were found (30.17 % ). A total of 134 specimens of rectal swabs and stool were collected, with 7 positive for norovirus and 6 for sappovirus. Salmonella, Shigella, lapactic Escherichia coli and Vibrio parahaemolyticus were not found in on dinner sets, residual foods, bottled water or in drinking fountains. Index on water hygiene was unsatisfactory in classrooms or dormitories where more cases were found. Accommodation, north-facing-classrooms, abnormal water hygiene indexes were found related to the occurance of the disease ( P <0.05). Conclusions: The outbreak was identified a gastroenteritis infection, caused by norovirus with symptoms as vomiting and abdominal pain. This event reached the reporting standards of public health emergencies-level Ⅳ. Discovery and isolation of the first case was not timely while transmission of the disease might be water-borne. Surveillance programs on symptoms, disinfection of vomit and stool in places like nurseries and schools should be strengthened to prevent the norovirus outbreak.

  13. Emergency Child Aid. Child Health and Safety Series (Module VI).

    Science.gov (United States)

    Iscoe, Louise; And Others

    This manual for child care personnel in day care homes and centers provides a step by step review of what to do in common emergency situations. It is emphasized that the manual is not a substitute for the complete first aid course which every careperson should have. Initial sections of the manual focus on preparing for emergency conditions,…

  14. Theory-based approaches to understanding public emergency preparedness: implications for effective health and risk communication.

    Science.gov (United States)

    Paek, Hye-Jin; Hilyard, Karen; Freimuth, Vicki; Barge, J Kevin; Mindlin, Michele

    2010-06-01

    Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.

  15. EDITORIAL Universal health coverage: A re-emerging paradigm?

    African Journals Online (AJOL)

    admin

    of earlier initiatives in global health that include the basic health ... the availability, accessibility (geographic, economic, cultural) and appropriateness ... public good nature of health leading to new .... fragmentation and towards universal.

  16. Manitoba Health's emerging work on wildland fire smoke

    Science.gov (United States)

    Jeffrey Joaquin; Darlene Oshanski

    2015-01-01

    Smoke caused by wildland fire events is an important public health issue, involving major risks to the health of people and the environment. Smoke from wildland fires can travel hundreds of kilometers, affecting air quality far from the flames. Through a partnership with Health Canada, Manitoba Health's Office of Disaster Management (ODM) has undertaken a number...

  17. How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services.

    Science.gov (United States)

    Mautner, Dawn; Peterson, Bridget; Cunningham, Amy; Ku, Bon; Scott, Kevin; LaNoue, Marianna

    2017-03-01

    Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.

  18. [Gender influence on health related quality of life among resident physicians working in an emergency department].

    Science.gov (United States)

    Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José

    2014-02-01

    The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

  19. Utilization of emergency medical transports and hospital admissions among persons with behavioral health conditions.

    Science.gov (United States)

    Cuddeback, Gary; Patterson, P Daniel; Moore, Charity Galena; Brice, Jane H

    2010-04-01

    Emergency medical services transport and emergency department misuse among persons with behavioral health conditions is a concern. Administrative data were used to examine medical transports and hospital admissions among persons with behavioral health conditions. Data on 70,126 medical transports to emergency departments in three southeastern counties were analyzed. Compared with general medical transports, fewer behavioral health transports resulted in a hospital admission. Among behavioral health transports, persons with schizophrenia were 2.62 times more likely than those with substance use disorders to be admitted, and persons with mood disorders were 4.36 times more likely than those with substance use disorders to be admitted. Also, among behavioral health transports, rural transports were less likely than more urban transports to result in a hospital admission. More training of emergency medical services personnel and more behavioral health crisis resources, especially targeting rural areas and substance use disorders, are needed.

  20. User violence towards nursing professionals in mental health services and emergency units

    Directory of Open Access Journals (Sweden)

    Bartolomé Llor-Esteban

    2017-01-01

    Full Text Available Workplace violence is present in many work sectors, but in the area of mental health, nurses have a higher risk due to the close relationship they have with users. This study analyzed hostile user statements against nursing professionals of Mental Health Services and Emergency Units in Health Service (MHS hospitals in Murcia, Spain, and determined the frequency of exposure to the different violent user behaviors. The study was carried out with a sample of 518 nursing professionals from four hospital services: Mental Health, Emergency Units, Medical Hospitalization, and Maternal-and-Child. The nursing staff of Mental Health and Emergency Units was the most exposed to violence. Non-physical violence was more frequent in Emergency Units, whereas physical violence was more frequent in Mental Health. Among the consequences of exposure to non-physical violence are workers’ emotional exhaustion and the presence of psychological distress.

  1. One Health approach: A platform for intervention in emerging public health challenges of Kerala state

    Directory of Open Access Journals (Sweden)

    A. Sukumaran

    2015-05-01

    Full Text Available The authors, key functionaries in the Kerala state public health system, review the communicable disease scenario of the state for the past 4 years, and in the background of the One Health concept, opines that the re-emerged discipline is perfectly in tune with the current challenges of the state. The unique model of Kerala state is witnessing newer challenges in its public health arena: The rapidly increasing migrant workforce from relatively poorer states of India, rapid urbanization and its consequent stress on public health, unsolved issues of urban waste disposal, reemergence of many communicable diseases like malaria, more so, the falciparum type, emergence of many zoonotic diseases like Lyme disease, scrub typhus, and Kyasanur forest disease etc. Conventional zoonotic infections such as anthrax and brucellosis remain potential threat for human health as well. Rabies continued to cause major concern from mortality point of view, as well as major drainer of state’s budget every year. Leptospirosis has remained major burden among the communicable disease for the past 10 years, and the annual incidence ranged from 2 to 7 per 100,000 population. Having a large section of its people working in various agriculture and animal rearing occupations, the state has all risk factors for propagation of Leptospirosis, but lacks interdisciplinary collaboration in its control and prevention area, the author highlights major avenues for collaboration. Japanese encephalitis appeared as an epidemic in 2011 in two of the southern districts in Kerala, one of the districts being famous tourist spot for both humans, as well as migrant birds. There is ample scope for collaborative research on the source of the virus, and in the subsequent years, the disease had been detected in more districts. Lyme disease was reported for the first time in India, from one of the districts in Kerala, promptly investigated by a joint team from Human Public Health and Veterinary

  2. Sustainable Model for Public Health Emergency Operations Centers for Global Settings

    OpenAIRE

    Balajee, S. Arunmozhi; Pasi, Omer G.; Etoundi, Alain Georges M.; Rzeszotarski, Peter; Do, Trang T.; Hennessee, Ian; Merali, Sharifa; Alroy, Karen A.; Phu, Tran Dac; Mounts, Anthony W.

    2017-01-01

    Capacity to receive, verify, analyze, assess, and investigate public health events is essential for epidemic intelligence. Public health Emergency Operations Centers (PHEOCs) can be epidemic intelligence hubs by 1) having the capacity to receive, analyze, and visualize multiple data streams, including surveillance and 2) maintaining a trained workforce that can analyze and interpret data from real-time emerging events. Such PHEOCs could be physically located within a ministry of health epidem...

  3. Public health response to radiation emergencies and the role of the Helsinki Project Office

    International Nuclear Information System (INIS)

    Baverstock, Keith F.

    1997-01-01

    This paper focuses on the public health element of nuclear emergency preparedness, defined as the mitigation of the long-term effects of radiation on exposed populations, as opposed to dealing with the health consequences of an exposure in an individual (termed medical aspects). The paper also approaches to the role of the Helsinki Project Office which is concerned with the protection of public health through effective response to nuclear emergencies, and falling into two categories, namely contingency planning or preparedness, and response

  4. Emergency contraception - Potential for women′s health

    Directory of Open Access Journals (Sweden)

    Suneeta Mittal

    2014-01-01

    Full Text Available Emergency contraception (EC is a safe and effective method which is used to prevent unwanted pregnancy after unprotected sexual intercourse. Many of the unwanted pregnancies end in unsafe abortions. The search for an ideal contraceptive, which does not interfere with spontaneity or pleasure of the sexual act, yet effectively controls the fertility, is still continuing. Numerous contraceptive techniques are available, yet contraceptive coverage continues to be poor in India. Thus, even when not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception. This need may also arise due to failure of contraceptive method being used (condom rupture, diaphragm slippage, forgotten oral pills or following sexual assault. Emergency contraception is an intervention that can prevent a large number of unwanted pregnancies resulting from failure of regular contraception or unplanned sexual activity, which in turn helps in reducing the maternal mortality and morbidity due to unsafe abortions. However, a concern has been expressed regarding repeated and indiscriminate usage of e-pill, currently the rational use of emergency contraception is being promoted as it is expected to make a significant dent in reducing the number of unwanted pregnancies and unsafe abortions. In fact, since the introduction of emergency contraception, the contribution of unsafe abortion towards maternal mortality has declined from 13 to 8 per cent.

  5. emergency psychiatry and mental health policy: an international ...

    African Journals Online (AJOL)

    psychiatric care such as clinical implications, care in large cities, the rights of the patients and deinstitutionalisation. Further chapters examine care on different continents. Emergency psychiatric services in the United States, Canada, the Netherlands, France, Italy, Denmark, Belgium, Germany,. Spain, Greece and South ...

  6. Adoption of One Health in Thailand's National strategic plan for emerging infectious diseases.

    Science.gov (United States)

    Sommanustweechai, Angkana; Iamsirithaworn, Sopon; Patcharanarumol, Walaiporn; Kalpravidh, Wantanee; Tangcharoensathien, Viroj

    2017-02-01

    This study illustrates how Thailand adopted the One Health concept. Massive socio-economic and health consequences of emerging infectious diseases, especially Avian Influenza in 2004, led to recognition of the importance of and need for One Health. Based on collaboration and consultative meetings between the national actors and international development partners, Thailand adopted One Health to drive more effective containment of Emerging Infectious Diseases. This concept gained support from the non-governmental and civil society organizations through processes of the National Health Assembly. In 2012, a Cabinet resolution endorsed a National Strategic Plan for Emerging Infectious Diseases (2013-2016), in which One Health appeared as a core principle. Collaboration among multi-disciplinary groups of professionals, particularly epidemiologists trained in Field Epidemiology Training Programs (FETP), including FETP, FETP-veterinarian, and FETP-wildlife veterinarians, promoted implementation of One Health.

  7. Sustainable Model for Public Health Emergency Operations Centers for Global Settings.

    Science.gov (United States)

    Balajee, S Arunmozhi; Pasi, Omer G; Etoundi, Alain Georges M; Rzeszotarski, Peter; Do, Trang T; Hennessee, Ian; Merali, Sharifa; Alroy, Karen A; Phu, Tran Dac; Mounts, Anthony W

    2017-10-01

    Capacity to receive, verify, analyze, assess, and investigate public health events is essential for epidemic intelligence. Public health Emergency Operations Centers (PHEOCs) can be epidemic intelligence hubs by 1) having the capacity to receive, analyze, and visualize multiple data streams, including surveillance and 2) maintaining a trained workforce that can analyze and interpret data from real-time emerging events. Such PHEOCs could be physically located within a ministry of health epidemiology, surveillance, or equivalent department rather than exist as a stand-alone space and serve as operational hubs during nonoutbreak times but in emergencies can scale up according to the traditional Incident Command System structure.

  8. Examining the importance of incorporating emergency preparedness and disaster training core competencies into allied health curricula.

    Science.gov (United States)

    Curtis, Tammy

    2015-01-01

    Preparation for responding to emergency events that does not warrant outside help beyond the local community resources or responding to disaster events that is beyond the capabilities of the local community both require first responders and healthcare professionals to have interdisciplinary skills needed to function as a team for saving lives. To date, there is no core emergency preparedness and disaster planning competencies that have been standardized at all levels across the various allied health curricula disciplines. To identify if emergency preparedness and disaster training content are currently being taught in allied health program courses, to identify possible gaps within allied health curricula, and to explore the perceptions of allied health college educators for implementing emergency preparedness and disaster training core competencies into their existing curricula, if not already included. A quantitative Internet-based survey was conducted in 2013. Convenient sample. Fifty-one allied health college educators completed the survey. Descriptive statistics indicated that the majority of allied health college instructors do not currently teach emergency preparedness and disaster training core competency content within their current allied health discipline; however, their perceived level of importance for inclusion of the competencies was high. The results of this study supported the need for developing and establishing a basic national set of standardized core emergency preparedness and disaster planning competencies at all levels across various allied health curricula disciplines to ensure victims receive the best patient care and have the best possible chance of survival.

  9. Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

    Science.gov (United States)

    Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

    2010-01-01

    Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

  10. A Review of State Public Health Emergency Declarations in Peru: 2014-2016.

    Science.gov (United States)

    Bambarén, Celso; Alatrista, Maria Del Socorro

    2018-04-01

    Peru has different legal mechanisms of emergency, one of which is the Public Health Emergency that is applicable when: there is high-risk for, or the existence of an outbreak, epidemic, or pandemic; the occurrence of cases of a disease classified as eliminated or eradicated; the occurrence of emerging or re-emerging infectious diseases with high epidemic potential; the occurrence of rapid disseminated epidemics that simultaneously affect more than one department; as well as the existence of an event that affects the continuity of health services. From July 2014 to December 2016, 23 Public Health Emergencies were declared, out of which 57% were in the high-risk or existence of epidemics, 30% were due to some natural or anthropic events that generate a sudden decrease in the operative capacity of health services, and 13% were due to the existence of a rapid spreading epidemic that could affect more than one department in the country. The risk or occurrence of epidemiological outbreaks, mainly of Dengue, was the main cause of emergency declaration. One-hundred and forty million US dollars were allocated to implement the action plans that were part of the declaration, of which 72% was used to keep the operational capacity of health services and 28% to vector and epidemiological control measures. Bambarén C , Alatrista MdS . A review of state public health emergency declarations in Peru: 2014-2016. Prehosp Disaster Med. 2018;33(2):197-200.

  11. Addressing the gap between public health emergency planning and incident response

    Science.gov (United States)

    Freedman, Ariela M; Mindlin, Michele; Morley, Christopher; Griffin, Meghan; Wooten, Wilma; Miner, Kathleen

    2013-01-01

    Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response. Methods: This study was conducted using critical case study methodology consisting of document review and 18 key-informant interviews with individuals who played key roles in planning and response. Thematic analysis was used to analyze data. Results: Several broad elements emerged as key to ensuring effective and efficient public health response: 1) developing a plan for emergency response; 2) establishing the framework for an ICS; 3) creating the infrastructure to support response; 4) supporting a workforce trained on emergency response roles, responsibilities, and equipment; and 5) conducting regular preparedness exercises. Conclusions: This research demonstrates the value of investments made and that effective emergency preparedness requires sustained efforts to maintain personnel and material resources. By having the infrastructure and experience based on ICS and EOC, the public health system had the capability to surge-up: to expand its day-to-day operation in a systematic and prolonged manner. None of these critical actions are possible without sustained funding for the public health infrastructure. Ultimately, this case study illustrates the importance of public health as a key leader in emergency response. PMID:28228983

  12. Globalisation, health and foreign policy: emerging linkages and interests

    Science.gov (United States)

    Owen, John Wyn; Roberts, Olivia

    2005-01-01

    A discussion of the growing links between the issues of globalisation, health and foreign policy. This article examines the effect this has on health, development and foreign policy communities in the UK and internationally and considers what steps the policy community must take to address the challenges and opportunities of this new relationship. PMID:16053520

  13. Suicide Prevention: An Emerging Priority For Health Care.

    Science.gov (United States)

    Hogan, Michael F; Grumet, Julie Goldstein

    2016-06-01

    Suicide is a significant public health problem. It is the tenth leading cause of death in the United States, and the rate has risen in recent years. Many suicide deaths are among people recently seen or currently under care in clinical settings, but suicide prevention has not been a core priority in health care. In recent years, new treatment and management strategies have been developed, tested, and implemented in some organizations, but they are not yet widely used. This article examines the feasibility of improving suicide prevention in health care settings. In particular, we consider Zero Suicide, a model for better identification and treatment of patients at risk for suicide. The approach incorporates new tools for screening, treatment, and support; it has been deployed with promising results in behavioral health programs and primary care settings. Broader adoption of improved suicide prevention care may be an effective strategy for reducing deaths by suicide. Project HOPE—The People-to-People Health Foundation, Inc.

  14. The approach of prehospital health care personnel working at emergency stations towards forensic cases

    OpenAIRE

    Ozlem Asci; Guleser Hazar; Isa Sercan

    2015-01-01

    Objectives: The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. Materials and methods: This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 201...

  15. Expert forecast on emerging psychosocial risks related to occupational safety and health

    NARCIS (Netherlands)

    Milczarek, M.; Brun, E.; Houtman, I.; Goudswaard, A.; Evers, M.; Bovenkamp, M. van de; Roskams, N.; Op de Beeck, R.; Pahkin, K.; Berthet, M.; Morvan, E.; Kuhn, K.; Kaluza, K.; Hupke, M.; Hauke, A.; Reinert, D.; Widerszal-Bazyl, M.; Perez, J.; Oncins de Frutos, M.

    2007-01-01

    This report is in cooperation with TNO Work and Employment and the European Agency for Safety and Health at Work. The expert forecast on emerging psychosocial risks was carried out by means of the Delphi method. The main emerging psychosocial risks revealed were related to new forms of employment

  16. EcoHealth Student: Emerging Researcher Awards encourages ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Addressing critical population health and environment issues through an ecohealth approach is a common ... Students' work was evaluated based on its contribution to science and ecohealth. .... La recherche, clé d'une meilleure nutrition.

  17. Emerging Issues and Models in College Mental Health Services

    Science.gov (United States)

    Locke, Ben; Wallace, David; Brunner, Jon

    2016-01-01

    This chapter provides a brief overview of the psychological issues facing today's college students, information about students receiving mental health services, and an evidence-based model describing the practice and functions of today's counseling centers.

  18. Microbial Threats to Health: Emergence, Detection, and Response

    National Research Council Canada - National Science Library

    Smolinski, Mark S; Hamburg, Margaret A; Lederberg, Joshua

    2003-01-01

    .... The recent SARS outbreak is a prime example. Knowing neither geographic nor political borders, often arriving silently and lethally, microbial pathogens constitute a grave threat to the health of humans...

  19. Emerging health problems among women: Inactivity, obesity, and metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Yi-Ju Tsai

    2014-02-01

    Full Text Available The increase in obesity and metabolic syndrome has been documented worldwide. However, few studies have investigated the risk of inactivity, obesity, and metabolic syndrome specifically in women. Hormone balance plays a crucial role in regulating metabolism and helps to maintain optimal health. It is likely that the sex difference in obesity may be due to the variation in hormone concentration throughout a woman's life, which predisposes them to weight gain. This paper reviews previous literature and discusses factors that influence the risk of adiposity-related health consequences among women for three critical biological transitions throughout a woman's life: puberty, menopause, and pregnancy. To improve quality of life and metabolic health for women, interventions are needed to target women at different transition stages and provide tailored health education programs. Interventions should raise awareness of physical inactivity, obesity, and metabolic syndrome, and promote healthy behavioral change in women.

  20. EMERGENCE OF ENTIRELY NEW POISONING IN RURAL INDIA; AN UPCOMING HEALTH HAZARD TO THE COMMUNITY HEALTH.

    Directory of Open Access Journals (Sweden)

    A Kumar

    2012-10-01

    Full Text Available Acute agrochemical poisoning is a leading cause of mortality and morbidity in India. Pendimethalin (herbicide and Pancycuron (fungicide are frequently used worldwide and considered quite a remarkably safe one for humans. Their acute toxicity is not yet widely known. Here we are reporting cases of their acute poisoning in young. To the best of our knowledge not a single such case of their poisoning has been reported so far in india. Such poisoning by entirely new compounds is an emerging problem in the tropics. In this communication we are reporting such unusual and entirely new toxicities and trying to highlight the need of their early recognition and timely management in rural regions where health facilities are already at the stake.

  1. Emerging sustainable/green cleaning products: health and environmental risks

    OpenAIRE

    Aydin, Mehmet Cihan; Işik, Ercan; Ulu, Ali Emre

    2016-01-01

    Sustainable development aims to bring a new perspective to our lives without compromising customer needs and quality. Along with sustainable development many innovative solutions came out. One of them is sustainable green cleaning products and techniques. Today, emissions from conventional cleaning products may cause severe health and environmental issues. Especially sick building syndromes such as eye, skin and respiratory irritations are main health effects of them. They may also contrib...

  2. Emerging uses of patient generated health data in clinical research.

    Science.gov (United States)

    Wood, William A; Bennett, Antonia V; Basch, Ethan

    2015-05-01

    Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  3. Air Quality and Heart Health: Managing an Emerging ...

    Science.gov (United States)

    Dr. Cascio will share with a broad range of federal agencies current understanding of the links between air quality and cardiovascular health. The key facts include that air pollution contributes a high attributable health burden. That certain well-defined vulnerable subpopulations are at higher risk. At-risk populations include those with heart disease, lung disease and diabetes, older adults, children and individuals living in low socioeconomic neighborhoods. There is no established threshold level for safe long-term exposure to air particle pollution, and some of the basic biological mechanisms that account for adverse health effects are now known. This knowledge is giving us insight into how we might mitigate the effects apart from the regulatory efforts to improve overall air quality. Moreover, the work that each State has done to improve air quality has resulted in improved health outcomes including cardiovascular outcomes, and longer lives. The presentation will address: 1) What do we know? 2) Who are the at-risk populations? 3) What can communities do to reduce risk? 4) What can healthcare professionals do to reduce risk of the at-risk population? And 5) What tools are available to help healthcare professionals and their patients reduce exposure and risk from air pollutants? The talk will feature a description of the Air Quality Index and associated EPA tools and health information that can be used by health care providers to educate their at-ris

  4. Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients.

    Science.gov (United States)

    Polak, Rani; Phillips, Edward M; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S; Burg, Tracey; Eisenberg, David

    2016-01-01

    Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges.

  5. Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients

    Science.gov (United States)

    Phillips, Edward M.; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S.; Burg, Tracey; Eisenberg, David

    2016-01-01

    Background: Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. Objective: The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. Methods: During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. Results: All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. Conclusions: There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges. PMID:26937315

  6. Addressing the gap between public health emergency planning and incident response

    OpenAIRE

    Freedman, Ariela M; Mindlin, Michele; Morley, Christopher; Griffin, Meghan; Wooten, Wilma; Miner, Kathleen

    2013-01-01

    Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response. Methods:?This study was conducted using critical case study methodology consisting of document review and 18 k...

  7. Ebola: Emergency preparedness and perceived response of Malaysian health care providers.

    Science.gov (United States)

    Rajiah, Kingston; Maharajan, Mari Kannan; Binti Samsudin, Sarah Zakiah; Tan, Choo Lin; Tan Yen Pei, Adeline; Wong San Ying, Audrey

    2016-12-01

    We studied the emergency preparedness and perceived response for Ebola virus disease among various health care providers in Malaysia using a self-report questionnaire. Most of the health care providers felt that they were able to respond to Ebola virus disease and were aware of the level of preparedness needed during emergency. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Is there a duty for private employers to provide emergency mental health care services?

    Science.gov (United States)

    Langlieb, Tammara F; Langlieb, Alan M; Everly, George S

    2006-01-01

    This article presents a discussion of whether employers in private companies have a duty to provide an emergency action plan with a mental health component for its employees. It discusses basic negligence concepts and focuses mainly on the "duty of care" component of negligence. It then applies the negligence concepts to private employers and discusses how private companies arguably might have a duty under the laws of negligence to provide employees with an emergency action plan, specifically a plan including mental health provisions.

  9. Health Economics in Medical Nutrition: An Emerging Science.

    Science.gov (United States)

    Nuijten, Mark

    2015-01-01

    The objective of this paper is to describe the applications of health economic theory to medical nutrition. The published literature provides evidence that medical nutrition, e.g. oral nutritional supplements, is an effective treatment for patients with disease related malnutrition. Malnutrition is associated with mortality risk and complication rates, including infections. Malnutrition is not a new problem and with an ageing population it continues to become a major public health concern as increasing age is associated with an increased risk of malnutrition. This overview shows that in the case RCTs are providing the clinical evidence, there is no methodological difference between a cost-effectiveness analysis for pharmaceutical or nutrition. However, in nutrition the evidence may not always come from RCT data, but will be more often based on observational data. Therefore the clinical evidence of nutrition in itself is not the issue, but the handling of clinical evidence from observational studies. As the link between the consumption of a food product and a resulting health status is often more difficult to establish than the effect of a drug treatment it requires the further development of adapted methodologies in order to correctly predict the impact of food-related health effects and health economic outcomes from a broader perspective. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.

  10. Childhood constipation as an emerging public health problem.

    Science.gov (United States)

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Crispus Perera, Bonaventure Jayasiri; Benninga, Marc Alexander

    2016-08-14

    Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.

  11. Occupational Safety and Health System for Workers Engaged in Emergency Response Operations in the USA.

    Science.gov (United States)

    Toyoda, Hiroyuki; Kubo, Tatsuhiko; Mori, Koji

    2016-12-03

    To study the occupational safety and health systems used for emergency response workers in the USA, we performed interviews with related federal agencies and conducted research on related studies. We visited the Federal Emergency Management Agency (FEMA) and National Institute for Occupational Safety and Health (NIOSH) in the USA and performed interviews with their managers on the agencies' roles in the national emergency response system. We also obtained information prepared for our visit from the USA's Occupational Safety and Health Administration (OSHA). In addition, we conducted research on related studies and information on the website of the agencies. We found that the USA had an established emergency response system based on their National Incident Management System (NIMS). This enabled several organizations to respond to emergencies cooperatively using a National Response Framework (NRF) that clarifies the roles and cooperative functions of each federal agency. The core system in NIMS was the Incident Command System (ICS), within which a Safety Officer was positioned as one of the command staff supporting the commander. All ICS staff were required to complete a training program specific to their position; in addition, the Safety Officer was required to have experience. The All-Hazards model was commonly used in the emergency response system. We found that FEMA coordinated support functions, and OSHA and NIOSH, which had specific functions to protect workers, worked cooperatively under NRF. These agencies employed certified industrial hygienists that play a professional role in safety and health. NIOSH recently executed support activities during disasters and other emergencies. The USA's emergency response system is characterized by functions that protect the lives and health of emergency response workers. Trained and experienced human resources support system effectiveness. The findings provided valuable information that could be used to improve the

  12. Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015

    Directory of Open Access Journals (Sweden)

    Stephen C. Dorner, MSc

    2016-01-01

    Full Text Available Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet minimum standards in order to be sold through the federal Marketplace. These standards to become a qualified health plan (QHP include maintaining a provider network sufficient to assure access to services. However, the complexity of emergency physician (EP employment practices – in which the EPs frequently serve as independent contractors of emergency departments, independently establish insurance contracts, etc... – and regulations governing insurance repayment may hinder the application of network adequacy standards to emergency medicine. As such, we hypothesized the existence of QHPs without in-network access to EPs. The objective is to identify whether there are QHPs without in-network access to EPs using information available through the federal Marketplace and publicly available provider directories. Results: In a national sample of Marketplace plans, we found that one in five provider networks lacks identifiable in-network EPs. QHPs lacking EPs spanned nearly half (44% of the 34 states using the federal Marketplace. Conclusion: Our data suggest that the present regulatory framework governing network adequacy is not generalizable to emergency care, representing a missed opportunity to protect patient access to in-network physicians. These findings and the current regulations governing insurance payment to EPs dis-incentivize the creation of adequate physician networks, incentivize the practice of balance billing, and shift the cost burden to patients.

  13. Report on Health Manpower and Programs in Ohio: Part Two. Allied Health, Area Health Education Centers, Dentistry, Emergency Medical Services, Nursing, Optometry, Pharmacy, Podiatry, and Veterinary Medicine.

    Science.gov (United States)

    Ohio Board of Regents, Columbus.

    Information on health occupations educational programs in Ohio and current and projected employment needs for health professionals are presented. The following health fields are examined: allied health, dentistry, emergency medical service, nursing, optometry, pharmacy, podiatry, and veterinary medicine. Issues and trends affecting each field are…

  14. 'Mind the gap!' rethinking the role of health in the emergency and development divide.

    Science.gov (United States)

    O'Dempsey, Tim; Munslow, Barry

    2009-10-01

    The 'Emergency Relief-Rehabilitation-Development' model is highly problematic, especially in fragile states which fluctuate in and out of crisis. Lack of definition as to what constitutes a humanitarian emergency and the absence of rules of engagement of NGOs and donors further complicates the problem. Restricted mandates and budgets of institutions and funding bodies lead to gaps in the provision of health services for affected populations. Reducing the gap between emergency and developmental healthcare requires approaching the issue from both sides, recognizing that the emergency-development gap is not a single uniform entity but a complex dynamic of heterogeneous gaps. Copyright (c) 2009 John Wiley & Sons, Ltd.

  15. Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

    Science.gov (United States)

    Ben-Assuli, Ofir; Leshno, Moshe

    2016-09-01

    In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.

  16. Emergency management in health: key issues and challenges in the UK.

    Science.gov (United States)

    Lee, Andrew C K; Phillips, Wendy; Challen, Kirsty; Goodacre, Steve

    2012-10-19

    Emergency planning in the UK has grown considerably in recent years, galvanised by the threat of terrorism. However, deficiencies in NHS emergency planning were identified and the evidence-base that underpins it is questionable. Inconsistencies in terminologies and concepts also exist. Different models of emergency management exist internationally but the optimal system is unknown. This study examines the evidence-base and evidence requirements for emergency planning in the UK health context. The study involved semi-structured interviews with key stakeholders and opinion leaders. Purposive sampling was used to obtain a breadth of views from various agencies involved in emergency planning and response. Interviews were then analysed using a grounded approach using standard framework analysis techniques. We conducted 17 key informant interviews. Interviewees identified greater gaps in operational than technical aspects of emergency planning. Social and behavioural knowledge gaps were highlighted with regards to how individuals and organisations deal with risk and behave in emergencies. Evidence-based approaches to public engagement and for developing community resilience to disasters are lacking. Other gaps included how knowledge was developed and used. Conflicting views with regards to the optimal configuration and operation of the emergency management system were voiced. Four thematic categories for future research emerged:(i) Knowledge-base for emergency management: Further exploration is needed of how knowledge is acquired, valued, disseminated, adopted and retained.(ii) Social and behavioural issues: Greater understanding of how individuals approach risk and behave in emergencies is required.(iii) Organisational issues in emergencies: Several conflicting organisational issues were identified; value of planning versus plans, flexible versus standardized procedures, top-down versus bottom-up engagement, generic versus specific planning, and reactive versus

  17. Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

    Science.gov (United States)

    Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

    2017-04-28

    Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health

  18. Major emerging vector-borne zoonotic diseases of public health importance in Canada.

    Science.gov (United States)

    Kulkarni, Manisha A; Berrang-Ford, Lea; Buck, Peter A; Drebot, Michael A; Lindsay, L Robbin; Ogden, Nicholas H

    2015-06-10

    In Canada, the emergence of vector-borne diseases may occur via international movement and subsequent establishment of vectors and pathogens, or via northward spread from endemic areas in the USA. Re-emergence of endemic vector-borne diseases may occur due to climate-driven changes to their geographic range and ecology. Lyme disease, West Nile virus (WNV), and other vector-borne diseases were identified as priority emerging non-enteric zoonoses in Canada in a prioritization exercise conducted by public health stakeholders in 2013. We review and present the state of knowledge on the public health importance of these high priority emerging vector-borne diseases in Canada. Lyme disease is emerging in Canada due to range expansion of the tick vector, which also signals concern for the emergence of human granulocytic anaplasmosis, babesiosis, and Powassan virus. WNV has been established in Canada since 2001, with epidemics of varying intensity in following years linked to climatic drivers. Eastern equine encephalitis virus, Jamestown Canyon virus, snowshoe hare virus, and Cache Valley virus are other mosquito-borne viruses endemic to Canada with the potential for human health impact. Increased surveillance for emerging pathogens and vectors and coordinated efforts among sectors and jurisdictions will aid in early detection and timely public health response.

  19. Rigorous Clinical Trial Design in Public Health Emergencies Is Essential

    DEFF Research Database (Denmark)

    Ellenberg, Susan S; Keusch, Gerald T; Babiker, Abdel G

    2018-01-01

    Randomized clinical trials are the most reliable approaches to evaluating the effects of new treatments and vaccines. During the 2014-15 West African Ebola epidemic, many argued that such trials were neither ethical nor feasible in an environment of limited health infrastructure and severe disease...

  20. Motorcycle injuries as an emerging public health problem in ...

    African Journals Online (AJOL)

    Key words: motorcycle injuries; prevalence, treatment outcome, injury pattern, Tanzania .... Data was analyzed using SPSS computer software version 11.5. ... the Weill Bugando University College of Health Sciences/Bugando Medical Centre ..... to helmet use include impaired rider vision, attenuation of critical traffic sounds, ...

  1. Childhood constipation as an emerging public health problem

    NARCIS (Netherlands)

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Crispus Perera, Bonaventure Jayasiri; Benninga, Marc Alexander

    2016-01-01

    Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a

  2. EcoHealth Student: Emerging Researcher Awards encourages ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2011-05-10

    May 10, 2011 ... ... who were paired with EcoHealth board members or journal editors to score ... Students' work was evaluated based on its contribution to science and ecohealth. ... Through her previous epidemiological and medical research, and ... Her research findings have been surprising and run counter to global ...

  3. STREET KETAMINE-ASSOCIATED BLADDER DYSFUNCTION: AN EMERGING HEALTH PROBLEM

    Directory of Open Access Journals (Sweden)

    TEH GC

    2009-08-01

    Full Text Available Introduction: Ketamine is frequently abused nowadays as a recreational drug. Case reports are emerging since 2007 to describe a new clinical entity of severe bladder dysfunction associated with chronic abuse of street ketamine. Clinical presentation: Severe lower urinary tract symptoms of urinary frequency and urgency which are refractory to conventional treatment. Quality of life is adversely affected as a consequence. Chronic kidney disease will develop in advanced cases. Investigation findings: The urine is sterile on culture. Ultrasound will show reduced bladder capacity with thickened bladder wall. In advanced stage, hydronephrosis and renal impairment will develop. Treatment: Patients should be advised to stop street ketamine use immediately. Anticholinergic medication could be tried to alleviate the symptoms. Refractory cases with dilatation of the upper urinary tract might need urinary diversion. Conclusion: Awareness of this new condition is essential in diagnosis. Early intervention offers better treatment outcome.

  4. The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

    Science.gov (United States)

    Pines, Jesse M

    2006-05-01

    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

  5. Occupational Risks of Health Professionals in Turkey as an Emerging Economy.

    Science.gov (United States)

    Ulutasdemir, Nilgun; Cirpan, Metin; Copur, Ebru Ozturk; Tanir, Ferdi

    2015-01-01

    Health services are one of the work areas that contain important risks in terms of the occupational health and safety of the laborer. Professionals in various areas of health services encounter biological, chemical, physical, ergonomic, and psychosocial risks, particularly in hospitals. This study has been performed to evaluate the impacts of the occupational risks on health of health professionals in Turkey. In Turkey, as an emerging economy, the history of studies on health professionals is not longstanding. There have been various regulations intended for the occupational health and safety of health professionals in line with the Regulation of the Provision on Patient and Staff Safety prepared in 2012. However, applications can differ from region to region, institution to institution, and person to person. We believe that this review will lead health professionals to be aware of occupational risks and contribute to planning health services for health professionals. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature.

    Science.gov (United States)

    Naslund, John A; Marsch, Lisa A; McHugo, Gregory J; Bartels, Stephen J

    2015-01-01

    Serious mental illness (SMI) is one of the leading causes of disability worldwide. Emerging mobile health (mHealth) and eHealth interventions may afford opportunities for reaching this at-risk group. To review the evidence on using emerging mHealth and eHealth technologies among people with SMI. We searched MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane Central, and Web of Science through July 2014. Only studies which reported outcomes for mHealth or eHealth interventions, defined as remotely delivered using mobile, online, or other devices, targeting people with schizophrenia, schizoaffective disorder, or bipolar disorder, were included. Forty-six studies spanning 12 countries were included. Interventions were grouped into four categories: (1) illness self-management and relapse prevention; (2) promoting adherence to medications and/or treatment; (3) psychoeducation, supporting recovery, and promoting health and wellness; and (4) symptom monitoring. The interventions were consistently found to be highly feasible and acceptable, though clinical outcomes were variable but offered insight regarding potential effectiveness. Our findings confirm the feasibility and acceptability of emerging mHealth and eHealth interventions among people with SMI; however, it is not possible to draw conclusions regarding effectiveness. Further rigorous investigation is warranted to establish effectiveness and cost benefit in this population.

  7. The Pediatric Emergency Care Applied Research Network Registry: A Multicenter Electronic Health Record Registry of Pediatric Emergency Care.

    Science.gov (United States)

    Deakyne Davies, Sara J; Grundmeier, Robert W; Campos, Diego A; Hayes, Katie L; Bell, Jamie; Alessandrini, Evaline A; Bajaj, Lalit; Chamberlain, James M; Gorelick, Marc H; Enriquez, Rene; Casper, T Charles; Scheid, Beth; Kittick, Marlena; Dean, J Michael; Alpern, Elizabeth R

    2018-04-01

     Electronic health record (EHR)-based registries allow for robust data to be derived directly from the patient clinical record and can provide important information about processes of care delivery and patient health outcomes.  A data dictionary, and subsequent data model, were developed describing EHR data sources to include all processes of care within the emergency department (ED). ED visit data were deidentified and XML files were created and submitted to a central data coordinating center for inclusion in the registry. Automated data quality control occurred prior to submission through an application created for this project. Data quality reports were created for manual data quality review.  The Pediatric Emergency Care Applied Research Network (PECARN) Registry, representing four hospital systems and seven EDs, demonstrates that ED data from disparate health systems and EHR vendors can be harmonized for use in a single registry with a common data model. The current PECARN Registry represents data from 2,019,461 pediatric ED visits, 894,503 distinct patients, more than 12.5 million narrative reports, and 12,469,754 laboratory tests and continues to accrue data monthly.  The Registry is a robust harmonized clinical registry that includes data from diverse patients, sites, and EHR vendors derived via data extraction, deidentification, and secure submission to a central data coordinating center. The data provided may be used for benchmarking, clinical quality improvement, and comparative effectiveness research. Schattauer.

  8. Role of India's wildlife in the emergence and re-emergence of zoonotic pathogens, risk factors and public health implications.

    Science.gov (United States)

    Singh, B B; Gajadhar, A A

    2014-10-01

    Evolving land use practices have led to an increase in interactions at the human/wildlife interface. The presence and poor knowledge of zoonotic pathogens in India's wildlife and the occurrence of enormous human populations interfacing with, and critically linked to, forest ecosystems warrant attention. Factors such as diverse migratory bird populations, climate change, expanding human population and shrinking wildlife habitats play a significant role in the emergence and re-emergence of zoonotic pathogens from India's wildlife. The introduction of a novel Kyasanur forest disease virus (family flaviviridae) into human populations in 1957 and subsequent occurrence of seasonal outbreaks illustrate the key role that India's wild animals play in the emergence and reemergence of zoonotic pathogens. Other high priority zoonotic diseases of wildlife origin which could affect both livestock and humans include influenza, Nipah, Japanese encephalitis, rabies, plague, leptospirosis, anthrax and leishmaniasis. Continuous monitoring of India's extensively diverse and dispersed wildlife is challenging, but their use as indicators should facilitate efficient and rapid disease-outbreak response across the region and occasionally the globe. Defining and prioritizing research on zoonotic pathogens in wildlife are essential, particularly in a multidisciplinary one-world one-health approach which includes human and veterinary medical studies at the wildlife-livestock-human interfaces. This review indicates that wild animals play an important role in the emergence and re-emergence of zoonotic pathogens and provides brief summaries of the zoonotic diseases that have occurred in wild animals in India. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Antimicrobial resistance: A global emerging threat to public health systems.

    Science.gov (United States)

    Ferri, Maurizio; Ranucci, Elena; Romagnoli, Paola; Giaccone, Valerio

    2017-09-02

    Antimicrobial resistance (AMR) became in the last two decades a global threat to public health systems in the world. Since the antibiotic era, with the discovery of the first antibiotics that provided consistent health benefits to human medicine, the misuse and abuse of antimicrobials in veterinary and human medicine have accelerated the growing worldwide phenomenon of AMR. This article presents an extensive overview of the epidemiology of AMR, with a focus on the link between food producing-animals and humans and on the legal framework and policies currently implemented at the EU level and globally. The ways of responding to the AMR challenges foresee an array of measures that include: designing more effective preventive measures at farm level to reduce the use of antimicrobials; development of novel antimicrobials; strengthening of AMR surveillance system in animal and human populations; better knowledge of the ecology of resistant bacteria and resistant genes; increased awareness of stakeholders on the prudent use of antibiotics in animal productions and clinical arena; and the public health and environmental consequences of AMR. Based on the global nature of AMR and considering that bacterial resistance does not recognize barriers and can spread to people and the environment, the article ends with specific recommendations structured around a holistic approach and targeted to different stakeholders.

  10. [Evaluation of new and emerging health technologies. Proposal for classification].

    Science.gov (United States)

    Prados-Torres, J D; Vidal-España, F; Barnestein-Fonseca, P; Gallo-García, C; Irastorza-Aldasoro, A; Leiva-Fernández, F

    2011-01-01

    Review and develop a proposal for the classification of health technologies (HT) evaluated by the Health Technology Assessment Agencies (HTAA). Peer review of AETS of the previous proposed classification of HT. Analysis of their input and suggestions for amendments. Construction of a new classification. Pilot study with physicians. Andalusian Public Health System. Spanish HTAA. Experts from HTAA. Tutors of family medicine residents. HT Update classification previously made by the research team. Peer review by Spanish HTAA. Qualitative and quantitative analysis of responses. Construction of a new and pilot study based on 12 evaluation reports of the HTAA. We obtained 11 thematic categories that are classified into 6 major head groups: 1, prevention technology; 2, diagnostic technology; 3, therapeutic technologies; 4, diagnostic and therapeutic technologies; 5, organizational technology, and 6, knowledge management and quality of care. In the pilot there was a good concordance in the classification of 8 of the 12 reports reviewed by physicians. Experts agree on 11 thematic categories of HT. A new classification of HT with double entry (Nature and purpose of HT) is proposed. APPLICABILITY: According to experts, the classification of the work of the HTAA may represent a useful tool to transfer and manage knowledge. Moreover, an adequate classification of the HTAA reports would help clinicians and other potential users to locate them and this can facilitate their dissemination. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

  11. Emerging Adults' Stress and Health: The Role of Parent Behaviors and Cognitions

    Science.gov (United States)

    Donnelly, Reesa; Renk, Kimberly; McKinney, Cliff

    2013-01-01

    Although parent behaviors and cognitions are important for stress/health outcomes throughout development, little research examines whether cognitions mediate the relationship between parent behaviors and stress/health outcomes. As a result, the current study examined the reports of 160 emerging adults regarding their mothers' and fathers'…

  12. Hurricane Hugo: Emergency Preparedness Planning and Response for Mental Health Services.

    Science.gov (United States)

    Carter, Nancy C.; And Others

    This report describes how, in the aftermath of Hurricane Hugo, the South Carolina Department of Mental Health activated its Emergency Preparedness Plan to assist mental health centers and their staff in providing crisis counseling services to the general public. The first section explains the history and structure of the involvement by the…

  13. Learning to Promote Health at an Emergency Care Department: Identifying Expansive and Restrictive Conditions

    Science.gov (United States)

    Gustavsson, Maria; Ekberg, Kerstin

    2015-01-01

    This article reports on the findings of a planned workplace health promotion intervention, and the aim is to identify conditions that facilitated or restricted the learning to promote health at an emergency care department in a Swedish hospital. The study had a longitudinal design, with interviews before and after the intervention and follow-up…

  14. Happy but unhealthy: The relationship between social ties and health in an emerging network.

    NARCIS (Netherlands)

    Howell, Jennifer L.; Koudenburg, Namkje; Loschelder, David D.; Weston, Dale; Fransen, Katrien; De Dominices, Stefano; Gallagher, Stephen; Haslam, S. Alexander

    2014-01-01

    Social connections are essential to health and well-being. However, when pursing social acceptance, people may sometimes engage in behavior that is detrimental to their health. Using a multi-time-point design, we examined whether the structure of an emerging network of students in an academic summer

  15. 78 FR 24153 - Notice of Emergency Approval of an Information Collection; National Animal Health Monitoring...

    Science.gov (United States)

    2013-04-24

    ...In accordance with the Paperwork Reduction Act of 1995, this notice announces that the Animal and Plant Health Inspection Service has requested and received emergency approval of an information collection for a National Animal Health Monitoring System Equine Herpesvirus Myeloencephalopathy Study to support the equine industry in the United States.

  16. Mental Health Literacy in Emerging Adults in a University Setting: Distinctions between Symptom Awareness and Appraisal

    Science.gov (United States)

    Gagnon, Michelle M.; Gelinas, Bethany L.; Friesen, Lindsay N.

    2017-01-01

    Despite the high prevalence of mental health concerns in university populations, students are unlikely to seek formal help. The current study examined help-seeking behaviors among emerging adults in a university setting using a mental health literacy framework. Responses from 122 university undergraduates were examined. Students ranged in age from…

  17. Research into Australian emergency services personnel mental health and wellbeing: An evidence map.

    Science.gov (United States)

    Varker, Tracey; Metcalf, Olivia; Forbes, David; Chisolm, Katherine; Harvey, Sam; Van Hooff, Miranda; McFarlane, Alexander; Bryant, Richard; Phelps, Andrea J

    2018-02-01

    Evidence maps are a method of systematically characterising the range of research activity in broad topic areas and are a tool for guiding research priorities. 'Evidence-mapping' methodology was used to quantify the nature and distribution of recent peer-reviewed research into the mental health and wellbeing of Australian emergency services personnel. A search of the PsycINFO, EMBASE and Cochrane Library databases was performed for primary research articles that were published between January 2011 and July 2016. In all, 43 studies of primary research were identified and mapped. The majority of the research focused on organisational and individual/social factors and how they relate to mental health problems/wellbeing. There were several areas of research where very few studies were detected through the mapping process, including suicide, personality, stigma and pre-employment factors that may contribute to mental health outcomes and the use of e-health. No studies were detected which examined the prevalence of self-harm and/or harm to others, bullying, alcohol/substance use, barriers to care or experience of families of emergency services personnel. In addition, there was no comprehensive national study that had investigated all sectors of emergency services personnel. This evidence map highlights the need for future research to address the current gaps in mental health and wellbeing research among Australian emergency services personnel. Improved understanding of the mental health and wellbeing of emergency services personnel, and the factors that contribute, should guide organisations' wellbeing policies and procedures.

  18. Partially wrong? Partial equilibrium and the economic analysis of public health emergencies of international concern.

    Science.gov (United States)

    Beutels, P; Edmunds, W J; Smith, R D

    2008-11-01

    We argue that traditional health economic analysis is ill-equipped to estimate the cost effectiveness and cost benefit of interventions that aim at controlling and/or preventing public health emergencies of international concern (such as pandemic influenza or severe acute respiratory syndrome). The implicit assumption of partial equilibrium within both the health sector itself and--if a wider perspective is adopted--the economy as a whole would be violated by such emergencies. We propose an alternative, with the specific aim of accounting for the behavioural changes and capacity problems that are expected to occur when such an outbreak strikes. Copyright (c) 2008 John Wiley & Sons, Ltd.

  19. EMERGING ANTIMICROBIAL RESISTANCE IN HOSPITAL A THREAT TO PUBLIC HEALTH

    Directory of Open Access Journals (Sweden)

    Vichal Rastogi

    2013-01-01

    Full Text Available Background: Antimicrobial resistance(AMR threatens the health of many throughout the world, since both old and new infectious diseases remain a formidable public health threat. When pathogenic microorganisms can multiply beyond some critical mass in the face of invading antimicrobials, treatment outcome is compromised. This phenomenon is referred as antimicrobial resistance (AMR. Objective: This retrospective study was conducted to assess the overall antimicrobial resistance in bacterial isolates from tertiary care hospitals as majority of patients here receive empirical antibiotics therapy. Method: This retrospective study was carried out in teaching hospital, Greater Noida to determine prevalence of multidrug resistance in patients in relation to empirical antibiotic therapy in hospital. Various samples (pus,urine,blood were collected for bacterial culture and antibiotic sensitivity. Results: Total 500 bacterial strains isolated from ICU, surgery, obstetrics & gynaecology and orthopaedics and their sensitivity pattern was compared in this study. The highest number of resistant bacterias were of pseudomonas sp. i.e. 21(33.87% followed by 16(25.80% of staphylococcus aureus, 12(19.35% of Escherichia coli, Klebseilla sp & Proteus vulgaris were 05(8.06% each & Citrobacter sp. 03(4.83%. Total 62(12.4% bacterial isolates were found to be resistant to multiple drugs. The 31 (50% of these resistant bacteria were prevalent in ICU, 12(19.35% in Surgery, 11(17.74% in Gynaecology, 08(12.90% in Orthopaedics.. All the bacterial strains were resistant to common antibiotics like Penicillin, Amoxicillin, Doxycycline & Cotrimoxazole and some were even resistant to Imipenem. Conclusion: Therefore we have outlined the nature of the antimicrobial resistance problem as an important health issue for national and international community. It is advised to avoid use of empirical antibiotics therapy.

  20. Relations of Behavioral Autonomy to Health Outcomes Among Emerging Adults With and Without Type 1 Diabetes

    Science.gov (United States)

    Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

    2014-01-01

    Objective To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. Methods High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. Results There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Conclusions Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. PMID:25157070

  1. 78 FR 60283 - Guidance for Temporary Reassignment of State and Local Personnel During a Public Health Emergency

    Science.gov (United States)

    2013-10-01

    ... Personnel During a Public Health Emergency AGENCY: Department of Health and Human Services, Office of the... and Local Personnel during a Public Health Emergency.'' Section 201 of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), Public Law 113-5, amends section 319 of the Public Health...

  2. Emerging photovoltaic technologies: Environmental and health issues update

    Science.gov (United States)

    Fthenakis, Vasilis M.; Moskowitz, Paul D.

    1997-02-01

    New photovoltaic (PV) technologies promise low-cost, reliable PV modules and have the potential for significant PV penetration into the energy market. These prospects for commercialization have attracted renewed interest in the advantageous environmental impact of using PV and also in the potential environmental, health and safety (EHS) burdens in PV manufacturing and decommissioning. In this paper, we highlight recent studies on EHS issues: a) An integrated energy-environmental-economic analysis which shows that large-scale use of PV can significantly contribute to alleviating the greenhouse effect; in the United States alone, it could displace 450 million tons of carbon emissions by the year 2030, b) Recycling of the spent modules and scarp is economically feasible; current research centers on improving the efficiency and economics of recycling CdTe and CIS modules, c) Toxicological studies conducted by the National Institute of Environmental Health Sciences (NIEHS) compared the acute toxicity of CdTe, CIS, and CGS; CdTe was the most toxic, and CGS the least toxic of the three. Additional studies are now comparing the systemic toxicity of these compounds with the toxicity of their precursors.

  3. Emerging photovoltaic technologies: Environmental and health issues update

    Energy Technology Data Exchange (ETDEWEB)

    Fthenakis, V.M.; Moskowitz, P.D. [Biomedical and Environmental Assessment Group, Department of Applied Science, Brookhaven National Laboratory, Upton, New York 11973 (United States)

    1997-02-01

    New photovoltaic (PV) technologies promise low-cost, reliable PV modules and have the potential for significant PV penetration into the energy market. These prospects for commercialization have attracted renewed interest in the advantageous environmental impact of using PV and also in the potential environmental, health and safety (EHS) burdens in PV manufacturing and decommissioning. In this paper, we highlight recent studies on EHS issues: (a) An integrated energy-environmental-economic analysis which shows that large-scale use of PV can significantly contribute to alleviating the greenhouse effect; in the United States alone, it could displace 450 million tons of carbon emissions by the year 2030, (b) Recycling of the spent modules and scarp is economically feasible; current research centers on improving the efficiency and economics of recycling CdTe and CIS modules, (c) Toxicological studies conducted by the National Institute of Environmental Health Sciences (NIEHS) compared the acute toxicity of CdTe, CIS, and CGS; CdTe was the most toxic, and CGS the least toxic of the three. Additional studies are now comparing the systemic toxicity of these compounds with the toxicity of their precursors. {copyright} {ital 1997 American Institute of Physics.}

  4. Signature Optical Cues: Emerging Technologies for Monitoring Plant Health

    Directory of Open Access Journals (Sweden)

    Anand K. Asundi

    2008-05-01

    Full Text Available Optical technologies can be developed as practical tools for monitoring plant health by providing unique spectral signatures that can be related to specific plant stresses. Signatures from thermal and fluorescence imaging have been used successfully to track pathogen invasion before visual symptoms are observed. Another approach for noninvasive plant health monitoring involves elucidating the manner with which light interacts with the plant leaf and being able to identify changes in spectral characteristics in response to specific stresses. To achieve this, an important step is to understand the biochemical and anatomical features governing leaf reflectance, transmission and absorption. Many studies have opened up possibilities that subtle changes in leaf reflectance spectra can be analyzed in a plethora of ways for discriminating nutrient and water stress, but with limited success. There has also been interest in developing transgenic phytosensors to elucidate plant status in relation to environmental conditions. This approach involves unambiguous signal creation whereby genetic modification to generate reporter plants has resulted in distinct optical signals emitted in response to specific stressors. Most of these studies are limited to laboratory or controlled greenhouse environments at leaf level. The practical translation of spectral cues for application under field conditions at canopy and regional levels by remote aerial sensing remains a challenge. The movement towards technology development is well exemplified by the Controlled Ecological Life Support System under development by NASA which brings together technologies for monitoring plant status concomitantly with instrumentation for environmental monitoring and feedback control.

  5. Health care providers' knowledge of, attitudes toward and provision of emergency contraceptives in Lagos, Nigeria.

    Science.gov (United States)

    Ebuehi, Olufunke Margaret; Ebuehi, Osaretin A T; Inem, Victor

    2006-06-01

    Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients. In 2003-2004, a sample of 256 health care providers within Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences. Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so. Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.

  6. Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan.

    Science.gov (United States)

    Imai, Hirohisa; Nakao, Hiroyuki; Nakagi, Yoshihiko; Niwata, Satoko; Sugioka, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

    2006-11-01

    The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction". Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

  7. Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.

    Science.gov (United States)

    Southard, Erik P; Neufeld, Jonathan D; Laws, Stephanie

    2014-07-01

    Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room. Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time. There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2 h (standard deviation=13.2 h) and 14.2 h, respectively, to 5.4 h (standard deviation =6.4 h) and 2.6 h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures. Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.

  8. Attending to scalar ethical issues in emerging approaches to environmental health research and practice.

    Science.gov (United States)

    Buse, Chris G; Smith, Maxwell; Silva, Diego S

    2018-06-04

    Accelerated changes to the planet have created novel spaces to re-imagine the boundaries and foci of environmental health research. Climate change, mass species extinction, ocean acidification, biogeochemical disturbance, and other emergent environmental issues have precipitated new population health perspectives, including, but not limited to, one health, ecohealth, and planetary health. These perspectives, while nuanced, all attempt to reconcile broad global challenges with localized health impacts by attending to the reciprocal relationships between the health of ecosystems, animals, and humans. While such innovation is to be encouraged, we argue that a more comprehensive engagement with the ethics of these emerging fields of inquiry will add value in terms of the significance and impact of associated interventions. In this contribution, we highlight how the concept of spatial and temporal scale can be usefully deployed to shed light on a variety of ethical issues common to emerging environmental health perspectives, and that the potential of scalar analysis implicit to van Potter's conceptualization of bioethics has yet to be fully appreciated. Specifically, we identify how scale interacts with key ethical issues that require consideration and clarification by one health, ecohealth, and planetary health researchers and practitioners to enhance the effectiveness of research and practice, including justice and governance.

  9. Responding to Public Health Emergencies on Tribal Lands: Jurisdictional Challenges and Practical Solutions.

    Science.gov (United States)

    Barnard, Justin B

    2015-01-01

    Response to public health emergencies on tribal lands poses a unique challenge for state and tribal public health officials. The complexity and intensely situation-specific nature of federal Indian jurisprudence leaves considerable question as to which government entity, state or tribal, has jurisdiction on tribal lands to undertake basic emergency measures such as closure of public spaces, quarantine, compulsory medical examination, and investigation. That jurisdictional uncertainty, coupled with cultural differences and an often troubled history of tribal-state relations, threatens to significantly impede response to infectious disease outbreaks or other public health emergencies on tribal lands. Given that tribal communities may be disproportionately impacted by public health emergencies, it is critical that tribal, state, and local governments engage with each other in coordinated planning for public health threats. This Article is offered as a catalyst for such planning efforts. The Article identifies some of the most pressing jurisdictional issues that may confront governments responding to a public health emergency on tribal lands, with the aim of highlighting the nature of the problem and the need for action. The Article goes on to examine the most promising means of addressing jurisdictional uncertainty: intergovernmental agreements. Already utilized in many areas of shared interest between tribe and state, intergovernmental agreements offer neighboring state, local, and tribal governments a vehicle for delineating roles and authorities in an emergency, and may lay the groundwork for sharing resources. The Article surveys various representative tribal public health intergovernmental agreements, and concludes with suggestions for tribes and state or local governments looking to craft their own agreements.

  10. [SARS: a new emergency in the world health].

    Science.gov (United States)

    Calza, Leonardo; Manfredi, Roberto; Verucchi, Gabriella; Chiodo, Francesco

    2003-01-01

    The Severe Acute Respiratory Syndrome (SARS) is a new life-threatening respiratory disease which has its origins in Guangdong province, China, where the earliest known cases were identified in November 2002. Since then, probable cases of SARS have been reported in 30 countries and the current cumulative number of cases is 8,240 with 745 deaths and a global fatality rate of 9%. The most frequently involved areas include China, Hong Kong, Singapore, Canada, Vietnam and Philippines. Most cases of SARS to date have occurred in young adults and this disease appears to spread most commonly by close person-to-person contact, involving exposure to infectious droplets and body fluids. This transmission pattern generally involves household members, health care workers and international travellers, while a large and sudden cluster of almost simultaneous cases in an housing estate of Hong Kong has raised the possibility of transmission from an environmental source. The most common presenting symptoms are fever, malaise, non-productive cough and dyspnea, associated with pulmonary interstitial infiltrates on chest radiography. A novel coronavirus is associated with this outbreak, and the laboratory evidences indicate that this virus has an etiologic role in SARS, but the role of other concurrent viral agents (such as metapneumovirus) identified in these patients requires further investigation.

  11. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    OpenAIRE

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-reso...

  12. Emergency mental health nursing for self-harming refugees and asylum seekers.

    Science.gov (United States)

    Procter, Nicholas G

    2005-09-01

    This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

  13. Emerging nicotine delivery products. Implications for public health.

    Science.gov (United States)

    Benowitz, Neal L

    2014-02-01

    The idea of clean nicotine delivery systems that would satisfy nicotine craving and promote smoking cessation has been considered as a possible public health tool for many years. Nicotine medications have been useful for smoking cessation but have not found widespread popularity among smokers, perhaps because of slow nicotine delivery and other sensory characteristics that differ from cigarettes. Traditional smokeless tobacco delivers as much nicotine as cigarettes and has been advocated for harm reduction but contains carcinogenic nitrosamines and has not been proven to promote cessation. Furthermore, there is concern that dual use of smokeless tobacco and cigarettes may inhibit quitting smoking. Newer oral dissolvable tobacco products contain lower levels of toxicants than other smokeless tobacco but also deliver much less nicotine and have not been popular with consumers. Electronic cigarettes that aerosolize nicotine without generating toxic tobacco combustion products have become quite popular and hold promise as a way to attract smokers away from cigarettes, although efficacy in promoting smoking cessation has not yet been demonstrated. There are concerns about safety of long-term use, and there is evidence that youth, including nonsmokers, are taking up e-cigarette use. E-cigarettes are marketed for use when one cannot smoke conventional cigarettes, and such use might result in more persistent cigarette smoking. Although their benefits and risks are being vigorously debated, e-cigarettes or other clean nicotine delivery devices could play an important role as an adjunct to a U.S. Food and Drug Administration regulatory intervention to make cigarettes less addictive and in this context could contribute to the end of cigarette smoking and smoking-induced disease.

  14. Cancer among circumpolar populations: an emerging public health concern

    Directory of Open Access Journals (Sweden)

    T. Kue Young

    2016-01-01

    Full Text Available Objectives: To determine and compare the incidence of cancer among the 8 Arctic States and their northern regions, with special focus on 3 cross-national indigenous groups – Inuit, Athabaskan Indians and Sami. Methods: Data were extracted from national and regional statistical agencies and cancer registries, with direct age-standardization of rates to the world standard population. For comparison, the “world average” rates as reported in the GLOBOCAN database were used. Findings: Age-standardized incidence rates by cancer sites were computed for the 8 Arctic States and 20 of their northern regions, averaged over the decade 2000–2009. Cancer of the lung and colon/rectum in both sexes are the commonest in most populations. We combined the Inuit from Alaska, Northwest Territories, Nunavut and Greenland into a “Circumpolar Inuit” group and tracked cancer trends over four 5-year periods from 1989 to 2008. There has been marked increase in lung, colorectal and female breast cancers, while cervical cancer has declined. Compared to the GLOBOCAN world average, Inuit are at extreme high risk for lung and colorectal cancer, and also certain rare cancers such as nasopharyngeal cancer. Athabaskans (from Alaska and Northwest Territories share some similarities with the Inuit but they are at higher risk for prostate and breast cancer relative to the world average. Among the Sami, published data from 3 cohorts in Norway, Sweden and Finland show generally lower risk of cancer than non-Sami. Conclusions: Cancer among certain indigenous people in the Arctic is an increasing public health concern, especially lung and colorectal cancer.

  15. Diagnosis of Life-Threatening Alpha-Gal Food Allergy Appears to Be Patient Driven.

    Science.gov (United States)

    Flaherty, Mary Grace; Kaplan, Samantha Jan; Jerath, Maya R

    2017-10-01

    Patients exhibiting life-threatening symptoms associated with the alpha-gal food allergy (delayed urticaria or anaphylaxis due to mammalian meat) are frequently undiagnosed, causing unnecessary emergency department (ED) and health care visits, and extensive pain and suffering. This study aimed to determine the path to diagnosis experienced by alpha-gal patients. Semistructured interviews were conducted from March to June 2016 with a chronological systematic sample of approximately 10% of patients diagnosed with alpha-gal and treated by the University of North Carolina Allergy and Immunology Clinic (n = 28). Main outcome measures included average length of time between first symptoms' appearance and diagnosis, number and type of health care encounters en route to diagnosis, and typical symptom severity. Six interviewees (21%) were diagnosed within a year of experiencing symptoms, of the remaining 22, mean time to diagnosis was 7.1 years. In over 100 medical encounters (including 28 ED visits and 2 urgent care) the correct diagnosis or effective diagnosing referral occurred less than 10% of the time. Seventy-one percent (20/28) described their first symptoms as severe. More patients found the allergist specializing in this condition on their own (n = 12; 43%) than those who were formally diagnosed or received referrals (n = 10; 36%) through the health care system. The medical community is challenged to stay abreast of emerging and newly uncovered illnesses through traditional medical literature communication channels. Presently, patients more often discover a diagnosis of alpha-gal allergy by using information resources on their own than by presenting to the ED with anaphylaxis.

  16. Involvement of the Public Health Authority in emergency planning and preparedness for nuclear facilities in Hungary

    International Nuclear Information System (INIS)

    Sztanyik, L.B.

    1986-01-01

    It is required by the Hungarian Atomic Energy Act and its enacting clause of 1980 that facilities established for the application of atomic energy be designed, constructed and operated in such a manner that abnormal operational occurrences can be avoided and unplanned exposures to radiation and radioactive substances can be prevented. The primary responsibility for planning and implementing emergency actions rests with the management of the operating organization. Thus one of the prerequisites of licensing the first nuclear power plant in Hungary was the preparation and submission for approval of an emergency plan by the operating organization. In addition to this, the council of the county where the power plant is located has also been obliged to prepare a complementary emergency plan, in co-operation with other regional and national authorities, for the prevention of consequences from an emergency that may extend beyond the site boundary of the plant. In preparing the complementary plan, the emergency plan of the facility had to be taken into account. Unlike most national authorities involved in nuclear matters, the Public Health Authority is involved in the preparation of plans for every kind of emergency in a nuclear facility, including even those whose consequences can probably be confined to the plant site. The paper discusses in detail the role and responsibility of the Public Health Authority in emergency planning and preparedness for nuclear facilities. (author)

  17. How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization

    Science.gov (United States)

    Charoenca, Naowarut; Kungskulniti, Nipapun; Mock, Jeremiah; Hamann, Stephen; Vathesatogkit, Prakit

    2015-01-01

    Background Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure. Objective In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. Design We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority – road accidents – to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. Results In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents. Conclusions Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization. PMID:26328948

  18. Preparedness and Emergency Response Learning Centers: supporting the workforce for national health security.

    Science.gov (United States)

    Richmond, Alyson L; Sobelson, Robyn K; Cioffi, Joan P

    2014-01-01

    The importance of a competent and prepared national public health workforce, ready to respond to threats to the public's health, has been acknowledged in numerous publications since the 1980s. The Preparedness and Emergency Response Learning Centers (PERLCs) were funded by the Centers for Disease Control and Prevention in 2010 to continue to build upon a decade of focused activities in public health workforce preparedness development initiated under the Centers for Public Health Preparedness program (http://www.cdc.gov/phpr/cphp/). All 14 PERLCs were located within Council on Education for Public Health (CEPH) accredited schools of public health. These centers aimed to improve workforce readiness and competence through the development, delivery, and evaluation of targeted learning programs designed to meet specific requirements of state, local, and tribal partners. The PERLCs supported organizational and community readiness locally, regionally, or nationally through the provision of technical consultation and dissemination of specific, practical tools aligned with national preparedness competency frameworks and public health preparedness capabilities. Public health agencies strive to address growing public needs and a continuous stream of current and emerging public health threats. The PERLC network represented a flexible, scalable, and experienced national learning system linking academia with practice. This system improved national health security by enhancing individual, organizational, and community performance through the application of public health science and learning technologies to frontline practice.

  19. How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization.

    Science.gov (United States)

    Charoenca, Naowarut; Kungskulniti, Nipapun; Mock, Jeremiah; Hamann, Stephen; Vathesatogkit, Prakit

    2015-01-01

    Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure. In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority - road accidents - to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents. Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.

  20. How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization

    Directory of Open Access Journals (Sweden)

    Naowarut Charoenca

    2015-08-01

    Full Text Available Background: Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs have not established adequate sustainable funding for health promotion and health infrastructure. Objective: In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. Design: We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority – road accidents – to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. Results: In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth to address a range of pressing health priorities, including programs that substantially reduced road accidents. Conclusions: Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.

  1. The approach of prehospital health care personnel working at emergency stations towards forensic cases.

    Science.gov (United States)

    Asci, Ozlem; Hazar, Guleser; Sercan, Isa

    2015-09-01

    The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 2013 and February 2014. Of 141 health personnel that constituted sample of the study, 48.9% were nurses, 9.9% emergency medicine technicians, and 41.1% ambulance and emergency care technicians. The rate of feeling sufficient in coping with forensic cases and incidents was 20.6%. There was a lower rate of receiving education about the approach towards forensic cases (15.6%). In the study, the frequency of encountering with at least one forensic case was 88.7%. Traffic accidents (72.5%), suicides (41.5%) and assaults (41.5%) were among the most frequent reasons of forensic cases. The practices of nurses were more successful in woundings by firearms compared to other health personnel (p forensic cases. The personnel with higher educational level and nurses have more successful practices in forensic cases. Health personnel have approaches that may negatively affect the solution of forensic cases.

  2. A world wide public health problem: the principal re-emerging infectious diseases.

    Science.gov (United States)

    De Luca D'Alessandro, E; Giraldi, G

    2011-01-01

    The extraordinary progress in the knowledge of infectious disease, the discovery of antibiotics and effective vaccines are among the great achievement of the nineteenth and twentieth centuries. These achievement have led to a dramatic reduction in the levels of mortality from these diseases. According to the World Health Organization, the term "re-emerging infectious diseases" refers to infectious diseases, which although well known, have not been of recent public health importance. However, climate change, migration, changes in health services, antibiotic resistance, population increase, international travel, the increase in the number of immune-depressed patients ,etc have lead to the re-emergence of these diseases. The climate changes are exposing sectors of the population to inadequate fresh air, water, food and resources for survival which, in consequence, provoke increases in both internal and international migration. In this particular period in which we find ourselves, characterized by globalization, the international community has become aware that the re-emergence of these diseases poses an important risk for public health underlines the necessity to adopt appropriate strategies for their prevention and control. The re-emerging diseases of the twenty-first century are a serious problem for public health and even though there has been enormous progress in medical science and in the battle against infectious diseases, they are still a long way from being really brought under control. A well organized monitoring system would enable the epidemiological characteristics of the infectious diseases to be analyzed and the success or otherwise of preventive interventions to be precisely evaluated. For this reason, the World Health Organization and the European Union have discussed the formation of a collaborative network for the monitoring and control of re-emerging diseases and has initiated special programmes. The battle between humanity and infectious disease

  3. How do we capture the emergency nurse practitioners' contribution to value in health service delivery?

    Science.gov (United States)

    Jennings, Natasha; Lutze, Matthew; Clifford, Stuart; Maw, Michael

    2017-03-01

    The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.

  4. Protecting Public Health in Nuclear Emergencies-the Need to Broaden the Process

    International Nuclear Information System (INIS)

    Carr, Z.; Roebbel, N.; Weiss, W.; Abrahams, J.

    2016-01-01

    It is necessary for the radiation protection system to broaden beyond radioactive dose, the view on impact of nuclear accidents, taking in consideration the psychological, social and economic determinants impacting the vulnerability of the exposed population, as well as the impacts of emergency countermeasures. It is strongly recommended to pursue strategies, approaches and services that will address these aspects within the general health protection system and will be applied before, during and after an emergency. The paper raises awareness and proposes a three-step development process for an integrated framework based on the social determinants of health approach. (authors)

  5. The Evolution of Public Health Emergency Management as a Field of Practice.

    Science.gov (United States)

    Rose, Dale A; Murthy, Shivani; Brooks, Jennifer; Bryant, Jeffrey

    2017-09-01

    The health impacts of recent global infectious disease outbreaks and other disasters have demonstrated the importance of strengthening public health systems to better protect communities from naturally occurring and human-caused threats. Public health emergency management (PHEM) is an emergent field of practice that draws on specific sets of knowledge, techniques, and organizing principles necessary for the effective management of complex health events. We highlight how the nascent field of PHEM has evolved in recent years. We explore this development by first examining multiple sites of intersection between the fields of public health and emergency management. We then analyze 2 of the principal pillars on which PHEM was built: organizational and programmatic (i.e., industry) standards and the incident management system. This is followed by a sketch of the key domains, or functional areas, of PHEM and their application to the emergency management cycle. We conclude with some observations about PHEM in a global context and discuss how the field might continue to evolve.

  6. Public Health System Research in Public Health Emergency Preparedness in the United States (2009-2015): Actionable Knowledge Base.

    Science.gov (United States)

    Savoia, Elena; Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P; Guicciardi, Stefano

    2017-09-01

    In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics. To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies. We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool. Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific

  7. The emergence of a health insurance system in a developing country: the case of South Korea.

    Science.gov (United States)

    Cho, S

    1989-12-01

    In an attempt to understand the social forces and the economic and political conditions under which new social policies emerge in developing countries, this study outlines factors affecting the introduction of the health insurance system in South Korea. The emergence of the South Korean health insurance system was influenced by changing labor needs of the industrial sector, increasing social expectations, external and international pressures, increasing medical costs, and class conflict. These pressures compelled the South Korean government to respond to demands for the introduction of new social welfare policies in the 1970s. In the case of South Korea, the new health insurance system resulted from the government's attempts to cope with political, economic, and social pressures rather than from an ideological commitment to the well-being of the population. The resulting insurance system was a way to maintain the social order and legitimacy of the regime, and a means to promote the health of groups important to defense or production.

  8. Terrorism and emergency preparedness in state and territorial public health departments--United States, 2004.

    Science.gov (United States)

    2005-05-13

    After the events of September 11, 2001, federal funding for state public health preparedness programs increased from $67 million in fiscal year (FY) 2001 to approximately $1 billion in FY 2002. These funds were intended to support preparedness for and response to terrorism, infectious disease outbreaks, and other public health threats and emergencies. The Council of State and Territorial Epidemiologists (CSTE) assessed the impact of funding on epidemiologic capacity, including terrorism preparedness and response, in state health departments in November 2001 and again in May 2004, after distribution of an additional $1 billion in FY 2003. This report describes the results of those assessments, which indicated that increased funding for terrorism preparedness and emergency response has rapidly increased the number of epidemiologists and increased capacity for preparedness at the state level. However, despite the increase in epidemiologists, state public health officials estimate that 192 additional epidemiologists, an increase of 45.3%, are needed nationwide to fully staff terrorism preparedness programs.

  9. Preparations for Severe Winter Conditions by Emergency Health Personnel in Turkey.

    Science.gov (United States)

    Calışkan, Cüneyt; Algan, Aysun; Koçak, Hüseyin; Biçer, Burcu Küçük; Sengelen, Meltem; Cakir, Banu

    2014-04-23

    Emergency and core ambulance personnel work under all environmental conditions, including severe weather condtions. We evaluated emergency medical personnel in Çanakkale, Turkey, for their degree of preparedness. A descriptive study was conducted in Çanakkale, Turkey, within 112 emergency service units and their 17 district stations. Surveys were developed to measure the level of preparedness for serious winter conditions that individual workers made for themselves, their homes, and their cars. Of the 167 survey participants, the mean age was 29.8 ± 7.9 years; 52.7% were women; more than half (54.75%) were emergency medical technicians; and 53.3% were married. Only 10.4% of those who heated their homes with natural gas had carbon monoxide detectors. Scores relating to household and individual preparation for severe winter conditions increased by participants' age (P tires (P winter conditions (P = .016). Many of the surveyed emergency health personel demonstrated insufficient preparations for serious winter conditions. To increase the safety and efficiency of emergency medical personnel, educational training programs should be rountinely conducted. (Disaster Med Public Health Preparedness. 2014;0:1-4).

  10. The emergence of a global right to health norm--the unresolved case of universal access to quality emergency obstetric care.

    Science.gov (United States)

    Hammonds, Rachel; Ooms, Gorik

    2014-02-27

    The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. Kingdon's model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for utilising right to health based

  11. Have Maryland local health departments effectively put in place the information technology relevant to emergency preparedness?

    Science.gov (United States)

    Nguh, Jonas

    2013-01-01

    Ever since the terrorist attacks of 9/11, the federal government has increased funding for emergency preparedness. However, the literature continues to document several areas of weaknesses in public health emergency management by local health departments (LHD). This lack of preparedness affects the entire public. The purpose of this study was to determine whether or not Maryland LHDs have effectively put in place the information technology (IT) that is relevant for emergency preparedness. Base Firm-wide IT Infrastructure Services and the Feeny/Willcocks Framework for Core IS Capabilities are the two conceptual frameworks used in this study. This qualitative study used the survey method and the data were analyzed through content analysis. The results revealed that utilization, practice, and performance of IT by Maryland LHDs are not efficient or effective. Recommendations included the development of "best practices," increased funding for IT infrastructure and the establishment of strategic management framework for IT initiatives. Implications for positive social change include the development of recommendations to enhance emergency preparedness practice, and advancement of knowledge so as to facilitate the functions, and duties of health departments in emergency preparedness operations.

  12. Model of Emergency and Observation Nursing Services at the Community Health Center in East Java

    Directory of Open Access Journals (Sweden)

    Dwi Ananto Wibrata

    2017-07-01

    Full Text Available Public health centers as the spearhead of health services, also provide 'emergency and observation' nursing services, due to the high number of accidents in East Java. The purpose of this study was to develop the nurse's performance model in providing 'emergency and obeservation' nursing services at Puskesgadarsi ('Emergency and Observation' Community Health Center in East Java, using cross sectional design. The subjects of 120 nurses were selected by multi stage sampling technique. Data were collected through questionnaires and FGDs, and then analyzed using structural equation modeling to produce an model of ‘emergency and observation’ nursing service for nurses at Puskesgadarsi. Components of the model were reinforcing factors, personal factors, cognition factors, affection factors, commitment, interpersonal, reinforcement and nurse performance. Nurses can use this model in providing nursing services with due regard to their knowledge and skills, facilities and infrastructure, as well as interaction and self-reinforcement, so as to be able to perform nursing services 'emergency and observation' well.

  13. Mental Health and Job Burnout Among Pre-Hospital Emergency Care Personnel

    Directory of Open Access Journals (Sweden)

    Mahsa Haji Mohammad Hoseini

    2017-01-01

    Full Text Available Background: Work environment dictates physical, social and mental tensions each of which affect the staff’s health. Likewise, pre-hospital emergency care staff, due to the special nature of their job, are exposed to the tensions of emergency situations which can affect their health. Therefore, this study was conducted to scrutinize the relationship between the job burnout and mental health in pre-hospital emergencies of Qom Province. Materials and Methods: In this descriptive sectional study, 150 employed personnel of Qom 115 Emergency Care entered the study using census method. Data were gathered using questionnaires of “Background and Clinical Information”, “Mental Health”, and “Job Burnout”, and then based on central indices, Pearson correlation test and multiple linear regression statistical tests were run through software SPSS13 and then analyzed. Results: The average age of the participants was 30.8±5.8. The averages of the values of burnout and mental health were 69.43±12.4 and 60±14.1, respectively. According to Pearson correlation test, the values of the burnout and mental health have a significant negative correlation (r=-0.8. The results of multiple linear regression test showed that the correlation of the burnout and mental health considering the confounding variables is significant. (P=0.05 Conclusion: Pre-hospital employed personnel have desirable mental health and [low] burnout. Furthermore, improved mental health results in decreasing job burnout. Therefore, it is advisable to consider necessary facilities for caring for oneself.

  14. Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care

    OpenAIRE

    Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

    2013-01-01

    Objectives The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventati...

  15. Public health challenges and emerging diseases: the case of São Paulo

    Directory of Open Access Journals (Sweden)

    Silva Luiz Jacintho da

    2001-01-01

    Full Text Available The author discusses the challenges posed by emerging infectious diseases in 100 years of public health in the state of São Paulo, Brazil. With an advanced and organized public health system, São Paulo responded to the emergence of infectious diseases by creating research institutions and control programs. The late 19th century witnessed the first modern research institution in microbiology, in response to the bubonic plague. A changing economy led to constant changes in ecosystems. The late 20th century presents a wide array of both emerging and rapidly changing infectious diseases. The present situation calls for creative solutions. Ecosystem analysis and more agile epidemiological surveillance are seen as the best alternatives.

  16. A Conceptual Framework for Allocation of Federally Stockpiled Ventilators During Large-Scale Public Health Emergencies.

    Science.gov (United States)

    Zaza, Stephanie; Koonin, Lisa M; Ajao, Adebola; Nystrom, Scott V; Branson, Richard; Patel, Anita; Bray, Bruce; Iademarco, Michael F

    2016-01-01

    Some types of public health emergencies could result in large numbers of patients with respiratory failure who need mechanical ventilation. Federal public health planning has included needs assessment and stockpiling of ventilators. However, additional federal guidance is needed to assist states in further allocating federally supplied ventilators to individual hospitals to ensure that ventilators are shipped to facilities where they can best be used during an emergency. A major consideration in planning is a hospital's ability to absorb additional ventilators, based on available space and staff expertise. A simple pro rata plan that does not take these factors into account might result in suboptimal use or unused scarce resources. This article proposes a conceptual framework that identifies the steps in planning and an important gap in federal guidance regarding the distribution of stockpiled mechanical ventilators during an emergency.

  17. Preventing Absenteeism and Promoting Resilience Among Health Care Workers In Biological Emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Lesperance, Ann M.; Miller, James S.

    2009-05-08

    The ability to ensure adequate numbers of medical staff represents a crucial part of the medical response to any disaster. However, healthcare worker absenteeism during disasters, especially in the event of an attack of biological terrorism or an epidemic such as pandemic influenza, is a serious concern. Though a significant rate of absenteeism is often included as a baseline assumption in emergency planning, published reports on strategies to minimize absenteeism are comparatively few. This report documents interviews with managers and emergency response planners at hospitals and public health agencies and reviews existing survey data on healthcare worker absenteeism and studies of disasters to glean lessons about the needs of healthcare workers during those disasters. Based on this research, expected rates of absenteeism and individual determinants of absenteeism are presented along with recommendations of steps that hospitals, emergency medical services departments, public health organizations, and government agencies can take to meet the needs of healthcare workers and minimize absenteeism during a biological event.

  18. Assessing the integration of health center and community emergency preparedness and response planning.

    Science.gov (United States)

    Wineman, Nicole V; Braun, Barbara I; Barbera, Joseph A; Loeb, Jerod M

    2007-11-01

    To assess the state of health center integration into community preparedness, we undertook a national study of linkages between health centers and the emergency preparedness and response planning initiatives in their communities. The key objectives of this project were to gain a better understanding of existing linkages in a nationally representative sample of health centers, and identify health center demographic and experience factors that were associated with strong linkages. The objectives of the study were to gain a baseline understanding of existing health center linkages to community emergency preparedness and response systems and to identify factors that were associated with strong linkages. A 60-item questionnaire was mailed to the population of health centers supported by the Health Resources and Services Administration's Bureau of Primary Health Care in February 2005. Results were aggregated and a chi square analysis identified factors associated with stronger linkages. Overall performance on study-defined indicators of strong linkages was low: 34% had completed a hazard vulnerability analysis in collaboration with the community emergency management agency, 30% had their role documented in the community plan, and 24% participated in community-wide exercises. Stronger linkages were associated with experience responding to a disaster and a perception of high risk for experiencing a disaster. The potential for health centers to participate in an integrated response is not fully realized, and their absence from community-based planning leaves an already vulnerable population at greater risk. Community planners should be encouraged to include health centers in planning and response and centers should receive more targeted resources for community integration.

  19. Public health awareness of emerging zoonotic viruses of bats: A European perspective

    NARCIS (Netherlands)

    Poel, van der W.H.M.; Lina, P.H.C.; Kramps, J.A.

    2006-01-01

    Bats classified in the order Chiroptera are the most abundant and widely distributed non-human mammalian species in the world. Several bat species are reservoir hosts of zoonotic viruses and therefore can be a public health hazard. Lyssaviruses of different genotypes have emerged from bats in

  20. Perceived Parental Relationships and Health-Risk Behaviors in College-Attending Emerging Adults

    Science.gov (United States)

    Schwartz, Seth J.; Zamboanga, Byron L.; Ravert, Russell D.; Kim, Su Yeong; Weisskirch, Robert S.; Williams, Michelle K.; Bersamin, Melina; Finley, Gordon E.

    2009-01-01

    The present study investigated the association of perceived parenting with health-risk behaviors in an ethnically diverse sample of 1,728 college-attending emerging adults. Participants completed retrospective measures of perceived maternal and paternal nurturance, connection, psychological control, and disrespect and reported their frequency of…

  1. Effects of armed conflict on access to emergency health care in Palestinian West Bank

    DEFF Research Database (Denmark)

    Rytter, Maren Johanne Heilskov; Kjaeldgaard, Anne-Lene; Brønnum-Hansen, Henrik

    2006-01-01

    , delay in access to hospital, and course of hospital contact. SETTING: Three hospital emergency departments in Bethlehem and Nablus, in the occupied Palestinian West Bank, during one week in each hospital. PARTICIPANTS: All patients seeking health care in the three hospitals during the study period...

  2. A Systematic Review on Recent Advances in mHealth Systems: Deployment Architecture for Emergency Response.

    Science.gov (United States)

    Gonzalez, Enrique; Peña, Raul; Avila, Alfonso; Vargas-Rosales, Cesar; Munoz-Rodriguez, David

    2017-01-01

    The continuous technological advances in favor of mHealth represent a key factor in the improvement of medical emergency services. This systematic review presents the identification, study, and classification of the most up-to-date approaches surrounding the deployment of architectures for mHealth. Our review includes 25 articles obtained from databases such as IEEE Xplore, Scopus, SpringerLink, ScienceDirect, and SAGE. This review focused on studies addressing mHealth systems for outdoor emergency situations. In 60% of the articles, the deployment architecture relied in the connective infrastructure associated with emergent technologies such as cloud services, distributed services, Internet-of-things, machine-to-machine, vehicular ad hoc network, and service-oriented architecture. In 40% of the literature review, the deployment architecture for mHealth considered traditional connective infrastructure. Only 20% of the studies implemented an energy consumption protocol to extend system lifetime. We concluded that there is a need for more integrated solutions specifically for outdoor scenarios. Energy consumption protocols are needed to be implemented and evaluated. Emergent connective technologies are redefining the information management and overcome traditional technologies.

  3. A Systematic Review on Recent Advances in mHealth Systems: Deployment Architecture for Emergency Response

    Directory of Open Access Journals (Sweden)

    Enrique Gonzalez

    2017-01-01

    Full Text Available The continuous technological advances in favor of mHealth represent a key factor in the improvement of medical emergency services. This systematic review presents the identification, study, and classification of the most up-to-date approaches surrounding the deployment of architectures for mHealth. Our review includes 25 articles obtained from databases such as IEEE Xplore, Scopus, SpringerLink, ScienceDirect, and SAGE. This review focused on studies addressing mHealth systems for outdoor emergency situations. In 60% of the articles, the deployment architecture relied in the connective infrastructure associated with emergent technologies such as cloud services, distributed services, Internet-of-things, machine-to-machine, vehicular ad hoc network, and service-oriented architecture. In 40% of the literature review, the deployment architecture for mHealth considered traditional connective infrastructure. Only 20% of the studies implemented an energy consumption protocol to extend system lifetime. We concluded that there is a need for more integrated solutions specifically for outdoor scenarios. Energy consumption protocols are needed to be implemented and evaluated. Emergent connective technologies are redefining the information management and overcome traditional technologies.

  4. Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps.

    Science.gov (United States)

    Meyer, James D; McKean, Alastair J S; Blegen, Rebecca N; Demaerschalk, Bart M

    2018-05-09

    Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.

  5. Injury Severity Score coding: Data analyst v. emerging m-health ...

    African Journals Online (AJOL)

    benchmarking and quality improvement initiatives in the trauma ... We hypothesised that emerging mobile health (mhealth) technology could offer a costeffective alternative to the .... 33.98), including a mortality rate of 4.6% (95% CI 2.71 7.57).

  6. Digital Twins in Health Care : Ethical Implications of an Emerging Engineering Paradigm

    NARCIS (Netherlands)

    Bruynseels, K.R.C.; Santoni De Sio, F.; van den Hoven, M.J.

    2018-01-01

    Personalized medicine uses fine grained information on individual persons, to pinpoint deviations from the normal. ‘Digital Twins’ in engineering provide a conceptual framework to analyze these emerging data-driven health care practices, as well as their conceptual and ethical implications for

  7. Global Warming and the Political Ecology of Health: Emerging Crisis and Systemic Solutions

    Directory of Open Access Journals (Sweden)

    Kate Smith

    2012-06-01

    Full Text Available Review of Global Warming and the Political Ecology of Health: Emerging Crisis and Systemic Solutions. Hans Baer and Merrill Singer. 2008. Left Coast Press, Inc., Walnut Creek, CA. Pp. 238. $32.95 (paperback. ISBN 978-1-59874-354-8.

  8. Air Quality and Heart Health: An Emerging Topic for Heart Month

    Science.gov (United States)

    Air Quality and Heart Health: An Emerging Topic for Heart Month: Ambient air particle pollution increases short- and long-term cardiovascular morbidity and mortality. Older-people, those with pre-existing heart disease and lung disease and diabetes are at higher risk. Mechanism...

  9. Global health and emergency care: a resuscitation research agenda--part 1

    NARCIS (Netherlands)

    Aufderheide, Tom P.; Nolan, Jerry P.; Jacobs, Ian G.; van Belle, Gerald; Bobrow, Bentley J.; Marshall, John; Finn, Judith; Becker, Lance B.; Bottiger, Bernd; Cameron, Peter; Drajer, Saul; Jung, Julianna J.; Kloeck, Walter; Koster, Rudolph W.; Huei-Ming Ma, Matthew; Shin, Sang Do; Sopko, George; Taira, Breena R.; Timerman, Sergio; Eng Hock Ong, Marcus

    2013-01-01

    At the 2013 Academic Emergency Medicine global health consensus conference, a breakout session on a resuscitation research agenda was held. Two articles focusing on cardiac arrest and trauma resuscitation are the result of that discussion. This article describes the burden of disease and outcomes,

  10. A web-based, patient driven registry for Angelman syndrome: the global Angelman syndrome registry.

    Science.gov (United States)

    Napier, Kathryn R; Tones, Megan; Simons, Chloe; Heussler, Helen; Hunter, Adam A; Cross, Meagan; Bellgard, Matthew I

    2017-08-01

    Angelman syndrome (AS) is a rare neurodevelopmental disorder that is characterised by severe global developmental delays, ataxia, loss of speech, epilepsy, sleep disorders, and a happy disposition. There is currently no cure for AS, though several pharmaceutical companies are anticipating drug trials for new therapies to treat AS. The Foundation for Angelman Therapeutics (FAST) Australia therefore identified a need for a global AS patient registry to identify patients for recruitment for clinical trials.The Global AS Registry was deployed in September 2016 utilising the Rare Disease Registry Framework, an open-source tool that enables the efficient creation and management of patient registries. The Global AS Registry is web-based and allows parents and guardians worldwide to register, provide informed consent, and enter data on individuals with AS. 286 patients have registered in the first 8 months since deployment.We demonstrate the successful deployment of the first patient-driven global registry for AS. The data generated from the Global AS Registry will be crucial in identifying patients suitable for clinical trials and in informing research that will identify treatments for AS, and ultimately improve the lives of individuals and their families living with AS.

  11. The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

    Science.gov (United States)

    Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

    2018-05-01

    Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

  12. Perceived Facilitators and Barriers to Local Health Department Workers' Participation in Infectious Disease Emergency Responses.

    Science.gov (United States)

    Rutkow, Lainie; Paul, Amy; Taylor, Holly A; Barnett, Daniel J

    Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood. To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response. From April 2015 to January 2016, we conducted 28 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff. Interviews were conducted with individuals throughout the United States. We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness staff (n = 10). Individuals' descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response. Factors that facilitate willingness to respond to an infectious disease emergency included availability of vaccines and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one's job and community. Factors that hinder willingness to respond to an infectious disease emergency included potential disease exposure for oneself and one's family; logistical considerations for care of children, the elderly, and pets; and perceptions about one's role during an infectious disease response. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in

  13. Ebola Hemorrhagic Fever as a Public Health Emergency of International Concern; a Review Article.

    Science.gov (United States)

    Safari, Saeed; Baratloo, Alireza; Rouhipour, Alaleh; Ghelichkhani, Parisa; Yousefifard, Mahmood

    2015-01-01

    Ebola hemorrhagic fever (EHF) was first reported in 1976 with two concurrent outbreaks of acute viral hemorrhagic fever centered in Yambuku (near the Ebola river), Democratic Republic of Congo, and in Nzara, Sudan. The current outbreak of the Ebola virus was started by reporting the first case in March 2014 in the forest regions of southeastern Guinea. Due to infection rates raising over 13,000% within a 6-month period, Ebola is now considered as a global public health emergency and on August 8(th), 2014 the World Health Organization (WHO) declared the epidemic to be a Public Health Emergency of International Concern. With more than 5000 involved cases and nearly 3000 deaths, this event has turned into the largest and most dangerous Ebola virus outbreak in the world. Based on the above-mentioned, the present article aimed to review the virologic characteristics, transmission, clinical manifestation, diagnosis, treatment, and prevention of Ebola virus disease.

  14. The Quality of Online Health-Related Information – an Emergent Consumer Health Issue

    Directory of Open Access Journals (Sweden)

    Nădăşan Valentin

    2016-12-01

    Full Text Available The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.

  15. Violence toward health care workers in emergency departments in Denizli, Turkey.

    Science.gov (United States)

    Boz, Bora; Acar, Kemalettin; Ergin, Ahmet; Erdur, Bulent; Kurtulus, Ayse; Turkcuer, Ibrahim; Ergin, Nesrin

    2006-01-01

    This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1% of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.

  16. Deciphering emerging Zika and dengue viral epidemics: Implications for global maternal–child health burden

    Directory of Open Access Journals (Sweden)

    Ernest Tambo

    2016-05-01

    Full Text Available Summary: Since its discovery in 1947 in Uganda and control and eradication efforts have aimed at its vectors (Aedes mosquitoes in Latin America in the 1950s, an absolute neglect of Zika programs and interventions has been documented in Aedes endemic and epidemic-prone countries. The current unprecedented Zika viral epidemics and rapid spread in the Western hemisphere pose a substantial global threat, with associated anxiety and consequences. The lack of safe and effective drugs and vaccines against Zika or dengue epidemics further buttresses the realization from the West Africa Ebola outbreak that most emerging disease-prone countries are still poorly prepared for an emergency response. This paper examines knowledge gaps in both emerging and neglected arthropod-borne flavivirus infectious diseases associated with poverty and their implications for fostering local, national and regional emerging disease preparedness, effective and robust surveillance–response systems, sustained control and eventual elimination. Strengthening the regional and Global Health Flavivirus Surveillance-Response Network (GHFV-SRN with other models of socio-economic, climatic, environmental and ecological mitigation and adaptation strategies will be necessary to improve evidence-based national and global maternal–child health agenda and action plans. Keywords: Zika virus, Epidemics, Health, Preparedness, Surveillance, Maternal–child

  17. Personal Protective Equipment Supply Chain: Lessons Learned from Recent Public Health Emergency Responses.

    Science.gov (United States)

    Patel, Anita; D'Alessandro, Maryann M; Ireland, Karen J; Burel, W Greg; Wencil, Elaine B; Rasmussen, Sonja A

    Personal protective equipment (PPE) that protects healthcare workers from infection is a critical component of infection control strategies in healthcare settings. During a public health emergency response, protecting healthcare workers from infectious disease is essential, given that they provide clinical care to those who fall ill, have a high risk of exposure, and need to be assured of occupational safety. Like most goods in the United States, the PPE market supply is based on demand. The US PPE supply chain has minimal ability to rapidly surge production, resulting in challenges to meeting large unexpected increases in demand that might occur during a public health emergency. Additionally, a significant proportion of the supply chain is produced off-shore and might not be available to the US market during an emergency because of export restrictions or nationalization of manufacturing facilities. Efforts to increase supplies during previous public health emergencies have been challenging. During the 2009 H1N1 influenza pandemic and the 2014 Ebola virus epidemic, the commercial supply chain of pharmaceutical and healthcare products quickly became critical response components. This article reviews lessons learned from these responses from a PPE supply chain and systems perspective and examines ways to improve PPE readiness for future responses.

  18. Enablers and Barriers to Community Engagement in Public Health Emergency Preparedness: A Literature Review.

    Science.gov (United States)

    Ramsbottom, Anna; O'Brien, Eleanor; Ciotti, Lucrezio; Takacs, Judit

    2018-04-01

    Public health emergency preparedness (PHEP) all too often focusses only on institutional capabilities, including their technical expertise and political influence, while overlooking community capabilities. However, the success of institutional emergency preparedness plans depends upon communities and institutions working together to ensure successful anticipation, response and recovery. Broader community engagement is therefore recommended worldwide. This literature review was carried out to identify enablers and barriers to community and institutional synergies in emergency preparedness. Searches were undertaken across bibliographic databases and grey literature sources. The literature identified was qualitative in nature. A qualitative, 'best fit' framework approach using a pre-existing framework was used to analyse the literature, whereby themes were added and changed as analysis progressed. A working definition of community was identified, based on a 'whole community' approach, inclusive of the whole multitude of stakeholders including community residents and emergency management staff. Given the diversity in community make-up, the types of emergencies that could be faced, the socio-economic, environmental and political range of communities, there are no set practices that will be effective for all communities. The most effective way of engaging communities in emergency preparedness is context-dependent and the review did draw out some important key messages for institutions to consider.

  19. Reverse quality management: developing evidence-based best practices in health emergency management.

    Science.gov (United States)

    Lynch, Tim; Cox, Paul

    2006-01-01

    The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.

  20. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    OpenAIRE

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Background: Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries.Objective: This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak.Design: A rigorous literature review was conducted using eight electronic databases a...

  1. Progress in Public Health Emergency Preparedness-United States, 2001-2016.

    Science.gov (United States)

    Murthy, Bhavini Patel; Molinari, Noelle-Angelique M; LeBlanc, Tanya T; Vagi, Sara J; Avchen, Rachel N

    2017-09-01

    To evaluate the Public Health Emergency Preparedness (PHEP) program's progress toward meeting public health preparedness capability standards in state, local, and territorial health departments. All 62 PHEP awardees completed the Centers for Disease Control and Prevention's self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016. Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources. Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.

  2. Police Mental Health Partnership project: Police Ambulance Crisis Emergency Response (PACER) model development.

    Science.gov (United States)

    Huppert, David; Griffiths, Matthew

    2015-10-01

    To review internationally recognized models of police interactions with people experiencing mental health crises that are sometimes complex and associated with adverse experience for the person in crisis, their family and emergency service personnel. To develop, implement and review a partnership model trial between mental health and emergency services that offers alternative response pathways with improved outcomes in care. Three unique models of police and mental health partnership in the USA were reviewed and used to develop the PACER (Police Ambulance Crisis Emergency Response) model. A three month trial of the model was implemented and evaluated. Significant improvements in response times, the interactions with and the outcomes for people in crisis were some of the benefits shown when compared with usual services. The pilot showed that a partnership involving mental health and police services in Melbourne, Australia could be replicated based on international models. Initial data supported improvements compared with usual care. Further data collection regarding usual care and this new model is required to confirm observed benefits. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  3. One Health, emerging infectious diseases and wildlife: two decades of progress?

    Science.gov (United States)

    Cunningham, Andrew A; Daszak, Peter; Wood, James L N

    2017-07-19

    Infectious diseases affect people, domestic animals and wildlife alike, with many pathogens being able to infect multiple species. Fifty years ago, following the wide-scale manufacture and use of antibiotics and vaccines, it seemed that the battle against infections was being won for the human population. Since then, however, and in addition to increasing antimicrobial resistance among bacterial pathogens, there has been an increase in the emergence of, mostly viral, zoonotic diseases from wildlife, sometimes causing fatal outbreaks of epidemic proportions. Concurrently, infectious disease has been identified as an increasing threat to wildlife conservation. A synthesis published in 2000 showed common anthropogenic drivers of disease threats to biodiversity and human health, including encroachment and destruction of wildlife habitat and the human-assisted spread of pathogens. Almost two decades later, the situation has not changed and, despite improved knowledge of the underlying causes, little has been done at the policy level to address these threats. For the sake of public health and wellbeing, human-kind needs to work better to conserve nature and preserve the ecosystem services, including disease regulation, that biodiversity provides while also understanding and mitigating activities which lead to disease emergence. We consider that holistic, One Health approaches to the management and mitigation of the risks of emerging infectious diseases have the greatest chance of success.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'. © 2017 The Authors.

  4. Relations of behavioral autonomy to health outcomes among emerging adults with and without type 1 diabetes.

    Science.gov (United States)

    Helgeson, Vicki S; Reynolds, Kerry A; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

    2014-01-01

    To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Implementation and evaluation of health passport communication tools in emergency departments.

    Science.gov (United States)

    Heifetz, Marina; Lunsky, Yona

    2018-01-01

    People with IDD (intellectual or developmental disabilities) and their families consistently report dissatisfaction with their emergency department experience. Clear care plans and communication tools may not only improve the quality of patient care, but also can prevent unnecessary visits and reduce the likelihood of return visits. To evaluate communication tools to be used by people with IDD in psychiatric and general emergency departments in three different regions of Ontario. Health passport communication tools were locally tailored and implemented in each of the three regions. A total of 28 questionnaires and 18 interviews with stakeholders (e.g., hospital staff, community agency representatives, families) were completed across the regions to obtain feedback on the implementation of health passports with people with IDD. Participants felt that the health passport tools provided helpful information, improved communication between patients with IDD and hospital staff, and were user friendly. Continued efforts are needed to work with communities on maintenance of this tool, ensuring all hospital staff are utilizing the information. These findings emphasize the merits of health passport tools being implemented in the health system to support communication between patients with IDD and health care practitioners and the importance of tailoring tools to local settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department.

    Science.gov (United States)

    Ngo, Stephanie; Shahsahebi, Mohammad; Schreiber, Sean; Johnson, Fred; Silberberg, Mina

    2017-11-09

    This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p management of behavioral health patients.

  7. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

    Science.gov (United States)

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-05-18

    The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Associations among stress, gender, sources of social support, and health in emerging adults.

    Science.gov (United States)

    Lee, Chih-Yuan Steven; Dik, Bryan J

    2017-10-01

    This study aimed to examine how sources of social support intersect with stress and health by testing two theoretical models. Three relationship-specific sources of social support (family, friends, and romantic partners) and two health indicators (self-rated physical health and depressive symptoms) were investigated. The sample consisted of 636 emerging adults attending college (age range: 18-25). Results suggest that only support from family was a stress-buffer, in that it buffered the adverse association between stress and depressive symptoms. Holding stress constant, only support from family was related to self-rated physical health and only support from friends or romantic partners was associated with depressive symptoms. There were no gender differences in the mean levels of self-rated physical health and depressive symptoms. However, gender moderations were found, in that the positive relationship between friends support and physical health was observed only in women, that the association between friends support and depressive symptoms was greater in men than in women, and that family support buffered the negative relationship between stress and physical health only in men. Findings of this study suggest that the associations among stress, social support, and health vary by the sources of support, the health outcome, and gender. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Health impact of sport and exercise in emerging adult men: a prospective study.

    Science.gov (United States)

    Henchoz, Yves; Baggio, Stéphanie; N'Goran, Alexandra A; Studer, Joseph; Deline, Stéphane; Mohler-Kuo, Meichun; Daeppen, Jean-Bernard; Gmel, Gerhard

    2014-10-01

    Health benefits of sport and exercise are well documented in children, adolescents and adults, but little is known about emerging adulthood-a period of life characterized by significant demographic and developmental changes. The present study aimed to assess the health impact of changes in sport and exercise levels during that specific period of life. The analysis used baseline and 15-month follow-up data (N = 4,846) from the cohort study on substance use risk factors. Associations between baseline exercise levels or changes in exercise levels and health indicators (i.e., health-related quality of life, depression, body mass index, alcohol dependence, nicotine dependence and cannabis use disorder) were measured using chi-squared tests and ANOVA. Direction of effects was tested using cross-lagged analysis. At baseline, all health indicator scores were observed to be better for regular exercisers than for other exercise levels. At follow-up, participants who had maintained regular exercise over time had better scores than those who had remained irregular exercisers or had discontinued, but their scores for health-related quality of life and depression were close to those of participants who had adopted regular exercise after the baseline questionnaire. Cross-lagged analysis indicated that regular exercise at baseline was a significant predictor of health-related quality of life and substance use dependence at follow-up, but was itself predicted only by health-related quality of life. From a health promotion perspective, this study emphasizes how important it is for emerging adult men to maintain, or adopt, regular sport and exercise.

  10. Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment.

    Science.gov (United States)

    Scott, Shannon D; Albrecht, Lauren; Given, Lisa M; Hartling, Lisa; Johnson, David W; Jabbour, Mona; Klassen, Terry P

    2018-01-01

    The majority of children requiring emergency care are treated in general emergency departments (EDs) with variable levels of pediatric care expertise. The goal of the Translating Emergency Knowledge for Kids (TREKK) initiative is to implement the latest research in pediatric emergency medicine in general EDs to reduce clinical variation. To determine national pediatric information needs, seeking behaviours, and preferences of health care professionals working in general EDs. An electronic cross-sectional survey was conducted with health care professionals in 32 Canadian general EDs. Data were collected in the EDs using the iPad and in-person data collectors. Total of 1,471 surveys were completed (57.1% response rate). Health care professionals sought information on children's health care by talking to colleagues (n=1,208, 82.1%), visiting specific medical/health websites (n=994, 67.7%), and professional development opportunities (n=941, 64.4%). Preferred child health resources included protocols and accepted treatments for common conditions (n=969, 68%), clinical pathways and practice guidelines (n=951, 66%), and evidence-based information on new diagnoses and treatments (n=866, 61%). Additional pediatric clinical information is needed about multisystem trauma (n=693, 49%), severe head injury (n=615, 43%), and meningitis (n=559, 39%). Health care professionals preferred to receive child health information through professional development opportunities (n=1,131, 80%) and printed summaries (n=885, 63%). By understanding health care professionals' information seeking behaviour, information needs, and information preferences, knowledge synthesis and knowledge translation initiatives can be targeted to improve pediatric emergency care. The findings from this study will inform the following two phases of the TREKK initiative to bridge the research-practice gap in Canadian general EDs.

  11. Laypeoples' preferred sources of health information on the emergency management of tooth avulsion.

    Science.gov (United States)

    Al-Sane, Mona; Bourisly, Nibal; Almulla, Taghreed; Andersson, Lars

    2011-12-01

    When planning nationwide information campaigns on the emergency management of tooth avulsion, the populations' preference to different modes of information delivery should be taken into consideration. We currently lack information on that. The aim of this study was, therefore, to assess laypeoples' preferred sources of information on the emergency management of tooth avulsion. This was a joint study undertaken by experts in media and experts in dental traumatology. Interview-assisted questionnaires were conducted on a sample of 579 adults from Kuwait. Subjects were asked to choose their three preferred sources of information on the emergency management of tooth avulsion. Subjects' responses and sociodemographic data were registered. The data were descriptively analyzed, and a chi-square test was used to assess the relation of the subjects' preferences to their registered demographics. The Internet, health care professionals, and TV were the three most preferred sources of information on the emergency management of tooth avulsion across all groups, regardless of the sociodemographic characteristics. Younger adults, singles and subjects with higher education significantly preferred the Internet. Older adults preferred TV. Family was a preferred source in geographic districts populated with extended families, while friends were a preferred source in geographic districts populated by expatriates. Younger people and those with higher education can be effectively targeted through the Internet, while it is more effective to target older people through TV. Information, on tooth avulsion management, given by health care professionals is preferred across all population segments. © 2011 John Wiley & Sons A/S.

  12. Parental Internet Use and Health Information Seeking Behavior Comparing Elective and Emergency Pediatric Surgical Situations.

    Science.gov (United States)

    Wong, Michael Kien Yee; Sivasegaran, Daveraj; Choo, Candy Suet Cheng; Nah, Shireen Anne

    2018-02-01

     This study evaluates usage patterns of online health information in parents with children undergoing elective or emergency surgical procedures.  We prospectively surveyed parents of children admitted to our institution for common emergency (appendicectomy, abscess drainage, gonadal torsion) or elective (herniotomy, orchidopexy) operations between March and September 2016. Each completed an anonymized modification of a previously published survey comprising 19 questions on demographic data, Internet usage, and review of Internet resources. Chi-square tests were used for categorical data with p  information in elective ( n  = 27; 54%) and emergency groups ( n  = 24;70.6%) than general practitioners or other health care workers. When condition-specific online information was sought, more than 95% felt that the information concurred with the doctor's. Most common reasons were for more information on the condition ( n  = 56; 90.3%) and on medical treatment ( n  = 52; 83.9%). Eighteen (18/62; 29%) parents reported excessively technical information. No significant difference in behavior was found comparing elective and emergency groups.  Approximately one quarter of parents do not access condition-specific online medical information despite high Internet penetration rates. More than half depend on friends and family for additional information, reflecting societal and cultural norms in our population. Surgeons must incorporate awareness of these behaviors during counselling. Georg Thieme Verlag KG Stuttgart · New York.

  13. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening.

    Science.gov (United States)

    Barasa, Edwine W; Cloete, Keith; Gilson, Lucy

    2017-11-01

    Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. A national survey on health department capacity for community engagement in emergency preparedness.

    Science.gov (United States)

    Schoch-Spana, Monica; Selck, Frederic W; Goldberg, Lisa A

    2015-01-01

    Limited systematic knowledge exists about how public health practitioners and policy makers can best strengthen community engagement in public health emergency preparedness ("CE-PHEP"), a top priority for US national health security. To investigate local health department (LHD) adoption of federally recommended participatory approaches to PHEP and to identify LHD organizational characteristics associated with more intense CE-PHEP. National survey in 2012 of LHDs using a self-administered Web-based questionnaire regarding LHD practices and resources for CE-PHEP ("The Community Engagement for Public Health Emergency Preparedness Survey"). Differences in survey responses were examined, and a multivariate analysis was used to test whether LHD organizational characteristics were associated with differences in CE-PHEP intensity. A randomized sample of 754 LHDs drawn from the 2565 LHDs that had been invited to participate in the 2010 National Profile of LHDs. Sample selection was stratified by the size of population served and geographic location. Emergency preparedness coordinators reporting on their respective LHDs. CE-PHEP intensity as measured with a scoring system that rated specific CE-PHEP practices by LHD according to the relative degrees of public participation and community capacity they represented. Survey response rate was 61%. The most common reported CE-PHEP activity was disseminating personal preparedness materials (90%); the least common was convening public forums on PHEP planning (22%). LHD characteristics most strongly associated with more intense CE-PHEP were having a formal CE-PHEP policy, allocating funds for CE-PHEP, having strong support from community-based organizations, and employing a coordinator with prior CE experience. Promising ways to engage community partners more fully in the PHEP enterprise are institutionalizing CE-PHEP objectives, employing sufficient and skilled staff, leveraging current community-based organization support, and

  15. Health insurance, neighborhood income, and emergency department usage by Utah children 1996–1998

    Directory of Open Access Journals (Sweden)

    Knight Stacey

    2005-04-01

    Full Text Available Abstract Background It is estimated that approximately half of emergency department (ED usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children. Methods Emergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care. Results Children with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88–2.96. There was no reduction in Medicaid ED usage following the transition to managed care. Conclusion Usage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.

  16. Rapid assessment of health needs in mass emergencies: review of current concepts and methods.

    Science.gov (United States)

    Guha-Sapir, D

    1991-01-01

    The increase in the number of natural disasters and their impact on population is of growing concern to countries at risk and agencies involved in health and humanitarian action. The numbers of persons killed or disabled as a result of earthquakes, cyclones, floods and famines have reached record levels in the last decade. Population density, rampant urbanization and climatic changes have brought about risk patterns that are exposing larger and larger sections of populations in developing countries to life-threatening natural disasters. Despite substantial spending on emergency relief, the approaches to relief remain largely ad hoc and amateurish, resulting generally in inappropriate and/or delayed action. In recent years, mass emergencies of the kind experienced in Bangladesh or the Sahelian countries have highlighted the importance of rapid assessment of health needs for better allocation of resources and relief management. As a result, the development of techniques for rapid assessment of health needs has been identified as a priority for effective emergency action. This article sketches the health context of disasters in terms of mortality and morbidity patterns; it describes initial assessment techniques currently used and their methodological biases and constraints; it also discusses assessment needs which vary between different types of disasters and the time frame within which assessments are undertaken. Earthquakes, cyclones, famines, epidemics or refugees all have specific risk profiles and emergency conditions which differ for each situation. Vulnerability to mortality changes according to age and occupation, for earthquakes and famines. These risk factors then have significant implications for the design of rapid assessment protocols and checklists. Experiences from the field in rapid survey techniques and estimation of death rates are discussed, with emphasis on the need for a reliable denominator even for the roughest assessment. Finally, the

  17. Comparing Burnout Across Emergency Physicians, Nurses, Technicians, and Health Information Technicians Working for the Same Organization

    OpenAIRE

    Schooley, Benjamin; Hikmet, Neset; Tarcan, Menderes; Yorgancioglu, Gamze

    2016-01-01

    Abstract Studies on the topic of burnout measure the effects of emotional exhaustion (EE), depersonalization (DP) (negative or cynical attitudes toward work), and reduced sense of personal accomplishment (PA). While the prevalence of burnout in practicing emergency medicine (EM) professionals has been studied, little is known of the prevalence and factors across physicians, nurses, technicians, and health information technicians working for the same institution. The aim of this study was to a...

  18. A virtual reality system for the training of volunteers involved in health emergency situations.

    Science.gov (United States)

    De Leo, Gianluca; Ponder, Michal; Molet, Tom; Fato, Marco; Thalmann, Daniel; Magnenat-Thalmann, Nadia; Bermano, Francesco; Beltrame, Francesco

    2003-06-01

    In order to guarantee an effective and punctual medical intervention to injured people involved in health emergency situations, where usually both professional and non-professional health operators are involved, a fast and accurate treatment has to be carried out. In case of catastrophic or very critical situations, non-professional operators who did not receive proper training (volunteers are among them) could be affected by psychological inhibitions. Their performances could slow down in such way that would affect the quality of the treatment and increase both direct and indirect costs. Our virtual reality system that is currently in use at the health care emergency center of San Martino Hospital in Genoa, Italy, has been designed and developed to check health emergency operators' capabilities to adopt correct decision-making procedures, to make optimal use of new technological equipment and to overcome psychological barriers. Our system is composed of (1) a high-end simulation PC, whose main functions are execution of the main software module, rendering of 3D scenes in stereo mode, rendering of sound, and control of data transmission from/to VR devices; (2) a low-end control PC, which controls the VR simulation running on the simulation PC, manages medical emergency simulation scenarios, introduces unexpected events to the simulation and controls the simulation difficulty level; (3) a magnetic-based motion tracking device used for head and hand tracking; (4) a wireless pair of shutter glasses together with a cathode ray tube wall projector; and (5) a high-end surround sound system. The expected benefits have been verified through the design and implementation of controlled clinical trials.

  19. Bridging the gap: to what extent do socioeconomic barriers impede response to emerging public health threats

    Science.gov (United States)

    2017-03-01

    peoples of the Far East, Southeast Asia, or the Indian subcontinent (Cambodia, China, India, Japan, Korea, Malaysia , Pakistan, the Philippine Islands...263 Ibid. 264 Ibid. 265 Ibid. 266 Ibid. 54 take responsibility.267 The Navy claims the “toxic contamination of Vieques” was not due to their...re-aligning policing activities to meet the needs of the health emergency, which could include the delivery of food and medicine to those quarantined

  20. Emerging Issues for our Nation's Health: The Intersection of Marijuana Use and Cardiometabolic Disease Risk

    OpenAIRE

    Vidot, Denise C.; Prado, Guillermo; Hlaing, WayWay M.; Arheart, Kristopher L.; Messiah, Sarah E.

    2014-01-01

    Current marijuana use rates are the highest in the past decade and not likely to decrease given the legalization of marijuana for medicinal and/or recreational use. Concurrently, the nation is facing epidemic levels of obesity, cardiovascular disease and diabetes but little is known about the intersecting relationships of marijuana use and cardiometabolic health. The objective of this study was to explore emerging issues in context to the intersection of cardiometabolic risk and marijuana use...

  1. Public Health Response Systems In-Action: Learning from Local Health Departments’ Experiences with Acute and Emergency Incidents

    Science.gov (United States)

    Hunter, Jennifer C.; Yang, Jane E.; Crawley, Adam W.; Biesiadecki, Laura; Aragón, Tomás J.

    2013-01-01

    As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems. PMID:24236137

  2. Using AquaticHealth.net to Detect Emerging Trends in Aquatic Animal Health

    Directory of Open Access Journals (Sweden)

    Geoff Grossel

    2013-05-01

    Full Text Available AquaticHealth.net is an open-source aquatic biosecurity intelligence application. By combining automated data collection and human analysis, AquaticHealth.net provides fast and accurate disease outbreak detection and forecasts, accompanied with nuanced explanations. The system has been online and open to the public since 1 January 2010, it has over 200 registered expert users around the world, and it typically publishes about seven daily reports and two weekly disease alerts. We document the major trends in aquatic animal health that the system has detected over these two years, and conclude with some forecasts for the future.

  3. mHealth Tool for Alcohol Use Disorders Among Latinos in Emergency Department.

    Science.gov (United States)

    Abujarad, Fuad; Vaca, Federico E

    2015-06-01

    Latino drinkers experience a disparate number of negative health and social consequences. Emergency Department Alcohol Screening Brief Intervention and Referral to Treatment (ED-SBIRT) is viable and effective at reducing harmful and hazardous drinking. However, barriers (e.g. readily available language translators, provider time burden, resources) to broad implementation remain and account for a major lag in adherence to national guidelines. We describe our approach to the design of a patient-centered bilingual Web-based mobile health ED-SBIRT App that could be integrated into a clinically complex ED environment and used regularly to provide ED-SBIRT for Spanish speaking patients.

  4. Participatory public health systems research: value of community involvement in a study series in mental health emergency preparedness.

    Science.gov (United States)

    McCabe, O Lee; Marum, Felicity; Semon, Natalie; Mosley, Adrian; Gwon, Howard; Perry, Charlene; Moore, Suzanne Straub; Links, Jonathan M

    2012-01-01

    Concerns have arisen over recent years about the absence of empirically derived evidence on which to base policy and practice in the public health system, in general, and to meet the challenge of public health emergency preparedness, in particular. Related issues include the challenge of disaster-caused, behavioral health surge, and the frequent exclusion of populations from studies that the research is meant to aid. To characterize the contributions of nonacademic collaborators to a series of projects validating a set of interventions to enhance capacity and competency of public mental health preparedness planning and response. Urban, suburban, and rural communities of the state of Maryland and rural communities of the state of Iowa. Study partners and participants (both of this project and the studies examined) were representatives of academic health centers (AHCs), local health departments (LHDs), and faith-based organizations (FBOs) and their communities. A multiple-project, case study analysis was conducted, that is, four research projects implemented by the authors from 2005 through 2011 to determine the types and impact of contributions made by nonacademic collaborators to those projects. The analysis involved reviewing research records, conceptualizing contributions (and providing examples) for government, faith, and (nonacademic) institutional collaborators. Ten areas were identified where partners made valuable contributions to the study series; these "value-areas" were as follows: 1) leadership and management of the projects; 2) formulation and refinement of research topics, aims, etc; 3) recruitment and retention of participants; 4) design and enhancement of interventions; 5) delivery of interventions; 6) collection, analysis, and interpretation of data; 7) dissemination of findings; 8) ensuring sustainability of faith/government preparedness planning relationships; 9) optimizing scalability and portability of the model; and 10) facilitating

  5. [Experience in training in emergencies, Division of Special Projects in Health, Instituto Mexicano del Seguro Social].

    Science.gov (United States)

    Cruz-Vega, Felipe; Loría-Castellanos, Jorge; Hernández-Olivas, Irma Patricia; Franco-Bey, Rubén; Ochoa-Avila, César; Sánchez-Badillo, Victoria

    2016-01-01

    There has been interest in the Division of Special Projects in Health to offer the Instituto Mexicano del Seguro Social personnel resources for training and quality thereby respond to potential contingencies. Presented here is their experience in this field. To describe and analyse the productivity in different training programs in emergencies and disasters developed by the Division of Special Projects in Health, Mexican Social Security Institute (IMSS). Observational study in which different training activities conducted by the Division of Special Projects in Health between 1989 and 2014 are described. Descriptive statistics were used. In these 25 years have trained 20,674 participants; 19.451 IMSS and 1,223 other health institutions. The most productive courses were life support (BLS/ACLS) (47.17%), distance courses "Hospital medical evacuation plans and units" (14.17%), the workshop-run "Evacuation of hospital units with an emphasis on critical areas" (5.93%) and course "Programme Evaluators of Hospital Insurance" (8.43%). Although the Special Projects Division Health has primarily operational functions, it nevertheless has neglected its responsibility to maintain constantly trained and updated institute staff that every day is in a position to face any type of emergency and disaster. This increases the chance that the answer to any contingency is more organised and of higher quality, always to the benefit of the population. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  6. The global and domestic politics of health policy in emerging nations.

    Science.gov (United States)

    Gómez, Eduardo J; Ruger, Jennifer Prah

    2015-02-01

    In recent years, several emerging nations with burgeoning economies and in transition to democracy have pursued health policy innovations. As these nations have integrated into the world economy through bilateral trade and diplomacy, they have also become increasingly exposed to international pressures and norms and focused on more effective, equitable health care systems. There are several lessons learned from the case studies of Brazil, Ghana, India, China, Vietnam, and Thailand in this special issue on the global and domestic politics of health policy in emerging nations. For the countries examined, although sensitive to international preferences, domestic governments preferred to implement policy on their own and at their own pace. During the policy-making and implementation process, international and domestic actors played different roles in health policy making vis-à-vis other reform actors -- at times the state played an intermediary role. In several countries, civil society also played a central role in designing and implementing policy at all levels of government. International institutions also have a number of mechanisms and strategies in their tool box to influence a country's domestic health governance, and they use them, particularly in the context of an uncertain state or internal discordance within the state. Copyright © 2015 by Duke University Press.

  7. The rise of Zika infection and microcephaly: what can we learn from a public health emergency?

    Science.gov (United States)

    McCloskey, B; Endericks, T

    2017-09-01

    To consider why Zika was declared a Public Health Emergency of International Concern (PHEIC), why it stopped being one and what we can learn from this for the future. This paper reviews the sequence of events and evidence base for the decision to declare Zika a PHEIC, the global response to this, the challenges in maintaining an evidence-based approach to outbreak response and identifies learning outcomes. Evidence review, all published articles in reputable UK and international journals were identified. The association between Zika virus infection and congenital malformations including microcephaly became a PHEIC on 1st February 2016 and was declared to be no longer an emergency in November 2016. This shaped the global response led by WHO in the first global emergency since Ebola in West Africa. The response to Zika highlights important issues and lessons for future outbreaks that might pose an international risk. Particular challenges arose in trying to maintain an evidence-based approach to public risk communication when the evidence is unclear or still evolving. The Zika incident also demonstrates the importance of public health practitioners and agencies understanding the political context in which outbreaks must be managed and understanding the competing factors that shape the political response. Copyright © 2017 The Royal Society for Public Health. All rights reserved.

  8. Oceans and human health: Emerging public health risks n the marine environment

    OpenAIRE

    Fleming, L.E.; Broad, K.; Clement, A.; Dewailly, E.; Elmir, S.; Knap, A.; Pomponi, S.A.; Smith, S.; Gabriele, H. Solo; Walsh, P.

    2006-01-01

    There has been an increasing recognition of the inter-relationship between human health and the oceans. Traditionally, the focus of research and concern has been on the impact of human activities on the oceans, particularly through anthropogenic pollution and the exploitation of marine resources. More recently, there has been recognition of the potential direct impact of the oceans on human health, both detrimental and beneficial. Areas identified include: global change, harmful algal blooms ...

  9. Emerging Therapeutic Enhancement Enabling Health Technologies and Their Discourses: What Is Discussed within the Health Domain?

    Science.gov (United States)

    Wolbring, Gregor; Diep, Lucy; Yumakulov, Sophya; Ball, Natalie; Leopatra, Verlyn; Yergens, Dean

    2013-01-01

    So far, the very meaning of health and therefore, treatment and rehabilitation is benchmarked to the normal or species-typical body. We expect certain abilities in members of a species; we expect humans to walk but not to fly, but a bird we expect to fly. However, increasingly therapeutic interventions have the potential to give recipients beyond species-typical body related abilities (therapeutic enhancements, TE). We believe that the perfect storm of TE, the shift in ability expectations toward beyond species-typical body abilities, and the increasing desire of health consumers to shape the health system will increasingly influence various aspects of health care practice, policy, and scholarship. We employed qualitative and quantitative methods to investigate among others how human enhancement, neuro/cognitive enhancement, brain machine interfaces, and social robot discourses cover (a) healthcare, healthcare policy, and healthcare ethics, (b) disability and (c) health consumers and how visible various assessment fields are within Neuro/Cogno/Human enhancement and within the BMI and social robotics discourse. We found that health care, as such, is little discussed, as are health care policy and ethics; that the term consumers (but not health consumers) is used; that technology, impact and needs assessment is absent; and that the imagery of disabled people is primarily a medical one. We submit that now, at this early stage, is the time to gain a good understanding of what drives the push for the enhancement agenda and enhancement-enabling devices, and the dynamics around acceptance and diffusion of therapeutic enhancements. PMID:27429129

  10. Emerging Therapeutic Enhancement Enabling Health Technologies and Their Discourses: What Is Discussed within the Health Domain?

    Directory of Open Access Journals (Sweden)

    Gregor Wolbring

    2013-07-01

    Full Text Available So far, the very meaning of health and therefore, treatment and rehabilitation is benchmarked to the normal or species-typical body. We expect certain abilities in members of a species; we expect humans to walk but not to fly, but a bird we expect to fly. However, increasingly therapeutic interventions have the potential to give recipients beyond species-typical body related abilities (therapeutic enhancements, TE. We believe that the perfect storm of TE, the shift in ability expectations toward beyond species-typical body abilities, and the increasing desire of health consumers to shape the health system will increasingly influence various aspects of health care practice, policy, and scholarship. We employed qualitative and quantitative methods to investigate among others how human enhancement, neuro/cognitive enhancement, brain machine interfaces, and social robot discourses cover (a healthcare, healthcare policy, and healthcare ethics, (b disability and (c health consumers and how visible various assessment fields are within Neuro/Cogno/ Human enhancement and within the BMI and social robotics discourse. We found that health care, as such, is little discussed, as are health care policy and ethics; that the term consumers (but not health consumers is used; that technology, impact and needs assessment is absent; and that the imagery of disabled people is primarily a medical one. We submit that now, at this early stage, is the time to gain a good understanding of what drives the push for the enhancement agenda and enhancement-enabling devices, and the dynamics around acceptance and diffusion of therapeutic enhancements.

  11. Microbial Threats to Health. Emerging Infections: Microbial Threats to Health in the United States.

    Science.gov (United States)

    1992-10-01

    and HIV in- fection. Although in the United States, HIV infection occurs predominately in male homosexuals and intravenous substance abusers, the rate...Davis. W. A., J. G. Kane, and V. G. Garagusi. 1978. Human Aerononas infections : a review of the literature and a case report of endocarditis ...AD-A257 841 AD____ GRANT NO: DAMD17-90-Z-0047 TITLE: MICROBIAL THREATS TO HEALTH SUBTITLE: REmerging Infections - Microbial Threats to Health in the

  12. Identifying and Prioritizing Information Needs and Research Priorities of Public Health Emergency Preparedness and Response Practitioners.

    Science.gov (United States)

    Siegfried, Alexa L; Carbone, Eric G; Meit, Michael B; Kennedy, Mallory J; Yusuf, Hussain; Kahn, Emily B

    2017-10-01

    This study describes findings from an assessment conducted to identify perceived knowledge gaps, information needs, and research priorities among state, territorial, and local public health preparedness directors and coordinators related to public health emergency preparedness and response (PHPR). The goal of the study was to gather information that would be useful for ensuring that future funding for research and evaluation targets areas most critical for advancing public health practice. We implemented a mixed-methods approach to identify and prioritize PHPR research questions. A web survey was sent to all state, city, and territorial health agencies funded through the Public Health Emergency Preparedness (PHEP) Cooperative Agreement program and a sample of local health departments (LHDs). Three focus groups of state and local practitioners and subject matter experts from the Centers for Disease Control and Prevention (CDC) were subsequently conducted, followed by 3 meetings of an expert panel of PHPR practitioners and CDC experts to prioritize and refine the research questions. We identified a final list of 44 research questions that were deemed by study participants as priority topics where future research can inform PHPR programs and practice. We identified differences in perceived research priorities between PHEP awardees and LHD survey respondents; the number of research questions rated as important was greater among LHDs than among PHEP awardees (75%, n=33, compared to 24%, n=15). The research questions identified provide insight into public health practitioners' perceived knowledge gaps and the types of information that would be most useful for informing and advancing PHPR practice. The study also points to a higher level of information need among LHDs than among PHEP awardees. These findings are important for CDC and the PHPR research community to ensure that future research studies are responsive to practitioners' needs and provide the information

  13. The Fukushima radiological emergency and challenges identified for future public health responses.

    Science.gov (United States)

    Miller, Charles W

    2012-05-01

    On 11 March 2011, northern Japan was rocked by first a magnitude 9.0 earthquake off the eastern coast and then an ensuing tsunami. The Fukushima Daiichi Nuclear Power Plant complex was hit by these twin disasters, and a cascade of events was initiated that led to radionuclide releases causing widespread radioactive contamination of residential areas, agricultural land, and coastal waters. Radioactive material from Japan was subsequently transmitted to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to be a concern for health effects, but the presence of this material in the environment was enough to create a public health emergency in the U.S. The radiation safety and public health communities in the U.S. are identifying challenges they faced in responding to this incident. This paper discusses three of those challenges: (1) The growing shortage of trained radiation subject matter experts in the field of environmental transport and dosimetry of radionuclides; (2) the need to begin expressing all radiation-related quantities in terms of the International System of Units; and (3) the need to define when a radiation dose is or is not one of "public health concern." This list represents only a small subset of the list of challenges being identified by public health agencies that responded to the Fukushima incident. However, these three challenges are fundamental to any radiological emergency response. Addressing them will have a significant positive impact on how the U.S. responds to the next radiological emergency.

  14. Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country.

    Science.gov (United States)

    Mir, Azeem Sultan; Malik, Raees

    2010-08-01

    Unsafe abortion is a major Public health problem in developing countries, where women make several unsafe attempts at termination of the unintended pregnancy before turning to health services. Community health workers can act as a bridge between the community and their health facilities and can use Emergency Contraceptive Pills to significantly reduce the mortality and morbidity related to unsafe abortions. This study explores the knowledge, attitudes and practices of the Lady Health Supervisor of the National Program for Family Planning, district Rawalpindi, regarding emergency contraception pills. The cross sectional survey was conducted during the monthly meeting of Lady Health Supervisors. Self administered, anonymous and voluntary questionnaire consisting of 17 items, regarding demographic profile, awareness, knowledge, attitudes and practices, was used. Insufficient knowledge, high misinformation and strongly negative attitudes were revealed. More than half did not know that emergency contraceptive pills do not cause abortion. About four fifths believed that emergency contraceptive pills will lead to 'evil' practices in society. More than four fifths recognized that the clients of National Program for Family Planning need emergency contraceptive pills. The attitudes were significantly associated with knowledge (P=0.034, Fisher's Exact Test). The awareness of emergency contraceptive pills is high. Serious gaps in knowledge have been identified. There is a clear recognition of the need of emergency contraceptive pills for the clients of National Program for Family Planning. However, any strategy to introduce emergency contraceptive pills must cater for the misplaced beliefs of the work force.

  15. 'BRICS without straw'? A systematic literature review of newly emerging economies' influence in global health.

    Science.gov (United States)

    Harmer, Andrew; Xiao, Yina; Missoni, Eduardo; Tediosi, Fabrizio

    2013-04-15

    Since 2010, five newly emerging economies collectively known as 'BRICS' (Brazil, India, Russia, China and South Africa) have caught the imagination, and scholarly attention, of political scientists, economists and development specialists. The prospect of a unified geopolitical bloc, consciously seeking to re-frame international (and global) health development with a new set of ideas and values, has also, if belatedly, begun to attract the attention of the global health community. But what influence, if any, do the BRICS wield in global health, and, if they do wield influence, how has that influence been conceptualized and recorded in the literature? We conducted a systematic literature review in (March-December 2012) of documents retrieved from the databases EMBASE, PubMed/Medline, Global Health, and Google Scholar, and the websites of relevant international organisations, research institutions and philanthropic organisations. The results were synthesised using a framework of influence developed for the review from the political science literature. Our initial search of databases and websites yielded 887 documents. Exclusion criteria narrowed the number of documents to 71 journal articles and 23 reports. Two researchers using an agreed set of inclusion criteria independently screened the 94 documents, leaving just 7 documents. We found just one document that provided sustained analysis of the BRICS' collective influence; the overwhelming tendency was to describe individual BRICS countries influence. Although influence was predominantly framed by BRICS countries' material capability, there were examples of institutional and ideational influence - particularly from Brazil. Individual BRICS countries were primarily 'opportunity seekers' and region mobilisers but with potential to become 'issue leaders' and region organisers. Though small in number, the written output on BRICS influence in global health has increased significantly since a similar review conducted in

  16. Oceans and human health: Emerging public health risks n the marine environment

    Science.gov (United States)

    Fleming, L.E.; Broad, K.; Clement, A.; Dewailly, E.; Elmir, S.; Knap, A.; Pomponi, S.A.; Smith, S.; Gabriele, H. Solo; Walsh, P.

    2008-01-01

    There has been an increasing recognition of the inter-relationship between human health and the oceans. Traditionally, the focus of research and concern has been on the impact of human activities on the oceans, particularly through anthropogenic pollution and the exploitation of marine resources. More recently, there has been recognition of the potential direct impact of the oceans on human health, both detrimental and beneficial. Areas identified include: global change, harmful algal blooms (HABs), microbial and chemical contamination of marine waters and seafood, and marine models and natural products from the seas. It is hoped that through the recognition of the inter-dependence of the health of both humans and the oceans, efforts will be made to restore and preserve the oceans. PMID:16996542

  17. Healthcare technology innovation adoption electronic health records and other emerging health information technology innovations

    CERN Document Server

    Daim, Tugrul U; Basoglu, Nuri; Kök, Orhun M; Hogaboam, Liliya

    2016-01-01

    This book aims to study the factors affecting the adoption and diffusion of Health Information Technology (HIT) innovation. It analyzes the adoption processes of various tools and applications, particularly Electronic Health Records (EHR), highlighting the impact on various sectors of the healthcare system, such as physicians, administration,  and patient care, while also identifying the various pitfalls and gaps in the literature. With the various challenges currently facing the United States healthcare system, the study, adoption and diffusion of healthcare technology innovation, particularly HIT, is imperative to achieving national goals. This book is organized into three sections. Section one reviews theories and applications for the diffusion of Health Care Technologies. Section two evaluates EHR technology, including the barriers and enables in adoption and alternative technologies. Finally, section three examines the factors impacting the adoption of EHR systems. This book will be a key source for stu...

  18. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

    Directory of Open Access Journals (Sweden)

    Chun Nok Lam

    2016-09-01

    Full Text Available Introduction: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods: We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results: Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino. Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds of hospital readmission, compared to non-homeless, non-mental health (NHNM patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3

  19. Reproductive health outcomes of insured adolescent and adult women who access oral levonorgestrel emergency contraception.

    Science.gov (United States)

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W; Goler, Nancy

    2015-04-01

    To assess the level of risk for adolescents and women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among adolescents and women aged 15-44 years who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Of 21,421 prescriptions, 14,531 (67.8%) were accessed through the call center. In the subsequent 12 months, 12,127 (56.6%) adolescents and women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264 (10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for adolescents and women who accessed it through the call center-1,569 (10.8%) and office visits-695 (10.1%) (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.13). In the subsequent 6 months, 2,056 (9.6%) adolescents and women became pregnant. Adolescents and women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82, 95% CI 0.72-0.94); however, they were more likely to become pregnant within 4-6 months (adjusted OR 1.37, 95% CI 1.16-1.60). Among adolescents and women who were tested for chlamydia and gonorrhea, 689 (7.8%) and 928 (7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Protocols to routinely address unmet needs for contraception at every call for emergency contraception and all office visits, including visits with primary care providers, should be investigated.

  20. Reproductive Health Outcomes of Insured Women Who Access Oral Levonorgestrel Emergency Contraception

    Science.gov (United States)

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W.; Goler, Nancy

    2015-01-01

    Objectives To assess the level of risk for women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. Methods This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among women aged 15-44 who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Results Of 21,421 prescriptions, 14,531(67.8%) were accessed through the call center. In the subsequent 12 months, 12,127(56.6%) women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264(10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for women who accessed it through the call center -1,569(10.8%) and office visits – 695(10.1%) (adjusted OR 1.02 95% confidence interval (CI) 0.93-1.13). In the subsequent 6 months, 2,056(9.6%) women became pregnant. Women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82 95% CI 0.72-0.94); however they were more likely to become pregnant within 4-6 months (adjusted OR 1.37 95%CI 1.16-1.60). Among women who were tested for chlamydia and gonorrhea, 689(7.8%) and 928(7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Conclusions Protocols to routinely address unmet need for contraception at every call for emergency contraception and all office visits including visits with primary care providers should be investigated. PMID:25751211

  1. Development of a health and safety manual for emergency response operations

    International Nuclear Information System (INIS)

    Riland, C.A.; Junio, S.S.

    2000-01-01

    The Federal Radiological Monitoring and Assessment Center (FRMAC) Health and Safety Manual, which has been under development by a multi-agency group, is nearing completion and publication. The manual applies to offsite monitoring during a radiological accident or incident. Though written for multi-agency offsite monitoring activities (FRMAC), the manual is generic in nature and should be readily adaptable for other emergency response operations. Health and safety issues for emergency response situations often differ from those of normal operations. Examples of these differences and methodologies to address these issues are discussed. Challenges in manual development, including lack of regulatory and guidance documentation, are also discussed. One overriding principle in the Health and Safety Manual development is the overall reduction of risk, not just dose. The manual is broken into several chapters, which include Overview of Responsibities, Health Physics, Industrial Hygiene and Safey, Medical, and Environmental Compliance and Records. Included is a series of appendices, which presents additional information on forms and plans for default scenarios

  2. A qualitative study of health problems, risk factors, and prevention among Emergency Medical Service workers.

    Science.gov (United States)

    Dropkin, Jonathan; Moline, Jacqueline; Power, Paul M; Kim, Hyun

    2015-01-01

    Risk factors among Emergency Medical Service (EMS) workers are difficult to characterize and inconsistencies remain about their main health problems. To identify main work-related health problems among EMS workers in the United States; identify risk factors at the organizational, task, and exposure level; identify prevention strategies; examine these issues between participants (EMS workers and supervisors). Two types of qualitative research methods based on grounded theory were used: in-depth interviews with emergency medical technicians/paramedics (EMS workers) and focus groups (EMS workers and supervisors). Most participants reported similar health problems (musculoskeletal injuries) and the task related to these injuries, patient handling. Participants also reported similar physical exposures (ascending stairs with patients and patient weight). For organization/psychosocial factors, participants agreed that fitness, wages, breaks, and shift scheduling were linked with injuries, but overall, perceptions about these issues differed more than physical exposures. Lack of trust between EMS workers and supervisors were recurrent concerns among workers. However, not all organizational/psychosocial factors differed. EMS workers and supervisors agreed pre-employment screening could reduce injuries. Participants identified micro- and macro-level prevention opportunities. The grounded theory approach identified workers' main health problems, and the organizational factors and exposures linked with them. Perceptions about work organization/psychosocial exposures appeared more diverse than physical exposures. Prevention among all participants focused on mechanized equipment, but EMS workers also wanted more organizational support.

  3. The emerging health paradigm in the 21st century: the formative first 1000 days of life

    Directory of Open Access Journals (Sweden)

    Jose Miguel De Angulo

    2016-01-01

    Full Text Available During the 20th Century Western society's thinking regarding health and wellbeing underwent profound and rapid changes. Towards the end of the century, a health paradigm based on social health determinants emerged, providing a strong foundation for influencing priorities in global health. In this paper we will present evidence that supports a new paradigm. It avers that human health and development is founded on infants’ brain architecture and their capacity to transform the brains and lives of adults. Neuroscience now shows how the brain architecture of the person becomes established during the intrauterine period and the first two to three years of life. This brain architecture determines the capacity of the organism to self-regulate its biological, emotional, cognitive, and interactional processes with the environment. The more robust this brain architecture, the more potential and capability that individual has to enjoy physical, emotional, and mental health as well as his/her capacity to contribute to the health and wellbeing of others. We hold that the transformative value of infants to society is biblical. This new understanding can generate a shift towards a focus on early infancy as the best strategy to foster development of healthy and sustainable societies.

  4. Health Communication With Same-Sex and Other-Sex Friends in Emerging Adulthood.

    Science.gov (United States)

    Ayotte, Brian; Mehta, Clare; Alfonso, Jacqueline

    2017-09-01

    Objective We examined health-related communication between same-sex and other-sex friends and how communication was related to health-related behavior. Participants Data from 243 emerging adults attending college ( Mage = 18.96, SD = 1.43; 55.6% male) were analyzed. Methods Participants completed measures assessing the frequency in which they talked about and made plans to engage in exercise and nutrition-related behaviors with friends, as well as how often they engaged in exercise and nutrition-related behaviors. Results In general, participants reported more health-related communication with same-sex friends. Health-related communication with same-sex friends was positively related to health behaviors for men and women. However, the pattern of results differed for men and women depending on the topic of communication and the behavior being examined. Conclusion Our study extends the literature by examining the role of sex of friends in health communication and planning and how interactions with friends relate to health-promoting behavior.

  5. Quality of coding diagnoses in emergency departments: effects on mapping the public's health.

    Science.gov (United States)

    Aharonson-Daniel, Limor; Schwartz, Dagan; Hornik-Lurie, Tzipi; Halpern, Pinchas

    2014-01-01

    Emergency department (ED) attendees reflect the health of the population served by that hospital and the availability of health care services in the community. To examine the quality and accuracy of diagnoses recorded in the ED to appraise its potential utility as a guage of the population's medical needs. Using the Delphi process, a preliminary list of health indicators generated by an expert focus group was converted to a query to the Ministry of Health's database. In parallel, medical charts were reviewed in four hospitals to compare the handwritten diagnosis in the medical record with that recorded on the standard diagnosis "pick list" coding sheet. Quantity and quality of coding were assessed using explicit criteria. During 2010 a total of 17,761 charts were reviewed; diagnoses were not coded in 42%. The accuracy of existing coding was excellent (mismatch 1%-5%). Database query (2,670,300 visits to 28 hospitals in 2009) demonstrated potential benefits of these data as indicators of regional health needs. The findings suggest that an increase in the provision of community care may reduce ED attendance. Information on ED visits can be used to support health care planning. A "pick list" form with common diagnoses can facilitate quality recording of diagnoses in a busy ED, profiling the population's health needs in order to optimize care. Better compliance with the directive to code diagnosis is desired.

  6. Caregiver and adolescent mental health in Ethiopian Kunama refugees participating in an emergency education program.

    Science.gov (United States)

    Betancourt, Theresa S; Yudron, Monica; Wheaton, Wendy; Smith-Fawzi, Mary C

    2012-10-01

    To examine the role of caregiver mental health and risk and protective factors in influencing levels of internalizing and externalizing emotional and behavioral symptoms over time among a sample of refugee adolescents. Prospective study of 153 Kunama refugee adolescents receiving an emergency education intervention while living in a camp in Ethiopia. Surveys were collected in 2001 (T1) and 2002 (T2). Adolescent and caregiver mental health were assessed using a Kunamenga adaptation of the Youth Self Report; caregiver mental health was assessed using the Hopkins Symptom Checklist-25. Attitudes toward education, satisfaction with education programming, socioeconomic status, and perceptions of access to services were also explored as variables potentially influencing adolescent mental health at follow-up. Caregiver distress was significantly associated with youth externalizing behavior symptoms (β = 8.34, p effect on externalizing behaviors (β = -7.54, p effect on internalizing symptoms. In terms of modifying effects, among youth with distressed caregivers, those who were satisfied with the International Rescue Committee education intervention had a lower internalizing score (β = -6.34, p refugee displacement. Results suggest that programs targeting mental health in refugee children should consider children within the larger family system, including caregiver influence on child and adolescent mental health adjustment over time. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  7. An assessment of key health indicators among emergency medical services professionals.

    Science.gov (United States)

    Studnek, Jonathan R; Bentley, Melissa; Crawford, J Mac; Fernandez, Antonio R

    2010-01-01

    Ensuring the health and productivity of emergency medical services (EMS) professionals is important. However, there has been no known national baseline assessment of the health and wellness of EMS professionals in the United States. According to Healthy People 2010, top indicators of personal health include physical activity, body mass index (BMI), and smoking prevalence. The objectives of this study included quantifying existing health conditions and describing key health indicators among EMS professionals. It was hypothesized that work-life characteristics were associated with existing health conditions and key health indicators. Data utilized for this analysis were obtained from a 2007 questionnaire included in biennial national recertification packets. This questionnaire utilized validated items from the Behavioral Risk Factor Surveillance System (BRFSS) and the Longitudinal EMT Attributes and Demographics Study (LEADS). Along with common demographic characteristics, items inquired about existing health conditions (diabetes, asthma, hypertension, myocardial infarction, angina, stroke, and/or high blood cholesterol level), general health, physical activity, and smoking status. Descriptive analyses were performed utilizing chi-square tests, and logistic regression was utilized to describe associations between existing health conditions and the key health indicators. There were 58,435 individuals who became recertified in 2007, with 30,560 (52%) returning questionnaires. Individuals with missing data were removed, leaving 19,960 individual records. There were 4,681 (23.5%) individuals who reported at least one existing health condition. The mean BMI for the study participants was 27.69 kg/m(2). There were 5,742 (28.8%) individuals classified as having normal weight and 5,146 (25.8%) who were obese. The overwhelming majority of individuals did not meet the Centers for Disease Control and Prevention (CDC) recommendations for physical activity (15,022, 75.3%). There

  8. Emerging vector-borne zoonoses: eco-epidemiology and public health implications in India.

    Science.gov (United States)

    Dhiman, Ramesh C

    2014-01-01

    The diseases originating from animals or associated with man and animals are remerging and have resulted in considerable morbidity and mortality. The present review highlights the re-emergence of emerging mainly zoonotic diseases like chikungunya, scrub typhus, and extension of spatial distribution of cutaneous leishmaniasis from western Rajasthan to Himachal Pradesh, Kerala, and Haryana states; West Nile virus to Assam, and non-endemic areas of Japanese encephalitis (JE) like Maharashtra and JE to Delhi; Crimean-Congo hemorrhagic fever making inroads in Ahmedabad; and reporting fifth parasite of human malaria with possibility of zoonosis have been highlighted, which necessitates further studies for prevention and control. Emphasis has been given on understanding the ecology of reservoir hosts of pathogen, micro niche of vector species, climatic, socioeconomic risk factors, etc. Development of facilities for diagnosis of virus from insects, reservoirs, and human beings (like BSL4, which has been established in NIV, Pune), awareness about symptoms of new emerging viral and other zoonotic diseases, differential diagnosis, risk factors (climatic, ecological, and socioeconomic) and mapping of disease-specific vulnerable areas, and mathematical modeling for projecting epidemiological scenario is needed for preparedness of public health institutes. It is high time to understand the ecological link of zoonotic or anthroponotic diseases for updated risk maps and epidemiological knowledge for effective preventive and control measures. The public health stakeholders in India as well as in Southeast Asia should emphasize on understanding the eco-epidemiology of the discussed zoonotic diseases for taking preventive actions.

  9. Emerging contaminants of public health significance as water quality indicator compounds in the urban water cycle.

    Science.gov (United States)

    Pal, Amrita; He, Yiliang; Jekel, Martin; Reinhard, Martin; Gin, Karina Yew-Hoong

    2014-10-01

    The contamination of the urban water cycle (UWC) with a wide array of emerging organic compounds (EOCs) increases with urbanization and population density. To produce drinking water from the UWC requires close examination of their sources, occurrence, pathways, and health effects and the efficacy of wastewater treatment and natural attenuation processes that may occur in surface water bodies and groundwater. This paper researches in details the structure of the UWC and investigates the routes by which the water cycle is increasingly contaminated with compounds generated from various anthropogenic activities. Along with a thorough survey of chemicals representing compound classes such as hormones, antibiotics, surfactants, endocrine disruptors, human and veterinary pharmaceuticals, X-ray contrast media, pesticides and metabolites, disinfection-by-products, algal toxins and taste-and-odor compounds, this paper provides a comprehensive and holistic review of the occurrence, fate, transport and potential health impact of the emerging organic contaminants of the UWC. This study also illustrates the widespread distribution of the emerging organic contaminants in the different aortas of the ecosystem and focuses on future research needs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Emerging Vector borne zoonoses: eco-­epidemiology and public health implications in India

    Directory of Open Access Journals (Sweden)

    Ramesh C Dhiman

    2014-09-01

    Full Text Available The diseases originating from animals or associated with man and animals are remerging and have resulted in considerable morbidity and mortality. The present review highlights the re-emergence of emerging mainly zoonotic diseases like chikungunya, scrub typhus, extension of spatial distribution of cutaneous leishmaniasis from Western Rajasthan to Himachal Pradesh, Kerala, and Haryana states; West Nile virus to Assam, and non- endemic areas of JE like Maharashtra and JE to Delhi; Crimean Congo Hemorrhagic Fever making inroads in Ahmedabad; reporting fifth parasite of human malaria with possibility of zoonosis have been highlighted which necessitates further studies for prevention and control. Emphasis has been given on understanding the ecology of reservoir hosts of pathogen, micro niche of vector species, climatic, socioeconomic risk factors etc. Development of facilities for diagnosis of virus from insects, reservoirs and human beings (like BSL4 which has been established in NIV, Pune, awareness about symptoms of new emerging viral and other zoonotic diseases, differential diagnosis, risk factors (Climatic, ecological and socioeconomic and mapping of disease specific vulnerable areas, mathematical modeling for projecting epidemiological scenario, are needed for preparedness of public health institutes. It is high time to understand the ecological link of zoonotic or anthroponotic diseases for updated risk maps and epidemiological knowledge for effective preventive and control measures. The public health stakeholders in India as well as in south East Asia should emphasize on understanding the eco-epidemiology of the discussed zoonotic diseases for taking preventive actions.

  11. Surveillance of Washington OSHA exposure data to identify uncharacterized or emerging occupational health hazards.

    Science.gov (United States)

    Lofgren, Don J; Reeb-Whitaker, Carolyn K; Adams, Darrin

    2010-07-01

    Chemical substance exposure data from the Washington State Occupational Safety and Health Administration (OSHA) program were reviewed to determine if inspections conducted as a result of a report of a hazard from a complainant or referent may alert the agency to uncharacterized or emerging health hazards. Exposure and other electronically stored data from 6890 health inspection reports conducted between April 2003 and August 2008 were extracted from agency records. A total of 515 (7%) inspections with one or more personal airborne chemical substance samples were identified for further study. Inspections by report of a hazard and by targeting were compared for the following: number of inspections, number and percentage of inspections with workers exposed to substances above an agency's permissible exposure limit, types of industries inspected, and number and type of chemical substances assessed. Report of a hazard inspections documented work sites with worker overexposure at the same rate as agency targeted inspections (approximately 35% of the time), suggesting that complainants and referents are a credible pool of observers capable of directing the agency to airborne chemical substance hazards. Report of a hazard inspections were associated with significantly broader distribution of industries as well as a greater variety of chemical substance exposures than were targeted inspections. Narrative text that described business type and processes inspected was more useful than NAICS codes alone and critical in identifying processes and industries that may be associated with new hazards. Finally, previously identified emerging hazards were found among the report of a hazard data. These findings indicate that surveillance of OSHA inspection data can be a valid tool to identify uncharacterized and emerging health hazards. Additional research is needed to develop criteria for objective review and prioritization of the data for intervention. Federal OSHA and other state

  12. Exploring the psychological health of emergency dispatch centre operatives: a systematic review and narrative synthesis

    Directory of Open Access Journals (Sweden)

    Sarah E. Golding

    2017-10-01

    Full Text Available Background The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC operatives, and to identify key stressors experienced by EDC operatives. Methods Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis. Results A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: ‘Organisational and Operational Factors’ and ‘Interactions with Others’. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pressured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress. Discussion EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health. PROSPERO Registration Number CRD42014010806.

  13. Rapid qualitative research methods during complex health emergencies: A systematic review of the literature.

    Science.gov (United States)

    Johnson, Ginger A; Vindrola-Padros, Cecilia

    2017-09-01

    The 2013-2016 Ebola outbreak in West Africa highlighted both the successes and limitations of social science contributions to emergency response operations. An important limitation was the rapid and effective communication of study findings. A systematic review was carried out to explore how rapid qualitative methods have been used during global heath emergencies to understand which methods are commonly used, how they are applied, and the difficulties faced by social science researchers in the field. We also asses their value and benefit for health emergencies. The review findings are used to propose recommendations for qualitative research in this context. Peer-reviewed articles and grey literature were identified through six online databases. An initial search was carried out in July 2016 and updated in February 2017. The PRISMA checklist was used to guide the reporting of methods and findings. The articles were assessed for quality using the MMAT and AACODS checklist. From an initial search yielding 1444 articles, 22 articles met the criteria for inclusion. Thirteen of the articles were qualitative studies and nine used a mixed-methods design. The purpose of the rapid studies included: the identification of causes of the outbreak, and assessment of infrastructure, control strategies, health needs and health facility use. The studies varied in duration (from 4 days to 1 month). The main limitations identified by the authors were: the low quality of the collected data, small sample sizes, and little time for cross-checking facts with other data sources to reduce bias. Rapid qualitative methods were seen as beneficial in highlighting context-specific issues that need to be addressed locally, population-level behaviors influencing health service use, and organizational challenges in response planning and implementation. Recommendations for carrying out rapid qualitative research in this context included the early designation of community leaders as a point of

  14. Health Hazards Associated with Consumption of Roof-Collected Rainwater in Urban Areas in Emergency Situations

    Directory of Open Access Journals (Sweden)

    Carol Stewart

    2016-10-01

    Full Text Available The greater Wellington region, New Zealand, is highly vulnerable to large earthquakes because it is cut by active faults. Bulk water supply pipelines cross the Wellington Fault at several different locations, and there is considerable concern about severe disruption of the provision of reticulated water supplies to households and businesses in the aftermath of a large earthquake. A number of policy initiatives have been launched encouraging householders to install rainwater tanks to increase post-disaster resilience. However, little attention has been paid to potential health hazards associated with consumption of these supplies. To assess health hazards for householders in emergency situations, six 200-litre emergency water tanks were installed at properties across the Wellington region, with five tanks being allowed to fill with roof-collected rainwater and one tank being filled with municipal tapwater as a control. Such tanks are predominantly set aside for water storage and, once filled, feature limited drawdown and recharge. Sampling from these tanks was carried out fortnightly for one year, and samples were analysed for E. coli, pH, conductivity, a range of major and trace elements, and organic compounds, enabling an assessment of the evolution of water chemistry in water storage tanks over time. Key findings were that the overall rate of E. coli detections in the rain-fed tanks was 17.7%, which is low in relation to other studies. We propose that low incidences of may be due to biocidal effects of high zinc concentrations in tanks, originating from unpainted galvanised steel roof cladding. Lead concentrations were high compared to other studies, with 69% of rain-fed tank samples exceeding the World Health Organisation’s health-based guideline of 0.01 mg/L. Further work is required to determine risks of short-term consumption of this water in emergency situations.

  15. Exploring the psychological health of emergency dispatch centre operatives: a systematic review and narrative synthesis.

    Science.gov (United States)

    Golding, Sarah E; Horsfield, Claire; Davies, Annette; Egan, Bernadette; Jones, Martyn; Raleigh, Mary; Schofield, Patricia; Squires, Allison; Start, Kath; Quinn, Tom; Cropley, Mark

    2017-01-01

    The study objective was to investigate and synthesize available evidence relating to the psychological health of Emergency Dispatch Centre (EDC) operatives, and to identify key stressors experienced by EDC operatives. Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo, PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar) were searched. All study designs were included, and no date limits were set. Studies were included if they were published in English, and explored the psychological health of any EDC operatives, across fire, police, and emergency medical services. Studies were excluded if they related solely to other emergency workers, such as police officers or paramedics. Methodological quality of included studies was assessed using checklists adapted from the Critical Appraisal Skills Programme. A narrative synthesis was conducted, using thematic analysis. A total of 16 articles were included in the review. Two overarching themes were identified during the narrative synthesis: 'Organisational and Operational Factors' and 'Interactions with Others'. Stressors identified included being exposed to traumatic calls, lacking control over high workload, and working in under-resourced and pressured environments. Lack of support from management and providing an emotionally demanding service were additional sources of stress. Peer support and social support from friends and family were helpful in managing work-related stress. EDC operatives experience stress as a result of their work, which appears to be related to negative psychological health outcomes. Future research should explore the long-term effects of this stress, and the potential for workplace interventions to alleviate the negative impacts on psychological health. CRD42014010806.

  16. Health Hazards Associated with Consumption of Roof-Collected Rainwater in Urban Areas in Emergency Situations.

    Science.gov (United States)

    Stewart, Carol; Kim, Nick D; Johnston, David M; Nayyerloo, Mostafa

    2016-10-15

    The greater Wellington region, New Zealand, is highly vulnerable to large earthquakes because it is cut by active faults. Bulk water supply pipelines cross the Wellington Fault at several different locations, and there is considerable concern about severe disruption of the provision of reticulated water supplies to households and businesses in the aftermath of a large earthquake. A number of policy initiatives have been launched encouraging householders to install rainwater tanks to increase post-disaster resilience. However, little attention has been paid to potential health hazards associated with consumption of these supplies. To assess health hazards for householders in emergency situations, six 200-litre emergency water tanks were installed at properties across the Wellington region, with five tanks being allowed to fill with roof-collected rainwater and one tank being filled with municipal tapwater as a control. Such tanks are predominantly set aside for water storage and, once filled, feature limited drawdown and recharge. Sampling from these tanks was carried out fortnightly for one year, and samples were analysed for E. coli , pH, conductivity, a range of major and trace elements, and organic compounds, enabling an assessment of the evolution of water chemistry in water storage tanks over time. Key findings were that the overall rate of E. coli detections in the rain-fed tanks was 17.7%, which is low in relation to other studies. We propose that low incidences of may be due to biocidal effects of high zinc concentrations in tanks, originating from unpainted galvanised steel roof cladding. Lead concentrations were high compared to other studies, with 69% of rain-fed tank samples exceeding the World Health Organisation's health-based guideline of 0.01 mg/L. Further work is required to determine risks of short-term consumption of this water in emergency situations.

  17. Affect and Health Behavior Co-Occurrence: The Emerging Roles of Transdiagnostic Factors and Sociocultural Factors.

    Science.gov (United States)

    Zvolensky, Michael J; Leventhal, Adam M

    2016-01-01

    The majority of scientific work addressing relations among affective states and health correlates has focused primarily on their co-occurrence and a limited range of health conditions. We have developed a Special Issue to highlight recent advances in this emerging field of work that addresses the nature and interplay between affective states and disorders, in terms of their impact and consequences from health status and behavior. This Special Issue is organized into three parts classified as (a) co-occurrence and interplay between (b) transdiagnostic factors and (c) sociocultural factors. It is hoped that this issue will (a) alert readers to the significance of this work at different levels of analysis, (b) illustrate the many domains currently being explored via innovative approaches, and (c) identify fecund areas for future systematic study. © The Author(s) 2016.

  18. Health Literacy Among Parents of Pediatric Patients Seen in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Tran, T. Paul

    2008-08-01

    Full Text Available BACKGROUND: Health literacy is an important predictor of healthcare outcomes, but research on this topic has largely been absent from the emergency medicine literature.OBJECTIVE: We measured the prevalence of health literacy in parents or guardians of pediatric patients seen in the emergency department (ED.METHODS: This was an observational study conducted in a Midwestern urban, university-based, tertiary, Level 1 trauma center ED with 33,000 visits/year. Using convenience sampling during a three-month period, English-speaking parents or guardians of pediatric patients (< 19 yrs. were asked to complete the short version of the Test of Functional Health Literacy for Adults (s-TOFHLA. Parents/guardians were excluded if they had uncorrected visual impairment, required an interpreter, had altered mental status, or if the patients they accompanied were the subjects of a medical or trauma activation.RESULTS: Of the 188 parents or guardians approached, six did not consent or withdrew, one was excluded, leaving 181 (96.3% in the study. Of these, 19 (10.5% had either "marginal" or "inadequate" health literacy, while 162 (89.5%, 95% CI: 84.1%, 93.6% had "adequate" health literacy.CONCLUSION: A large majority (89.5% of English-speaking parents or guardians of pediatric patients evaluated in the ED have adequate health literacy. This data may prompt ED professionals to adjust their communication styles in the evaluation of children. Future multi-center studies are needed to confirm the findings in this pilot study.

  19. Clinical reasoning and population health: decision making for an emerging paradigm of health care.

    Science.gov (United States)

    Edwards, Ian; Richardson, Barbara

    2008-01-01

    Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.

  20. The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study.

    Science.gov (United States)

    Jat, Tej Ram; Deo, Prakash Ramchandra; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel

    2013-09-30

    Politics plays a critical role in agenda setting in health affairs; therefore, understanding the priorities of the political agenda in health is very important. The political priority for safe motherhood has been investigated at the national level in different countries. The objective of this study was to explore why and how maternal health became a political priority at sub-national level in the state of Madhya Pradesh in India. This study followed a qualitative design. Data were collected by carrying out interviews and review of documents. Semi-structured interviews were carried out with twenty respondents from four stakeholder groups: government officials, development partners, civil society and academics. Data analysis was performed using thematic analysis. The analysis was guided by Kingdon's multiple streams model. The emergence of maternal health as a political priority in Madhya Pradesh was the result of convergence in the developments in different streams: the development of problem definition, policy generation and political change. The factors which influenced this process were: emerging evidence of the high magnitude of maternal mortality, civil society's positioning of maternal mortality as a human rights violation, increasing media coverage, supportive policy environment and launch of the National Rural Health Mission (NRHM), the availability of effective policy solutions, India's aspiration of global leadership, international influence, maternal mortality becoming a hot debate topic and political transition at the national and state levels. Most of these factors first became important at national level which then cascaded to the state level. Currently, there is a supportive policy environment in the state for maternal health backed by greater political will and increased resources. However, malnutrition and population stabilization are the competing priorities which may push maternal health off the agenda. The influence of the events and factors

  1. Social Media Messages in an Emerging Health Crisis: Tweeting Bird Flu.

    Science.gov (United States)

    Vos, Sarah C; Buckner, Marjorie M

    2016-01-01

    Limited research has examined the messages produced about health-related crises on social media platforms and whether these messages contain content that would allow individuals to make sense of a crisis and respond effectively. This study uses the crisis and emergency risk communication (CERC) framework to evaluate the content of messages sent via Twitter during an emerging crisis. Using manual and computer-driven content analysis methods, the study analyzed 25,598 tweets about the H7N9 virus that were produced in April 2013. The study found that a large proportion of messages contained sensemaking information. However, few tweets contained efficacy information that would help individuals respond to the crisis appropriately. Implications and recommendations for practice and future study are discussed.

  2. Predicting Positive Education Outcomes for Emerging Adults in Mental Health Systems of Care.

    Science.gov (United States)

    Brennan, Eileen M; Nygren, Peggy; Stephens, Robert L; Croskey, Adrienne

    2016-10-01

    Emerging adults who receive services based on positive youth development models have shown an ability to shape their own life course to achieve positive goals. This paper reports secondary data analysis from the Longitudinal Child and Family Outcome Study including 248 culturally diverse youth ages 17 through 22 receiving mental health services in systems of care. After 12 months of services, school performance was positively related to youth ratings of school functioning and service participation and satisfaction. Regression analysis revealed ratings of young peoples' perceptions of school functioning, and their experience in services added to the significant prediction of satisfactory school performance, even controlling for sex and attendance. Finally, in addition to expected predictors, participation in planning their own services significantly predicted enrollment in higher education for those who finished high school. Findings suggest that programs and practices based on positive youth development approaches can improve educational outcomes for emerging adults.

  3. Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review.

    Science.gov (United States)

    2015-04-01

    Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Law and Politics, an Emerging Epidemic: A Call for Evidence-Based Public Health Law.

    Science.gov (United States)

    Ulrich, Michael R

    2016-05-01

    As Jacobson v. Massachusetts recognized in 1905, the basis of public health law, and its ability to limit constitutional rights, is the use of scientific data and empirical evidence. Far too often, this important fact is lost. Fear, misinformation, and politics frequently take center stage and drive the implementation of public health law. In the recent Ebola scare, political leaders passed unnecessary and unconstitutional quarantine measures that defied scientific understanding of the disease and caused many to have their rights needlessly constrained. Looking at HIV criminalization and exemptions to childhood vaccine requirements, it becomes clear that the blame cannot be placed on the hysteria that accompanies emergencies. Indeed, these examples merely illustrate an unfortunate array of examples where empirical evidence is ignored in the hopes of quelling paranoia. These policy approaches are not only constitutionally questionable, they generate their own risk to public health. The ability of the law to jeopardize public health approaches to infectious disease control can, and should, be limited through a renewed emphasis on science as the foundation of public health, coordination through all levels and branches of government, and through a serious commitment by the judiciary to provide oversight. Infectious disease creates public anxiety, but this cannot justify unwarranted dogmatic approaches as a response. If we as a society hope to ensure efficient, constitutional control over the spread of disease, it is imperative that science take its rightful place at the forefront of governmental decision-making and judicial review. Otherwise, the law becomes its own public health threat.

  5. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Helen Barratt

    Full Text Available The characteristics of Emergency Department (ED attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics.Systematic review and meta-analysis of observational studies describing ED attendances by patients with common mental health conditions.18 studies from seven countries met eligibility criteria. Patients attending due to mental or behavioural health disorders accounted for 4% of ED attendances; a third were due to self-harm or suicidal ideation. 58.1% of attendees had a history of psychiatric illness and up to 58% were admitted. The majority of studies were single site and of low quality so results must be interpreted cautiously.Prevalence studies of mental health-related ED attendances are required to enable the development of services to meet specific needs.

  6. Health professionals' migration in emerging market economies: patterns, causes and possible solutions.

    Science.gov (United States)

    Nair, Manisha; Webster, Premila

    2013-03-01

    About a third of the countries affected by shortage of human resources for health are the emerging market economies (EMEs). The greatest shortage in absolute terms was found to be in India and Indonesia leading to health system crisis. This review identifies the patterns of migration of health workers, causes and possible solutions in these EMEs. A qualitative synthesis approach based on the 'critical review' and 'realist review' approaches to the literature review was used. The patterns of migration of health professionals' in the EMEs have led to two types of discrepancies between health needs and healthcare workers: (i) within country (rural-urban, public-private or government healthcare sector-private sector) and (ii) across countries (south to north). Factors that influence migration include lack of employment opportunities, appropriate work environment and wages in EMEs, growing demand in high-income countries due to demographic transition, favourable country policies for financial remittances by migrant workers and medical education system of EMEs. A range of successful national and international initiatives to address health workforce migration were identified. Measures to control migration should be country specific and designed in accordance with the push and pull factors existing in the EMEs.

  7. Social ecosystem health: confronting the complexity and emergence of infectious diseases

    Directory of Open Access Journals (Sweden)

    Cristina de Albuquerque Possas

    2001-02-01

    Full Text Available The emergence and re-emergence of infectious diseases and their rapid dissemination worldwide are challenging national health systems, particularly in developing countries affected by extreme poverty and environmental degradation. The expectations that new vaccines and drugs and global surveillance would help reverse these trends have been frustrated thus far by the complexity of the epidemiological transition, despite promising prospects for the near future in biomolecular research and genetic engineering. This impasse raises crucial issues concerning conceptual frameworks supporting priority-setting, risk anticipation, and the transfer of science and technology's results to society. This article discusses these issues and the limitations of social and economic sciences on the one hand and ecology on the other as the main theoretical references of the health sciences in confronting the complexity of these issues on their own. The tension between these historically dissociated paradigms is discussed and a transdisciplinary approach is proposed, that of social ecosystem health, incorporating these distinct perspectives into a comprehensive framework.

  8. Using a mobile app and mobile workforce to validate data about emergency public health resources.

    Science.gov (United States)

    Chang, Anna Marie; Leung, Alison C; Saynisch, Olivia; Griffis, Heather; Hill, Shawndra; Hershey, John C; Becker, Lance B; Asch, David A; Seidman, Ariel; Merchant, Raina Martha

    2014-07-01

    Social media and mobile applications that allow people to work anywhere are changing the way people can contribute and collaborate. We sought to determine the feasibility of using mobile workforce technology to validate the locations of automated external defibrillators (AEDs), an emergency public health resource. We piloted the use of a mobile workforce application, to verify the location of 40 AEDs in Philadelphia county. AEDs were pre-identified in public locations for baseline data. The task of locating AEDs was posted online for a mobile workforce from October 2011 to January 2012. Participants were required to submit a mobile phone photo of AEDs and descriptions of the location. Thirty-five of the 40 AEDs were identified within the study period. Most, 91% (32/35) of the submitted AED photo information was confirmed project baseline data. Participants also provided additional data such as business hours and other nearby AEDs. It is feasible to engage a mobile workforce to complete health research-related tasks. Participants were able to validate information about emergency public health resources. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. [Challenges in the assessment and managment of health risks associated with emerging water micropollutants].

    Science.gov (United States)

    Levi, Yves

    2009-06-01

    Analytical laboratories can now identify and quantify an impressive number of "new" pollutants present at very low concentrations in water. Nanotechnology products are a new cause for concern. " Emerging " pollutants are defined as substances that were not previously sought or detected (plasticizers, drugs, chlorination byproducts, persistant organic pollutants, ...) and that are now being identified in many continental water resources. The biological actions of these substances, alone and in combination with other more " classical "pollutants, include such effects as endocrine disruption. Contaminants may be present in surface and groundwater resources, may be generated during treatment, and are found in drinking water distribution networks. In industrialized countries, the main source of emerging pollutants for humans is not water, but rather food, cosmetics and air. Urgent measures are needed to protect biodiversity and human health, including quantitative risk assessment, toxicologic studies of xenobiotic mixtures and chronic effects, strategies to protect water resources, technological advances in wastewater treatment, reliable potable water production, and new inert materials for transport and storage. Good sanitation and safe tap water are major contributors to human health and well-being Major efforts and investments are needed, based on rigorous, objective assessments of risks for the environment and public health.

  10. Threshold Evaluation of Emergency Risk Communication for Health Risks Related to Hazardous Ambient Temperature.

    Science.gov (United States)

    Liu, Yang; Hoppe, Brenda O; Convertino, Matteo

    2018-04-10

    Emergency risk communication (ERC) programs that activate when the ambient temperature is expected to cross certain extreme thresholds are widely used to manage relevant public health risks. In practice, however, the effectiveness of these thresholds has rarely been examined. The goal of this study is to test if the activation criteria based on extreme temperature thresholds, both cold and heat, capture elevated health risks for all-cause and cause-specific mortality and morbidity in the Minneapolis-St. Paul Metropolitan Area. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear model is used to derive the exposure-response functions between daily maximum heat index and mortality (1998-2014) and morbidity (emergency department visits; 2007-2014). Specific causes considered include cardiovascular, respiratory, renal diseases, and diabetes. Six extreme temperature thresholds, corresponding to 1st-3rd and 97th-99th percentiles of local exposure history, are examined. All six extreme temperature thresholds capture significantly increased relative risks for all-cause mortality and morbidity. However, the cause-specific analyses reveal heterogeneity. Extreme cold thresholds capture increased mortality and morbidity risks for cardiovascular and respiratory diseases and extreme heat thresholds for renal disease. Percentile-based extreme temperature thresholds are appropriate for initiating ERC targeting the general population. Tailoring ERC by specific causes may protect some but not all individuals with health conditions exacerbated by hazardous ambient temperature exposure. © 2018 Society for Risk Analysis.

  11. Emerging technologies to measure neighborhood conditions in public health: implications for interventions and next steps.

    Science.gov (United States)

    Schootman, M; Nelson, E J; Werner, K; Shacham, E; Elliott, M; Ratnapradipa, K; Lian, M; McVay, A

    2016-06-23

    Adverse neighborhood conditions play an important role beyond individual characteristics. There is increasing interest in identifying specific characteristics of the social and built environments adversely affecting health outcomes. Most research has assessed aspects of such exposures via self-reported instruments or census data. Potential threats in the local environment may be subject to short-term changes that can only be measured with more nimble technology. The advent of new technologies may offer new opportunities to obtain geospatial data about neighborhoods that may circumvent the limitations of traditional data sources. This overview describes the utility, validity and reliability of selected emerging technologies to measure neighborhood conditions for public health applications. It also describes next steps for future research and opportunities for interventions. The paper presents an overview of the literature on measurement of the built and social environment in public health (Google Street View, webcams, crowdsourcing, remote sensing, social media, unmanned aerial vehicles, and lifespace) and location-based interventions. Emerging technologies such as Google Street View, social media, drones, webcams, and crowdsourcing may serve as effective and inexpensive tools to measure the ever-changing environment. Georeferenced social media responses may help identify where to target intervention activities, but also to passively evaluate their effectiveness. Future studies should measure exposure across key time points during the life-course as part of the exposome paradigm and integrate various types of data sources to measure environmental contexts. By harnessing these technologies, public health research can not only monitor populations and the environment, but intervene using novel strategies to improve the public health.

  12. Business and public health collaboration for emergency preparedness in Georgia: a case study

    Directory of Open Access Journals (Sweden)

    Berkelman Ruth L

    2006-11-01

    Full Text Available Abstract Background Governments may be overwhelmed by a large-scale public health emergency, such as a massive bioterrorist attack or natural disaster, requiring collaboration with businesses and other community partners to respond effectively. In Georgia, public health officials and members of the Business Executives for National Security have successfully collaborated to develop and test procedures for dispensing medications from the Strategic National Stockpile. Lessons learned from this collaboration should be useful to other public health and business leaders interested in developing similar partnerships. Methods The authors conducted a case study based on interviews with 26 government, business, and academic participants in this collaboration. Results The partnership is based on shared objectives to protect public health and assure community cohesion in the wake of a large-scale disaster, on the recognition that acting alone neither public health agencies nor businesses are likely to manage such a response successfully, and on the realization that business and community continuity are intertwined. The partnership has required participants to acknowledge and address multiple challenges, including differences in business and government cultures and operational constraints, such as concerns about the confidentiality of shared information, liability, and the limits of volunteerism. The partnership has been facilitated by a business model based on defining shared objectives, identifying mutual needs and vulnerabilities, developing carefully-defined projects, and evaluating proposed project methods through exercise testing. Through collaborative engagement in progressively more complex projects, increasing trust and understanding have enabled the partners to make significant progress in addressing these challenges. Conclusion As a result of this partnership, essential relationships have been established, substantial private resources and

  13. Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care.

    Science.gov (United States)

    Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

    2013-10-01

    The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventative medicine, to help promote a healthy rural community. We investigate the approaches of patient health monitoring, emergency care, and an ambulance alert alarm (AAA) under mobile cloud-based telecare or community cloud controller systems. Considering permanent mobile users, an efficient health promotion method is proposed. Experiments were conducted to verify the effectiveness of the method. The performance was evaluated from September 2011 to July 2012. A total of 1,856,454 cases were transported and referred to hospital, identified with health problems, and were monitored. We selected all the peer groups and the control server N0 which controls N1, N2, and N3 proxied peer groups. The hospital cloud controller maintains the database of the patients through a JXTA network. Among 1,856,454 transported cases with beneficiaries of 1,712,877 cases there were 1,662,834 lives saved and 8,500 cases transported per day with 104,530 transported cases found to be registered in a JXTA network. The registered case histories were referred from the Hospital community cloud (HCC). SMS messages were sent from node N0 to the relay peers which connected to the N1, N2, and N3 nodes, controlled by the cloud controller through a JXTA network.

  14. Business and public health collaboration for emergency preparedness in Georgia: a case study

    Science.gov (United States)

    Buehler, James W; Whitney, Ellen A; Berkelman, Ruth L

    2006-01-01

    Background Governments may be overwhelmed by a large-scale public health emergency, such as a massive bioterrorist attack or natural disaster, requiring collaboration with businesses and other community partners to respond effectively. In Georgia, public health officials and members of the Business Executives for National Security have successfully collaborated to develop and test procedures for dispensing medications from the Strategic National Stockpile. Lessons learned from this collaboration should be useful to other public health and business leaders interested in developing similar partnerships. Methods The authors conducted a case study based on interviews with 26 government, business, and academic participants in this collaboration. Results The partnership is based on shared objectives to protect public health and assure community cohesion in the wake of a large-scale disaster, on the recognition that acting alone neither public health agencies nor businesses are likely to manage such a response successfully, and on the realization that business and community continuity are intertwined. The partnership has required participants to acknowledge and address multiple challenges, including differences in business and government cultures and operational constraints, such as concerns about the confidentiality of shared information, liability, and the limits of volunteerism. The partnership has been facilitated by a business model based on defining shared objectives, identifying mutual needs and vulnerabilities, developing carefully-defined projects, and evaluating proposed project methods through exercise testing. Through collaborative engagement in progressively more complex projects, increasing trust and understanding have enabled the partners to make significant progress in addressing these challenges. Conclusion As a result of this partnership, essential relationships have been established, substantial private resources and capabilities have been engaged in

  15. A systematic review and overview of health economic evaluations of emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Sohail Bampoe

    2017-11-01

    Full Text Available Abstract Background Little is known about the economic impact of emergency laparotomy (EL surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. Methods MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC checklist. Results Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. Discussion EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Conclusions Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to

  16. A systematic review and overview of health economic evaluations of emergency laparotomy.

    Science.gov (United States)

    Bampoe, Sohail; Odor, Peter M; Ramani Moonesinghe, S; Dickinson, Matthew

    2017-01-01

    Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015. Quality of studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist. Sixteen studies were included from a range of countries. One study was a full economic analysis. Fifteen studies were partial economic evaluations. These studies revealed that emergency abdominal surgery is expensive compared to similar elective surgery when comparing primary resource utilisation costs, with an important societal impact. Most contemporaneous studies indicate that in-hospital costs for EL are in excess of US$10,000 per patient episode, rising substantially when societal costs are considered. EL is a high-risk and costly procedure with a disproportionate financial burden for healthcare providers, relative to national funding provisions and wider societal cost impact. There is substantial heterogeneity in the methodologies and quality of published economic evaluations of EL; therefore, the true economic costs of EL are yet to be fully defined. Future research should focus on developing strategies to embed health economic evaluations within national programmes aiming to improve EL care, including developing the required measures and infrastructure. Emergency laparotomy is expensive, with a significant cost burden to healthcare and systems and society worldwide. Novel strategies for reducing this econmic burden should urgently be explored if greater access to this type of surgery is to be pursued as a global health target. PROSPERO

  17. Tuskegee as Sacred Rhetoric: Focal Point for the Emergent Field of African American Religion and Health.

    Science.gov (United States)

    Laws, Terri

    2018-02-01

    Scholars in African American religion engage the Tuskegee Syphilis Study as the focal point of the African American experience in institutional medicine. Seeking a way forward from this history and its intentional evil, the author proposes to position Tuskegee as a form of Lynch's culturally contextual sacred rhetoric to make use of its metaphoric value in the emerging field of African American religion and health. In this broader meaning-making frame, Tuskegee serves as a reminder that African American religious sensibility has long been an agential resource that counters abuse of the Black body. It also acknowledges the complex decisions facing African American clinical trial participants.

  18. Cosmetic Ingredients as Emerging Pollutants of Environmental and Health Concern. A Mini-Review

    Directory of Open Access Journals (Sweden)

    Claudia Juliano

    2017-04-01

    Full Text Available Cosmetic and personal care products are used in huge quantities throughout the world; as a result of their regular use, they are continuously released into the environment in very large amounts. Many of these products are biologically active and are characterized by persistence and bioaccumulation potential, posing a threat to ecosystem and human health. On the basis of the most recent scientific literature available on this subject, this paper provides an overview of some cosmetic ingredients that are considered environmental emerging pollutants of particular concern such as UV filters, some preservatives (parabens, triclosan, and microplastics.

  19. Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study

    Directory of Open Access Journals (Sweden)

    Xu Yihua

    2008-10-01

    Full Text Available Abstract Background Since the 9/11 attack and severe acute respiratory syndrome (SARS, the development of qualified and able public health leaders has become a new urgency in building the infrastructure needed to address public health emergencies. Although previous studies have reported that the training of individual leaders is an important approach, the systemic and scientific training model need further improvement and development. The purpose of this study was to develop, deliver, and evaluate a participatory leadership training program for emergency response. Methods Forty-one public health leaders (N = 41 from five provinces completed the entire emergency preparedness training program in China. The program was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-month after training (Follow-up. Results The emergency preparedness training resulted in positive shifts in knowledge, self-assessment of skills for public health leaders. More than ninety-five percent of participants reported that the training model was scientific and feasible. Moreover, the response of participants in the program to the avian influenza outbreak, as well as the planned evaluations for this leadership training program, further demonstrated both the successful approaches and methods and the positive impact of this integrated leadership training initiative. Conclusion The emergency preparedness training program met its aims and objectives satisfactorily, and improved the emergency capability of public health leaders. This suggests that the leadership training model was effective and feasible in improving the emergency preparedness capability.

  20. Accreditation of emerging oral health professions: options for dental therapy education programs.

    Science.gov (United States)

    Gelmon, Sherril B; Tresidder, Anna Foucek

    2011-01-01

    The study explored the options for accreditation of educational programs to prepare a new oral health provider, the dental therapist. A literature review and interviews of 10 content experts were conducted. The content experts represented a wide array of interests, including individuals associated with the various dental stakeholder organizations in education, accreditation, practice, and licensure, as well as representatives of non-dental accrediting organizations whose experience could inform the study. Development of an educational accreditation program for an emerging profession requires collaboration among key stakeholders representing education, practice, licensure, and other interests. Options for accreditation of dental therapy education programs include establishment of a new independent accrediting agency; seeking recognition as a committee within the Commission on Accreditation of Allied Health Education Programs; or working with the Commission on Dental Accreditation (CODA) to create a new accreditation program within CODA. These options are not mutually exclusive, and more than one accreditation program could potentially exist. An educational accreditation program is built upon a well-defined field, where there is a demonstrated need for the occupation and for accreditation of educational programs that prepare individuals to enter that occupation. The fundamental value of accreditation is as one player in the overall scheme of improving the quality of higher education delivered to students and, ultimately, the delivery of health services. Leaders concerned with the oral health workforce will need to consider future directions and the potential roles of new oral health providers as they determine appropriate directions for educational accreditation for dental therapy.

  1. The IRSN Emergency Center during the Fukushima NPS Accident: Responding to Health Concerns

    International Nuclear Information System (INIS)

    Jourdain, J.R.; Busset, A.; Monti, P.; Vial, E.; Laloi, P.; Bottollier-Depois, J.F.; Rannou, A.; Aigueperse, J.

    2012-01-01

    This series of slides presents the response brought by IRSN (Institute of Radiation protection and Nuclear Safety) to the health worries of public authorities and the population about the Fukushima accident. In order to tackle this problem efficiently, IRSN decided to bring together health experts in a dedicated team within the IRSN's emergency response center. The objective of the Health Unit were to evaluate and communicate the potential health consequences for people exposed to radioactive releases in Japan and France. 6 dedicated phone lines and one e-mail address have been opened to answer questions from the French population and nationals living in Japan. During the 4 weeks following the tsunami, more than 1300 requests have been received. Another task of the Health Unit was to organize provision of dosimeters and performing measurements for nationals returning from Japan. 287 passive dosimeters have been provided, mostly for journalists and the French embassy in Tokyo, 40 active dosimeters have been provided to the French embassy in Tokyo. Among the lessons learnt we can say that the consequences of the lack of transparency for the Chernobyl accident are still present in France, that French public does not trust the politicians but is confident with information given by experts, and the most important: there is a clear lack of knowledge about radiation protection issues in the French medical communities. (A.C.)

  2. Ethics of clinical science in a public health emergency: drug discovery at the bedside.

    Science.gov (United States)

    Edwards, Sarah J L

    2013-01-01

    Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed.

  3. Scenario-based design: a method for connecting information system design with public health operations and emergency management.

    Science.gov (United States)

    Reeder, Blaine; Turner, Anne M

    2011-12-01

    Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Interview analysis identified 25 information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create 25 scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Information Dissemination of Public Health Emergency on Social Networks and Intelligent Computation

    Directory of Open Access Journals (Sweden)

    Hongzhi Hu

    2015-01-01

    Full Text Available Due to the extensive social influence, public health emergency has attracted great attention in today’s society. The booming social network is becoming a main information dissemination platform of those events and caused high concerns in emergency management, among which a good prediction of information dissemination in social networks is necessary for estimating the event’s social impacts and making a proper strategy. However, information dissemination is largely affected by complex interactive activities and group behaviors in social network; the existing methods and models are limited to achieve a satisfactory prediction result due to the open changeable social connections and uncertain information processing behaviors. ACP (artificial societies, computational experiments, and parallel execution provides an effective way to simulate the real situation. In order to obtain better information dissemination prediction in social networks, this paper proposes an intelligent computation method under the framework of TDF (Theory-Data-Feedback based on ACP simulation system which was successfully applied to the analysis of A (H1N1 Flu emergency.

  5. Risk-communication capability for public health emergencies varies by community diversity

    Directory of Open Access Journals (Sweden)

    Viswanath Kasisomayajula

    2008-03-01

    Full Text Available Abstract Background Public health emergencies heighten several challenges in risk-communication: providing trustworthy sources of information, reaching marginalized populations, and minimizing fear and public confusion. In emergencies, however, information may not diffuse equally among all social groups, and gaps in knowledge may increase. Such knowledge gaps vary by social structure and the size, socioeconomic status, and diversity of the population. This study explores the relationship between risk-communication capabilities, as perceived by public officials participating in emergency tabletop exercises, and community size and diversity. Findings For each of the three communication functions tested, risk-communication capabilities are perceived to be greater in communities with fewer then 10% of the population speaking a language other than English at home, decreasing as the percentage grows to 20% (ANOVA P ≤ 0.02. With respect to community size, however, we found an N-shaped relationship between perceived risk communication capabilities and population size. Capabilities are perceived highest in the largest communities and lowest in the smallest, but lower in communities with 20,000–49,999 inhabitants compared to those with 2,500–19,999. Conclusion The results of this study suggest the need to factor population diversity into risk communication plans and the need for improved state or regional risk-communication capabilities, especially for communities with limited local capacity.

  6. Information Dissemination of Public Health Emergency on Social Networks and Intelligent Computation.

    Science.gov (United States)

    Hu, Hongzhi; Mao, Huajuan; Hu, Xiaohua; Hu, Feng; Sun, Xuemin; Jing, Zaiping; Duan, Yunsuo

    2015-01-01

    Due to the extensive social influence, public health emergency has attracted great attention in today's society. The booming social network is becoming a main information dissemination platform of those events and caused high concerns in emergency management, among which a good prediction of information dissemination in social networks is necessary for estimating the event's social impacts and making a proper strategy. However, information dissemination is largely affected by complex interactive activities and group behaviors in social network; the existing methods and models are limited to achieve a satisfactory prediction result due to the open changeable social connections and uncertain information processing behaviors. ACP (artificial societies, computational experiments, and parallel execution) provides an effective way to simulate the real situation. In order to obtain better information dissemination prediction in social networks, this paper proposes an intelligent computation method under the framework of TDF (Theory-Data-Feedback) based on ACP simulation system which was successfully applied to the analysis of A (H1N1) Flu emergency.

  7. Probiotics for human health –new innovations and emerging trends

    Directory of Open Access Journals (Sweden)

    Grover Sunita

    2012-11-01

    Full Text Available Abstract The role of the gut microbiome in human health and disease with a particular emphasis on therapeutic use of probiotics under specific medical conditions was mainly highlighted in 1st Annual conference of Probiotic Association of India (PAi and International Symposium on “Probiotics for Human Health - New Innovations and Emerging Trends” held on 27th-28th August, 2012 at New Delhi, India. There is increasing recognition of the fact that dysbiosis or alteration of this gut microbiome may be implicated in gastro-intestinal disorders including diarrheal diseases, ulcerative colitis, inflammatory bowel diseases, life style diseases viz. Diabetes Mellitus-2 and obesity etc. This report summarizes the proceedings of the conference and the symposium comprehensively. Although, research on probiotics has been continuing for the past few decades, the subject has been currently the major focus of attention across the world due to recent advances and new developments in genomics, transcriptomics, proteomics, metabolomics and emergence of new generation of high through put sequencing technologies that have immensely helped in understanding the probiotic functionality and mode of action from nutritional and health perspectives. There is now sufficient evidence backed up with good quality scientific clinical data to suggest that probiotic interventions could indeed be effective in various types of diarrheal diseases, other chronic gastrointestinal inflammatory disorders like pouchitis, necrotizing entero-colitis, allergic responses and lactose intolerance etc. This report makes a modest attempt to give all the stake holders involved in development of probiotic based functional/health foods an overview of the current status of probiotics research at the Global and National level. The most crucial issues that emerged from the lead talks delivered by the eminent speakers from India and abroad were the major focus of discussions in different plenary

  8. Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey.

    Science.gov (United States)

    Kyei-Onanjiri, Minerva; Carolan-Olah, Mary; Awoonor-Williams, John Koku; McCann, Terence V

    2018-03-15

    Maternal morbidity and mortality is most prevalent in resource-poor settings such as sub-Saharan Africa and southern Asia. In sub-Saharan Africa, Ghana is one of the countries still facing particular challenges in reducing its maternal morbidity and mortality. Access to emergency obstetric care (EmOC) interventions has been identified as a means of improving maternal health outcomes. Assessing the range of interventions provided in health facilities is, therefore, important in determining capacity to treat obstetric emergencies. The aim of this study was to examine the availability of emergency obstetric care interventions in the Upper East Region of Ghana. A cross-sectional survey of 120 health facilities was undertaken. Status of emergency obstetric care was assessed through an interviewer administered questionnaire to directors/in-charge officers of maternity care units in selected facilities. Data were analysed using descriptive statistics. Eighty per cent of health facilities did not meet the criteria for provision of emergency obstetric care. Comparatively, private health facilities generally provided EmOC interventions less frequently than public health facilities. Other challenges identified include inadequate skill mix of maternity health personnel, poor referral processes, a lack of reliable communication systems and poor emergency transport systems. Multiple factors combine to limit women's access to a range of essential maternal health services. The availability of EmOC interventions was found to be low across the region; however, EmOC facilities could be increased by nearly one-third through modest investments in some existing facilities. Also, the key challenges identified in this study can be improved by enhancing pre-existing health system structures such as Community-based Health Planning and Services (CHPS), training more midwifery personnel, strengthening in-service training and implementation of referral audits as part of health service

  9. [Satisfaction according to health care insurance systems in an emergency department].

    Science.gov (United States)

    Dávila, F A; Herrera, J S; Yasnó, D A; Forero, L C; Alvarado, M V

    Health satisfaction is a fundamental measure of the quality of health services. This study aims to validate and analyse the results of a quality of care questionnaire to assess the level of satisfaction of patients attended in the emergency department of a high complexity hospital. Observational, cross-sectional study, with a questionnaire designed to assess the quality of service and satisfaction at the end of care in the emergency department. Descriptive statistics of scale were established and presented, as well as determining the construct validity, overall reliability, internal and concurrent validity of an overall against a uni-dimensional scale. A total of 5,961 records were reviewed, most of them (77.3%) reported by patients in the Mandatory Health Plan. High levels of satisfaction overall and by subgroups were found. There were no significant differences between subgroups, with 86.8 for those with Pre-paid Medical Care Plan and 84.4 for mandatory health plan. Cronbach's alpha for the questionnaire was 0.90. The questionnaire proved to be reliable and valid in determining the quality and satisfaction with care. The results showed high levels of satisfaction overall and in the domains. A low consistency between the results of the multidimensional and unidimensional satisfaction scales suggests that there were aspects of satisfaction not investigated on the multidimensional scale. Ecologically-designed before and after studies are required to evaluate the effectiveness of interventions in satisfaction. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Looking behind the bars: emerging health issues for people in prison.

    Science.gov (United States)

    Stürup-Toft, S; O'Moore, E J; Plugge, E H

    2018-03-01

    There are more than 10 million people imprisoned worldwide. These individuals experience a higher burden of communicable and non-communicable disease, mental health and substance misuse problems than the general population and often come from marginalized and underserved groups in the community. Prisons offer an important opportunity for tackling health problems in a way that can deliver benefits to the individual and to the community. This paper focuses specifically on emerging health issues for prisons across the world. This paper uses sources of international data from published systematic reviews and research studies, the Ministry of Justice for England and Wales, the Prisons and Probations Ombudsmen Review and other United Kingdom government briefing papers. Deaths in custody are a key concern for the justice system as well as the health system. Suicide is the leading cause of mortality in prisons worldwide but non-communicable diseases, such as cardiovascular disease, are increasing in importance in high-income countries and are now the leading cause of mortality in prisons in England and Wales. The prison population is ageing in most high-income countries. Older people in prison typically have multiple and complex medical and social care needs including reduced mobility and personal care needs as well as poor health. Further research is needed to understand the complex relationship between sentencing patterns, the ageing prison population and deaths in custody; to model its impact on prisons and healthcare provision in the future and to determine effective and cost-effective models of care. Research into the health of prisoners is important in improving the health of prisoners but there is considerable variation in quantity and quality between countries. Recent innovations seek to address this disparity and facilitate the sharing of good practice.

  11. Violence in the emergency department: a survey of health care workers.

    Science.gov (United States)

    Fernandes, C M; Bouthillette, F; Raboud, J M; Bullock, L; Moore, C F; Christenson, J M; Grafstein, E; Rae, S; Ouellet, L; Gillrie, C; Way, M

    1999-11-16

    Violence in the workplace is an ill-defined and underreported concern for health care workers. The objectives of this study were to examine perceived levels of violence in the emergency department, to obtain health care workers' definitions of violence, to determine the effect of violence on health care workers and to determine coping mechanisms and potential preventive strategies. A retrospective written survey of all 163 emergency department employees working in 1996 at an urban inner-city tertiary care centre in Vancouver. The survey elicited demographic information, personal definition of violence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 1996. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies. Of the 163 staff, 106 (65%) completed the survey. A total of 68% (70/103) reported an increased frequency of violence over time, and 60% (64/106) reported an increased severity. Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 1996. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. Seventy-seven respondents (73%) were afraid of patients as a result of violence, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in the emergency department, 12 (67%) reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of

  12. Dermatologic challenges of health care for displaced people. lessons from a German emergency refugee camp

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2016-04-01

    Full Text Available Background: The World faces the highest waves of displaced people since World War II. There is limited knowledge about need of dermatological care for refugees and asylum seekers. Methods: We report the experience with a temporary emergency refugee camp in Dresden form the viewpoint of a hospital department. This is a descriptive report covering the period of 10 weeks. Results: In this refugee camp up to 1 100 people were hosted. The male to female ratio was 5.3. The majority of inhabitants were young males (60%, 20% were children. While 40% of refuges came from Syria, Afghanistan, Iraq and Pakistan were also important countries of origin. Communication war a crucial issue while providing health care. Dermatologic service was granted as consultation, outpatient and inpatient clinic. Most contacts were noted in the outpatient clinic. The majority of patient attended the clinic with communicable diseases such as bacterial or viral infections and infestations. Wounds and chronic inflammatory diseases were rather uncommon. Only 4 patients had to be treated in the hospital (inpatient clinic. Conclusions: Displaced people (refugees, asylum seekers come in big waves to Europe. Dermatologic service is an important part of first aid health care in an emergency camp. Language barriers and cultural barriers have to overcome for optimal service. This is the first report from Germany.

  13. Health smart cards: differing perceptions of emergency department patients and staff.

    Science.gov (United States)

    Mohd Rosli, Reizal; Taylor, David McD; Knott, Jonathan C; Das, Atandrila; Dent, Andrew W

    2009-02-01

    An analytical, cross-sectional survey of 270 emergency department patients and 92 staff undertaken in three tertiary referral hospital emergency departments was completed to compare the perceptions of patients and staff regarding the use of health smart cards containing patient medical records. The study recorded data on a range of health smart card issues including awareness, privacy, confidentiality, security, advantages and disadvantages, and willingness to use. A significantly higher proportion of staff had heard of the card. The perceived disadvantages reported by patients and staff were, overall, significantly different, with the staff reporting more disadvantages. A significantly higher proportion of patients believed that they should choose what information is on the card and who should have access to the information. Patients were more conservative regarding what information should be included, but staff were more conservative regarding who should have access to the information. Significantly fewer staff believed that patients could reliably handle the cards. Overall, however, the cards were considered acceptable and useful, and their introduction would be supported.

  14. Identifying Factors Associated with Risk Assessment Competencies of Public Health Emergency Responders.

    Science.gov (United States)

    Hao, Jiejing; Ren, Jiaojiao; Wu, Qunhong; Hao, Yanhua; Sun, Hong; Ning, Ning; Ding, Ding

    2017-06-04

    This study aimed to better understand the current situation of risk assessment and identify the factors associated with competence of emergency responders in public health risk assessment. The participants were selected by a multi-stage, stratified cluster sampling method in Heilongjiang Centers for Disease Control and Prevention (CDC). The questionnaires that measured their perceptions on risk assessment competences were administered through the face-to-face survey. A final sample of 1889 staff was obtained. Of this sample, 78.6% of respondents rated their own risk assessment competences as "relatively low", contrasting with 21.4% rated as "relatively high". Most of the respondents (62.7%) did not participate in any risk assessment work. Only 13.7% and 42.7% of respondents reported participating in risk assessment training and were familiar with risk assessment tools. There existed statistical significance between risk assessment-related characteristics of respondents and their self-rated competences scores. Financial support from the government and administrative attention were regarded as the important factors contributing to risk assessment competences of CDC responders. Higher attention should be given to risk assessment training and enhancing the availability of surveillance data. Continuous efforts should be made to remove the financial and technical obstacles to improve the competences of risk assessment for public health emergency responders.

  15. Converging requirements and emerging challenges to public health diseases surveillance and bio surveillance

    International Nuclear Information System (INIS)

    Rao, V.; Abel, T.

    2009-01-01

    Disease surveillance systems are a critical component of an early warning system for public health agencies to prepare and respond to major public health catastrophes. With a growing emphasis for more robust early indicator and warning systems to track emerging and dangerous diseases of suspicious nature, considerable emphasis is now placed on deployment of more expanded electronic disease surveillance systems. The architectural considerations for bio surveillance information system are based on collection, analysis and dissemination of human, veterinary and agricultural related disease surveillance to broader regional areas likely to be affected in the event of an emerging disease, or due to bioterrorism and better coordinate plans, preparations and response by governmental agencies and multilateral forums. The diseases surveillance systems architectures by intent and design could as well support biological threat monitoring and threat reduction initiatives. As an illustrative sample set, this paper will describe the comparative informatics requirements for a disease surveillance systems developed by CSC for the US Centers for Diseases Control and Prevention (CDC) currently operational nationwide, and biological weapons threat assessment developed as part of the Threat Agent Detection and Response (TADR) Network under the US Biological Threat Reduction Program and deployed at Uzbekistan, Kazakhstan, Georgia, and Azerbaijan.(author)

  16. How does a Belgian health care provider deal with a request for emergency contraception?

    Science.gov (United States)

    Peremans, Lieve; Verhoeven, Veronique; Philips, Hilde; Denekens, Joke; Van Royen, Paul

    2007-12-01

    To evaluate how Belgian health care providers deal with a request for emergency contraception. In 2002-2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay. All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents. The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.

  17. The public health emergency management system in China: trends from 2002 to 2012.

    Science.gov (United States)

    Sun, Mei; Xu, Ningze; Li, Chengyue; Wu, Dan; Zou, Jiatong; Wang, Ying; Luo, Li; Yu, Mingzhu; Zhang, Yu; Wang, Hua; Shi, Peiwu; Chen, Zheng; Wang, Jian; Lu, Yueliang; Li, Qi; Wang, Xinhua; Bi, Zhenqiang; Fan, Ming; Fu, Liping; Yu, Jingjin; Hao, Mo

    2018-04-11

    Public health emergencies have challenged the public health emergency management systems (PHEMSs) of many countries critically and frequently since this century. As the world's most populated country and the second biggest economy in the world, China used to have a fragile PHEMS; however, the government took forceful actions to build PHEMS after the 2003 SARS outbreak. After more than one decade's efforts, we tried to assess the improvements and problems of China's PHEMS between 2002 and 2012. We conducted two rounds of national surveys and collected the data of the year 2002 and 2012, including all 32 provincial, 139 municipal, and 489 county CDCs. The municipal and county CDCs were selected by systematic random sampling. Twenty-one indicators of four stages (preparation, readiness, response and recovery) from the National Assessment Criteria for CDC Performance were chosen to assess the ten-year trends. At the preparation stage, organization, mechanisms, workforce, and stockpile across all levels and regions were significantly improved after one decade's efforts. At the readiness stage, the capability for formulating an emergency plan was also significantly improved during the same period. At the response stage, internet-based direct reporting was 98.8%, and coping scores were nearly full points of ten in 2012. At the recovery stage, the capabilities were generally lower than expected. Due to forceful leadership, sounder regulations, and intensive resources, China's PHEMS has been improved at the preparation, readiness, and response stages; however, the recovery stage was still weak and could not meet the requirements of crisis management and preventive governance. In addition, CDCs in the Western region and counties lagged behind in performance on most indicators. Future priorities should include developing the recovery stage, establishing a closed feedback loop, and strengthening the capabilities of CDCs in Western region and counties.

  18. The role of surgeons in identifying emerging technologies for health technology assessment.

    Science.gov (United States)

    Stafinski, Tania; Topfer, Leigh-Ann; Zakariasen, Ken; Menon, Devidas

    2010-04-01

    Health technology assessment (HTA) is a tool intended to help policy-makers decide which technologies to fund. However, given the proliferation of new technologies, it is not possible to undertake an HTA of each one before it becomes funded. Consequently, "horizon-scanning" processes have been developed to identify emerging technologies that are likely to have a substantial impact on clinical practice. Although the importance of physicians in the adoption of new technologies is well recognized, their role in horizon scanning in Canada has been limited. The purpose of this project was to pilot an approach to engage physicians, specifically surgeons, in provincial horizon-scanning activities. We invited 18 surgeons from Alberta's 2 medical schools to a horizon-scanning workshop to solicit their views on emerging technologies expected to impact surgical practice within the next 5 years and/or the importance of different attributes or characteristics of new technologies. Surgeons, regardless of specialty, identified developments designed to enhance existing minimally invasive surgical techniques, such as endoscopic, robotic and image-guided surgery. Several nonsurgical areas, including molecular genetics and nano technology, were also identified. Of the 13 technology attributes discussed, safety or risk, effectiveness and feasibility were rated as most important. Lastly, participating surgeons expressed an interest in becoming further involved in local HTA initiatives. Surgeons, as adopters and users of health technologies, represent an important and accessible information source for identifying emerging technologies for HTA. A more formal, ongoing relationship between the government, HTA and surgeons may help to optimize the use of HTA resources.

  19. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes.

    Science.gov (United States)

    Shah, Adil A; Latif, Asad; Zogg, Cheryl K; Zafar, Syed Nabeel; Riviello, Robert; Halim, Muhammad Sohail; Rehman, Zia; Haider, Adil H; Zafar, Hasnain

    2016-02-01

    Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context. March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors. A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%). This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Beyond Participation: Politics, Incommensurability and the Emergence of Mental Health Service Users' Activism in Chile.

    Science.gov (United States)

    Montenegro, Cristian R

    2018-04-24

    Although the organisation of mental health service users and ex-users in Latin America is a recent and under-researched phenomenon, global calls for their involvement in policy have penetrated national agendas, shaping definitions and expectations about their role in mental health systems. In this context, how such groups react to these expectations and define their own goals, strategies and partnerships can reveal the specificity of the "user movement" in Chile and Latin America. This study draws on Jacques Rancière's theorisation of "police order" and "politics" to understand the emergence of users' collective identity and activism, highlighting the role of practices of disengagement and rejection. It is based on interviews and participant observation with a collective of users, ex-users and professionals in Chile. The findings show how the group's aims and self-understandings evolved through hesitations and reflexive engagements with the legal system, the mental health system, and wider society. The notion of a "politics of incommensurability" is proposed to thread together a reflexive rejection of external expectations and definitions and the development of a sense of being "outside" of the intelligibility of the mental health system and its frameworks of observation and proximity. This incommensurability problematises a technical definition of users' presence and influence and the generalisation of abstract parameters of engagement, calling for approaches that address how these groups constitute themselves meaningfully in specific situations.

  1. Emergency response in a global health crisis: epidemiology, ethics, and Ebola application.

    Science.gov (United States)

    Salerno, Jennifer; Hlaing, WayWay M; Weiser, Thomas; Striley, Catherine; Schwartz, Lisa; Angulo, Frederick J; Neslund, Verla S

    2016-04-01

    The link between ethics and epidemiology can go unnoticed in contemporary gatherings of professional epidemiologists or trainees at conferences and workshops, as well as in teaching. Our goal is to provide readers with information about the activities of the College and to provide a broad perspective on a recent major issue in epidemiology. The Ethics Committee of the American College of Epidemiology (ACE) presented a plenary session at the 2015 Annual Meeting in Atlanta, GA, on the complexities of ethics and epidemiology in the context of the 2014-2015 Ebola virus disease outbreak and response in West Africa. This article presents a summary and further discussion of that plenary session. Three main topic areas were presented: clinical trials and ethics in public health emergencies, public health practice, and collaborative work. A number of key ethical concepts were highlighted and discussed in relation to Ebola and the ACE Ethics Guidelines. The Ebola virus disease outbreak is an example of a public health humanitarian crisis from which we hope to better understand the role of professional epidemiologists in public health practice and research and recognize ethical challenges epidemiologists faced. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [Field epidemiological study on news reports that related to public health emergencies].

    Science.gov (United States)

    Zhang, Shun-xiang; Li, Xue-mei; Luo, Nian-ci; Mei, Shu-jiang; Jiang, Li-juan

    2013-12-01

    All news reports (NR) that were related to public health emergency (PHE) were collected from the Southern Metropolis Daily (SMD) to explore the characteristics of epidemiology in the fields. Based on the theory of communication that including both case and text analysis, qualitative analysis on all the NR regarding PHE published in SMD from the years of 2008 to 2012, was carried out and input to database using the EpiData. Numbers of articles as indicators were compared to show the yearly change of different types of events. Various features of the NR including coverage, source of information, location of the incident, style and size of news, with or without editorials etc. were statistically analyzed by SPSS version 18.0. Among all the 998 reports related to PHE, higher proportion was found in the events of Infectious diseases (35.3%) and food safety (34.1%)respectively. Events on vaccines and drugs used for disease prevention and control (8.9%), environmental pollution caused incidents (8.0%)appeared to be less frequent. Events related to occupational disease, poisoning, bioterrorism and biochemical events were rare. Looking at the monthly distribution of reports, we noticed that the peaks occurred in 2008 and in 2009, which were caused by the Melamine-contamination events and the 2009 H1N1 pandemic. Between 2010 and 2012, figures of monthly reports were smooth, including some critical events from the interests of the media. Most events took place in Guangdong province (34.3%) and other provinces (50.9%), with some were from Hong Kong, Macao and Taiwan regions (9.5%). However, international events (5.2%)were less seen. Extensive coverage accounted for 17.6% of all of reports, and 11.5% allotted the editorials or other forms of in-depth reports. Most of the source of reports on infectious diseases and food safety were from the official release, however. The main sources of occupational diseases and poisoning, vaccines and drug incidents, environmental pollution

  3. Feasibility of a patient-driven approach to recruiting older adults, caregivers, and clinicians for provider-patient communication research.

    Science.gov (United States)

    Lingler, Jennifer H; Martire, Lynn M; Hunsaker, Amanda E; Greene, Michele G; Dew, Mary Amanda; Schulz, Richard

    2009-07-01

    This report describes the implementation of a novel, patient-driven approach to recruitment for a study of interpersonal communication in a primary care setting involving persons with Alzheimer's disease (AD), their family caregivers, and their primary care providers (PCPs). Patients and caregivers were centrally recruited from a university-based memory clinic, followed by the recruitment of patient's individual PCPs. Recruitment tracking, naturalistic observation, and survey methods were used to evaluate recruitment success. About half of the patients and caregivers (n = 54; 51%) and most of the PCPs (n = 31; 76%) who we approached agreed to an audiorecording of the patient's next PCP visit. Characteristics of patient, caregiver, and PCP participants were compared to those of nonparticipants. Patient characteristics did not differ by participation status. Caregivers who volunteered for the study were more likely to be female and married than were those who declined to participate. Compared to nonparticipants, PCPs who agreed to the study were appraised slightly more favorably by patients' caregivers on a measure of satisfaction with care on the day of the visit. The vast majority of participating PCPs (95%) reported that the study had little or no impact on the flow of routine clinical operations. Findings support the feasibility of a patient-driven approach to recruitment for studies involving multiple linked participants. Our discussion highlights possible advantages of such an approach, including the potential to empower patient participants while achieving maximum variability within the pool of clinician participants.

  4. The health worker recruitment and deployment process in Kenya: an emergency hiring program

    Directory of Open Access Journals (Sweden)

    Adano Ummuro

    2008-09-01

    Full Text Available Abstract Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART. Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. This model used the private sector to recruit and deploy new health workers and manage the payroll and employment contracts, with an agreement from the government to transfer these staff to the government payroll after three years. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the program increased employee retention and satisfaction. Most of the active roadblocks to changes in the health workforce policies and systems are 'human' and not technical, stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. It is essential to establish partnerships and foster commitment and collaboration to create needed change in human resource management (HRM. Strengthening appointment on merit is one of the most powerful, yet simplest ways in which the health sector and governments that seek to tackle the challenges of corruption and poor governance can improve their image and efficiency. The quality and integrity of the public health sector can be improved only through professionalizing HRM, reformulating and consolidating the currently fragmented HR functions, and bringing all the pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions

  5. Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia

    Directory of Open Access Journals (Sweden)

    Bronwyn A Myers

    2015-07-01

    Full Text Available The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season, modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes.

  6. The health worker recruitment and deployment process in Kenya: an emergency hiring program.

    Science.gov (United States)

    Adano, Ummuro

    2008-09-16

    Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART). Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. This model used the private sector to recruit and deploy new health workers and manage the payroll and employment contracts, with an agreement from the government to transfer these staff to the government payroll after three years. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the program increased employee retention and satisfaction. Most of the active roadblocks to changes in the health workforce policies and systems are 'human' and not technical, stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. It is essential to establish partnerships and foster commitment and collaboration to create needed change in human resource management (HRM). Strengthening appointment on merit is one of the most powerful, yet simplest ways in which the health sector and governments that seek to tackle the challenges of corruption and poor governance can improve their image and efficiency. The quality and integrity of the public health sector can be improved only through professionalizing HRM, reformulating and consolidating the currently fragmented HR functions, and bringing all the pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions and not generalists who are

  7. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and health care education.

    Science.gov (United States)

    Kamel Boulos, Maged N; Wheeler, Steve

    2007-03-01

    Web 2.0 sociable technologies and social software are presented as enablers in health and health care, for organizations, clinicians, patients and laypersons. They include social networking services, collaborative filtering, social bookmarking, folksonomies, social search engines, file sharing and tagging, mashups, instant messaging, and online multi-player games. The more popular Web 2.0 applications in education, namely wikis, blogs and podcasts, are but the tip of the social software iceberg. Web 2.0 technologies represent a quite revolutionary way of managing and repurposing/remixing online information and knowledge repositories, including clinical and research information, in comparison with the traditional Web 1.0 model. The paper also offers a glimpse of future software, touching on Web 3.0 (the Semantic Web) and how it could be combined with Web 2.0 to produce the ultimate architecture of participation. Although the tools presented in this review look very promising and potentially fit for purpose in many health care applications and scenarios, careful thinking, testing and evaluation research are still needed in order to establish 'best practice models' for leveraging these emerging technologies to boost our teaching and learning productivity, foster stronger 'communities of practice', and support continuing medical education/professional development (CME/CPD) and patient education.

  8. Early economic evaluation of emerging health technologies: protocol of a systematic review

    Science.gov (United States)

    2014-01-01

    Background The concept of early health technology assessment, discussed well over a decade, has now been collaboratively implemented by industry, government, and academia to select and expedite the development of emerging technologies that may address the needs of patients and health systems. Early economic evaluation is essential to assess the value of emerging technologies, but empirical data to inform the current practice of early evaluation is limited. We propose a systematic review of early economic evaluation studies in order to better understand the current practice. Methods/design This protocol describes a systematic review of economic evaluation studies of regulated health technologies in which the evaluation is conducted prior to regulatory approval and when the technology effectiveness is not well established. Included studies must report an economic evaluation, defined as the comparative analysis of alternatives with respect to their associated costs and health consequences, and must evaluate some regulated health technology such as pharmaceuticals, biologics, high-risk medical devices, or biomarkers. We will conduct the literature search on multiple databases, including MEDLINE, EMBASE, the Centre for Reviews and Dissemination Databases, and EconLit. Additional citations will be identified via scanning reference lists and author searching. We suspect that many early economic evaluation studies are unpublished, especially those conducted for internal use only. Additionally, we use a chain-referral sampling approach to identify authors of unpublished studies who work in technology discovery and development, starting out with our contact lists and authors who published relevant studies. Citation screening and full-text review will be conducted by pairs of reviewers. Abstracted data will include those related to the decision context and decision problem of the early evaluation, evaluation methods (e.g., data sources, methods, and assumptions used to

  9. Factors Associated With the Likelihood of Hospitalization Following Emergency Department Visits for Behavioral Health Conditions.

    Science.gov (United States)

    Hamilton, Jane E; Desai, Pratikkumar V; Hoot, Nathan R; Gearing, Robin E; Jeong, Shin; Meyer, Thomas D; Soares, Jair C; Begley, Charles E

    2016-11-01

    Behavioral health-related emergency department (ED) visits have been linked with ED overcrowding, an increased demand on limited resources, and a longer length of stay (LOS) due in part to patients being admitted to the hospital but waiting for an inpatient bed. This study examines factors associated with the likelihood of hospital admission for ED patients with behavioral health conditions at 16 hospital-based EDs in a large urban area in the southern United States. Using Andersen's Behavioral Model of Health Service Use for guidance, the study examined the relationship between predisposing (characteristics of the individual, i.e., age, sex, race/ethnicity), enabling (system or structural factors affecting healthcare access), and need (clinical) factors and the likelihood of hospitalization following ED visits for behavioral health conditions (n = 28,716 ED visits). In the adjusted analysis, a logistic fixed-effects model with blockwise entry was used to estimate the relative importance of predisposing, enabling, and need variables added separately as blocks while controlling for variation in unobserved hospital-specific practices across hospitals and time in years. Significant predisposing factors associated with an increased likelihood of hospitalization following an ED visit included increasing age, while African American race was associated with a lower likelihood of hospitalization. Among enabling factors, arrival by emergency transport and a longer ED LOS were associated with a greater likelihood of hospitalization while being uninsured and the availability of community-based behavioral health services within 5 miles of the ED were associated with lower odds. Among need factors, having a discharge diagnosis of schizophrenia/psychotic spectrum disorder, an affective disorder, a personality disorder, dementia, or an impulse control disorder as well as secondary diagnoses of suicidal ideation and/or suicidal behavior increased the likelihood of hospitalization

  10. Physical health and wellbeing of emerging and young adults with mental illness: an integrative review of international literature.

    Science.gov (United States)

    McCloughen, Andrea; Foster, Kim; Huws-Thomas, Michelle; Delgado, Cynthia

    2012-06-01

    Physical health in people with mental illness is often compromised. Chronic physical conditions and disease risk factors occur at higher rates than in the general population. Although substantial research exists regarding mental-physical comorbidities in middle to older-aged adults and mental illness consequential to childhood physical illness, research addressing physical health in young people/emerging adults of 16-24 years with primary mental illnesses is minimal. Health problems often track from youth to adulthood, indicating a need to better recognize and understand the overall health of young people with mental illness. This paper reports findings from an integrative review of published research investigating physical health of emerging/young adults with mental illness. A total of 18 research papers were systematically analysed. The review found that comorbid mental-physical illness/conditions were evident across a wide age span. Specific physical health problems, including pain, gastrointestinal, and respiratory disorders, were apparent in those 16 years to those in their mid-late 20s, and/or with first episode psychosis. Lifestyle risk factors for cardiometabolic disorders occurred with some frequency and originated prior to adulthood. These findings highlight the need for targeted health screening and illness prevention strategies for emerging/young adults with mental health problems and draws attention to the need for young people to be supported in their health-care behaviours. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  11. Current and emerging occupational safety and health (OSH) issues in the healthcare sector, including home and community care

    NARCIS (Netherlands)

    Jong, T. de; Bos, E.; Pawlowska-Cyprysiak, K.; Hildt-Ciupinska, K.; Malinska, M.; Nicolescu, G.; Trifu, A.

    2014-01-01

    This report gives an overview of the current and emerging OSH issues for health- and social care workers and how these affect their safety and health at work and influence the quality of care they provide. It combines a literature review and the responses received to a questionnaire sent to OSH

  12. Digital Twins in Health Care: Ethical Implications of an Emerging Engineering Paradigm.

    Science.gov (United States)

    Bruynseels, Koen; Santoni de Sio, Filippo; van den Hoven, Jeroen

    2018-01-01

    Personalized medicine uses fine grained information on individual persons, to pinpoint deviations from the normal. 'Digital Twins' in engineering provide a conceptual framework to analyze these emerging data-driven health care practices, as well as their conceptual and ethical implications for therapy, preventative care and human enhancement. Digital Twins stand for a specific engineering paradigm, where individual physical artifacts are paired with digital models that dynamically reflects the status of those artifacts. When applied to persons, Digital Twins are an emerging technology that builds on in silico representations of an individual that dynamically reflect molecular status, physiological status and life style over time. We use Digital Twins as the hypothesis that one would be in the possession of very detailed bio-physical and lifestyle information of a person over time. This perspective redefines the concept of 'normality' or 'health,' as a set of patterns that are regular for a particular individual , against the backdrop of patterns observed in the population. This perspective also will impact what is considered therapy and what is enhancement, as can be illustrated with the cases of the 'asymptomatic ill' and life extension via anti-aging medicine. These changes are the consequence of how meaning is derived, in case measurement data is available. Moral distinctions namely may be based on patterns found in these data and the meanings that are grafted on these patterns. Ethical and societal implications of Digital Twins are explored. Digital Twins imply a data-driven approach to health care. This approach has the potential to deliver significant societal benefits, and can function as a social equalizer, by allowing for effective equalizing enhancement interventions. It can as well though be a driver for inequality, given the fact that a Digital Twin might not be an accessible technology for everyone, and given the fact that patterns identified across a

  13. Digital Twins in Health Care: Ethical Implications of an Emerging Engineering Paradigm

    Directory of Open Access Journals (Sweden)

    Koen Bruynseels

    2018-02-01

    Full Text Available Personalized medicine uses fine grained information on individual persons, to pinpoint deviations from the normal. ‘Digital Twins’ in engineering provide a conceptual framework to analyze these emerging data-driven health care practices, as well as their conceptual and ethical implications for therapy, preventative care and human enhancement. Digital Twins stand for a specific engineering paradigm, where individual physical artifacts are paired with digital models that dynamically reflects the status of those artifacts. When applied to persons, Digital Twins are an emerging technology that builds on in silico representations of an individual that dynamically reflect molecular status, physiological status and life style over time. We use Digital Twins as the hypothesis that one would be in the possession of very detailed bio-physical and lifestyle information of a person over time. This perspective redefines the concept of ‘normality’ or ‘health,’ as a set of patterns that are regular for a particular individual, against the backdrop of patterns observed in the population. This perspective also will impact what is considered therapy and what is enhancement, as can be illustrated with the cases of the ‘asymptomatic ill’ and life extension via anti-aging medicine. These changes are the consequence of how meaning is derived, in case measurement data is available. Moral distinctions namely may be based on patterns found in these data and the meanings that are grafted on these patterns. Ethical and societal implications of Digital Twins are explored. Digital Twins imply a data-driven approach to health care. This approach has the potential to deliver significant societal benefits, and can function as a social equalizer, by allowing for effective equalizing enhancement interventions. It can as well though be a driver for inequality, given the fact that a Digital Twin might not be an accessible technology for everyone, and given the fact

  14. Digital Twins in Health Care: Ethical Implications of an Emerging Engineering Paradigm

    Science.gov (United States)

    Bruynseels, Koen; Santoni de Sio, Filippo; van den Hoven, Jeroen

    2018-01-01

    Personalized medicine uses fine grained information on individual persons, to pinpoint deviations from the normal. ‘Digital Twins’ in engineering provide a conceptual framework to analyze these emerging data-driven health care practices, as well as their conceptual and ethical implications for therapy, preventative care and human enhancement. Digital Twins stand for a specific engineering paradigm, where individual physical artifacts are paired with digital models that dynamically reflects the status of those artifacts. When applied to persons, Digital Twins are an emerging technology that builds on in silico representations of an individual that dynamically reflect molecular status, physiological status and life style over time. We use Digital Twins as the hypothesis that one would be in the possession of very detailed bio-physical and lifestyle information of a person over time. This perspective redefines the concept of ‘normality’ or ‘health,’ as a set of patterns that are regular for a particular individual, against the backdrop of patterns observed in the population. This perspective also will impact what is considered therapy and what is enhancement, as can be illustrated with the cases of the ‘asymptomatic ill’ and life extension via anti-aging medicine. These changes are the consequence of how meaning is derived, in case measurement data is available. Moral distinctions namely may be based on patterns found in these data and the meanings that are grafted on these patterns. Ethical and societal implications of Digital Twins are explored. Digital Twins imply a data-driven approach to health care. This approach has the potential to deliver significant societal benefits, and can function as a social equalizer, by allowing for effective equalizing enhancement interventions. It can as well though be a driver for inequality, given the fact that a Digital Twin might not be an accessible technology for everyone, and given the fact that patterns

  15. Editorial: eHealth literacy: Emergence of a new concept for creating, evaluating and understanding online health resources for the public

    Directory of Open Access Journals (Sweden)

    Andre W. Kushniruk (ACMI Fellow; CAHS Fellow

    2015-12-01

    Full Text Available The ability of consumers of health information to effectively understand, process and apply health information presented to them is a critical factor in improving health knowledge and developing effective health promotion strategies. Nowhere has this become more apparent than in efforts to apply information technology in the development of a range of systems and applications targeted for use by patients, and the general population. Indeed, success and failure of eHealth initiatives has been shown to depend on consideration of how to effectively design and deploy health information to consumers. Health literacy has become an important area of study that focuses on studying how health information can be understood and applied to improve health. In recent years the concept of eHealth literacy has also emerged, that sits at the intersection of health literacy and information technology literacy. In this special issue, a range of papers are presented that focus on the emerging concept of eHealth literacy. The papers in the special issue focus on basic definitional and conceptual issues as well as methodological approaches to studying health and eHealth literacy. A special focus of the issue is on how these concepts apply and can be adapted for improving health information technologies and applications.

  16. Polio eradication in the African Region on course despite public health emergencies.

    Science.gov (United States)

    Okeibunor, Joseph C; Ota, Martin C; Akanmori, Bartholomew D; Gumede, Nicksy; Shaba, Keith; Kouadio, Koffi I; Poy, Alain; Mihigo, Richard; Salla, Mbaye; Moeti, Matshidiso R

    2017-03-01

    The World Health Organization, African Region is heading toward eradication of the three types of wild polio virus, from the Region. Cases of wild poliovirus (WPV) types 2 and 3 (WPV2 and WPV3) were last reported in 1998 and 2012, respectively, and WPV1 reported in Nigeria since July 2014 has been the last in the entire Region. This scenario in Nigeria, the only endemic country, marks a remarkable progress. This significant progress is as a result of commitment of key partners in providing the much needed resources, better implementation of strategies, accountability, and innovative approaches. This is taking place in the face of public emergencies and challenges, which overburden health systems of countries and threaten sustainability of health programmes. Outbreak of Ebola and other diseases, insecurity, civil strife and political instability led to displacement of populations and severely affected health service delivery. The goal of eradication is now within reach more than ever before and countries of the region should not relent in their efforts on polio eradication. WHO and partners will redouble their efforts and introduce better approaches to sustain the current momentum and to complete the job. The carefully planned withdrawal of oral polio vaccine type II (OPV2) with an earlier introduction of one dose of inactivated poliovirus vaccine (IPV), in routine immunization, will boost immunity of populations and stop cVDPVs. Environmental surveillance for polio viruses will supplement surveillance for AFP and improve sensitivity of detection of polio viruses. Copyright © 2016 World Health Organization. Published by Elsevier Ltd. Published by Elsevier Ltd.. All rights reserved.

  17. Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework.

    Science.gov (United States)

    Gushulak, Bd; Weekers, J; Macpherson, Dw

    2009-01-01

    International population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. These risks are often related, but not limited, to transmissible pathogens. Mobile populations can link zones of disease emergence to lowprevalence or nonendemic areas through rapid or high-volume international movements, or both. Against this background of human movement, other global processes such as economics, trade, transportation, environment and climate change, as well as civil security influence the health impacts of disease emergence. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, affect organizational and public awareness of events of potential public health significance. International regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement. The thesis that human population mobility is itself a major determinant of global public health is supported in this article by review of the published literature from the perspective of determinants of health (such as genetics/biology, behavior, environment, and socioeconomics), population-based disease prevalence differences, existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. This paper highlights some of the emerging threats and risks to public health, identifies gaps in existing frameworks to manage health issues associated with migration, and suggests changes in approach to population mobility, globalization, and public health. The proposed integrated approach includes a broad spectrum of stakeholders ranging from individual health-care providers to policy makers and international organizations that are primarily involved in global health management, or are influenced

  18. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues.

    Science.gov (United States)

    Lewis, Tené T; Cogburn, Courtney D; Williams, David R

    2015-01-01

    Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.

  19. Tocopherols and Tocotrienols in Common and Emerging Dietary Sources: Occurrence, Applications, and Health Benefits.

    Science.gov (United States)

    Shahidi, Fereidoon; de Camargo, Adriano Costa

    2016-10-20

    Edible oils are the major natural dietary sources of tocopherols and tocotrienols, collectively known as tocols. Plant foods with low lipid content usually have negligible quantities of tocols. However, seeds and other plant food processing by-products may serve as alternative sources of edible oils with considerable contents of tocopherols and tocotrienols. Tocopherols are among the most important lipid-soluble antioxidants in food as well as in human and animal tissues. Tocopherols are found in lipid-rich regions of cells (e.g., mitochondrial membranes), fat depots, and lipoproteins such as low-density lipoprotein cholesterol. Their health benefits may also be explained by regulation of gene expression, signal transduction, and modulation of cell functions. Potential health benefits of tocols include prevention of certain types of cancer, heart disease, and other chronic ailments. Although deficiencies of tocopherol are uncommon, a continuous intake from common and novel dietary sources of tocopherols and tocotrienols is advantageous. Thus, this contribution will focus on the relevant literature on common and emerging edible oils as a source of tocols. Potential application and health effects as well as the impact of new cultivars as sources of edible oils and their processing discards are presented. Future trends and drawbacks are also briefly covered.

  20. Democratic transitions, health institutions, and financial protection in the emerging economies: insights from Asia.

    Science.gov (United States)

    Gómez, Eduardo J

    2017-07-01

    In recent years, several emerging economies have introduced national health insurance programs ensuring access to health care while offering financial protection from out-of-pocket and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to health care during transitions to democracy, civil societal mobilization, constitutional constraints and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia's success and China's failure to ensure financial protection.

  1. Assessment of work ability of health professionals in the mobile emergency unit.

    Science.gov (United States)

    Santos, Y; Porto, F; Marques, L; Tomaz, A; Toledo, R; Lucena, N

    2012-01-01

    Ergonomics is the study of a workplace and the worker. Its aim is to better adapt the workplace to man by preserving the body for short and long term work. This helps to adjust and improve functionality, thus preserving the body for short and long term work. It was through the observation of SAMU's (Mobile Emergency Unit) professional's helpers that the interest to evaluate these individuals arose. In addition, the aim of this research is to investigate the work ability of health professionals that work for SAMU/JP. The population was composed of 97 health professionals who currently work for SAMU/JP. A sociodemographic questionnaire was used as data collection instrument and it was validated by the index of the Work Ability (WAI). The research took place in 2010, in the headquarters of SAMU, in the city of João Pessoa, state of Paraíba - Brazil. The data analysis was carried out by simple descriptive statistics followed by comparison of the results with the pertinent literature. The quantity of daily sleeping hours, the levels of satisfaction in the job and the number of diagnosed diseases were among the most worrying factors. In spite of this, the health professionals obtained a work ability average considered to be "good".

  2. The hookworm Ancylostoma ceylanicum: An emerging public health risk in Australian tropical rainforests and Indigenous communities.

    Science.gov (United States)

    Smout, Felicity A; Skerratt, Lee F; Butler, James R A; Johnson, Christopher N; Congdon, Bradley C; Thompson, R C Andrew

    2017-06-01

    Ancylostoma ceylanicum is the common hookworm of domestic dogs and cats throughout Asia, and is an emerging but little understood public health risk in tropical northern Australia. We investigated the prevalence of A. ceylanicum in soil and free-ranging domestic dogs at six rainforest locations in Far North Queensland that are Indigenous Australian communities and popular tourist attractions within the Wet Tropics World Heritage Area. By combining PCR-based techniques with traditional methods of hookworm species identification, we found the prevalence of hookworm in Indigenous community dogs was high (96.3% and 91.9% from necropsy and faecal samples, respectively). The majority of these infections were A. caninum. We also observed, for the first time, the presence of A. ceylanicum infection in domestic dogs (21.7%) and soil (55.6%) in an Indigenous community. A. ceylanicum was present in soil samples from two out of the three popular tourist locations sampled. Our results contribute to the understanding of dogs as a public health risk to Indigenous communities and tourists in the Wet Tropics. Dog health needs to be more fully addressed as part of the Australian Government's commitments to "closing the gap" in chronic disease between Indigenous and other Australians, and encouraging tourism in similar locations.

  3. The hookworm Ancylostoma ceylanicum: An emerging public health risk in Australian tropical rainforests and Indigenous communities

    Directory of Open Access Journals (Sweden)

    Felicity A. Smout

    2017-06-01

    Full Text Available Ancylostoma ceylanicum is the common hookworm of domestic dogs and cats throughout Asia, and is an emerging but little understood public health risk in tropical northern Australia. We investigated the prevalence of A. ceylanicum in soil and free-ranging domestic dogs at six rainforest locations in Far North Queensland that are Indigenous Australian communities and popular tourist attractions within the Wet Tropics World Heritage Area. By combining PCR-based techniques with traditional methods of hookworm species identification, we found the prevalence of hookworm in Indigenous community dogs was high (96.3% and 91.9% from necropsy and faecal samples, respectively. The majority of these infections were A. caninum. We also observed, for the first time, the presence of A. ceylanicum infection in domestic dogs (21.7% and soil (55.6% in an Indigenous community. A. ceylanicum was present in soil samples from two out of the three popular tourist locations sampled. Our results contribute to the understanding of dogs as a public health risk to Indigenous communities and tourists in the Wet Tropics. Dog health needs to be more fully addressed as part of the Australian Government's commitments to “closing the gap” in chronic disease between Indigenous and other Australians, and encouraging tourism in similar locations.

  4. Tocopherols and Tocotrienols in Common and Emerging Dietary Sources: Occurrence, Applications, and Health Benefits

    Science.gov (United States)

    Shahidi, Fereidoon; de Camargo, Adriano Costa

    2016-01-01

    Edible oils are the major natural dietary sources of tocopherols and tocotrienols, collectively known as tocols. Plant foods with low lipid content usually have negligible quantities of tocols. However, seeds and other plant food processing by-products may serve as alternative sources of edible oils with considerable contents of tocopherols and tocotrienols. Tocopherols are among the most important lipid-soluble antioxidants in food as well as in human and animal tissues. Tocopherols are found in lipid-rich regions of cells (e.g., mitochondrial membranes), fat depots, and lipoproteins such as low-density lipoprotein cholesterol. Their health benefits may also be explained by regulation of gene expression, signal transduction, and modulation of cell functions. Potential health benefits of tocols include prevention of certain types of cancer, heart disease, and other chronic ailments. Although deficiencies of tocopherol are uncommon, a continuous intake from common and novel dietary sources of tocopherols and tocotrienols is advantageous. Thus, this contribution will focus on the relevant literature on common and emerging edible oils as a source of tocols. Potential application and health effects as well as the impact of new cultivars as sources of edible oils and their processing discards are presented. Future trends and drawbacks are also briefly covered. PMID:27775605

  5. Emergency Medical Services Public Health Implications and Interim Guidance for the Ebola Virus in the United States

    Directory of Open Access Journals (Sweden)

    Christopher E. McCoy

    2014-11-01

    Full Text Available The 25th known outbreak of the Ebola Virus Disease (EVD is now a global public health emergency and the World Health Organization (WHO has declared the epidemic to be a Public Health Emergency of International Concern (PHEIC. Since the first cases of the West African epidemic were reported in March 2014, there has been an increase in infection rates of over 13,000% over a 6-month period. The Ebola virus has now arrived in the United States and public health professionals, doctors, hospitals, Emergency Medial Services Administrators, Medical Directors, and policy makers have been working with haste to develop strategies to prevent the disease from reaching epidemic proportions. Prehospital care providers (emergency medical technicians and paramedics and medical first responders (including but not limited to firefighters and law enforcement are the healthcare systems front lines when it comes to first medical contact with patients outside of the hospital setting. Risk of contracting Ebola can be particularly high in this population of first responders if the appropriate precautions are not implemented. This article provides a brief clinical overview of the Ebola Virus Disease and provides a comprehensive summary of the Center for Disease Control and Prevention’s Interim Guidance for Emergency Medical Services (EMS Systems and 9-1-1 Public Safety Answering Points (PSAPS for Management of Patients with Known of Suspected Ebola Virus Disease in the United States. [West J Emerg Med. 2014;15(7:-0.

  6. Empathy and burnout of emergency professionals of a health region: A cross-sectional study.

    Science.gov (United States)

    Yuguero, Oriol; Forné, Carles; Esquerda, Montserrat; Pifarré, Josep; Abadías, María José; Viñas, Joan

    2017-09-01

    The objective of this study is to assess the association between levels of empathy and burnout of emergency professionals in all the assistance levels.A cross-sectional observational study was conducted in the health region of Lleida and the Pyrenees with 100 professionals from the field of Urgency. Participation reached 40.8%. Empathy and burnout were measured using the Spanish versions of the Jefferson Scale of Physician Empathy (JSPE) and Maslach Burnout Inventory (MBI) respectively. The total MBI score and its 3 dimensions (emotional exhaustion, depersonalization, and personal accomplishment) were analyzed. The JSPE and MBI scores were categorized into tertiles that were identified as "low," "moderate," and "high" levels.The median (interquartile range) was 112 (102-123) and 37 (27-53.5) for the JSPE and MBI scores respectively. Professionals with high burnout (MBI≥47) showed the lowest levels of empathy, that is, JSPE score of 105 (98-114); those with moderate burnout (31≤MBI empathy were associated with the lowest levels of burnout, especially in depersonalization, and to a lesser extent in personal accomplishment. There were no differences in empathy and burnout for any of the other study variables.Our findings suggest that the empathy of emergency professionals is associated with burnout. Hence, reducing professional burnout could help keep emergency professionals' empathy levels high, which in turn would ensure a better quality of care. Nevertheless, it would be necessary to carry out prospective studies to describe the profiles of burnout and empathy as well as their association and evolution.

  7. The academic health center in complex humanitarian emergencies: lessons learned from the 2010 Haiti earthquake.

    Science.gov (United States)

    Babcock, Christine; Theodosis, Christian; Bills, Corey; Kim, Jimin; Kinet, Melodie; Turner, Madeleine; Millis, Michael; Olopade, Olufunmilayo; Olopade, Christopher

    2012-11-01

    On January 12, 2010, a 7.0-magnitude earthquake struck Haiti. The event disrupted infrastructure and was marked by extreme morbidity and mortality. The global response to the disaster was rapid and immense, comprising multiple actors-including academic health centers (AHCs)-that provided assistance in the field and from home. The authors retrospectively examine the multidisciplinary approach that the University of Chicago Medicine (UCM) applied to postearthquake Haiti, which included the application of institutional structure and strategy, systematic deployment of teams tailored to evolving needs, and the actual response and recovery. The university mobilized significant human and material resources for deployment within 48 hours and sustained the effort for over four months. In partnership with international and local nongovernmental organizations as well as other AHCs, the UCM operated one of the largest and more efficient acute field hospitals in the country. The UCM's efforts in postearthquake Haiti provide insight into the role AHCs can play, including their strengths and limitations, in complex disasters. AHCs can provide necessary intellectual and material resources as well as technical expertise, but the cost and speed required for responding to an emergency, and ongoing domestic responsibilities, may limit the response of a large university and hospital system. The authors describe the strong institutional backing, the detailed predeployment planning and logistical support UCM provided, the engagement of faculty and staff who had previous experience in complex humanitarian emergencies, and the help of volunteers fluent in the local language which, together, made UCM's mission in postearthquake Haiti successful.

  8. Comparing Burnout Across Emergency Physicians, Nurses, Technicians, and Health Information Technicians Working for the Same Organization.

    Science.gov (United States)

    Schooley, Benjamin; Hikmet, Neset; Tarcan, Menderes; Yorgancioglu, Gamze

    2016-03-01

    Studies on the topic of burnout measure the effects of emotional exhaustion (EE), depersonalization (DP) (negative or cynical attitudes toward work), and reduced sense of personal accomplishment (PA). While the prevalence of burnout in practicing emergency medicine (EM) professionals has been studied, little is known of the prevalence and factors across physicians, nurses, technicians, and health information technicians working for the same institution. The aim of this study was to assess burnout differences across EM professional types.The total population of 250 EM professionals at 2 public urban hospitals in Turkey were surveyed using the Maslach Burnout Inventory and basic social- and work-related demographics. Descriptive statistics, ANOVA, and additional post hoc tests were computed.Findings show that EE and DP scores were high across all occupational groups, while scores on PA were low. There was a statistically significant difference between nurses and medical technicians (P nurses and medical technicians (P Burnout can be high across occupational groups in the emergency department. Burnout is important for EM administrators to assess across human resources. Statistically significant differences across socio-demographic groups vary across occupational groups. However, differences between occupational groups may not be explained effectively by the demographic factors assessed in this or other prior studies. Rather, the factors associated with burnout are incomplete and require further institutional, cultural, and organizational analyses including differentiating between job tasks carried out by each EM job type.

  9. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making.

    Science.gov (United States)

    Gordon, Bradley D; Bernard, Kyle; Salzman, Josh; Whitebird, Robin R

    2015-12-01

    The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

  10. Lessons learned from Ebola Vaccine R&D during a public health emergency.

    Science.gov (United States)

    Kieny, Marie-Paule

    2018-02-16

    In spite of a complete lack of Research and Development (R&D) preparedness, the 2013-2016 West-Africa Ebola experience demonstrated that it is possible to compress R&D timelines to less than a single year, from a more usual decade or longer. This is mostly to be credited to an unprecedented collaborative effort building on the availability of a small number of candidate diagnostic tests, drugs and vaccines that could be moved rapidly into the clinical phase evaluation. The World Health Organization (WHO) led international consultations and activities - including the organization of a successful Ebola vaccine efficacy trial in Guinea - as a contribution to the unprecedented global efforts to control the Ebola epidemic. Since 2015, WHO expert teams and partners are implementing a novel R&D model for emerging infectious pathogens which are the most likely to cause severe outbreaks in the future, and for which no or only few medical countermeasures are available: the WHO R&D Blueprint. The objective for the Blueprint is the fostering of a R&D environment which is prepared for quickly and effectively responding to outbreaks due to emerging infectious disease.

  11. Hotspot health physics codes used as a tool for managing excess risk on radiological emergencies

    International Nuclear Information System (INIS)

    Andrade, Edson Ramos de; Alves, Nelson Mendes; Rocha, Joao B.T.; Cruz, Ivana B. Manica da; Santos, Greice F. Fey dos; Machado, Michel Mansur; Rossato, Veronica Venturini; Bauermann, Liliane Freitas

    2008-01-01

    This work is aimed to use the Hotspot Health Physics codes in acute mode in order to estimate the immediate radiological impact associated with high acute radiation doses, which is applied to special target organs such as lung, small intestine wall, and red bone marrow. Organic compounds such as Diphenyl Diselenide (C 6 H 5 Se 2 C 6 H 5 ) and Ebselen (C 13 H 9 NOSe), an antioxidants selenium containing compounds, were used over irradiated phospholipids extracted from chicken yolk eggs, in vitro in order to reduce lipo-peroxidation. Experimental data were measured by Thiobarbituric Acid Reactive Substance (TBARS) assay which is able to measure the production of oxidative stress in the sample. Experimental data were extrapolated and applied as a reduction factors over equations for cancer excess risk calculation from BEIR V, for helping the decisonmaking process on Radiological Emergency Scenarios. (author)

  12. Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) Training Evaluation: Potential Implications for Disaster Health Care Volunteers.

    Science.gov (United States)

    Schmitz, Susan; Radcliff, Tiffany A; Chu, Karen; Smith, Robert E; Dobalian, Aram

    2018-02-20

    The US Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions. DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: "Training Satisfaction," "Attitudes about Training," "Continued Engagement in DEMPS." Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology. Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-valuevolunteer engagement. A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018; page 1 of 8).

  13. Critical incident exposure in South African emergency services personnel: prevalence and associated mental health issues

    Science.gov (United States)

    Ward, C L; Lombard, C J; Gwebushe, N

    2006-01-01

    Objectives To assess critical incident exposure among prehospital emergency services personnel in the developing world context of South Africa; and to assess associated mental health consequences. Methods We recruited a representative sample from emergency services in the Western Cape Province, South Africa, to participate in this cross sectional epidemiological study. Questionnaires covered critical incident exposure, general psychopathology, risky alcohol use, symptoms of post‐traumatic stress disorder (PTSD), and psychological and physical aggression between co‐workers. Open ended questions addressed additional stressors. Results Critical incident exposure and rates of general psychopathology were higher than in studies in the developed world. Exposure to critical incidents was associated with general psychopathology, symptoms of PTSD, and with aggression between co‐workers, but not with alcohol use. Ambulance, fire, and sea rescue services had lower general psychopathology scores than traffic police. The sea rescue service also scored lower than traffic police on PTSD and psychological aggression. The defence force had higher rates of exposure to physical assault, and in ambulance services, younger staff were more vulnerable to assault. Women had higher rates of general psychopathology and of exposure to psychological aggression. Other stressors identified included death notification, working conditions, and organisational problems. Conclusions Service organisations should be alert to the possibility that their personnel are experiencing work ‐related mental health and behavioural problems, and should provide appropriate support. Attention should also be given to organisational issues that may add to the stress of incidents. Workplace programmes should support vulnerable groups, and address death notification and appropriate expression of anger. PMID:16498167

  14. Levonorgestrel emergency contraceptive pills use during breastfeeding; effect on infants' health and development.

    Science.gov (United States)

    Shaaban, Omar M; Abbas, Ahmed M; Mahmoud, Hanaa R; Yones, Entsar M; Mahmoud, Ahmed; Zakherah, Mahmoud S

    2018-02-20

    The current study aims to evaluate the effect of the use of single packet of levonorgestrel emergency contraceptive pills (LNG-ECPs) during breastfeeding on the health and development of the nursing infant. The current study was an ancillary observational cohort study carried out in a university hospital. We counseled all women delivered and planning birth-space and breastfeed for at least 1 year for participation during postpartum hospital stay. Eligible participants for inclusion in the randomized controlled trial (NCT 01111929) were allocated to receive adequate Lactational Amenorrhea Method (LAM) counseling (LAM-only group) or the LAM counseling in addition to counseling about LNG-ECPs use (LAM + emergency contraception (EC) group). These pills were to be used once if unprotected intercourse did occur after expiry of any of the LAM prerequisites and before the couples started to use a reliable method of contraception. We included the first 100 women in the LAM + EC who did use the pills and the first 100 women in the control group who completed the follow-up visits for 6 months to draw the infants' outcome. The primary outcome was the difference of anthropometric measurements of the infants at 3 and 6 months postpartum. Secondary outcome was the difference in the Psycho-social, fine and gross motor, and language development using Denver development screening test. There were no statistical significant differences between both the groups regarding the infants' weight, length, head circumference, chest circumference, and mid-arm circumference at each visit (p > .05). Additionally, there were no statistically significant differences regarding all items (psycho-social, fine and gross motor, and language) of Denver development screening test between the infants in LAM-only and LAM + EC groups (p = .081). The use of single packet of LNG-ECPs during breastfeeding not objectively affects health and development of nursing infants or subjectively

  15. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider.

    Science.gov (United States)

    Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S

    2011-02-01

    PRIMARY CARE PROVIDERS SHOULD BE AWARE OF TWO NEW DEVELOPMENTS IN NICOTINE ADDICTION AND SMOKING CESSATION: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as "thirdhand smoke". The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking.

  16. Anticipated changes in reimbursements for US outpatient emergency department encounters after health reform.

    Science.gov (United States)

    Galarraga, Jessica E; Pines, Jesse M

    2014-04-01

    We study how reimbursements to emergency departments (EDs) for outpatient visits may be affected by the insurance coverage expansion of the Patient Protection and Affordable Care Act as previously uninsured patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. We specified multiple linear regression models to examine differences in the payments, charges, and reimbursement ratios by insurance category. Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. From 2005 to 2010, as a percentage of total ED charges, outpatient ED encounters for Medicaid beneficiaries reimbursed 17% more than for uninsured individuals who will become Medicaid eligible after Patient Protection and Affordable Care Act implementation: 40.0% versus 34.0%, mean absolute difference=5.9%, 95% confidence interval 5.7% to 6.2%. During the same period, the privately insured reimbursed 39% more than for uninsured individuals who will not be Medicaid eligible after Patient Protection and Affordable Care Act implementation: 54.0% versus 38.8%, mean absolute difference=15.2%, 95% confidence interval 12.8% to 17.6%. Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges. Although our study does provide insight into the future, multiple factors will ultimately influence reimbursements after implementation

  17. E-learning for grass-roots emergency public health personnel: Preliminary lessons from a national program in China.

    Science.gov (United States)

    Xu, Wangquan; Jiang, Qicheng; Qin, Xia; Fang, Guixia; Hu, Zhi

    2016-07-19

    In China, grass-roots emergency public health personnel have relatively limited emergency response capabilities and they are constantly required to update their professional knowledge and skills due to recurring and new public health emergencies. However, professional training, a principal solution to this problem, is inadequate because of limitations in manpower and financial resources at grass-roots public health agencies. In order to provide a cost-effective and easily expandable way for grass-roots personnel to acquire knowledge and skills, the National Health Planning Commission of China developed an emergency response information platform and provided trial access to this platform in Anhui and Heilongjiang provinces in China. E-learning was one of the modules of the platform and this paper has focused on an e-learning pilot program. Results indicated that e-learning had satisfactorily improved the knowledge and ability of grass-roots emergency public health personnel, and the program provided an opportunity to gain experience in e-course design and implementing e-learning. Issues such as the lack of personalized e-courses and the difficulty of evaluating the effectiveness of e-learning are topics for further study.

  18. Championing mental health at work: emerging practice from innovative projects in the UK.

    Science.gov (United States)

    Robinson, Mark; Tilford, Sylvia; Branney, Peter; Kinsella, Karina

    2014-09-01

    This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based 'business champions' to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the 'business champion' emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments. © The Author (2013). Published by Oxford University Press. All rights reserved. For

  19. Comparing the implementation consequences of the immunisation and emergency department health targets in New Zealand.

    Science.gov (United States)

    Tenbensel, Tim; Chalmers, Linda; Willing, Esther

    2016-09-19

    Purpose Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments. Design/methodology/approach For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation. Findings Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure; and the dynamics of the intra-organisational and inter-organisational implementation context. Research limitations/implications The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution. Practical implications While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff. Originality/value The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.

  20. [Estimating emergency hospital admissions to gauge short-term effects of air pollution: evaluation of health data quality].

    Science.gov (United States)

    Bois de Fer, Béatrice; Host, Sabine; Chardon, Benoît; Chatignoux, Edouard; Beaujouan, Laure; Brun-Ney, Dominique; Grémy, Isabelle

    2009-01-01

    The study of the short-term effects and health impact of air pollution is carrier out by the ERPURS regional surveillance program which utilizes hospitalization data obtained from the French hospital information system (PMSI) to determine these links. This system does not permit the distinction between emergency hospital admissions from scheduled ones, which cannot be related to short term changes in air pollution levels. This study examines how scheduled admissions affect the quality of the health indicators used to estimate air pollution effects. This indicator is compared to three new emergency hospitalisation indicators reconstructed based on data from the public hospitals in Paris, partly from the PMSI data and partly with data from an on-line emergency network that regroups all of the computerized emergency services. According to the pathology, scheduled admissions present a difficulty which affects the capacity to highlight the weakest risks with any precision.

  1. Implementing a national early awareness and alert system for new and emerging health technologies in Italy: the COTE Project.

    Science.gov (United States)

    Migliore, Antonio; Perrini, Maria Rosaria; Jefferson, Tom; Cerbo, Marina

    2012-07-01

    The aim of this study was to establish a national Early Awareness and Alert (EAA) system for the identification and assessment of new and emerging health technologies in Italy. In 2008, Agenas, a public body supporting Regions and the Ministry of Health (MoH) in health services research, started a project named COTE (Observatory of New and Emerging Health Technologies) with the ultimate aim of implementing a national EAA system. The COTE project involved all stakeholders (MoH, Regions, Industry, Universities, technical government bodies, and Scientific Societies), in defining the key characteristics and methods of the EAA system. Agreement with stakeholders was reached using three separate workshops. During the workshops, participants shared and agreed methods for identification of new and emerging health technologies, prioritization, and assessment. The structure of the Horizon Scanning (HS) reports was discussed and defined. The main channels for dissemination of outputs were identified as the EuroScan database, and the stakeholders' Web portals. During the final workshop, Agenas presented the first three HS reports produced at national level and proposed the establishment of a permanent national EAA system. The COTE Project created the basis for a permanent national EAA system in Italy. An infrastructure to enable the stakeholders network to grow was created, methods to submit new and emerging health technologies for possible evaluation were established, methods for assessment of the technologies selected were defined, and the stakeholders involvement was delineated (in the identification, assessment, and dissemination stages).

  2. Feasibility of a patient-driven approach to recruiting older adults, caregivers, and clinicians for provider–patient communication research

    Science.gov (United States)

    Lingler, Jennifer H.; Martire, Lynn M.; Hunsaker, Amanda E.; Greene, Michele G.; Dew, Mary Amanda; Schulz, Richard

    2009-01-01

    Purpose This report describes the implementation of a novel, patient-driven approach to recruitment for a study of interpersonal communication in a primary care setting involving persons with Alzheimer’s disease (AD), their family caregivers, and their primary care providers (PCPs). Data sources Patients and caregivers were centrally recruited from a university-based memory clinic, followed by the recruitment of patient’s individual PCPs. Recruitment tracking, naturalistic observation, and survey methods were used to evaluate recruitment success. Conclusions About half of the patients and caregivers (n = 54; 51%) and most of the PCPs (n = 31; 76%) who we approached agreed to an audiorecording of the patient’s next PCP visit. Characteristics of patient, caregiver, and PCP participants were compared to those of nonparticipants. Patient characteristics did not differ by participation status. Caregivers who volunteered for the study were more likely to be female and married than were those who declined to participate. Compared to nonparticipants, PCPs who agreed to the study were appraised slightly more favorably by patients’ caregivers on a measure of satisfaction with care on the day of the visit. The vast majority of participating PCPs (95%) reported that the study had little or no impact on the flow of routine clinical operations. Implications for research Findings support the feasibility of a patient-driven approach to recruitment for studies involving multiple linked participants. Our discussion highlights possible advantages of such an approach, including the potential to empower patient participants while achieving maximum variability within the pool of clinician participants. PMID:19594656

  3. Can free open access resources strengthen knowledge-based emerging public health priorities, policies and programs in Africa?

    Science.gov (United States)

    Tambo, Ernest; Madjou, Ghislaine; Khayeka-Wandabwa, Christopher; Tekwu, Emmanuel N; Olalubi, Oluwasogo A; Midzi, Nicolas; Bengyella, Louis; Adedeji, Ahmed A; Ngogang, Jeanne Y

    2016-01-01

    Tackling emerging epidemics and infectious diseases burden in Africa requires increasing unrestricted open access and free use or reuse of regional and global policies reforms as well as timely communication capabilities and strategies. Promoting, scaling up data and information sharing between African researchers and international partners are of vital importance in accelerating open access at no cost. Free Open Access (FOA) health data and information acceptability, uptake tactics and sustainable mechanisms are urgently needed. These are critical in establishing real time and effective knowledge or evidence-based translation, proven and validated approaches, strategies and tools to strengthen and revamp health systems.  As such, early and timely access to needed emerging public health information is meant to be instrumental and valuable for policy-makers, implementers, care providers, researchers, health-related institutions and stakeholders including populations when guiding health financing, and planning contextual programs.

  4. PERSISTENT ORGANIC POLLUTANTS IN HUMANS AND WILDLIFE: EMERGING ISSUES FOR ENVIRONMENTAL AND PUBLIC HEALTH

    Directory of Open Access Journals (Sweden)

    Aldo Pacheco Ferreira

    2013-08-01

    Full Text Available Persistent organic pollutants persevere in the environment for a long time, are toxic to humans and/or wildlife, and have a resilient propensity to bioaccumulate in the food chain. Due to its chemical stability, their lipid solubility, and its ubiquitous prevalence in environmental, these pollutants are disposed to long-range transport. The success of modern societies is in part based on extensive achievements of chemistry with a systematic development of products in medicine, agriculture, and in almost all manufacturing industry sectors and materials for daily use. Although, these chemicals unequivocally contribute to the quality of life for billions of human beings, however, the negative impacts to environment and health are an important issue for ostensible monitoring. Social and environmental benefits should not be ignored, in spite of economic forces.The recognition that prevention is the best method to mitigate the risk of diseases to public health related to the environment, mainly driven by technological development, becomes essential the individuation and quantification of toxicological endpoints for systematic monitoring of these emerging pollutants.

  5. [Hardy personality, self-efficacy, and general health in nursing professionals of intensive and emergency services].

    Science.gov (United States)

    Ríos Rísquez, María Isabel; Sánchez Meca, Julio; Godoy Fernández, Carmen

    2010-11-01

    In this study, the predictive power of hardy personality and generalized self-efficacy on general health perception was investigated in a sample of nursing personnel working in emergency and intensive care services. A cross-sectional retrospective design was used, and the following measurement instruments were applied: a sociodemographic and work questionnaire, Goldberg's GHQ-28 Health Questionnaire, the Baessler and Schwarzer General Self-efficacy Questionnaire, and the Hardy Personality Subscale of Moreno's Nursing Burnout Questionnaire (CDPE). The results revealed a positive and statistically significant relationship between the individual variables of generalized self-efficacy and hardy personality. A canonical correlation analysis carried out on the psychological distress symptoms with self-efficacy and hardy personality as predictor variables, led us to emphasize the relevance of the construct total hardy personality as a predictor and, consequently, as a protective factor against the onset of psychological distress symptoms in the sample of professionals studied. Lastly, the implications of the results for clinical practice are discussed.

  6. Accidents involving Brazilian indigenous treated at urgent and emergency services of the Unified Health System.

    Science.gov (United States)

    Souza, Edinilsa Ramos de; Njaine, Kathie; Mascarenhas, Márcio Dênis Medeiros; Oliveira, Maria Conceição de

    2016-12-01

    Abstract We analyzed the accidents with Brazilian indigenous treated at urgent and emergency services of the Unified Health System (SUS). Data were obtained from the 2014 Viva Survey, which included 86 services from 24 capitals and the Federal District. The demographic profile of the indigenous, the event and the attendance were characterized. Most of the attended people were male in the 20-39 years age group. Falls and traffic accidents were the main reasons for attendance. Alcohol use was informed by 5.6% of the attended people, a figure that increases to 19.1% in traffic accidents, 26.1% among drivers and 22.8% among motorcyclists. There was a statistical difference between genders in relation to age, disability, place of occurrence of the event, work-related event and victim's condition in the traffic accident. We emphasize the importance of providing visibility to accidents with indigenous and engage them in the prevention of such events. Data reliability depends on the adequate completion in indigenous health information systems.

  7. Immune System: An Emerging Player in Mediating Effects of Endocrine Disruptors on Metabolic Health.

    Science.gov (United States)

    Bansal, Amita; Henao-Mejia, Jorge; Simmons, Rebecca A

    2018-01-01

    The incidence of metabolic disorders like type 2 diabetes and obesity continues to increase. In addition to the well-known contributors to these disorders, such as food intake and sedentary lifestyle, recent research in the exposure science discipline provides evidence that exposure to endocrine-disrupting chemicals like bisphenol A and phthalates via multiple routes (e.g., food, drink, skin contact) also contribute to the increased risk of metabolic disorders. Endocrine-disrupting chemicals (EDCs) can disrupt any aspect of hormone action. It is becoming increasingly clear that EDCs not only affect endocrine function but also adversely affect immune system function. In this review, we focus on human, animal, and in vitro studies that demonstrate EDC exposure induces dysfunction of the immune system, which, in turn, has detrimental effects on metabolic health. These findings highlight how the immune system is emerging as a novel player by which EDCs may mediate their effects on metabolic health. We also discuss studies highlighting mechanisms by which EDCs affect the immune system. Finally, we consider that a better understanding of the immunomodulatory roles of EDCs will provide clues to enhance metabolic function and contribute toward the long-term goal of reducing the burden of environmentally induced diabetes and obesity. Copyright © 2018 Endocrine Society.

  8. The emergence of translational epidemiology: from scientific discovery to population health impact.

    Science.gov (United States)

    Khoury, Muin J; Gwinn, Marta; Ioannidis, John P A

    2010-09-01

    Recent emphasis on translational research (TR) is highlighting the role of epidemiology in translating scientific discoveries into population health impact. The authors present applications of epidemiology in TR through 4 phases designated T1-T4, illustrated by examples from human genomics. In T1, epidemiology explores the role of a basic scientific discovery (e.g., a disease risk factor or biomarker) in developing a "candidate application" for use in practice (e.g., a test used to guide interventions). In T2, epidemiology can help to evaluate the efficacy of a candidate application by using observational studies and randomized controlled trials. In T3, epidemiology can help to assess facilitators and barriers for uptake and implementation of candidate applications in practice. In T4, epidemiology can help to assess the impact of using candidate applications on population health outcomes. Epidemiology also has a leading role in knowledge synthesis, especially using quantitative methods (e.g., meta-analysis). To explore the emergence of TR in epidemiology, the authors compared articles published in selected issues of the Journal in 1999 and 2009. The proportion of articles identified as translational doubled from 16% (11/69) in 1999 to 33% (22/66) in 2009 (P = 0.02). Epidemiology is increasingly recognized as an important component of TR. By quantifying and integrating knowledge across disciplines, epidemiology provides crucial methods and tools for TR.

  9. Effect of a Targeted Women's Health Intervention in an Inner-City Emergency Department

    Directory of Open Access Journals (Sweden)

    Debra Houry

    2011-01-01

    Full Text Available Objective. To evaluate the effect of an Emergency Department (ED based, educational intervention for at-risk health behaviors. Methods. A randomized trial over a one-year period. African American women, aged 21–55, presenting to the ED waiting room were eligible. Each participant took a computer-based survey on health risk behaviors. Participants who screened positive on any of four validated scales (for IPV, nicotine, alcohol, or drug dependence were randomized to standard information about community resources (control or to targeted educational handouts based upon their screening results (intervention. Participants were surveyed at 3 months regarding contacts with community resources and harm-reduction actions. Results. 610 women were initially surveyed; 326 screened positive (13.7% for IPV, 40.1% for nicotine addiction, 26.6% for alcohol abuse, and 14.4% for drug abuse. 157 women were randomized to intervention and 169 to control. Among women who completed follow-up (=71, women in the Intervention Group were significantly more likely to have contacted local resources (37% versus 9%, =0.04 and were more likely to have taken risk-reducing action (97% versus 79%, =0.04. Conclusion. Targeted, brief educational interventions may be an effective method for targeting risk behaviors among vulnerable ED populations.

  10. An Assesment of Emergency Contraception Knowledge of Women Attending the Primary Health Care Center in Umraniye

    Directory of Open Access Journals (Sweden)

    M. Fatih Onsuz

    2008-10-01

    Full Text Available BACKGROUND: The aim of the study was to determined the knowledge of women who were in reproductive age that were attending to a primary health care center which was having family planning service in Umraniye. METHODS: This descriptive research has been performed at a primary health care center in Umraniye, between 18-20 December 2006. In our study study sample isn’t selected and we include women of reproductive age who are attending to the primary health care with any cause in the study dates. Study has been performed at 241 women (89.9% that has been interwieved of 268. Study data has been collected by a three part questionnaire which has 33 question. The data has been evaluated by chi square and Fisher exact tests. RESULTS: The median age of the participants was 28 (25p-75p. Small part of participants have heard emergency contraception (13.7%. There was a significant relationship between hearing the method, being nullipar and high education level (p<0.05. The participants who were hearing the method just 60.6% of them also knew the aim of the method (8.3% of the all participants. In the same group of the participants only 36.4% knew correctly of taking time of the pills and 9.0% of them knew correctly of taking piece of tablet after an unprotected sexual intercourse. Only one of the women who were determining of hearing the method also ever used it. There was a statistically significant difference between young age and high education level and knowing correctly of the aim of the method. Also there was a statisticaly significant difference between high education level and knowing correctly of taking time of the method after an unprotected sexual intercourse (p<0.05. CONCLUSION: Although awareness of emergency contraception is at an apparent level the using rate of the method is at a very low level. Giving education about the aim, taking time and how taking of the method to the women who are living at the study area is providing of giving shape

  11. Can mHealth improve access to safe blood for transfusion during obstetric emergency?

    Directory of Open Access Journals (Sweden)

    Rahman A

    2017-04-01

    Full Text Available Aminur Rahman,1,2 Sadika Akhter,1 Monjura Khatun Nisha,3 Syed Shariful Islam,4 Fatema Ashraf,5 Monjur Rahman,1 Nazneen Begum,6 Mahbub Elahi Chowdhury,1 Anne Austin,7 Iqbal Anwar1 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b, Dhaka, Bangladesh; 2College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 3Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 4Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, 5Department of Gyenaecology and Obstetric, Shaheed Suhrawardi Medical College and Hospital, 6Department of Gyenaecology and Obstetric, Dhaka Medical College and Hospital, Dhaka, Bangladesh; 7JSI Research & Training Institute, Inc., Boston, MA, USA Purpose: Of the 99% maternal deaths that take place in developing countries, one-fourth is due to postpartum hemorrhage (PPH. PPH accounts for one-third of all blood transfusions in Bangladesh where the transfusion process is lengthy as most facilities do not have in-house blood bank facilities. In this context, the location where blood is obtained and the processes of obtaining blood products are not standardized, leading to preventable delays in collecting blood, when it is needed. This study evaluated the effectiveness of an online Blood Information Management Application (BIMA system for reducing lag time in the blood transfusion process.Patients and methods: The study was conducted in a public medical college hospital in Dhaka, Bangladesh, and in two proximate, licensed blood banks between January 2014 and March 2015, using a before after design. A total of 310 women (143 before and 177 after, who needed emergency blood transfusion during their perinatal period, as determined by a medical professional, were included in the study. A median linear regression model was employed to assess the adjusted effect of BIMA on transfusion time.Results: After the

  12. Electronic health record adoption in US hospitals: the emergence of a digital "advanced use" divide.

    Science.gov (United States)

    Adler-Milstein, Julia; Holmgren, A Jay; Kralovec, Peter; Worzala, Chantal; Searcy, Talisha; Patel, Vaishali

    2017-11-01

    While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources - small, rural, safety-net - are keeping up. Using 2008-2015 American Hospital Association Information Technology Supplement survey data, we measured "basic" and "comprehensive" EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital "advanced use" divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain. We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P functions (OR = 0.68; P = 0.02). While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance. Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions

  13. [Zika virus infection: a new public health emergency with great media impact].

    Science.gov (United States)

    Caylà, Joan A; Domínguez, Ángela; Rodríguez Valín, Elena; de Ory, Fernando; Vázquez, Ana; Fortuny, Claudia

    Infection with Zika virus (ZV) has become a new epidemic, with great impact on the media, and is having a strong effect in Latin American countries. Its possible association with microcephaly and Guillain-Barré syndrome prompted the World Health Organization (WHO) to declare on 1 February 2016 that this epidemic is a public health emergency of international concern. Epidemiological data show an increasing incidence in countries like Brazil and Colombia, and that the epidemic is still expanding in many other countries. Between January 2007 and 27 April 2016, the WHO detected transmission in 55 countries (in 42 of these, this was the first outbreak of Zika) and 1,198 microcephalies and other neurological disorders in Brazil. Also, during 2015-2016, 13 countries detected an increase in Guillain-Barré syndrome and/or confirmation of ZV associated with Guillain-Barré syndrome. Research has already demonstrated a causal relationship between microcephaly and other serious brain disorders in newborns and ZV infection in the mother. Clinically, many cases are asymptomatic and it can be difficult to distinguish this diagnosis from that of other arboviruses. Vector control in Spain is a priority because of the presence of the Aedes albopictus (tiger mosquito). Early diagnosis is recommended, as is avoiding travel to endemic areas and unprotected sex, and ensuring that the high political profile, which can prevent this epidemic from becoming a high prevalence endemic disease, does not cause us to forget about other health problems. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Past speculations of the future: a review of the methods used for forecasting emerging health technologies.

    Science.gov (United States)

    Doos, Lucy; Packer, Claire; Ward, Derek; Simpson, Sue; Stevens, Andrew

    2016-03-10

    Forecasting can support rational decision-making around the introduction and use of emerging health technologies and prevent investment in technologies that have limited long-term potential. However, forecasting methods need to be credible. We performed a systematic search to identify the methods used in forecasting studies to predict future health technologies within a 3-20-year timeframe. Identification and retrospective assessment of such methods potentially offer a route to more reliable prediction. Systematic search of the literature to identify studies reported on methods of forecasting in healthcare. People are not needed in this study. The authors searched MEDLINE, EMBASE, PsychINFO and grey literature sources, and included articles published in English that reported their methods and a list of identified technologies. Studies reporting methods used to predict future health technologies within a 3-20-year timeframe with an identified list of individual healthcare technologies. Commercially sponsored reviews, long-term futurology studies (with over 20-year timeframes) and speculative editorials were excluded. 15 studies met our inclusion criteria. Our results showed that the majority of studies (13/15) consulted experts either alone or in combination with other methods such as literature searching. Only 2 studies used more complex forecasting tools such as scenario building. The methodological fundamentals of formal 3-20-year prediction are consistent but vary in details. Further research needs to be conducted to ascertain if the predictions made were accurate and whether accuracy varies by the methods used or by the types of technologies identified. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records.

    Science.gov (United States)

    Ozkaynak, Mustafa; Dziadkowiec, Oliwier; Mistry, Rakesh; Callahan, Tiffany; He, Ze; Deakyne, Sara; Tham, Eric

    2015-10-01

    The purpose of this study was to describe a workflow analysis approach and apply it in emergency departments (EDs) using data extracted from the electronic health record (EHR) system. We used data that were obtained during 2013 from the ED of a children's hospital and its four satellite EDs. Workflow-related data were extracted for all patient visits with either a primary or secondary diagnosis on discharge of asthma (ICD-9 code=493). For each patient visit, eight different a priori time-stamped events were identified. Data were also collected on mode of arrival, patient demographics, triage score (i.e. acuity level), and primary/secondary diagnosis. Comparison groups were by acuity levels 2 and 3 with 2 being more acute than 3, arrival mode (ambulance versus walk-in), and site. Data were analyzed using a visualization method and Markov Chains. To demonstrate the viability and benefit of the approach, patient care workflows were visually and quantitatively compared. The analysis of the EHR data allowed for exploration of workflow patterns and variation across groups. Results suggest that workflow was different for different arrival modes, settings and acuity levels. EHRs can be used to explore workflow with statistical and visual analytics techniques novel to the health care setting. The results generated by the proposed approach could be utilized to help institutions identify workflow issues, plan for varied workflows and ultimately improve efficiency in caring for diverse patient groups. EHR data and novel analytic techniques in health care can expand our understanding of workflow in both large and small ED units. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Paper based diagnostics for personalized health care: Emerging technologies and commercial aspects.

    Science.gov (United States)

    Mahato, Kuldeep; Srivastava, Ananya; Chandra, Pranjal

    2017-10-15

    Personalized health care (PHC) is being appreciated globally to combat clinical complexities underlying various metabolic or infectious disorders including diabetes, cardiovascular, communicable diseases etc. Effective diagnoses majorly depend on initial identification of the causes which are nowadays being practiced in disease-oriented approach, where personal health profile is often overlooked. The adoption of PHC has shown significantly improved diagnoses in various conditions including emergency, ambulatory, and remote area. PHC includes personalized health monitoring (PHM), which is its integral part and may provide valuable information's on various clinical conditions. In PHC, bio-fluids are analyzed using various diagnostic devices including lab based equipment and biosensors. Among all types of biosensing systems, paper based biosensors are commercially attracted due to its portability, easy availability, cheaper manufacturing cost, and transportability. Not only these, various intrinsic properties of paper has facilitated the development of paper based miniaturized sensors, which has recently gained ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment free, Deliverable to all end-users) status for point of care diagnosis in miniaturized settings. In this review, importance of paper based biosensors and their compatibility for affordable and low cost diagnostics has been elaborated with various examples. Limitations and strategies to overcome the challenges of paper biosensor have also been discussed. We have provided elaborated tables which describe the types, model specifications, sensing mechanisms, target biomarkers, and analytical performance of the paper biosensors with their respective applications in real sample matrices. Different commercial aspects of paper biosensor have also been explained using SWOT (Strength, Weakness, Opportunities, Threats) analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Immigrants’ use of emergency primary health care in Norway: a registry-based observational study

    Directory of Open Access Journals (Sweden)

    Sandvik Hogne

    2012-09-01

    Full Text Available Abstract Background Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC services for non-urgent purposes. The aim of the present study was to analyse immigrants’ use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. Methods We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of socio-demographic and socio-economic variables were done by multiple logistic regression analyses. Results Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%. Total contact rates for Polish and German immigrants (mostly work immigrants were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants’ rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used

  18. Immigrants’ use of emergency primary health care in Norway: a registry-based observational study

    Science.gov (United States)

    2012-01-01

    Background Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC) services for non-urgent purposes. The aim of the present study was to analyse immigrants’ use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. Methods We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of socio-demographic and socio-economic variables were done by multiple logistic regression analyses. Results Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%). Total contact rates for Polish and German immigrants (mostly work immigrants) were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers) 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants’ rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used for Somalis and Iraqis

  19. Emergence of visceral leishmaniasis in Sri Lanka: a newly established health threat.

    Science.gov (United States)

    Siriwardana, H V Y D; Karunanayake, P; Goonerathne, L; Karunaweera, N D

    2017-09-01

    Sri Lanka is a new focus of human cutaneous leishmaniasis caused by a genetic variant of usually visceralizing parasite Leishmania donovani. Over 3000 cases have been reported to our institution alone, during the past two decades. Recent emergence of visceral leishmaniasis is of concern. Patients suspected of having visceral leishmaniasis (n = 120) fulfilling at least two of six criteria (fever > 2 weeks, weight loss, tiredness affecting daily functions, splenomegaly, hepatomegaly and anemia) were studied using clinic-epidemiological, immunological and haematological parameters. Seven cases (four progressive, treated (group A) and 3 non- progressive, potentially asymptomatic and observed (group B) were identified. Clinical cases were treated with systemic sodium stibogluconate or amphotericin B and all were followed up at the leishmaniasis clinic of University of Colombo for 3 years with one case followed up for 9 years. All treated cases responded well to anti leishmanial treatment. Relapses were not noticed. Clinical features subsided in all non-progressive cases and did not develop suggestive clinical features or change of laboratory parameters. Visceral leishmaniasis cases have been originated from different districts within the country. Majority had a travel history to identified local foci of cutaneous leishmaniasis. Visceral leishmaniasis is recognized as an emerging health threat in Sri Lanka. At least a proportion of locally identified strains of L. donovani possess the ability to visceralize. Apparent anti leishmanial sensitivity is encouraging. Timely efforts in disease containment will be important in which accurate understanding of transmission characteristics, increased professional and community awareness, improved diagnostics and availability of appropriate treatment regimens.

  20. Violence toward health care workers in emergency departments in west Turkey.

    Science.gov (United States)

    Ayranci, Unal

    2005-04-01

    The aims of this study were to describe the epidemiology of violence in Turkish emergency departments (EDs), and to provide a more specific focus on violence. This study was conducted in 18 EDs in west Turkey for 3 months. Emergency staff in the EDs were asked to recall experiences of violence directed at them at work over the previous year. We then put these experiences into five categories: verbal abuse, specific threats, physical action with or without injury, sexual violence, and the last category, acts not falling in the other four categories. The data were analyzed using chi-square test and percent ratios. Of the 195 respondents answering the questions regarding violence against them, 72.3% (141/195) had experienced some form of violence. Most of the respondents stated that they had experienced verbal/emotional abuse (69.5%), followed by specific threats (53.2%), and physical action (8.5%). Groups experiencing the highest percentage of any type of violence during the previous year were as follows: 30-39-year-olds (82.1%), nurses and physicians (80.8% and 78.0%, respectively), public hospital health care staff (81.0%), staff working for 61-120 months (82.8%), those working between 8:00 a.m. and 5:00 p.m. (81.8%), and those working in low deprivation practices (79.6%). Most of the aggressors were patients' relatives (89%) as compared with patients' themselves (52%). Half of those experiencing physical action (50% [6/12]) during the course of the last year received support and inability reports due to minor injuries. There were no major injuries such as lacerations or fractures. We recommend that training to deal with violence in the workplace be specifically targeted at members of staff who are most likely to be at risk of threats of violence and actual physical aggression.

  1. Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force.

    Science.gov (United States)

    Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy

    2016-01-01

    Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis.

    Science.gov (United States)

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. The importance of PHLP has grown during the past decade and focuses mainly on infection-disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States' utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.

  3. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    Directory of Open Access Journals (Sweden)

    Odeya Cohen

    2015-10-01

    Full Text Available Background: Public health legal preparedness (PHLP for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC and developed countries. Objective: This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design: A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results: The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions: The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended.

  4. Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

    Science.gov (United States)

    Cohen, Odeya; Feder-Bubis, Paula; Bar-Dayan, Yaron; Adini, Bruria

    2015-01-01

    Background Public health legal preparedness (PHLP) for emergencies is a core component of the health system response. However, the implementation of health legal preparedness differs between low- and middle-income countries (LMIC) and developed countries. Objective This paper examines recent trends regarding public health legal preparedness for emergencies and discusses its role in the recent Ebola outbreak. Design A rigorous literature review was conducted using eight electronic databases as well as Google Scholar. The results encompassed peer-reviewed English articles, reports, theses, and position papers dating from 2011 to 2014. Earlier articles concerning regulatory actions were also examined. Results The importance of PHLP has grown during the past decade and focuses mainly on infection–disease scenarios. Amid LMICs, it mostly refers to application of international regulations, whereas in developed states, it focuses on independent legislation and creation of conditions optimal to promoting an effective emergency management. Among developed countries, the United States’ utilisation of health legal preparedness is the most advanced, including the creation of a model comprising four elements: law, competencies, information, and coordination. Only limited research has been conducted in this field to date. Nevertheless, in both developed and developing states, studies that focused on regulations and laws activated in health systems during emergencies, identified inconsistency and incoherence. The Ebola outbreak plaguing West Africa since 2014 has global implications, challenges and paralleling results, that were identified in this review. Conclusions The review has shown the need to broaden international regulations, to deepen reciprocity between countries, and to consider LMICs health capacities, in order to strengthen the national health security. Adopting elements of the health legal preparedness model is recommended. PMID:26449204

  5. Arboviruses emerging in Brazil: challenges for clinic and implications for public health.

    Science.gov (United States)

    Donalisio, Maria Rita; Freitas, André Ricardo Ribas; Zuben, Andrea Paula Bruno Von

    2017-04-10

    Arboviruses have been emerging in different parts of the world due to genetic changes in the virus, alteration of the host and vector population dynamics, or because of anthropogenic environmental factors. These viruses' capacity for adaptation is notable, as well as the likelihood of their emergence and establishment in new geographic areas. In Brazilian epidemiologic scenario, the most common arboviruses are DENV, CHIKV, and ZIKV, although others may spread in the country. Little is yet known of the impact of viral co-circulation, which would theoretically result in more intense viremia or other immunological alterations that could trigger autoimmune diseases, such as Guillain-Barré syndrome. The impact on morbidity and mortality intensifies as extensive epidemics lead to a high number of affected individuals, severe cases, and implications for health services, mainly due to the absence of treatment, vaccines, and effective prevention and control measures. RESUMO Notifica-se a emergência de arboviroses em diferentes regiões do planeta em decorrência de mudanças genéticas no vírus, alteração da dinâmica populacional de hospedeiros e vetores ou por fatores ambientais de origem antropogênica. É notável a capacidade de adaptação desses vírus e a possibilidade de emergirem e se estabelecerem em novas áreas geográficas. No contexto epidemiológico brasileiro, os arbovírus de maior circulação são DENV, CHIKV e ZIKV, embora existam outros com potencial de disseminação no País. O impacto da cocirculação viral ainda é pouco conhecido, a qual teoricamente resultaria em viremias mais intensas ou outras alterações imunológicas que poderiam ser o gatilho para doenças autoimunes, como a síndrome de Guillain-Barré. O impacto na morbidade e mortalidade se intensifica à medida que extensas epidemias pressupõem grande número de indivíduos acometidos, casos graves e implicações sobre os serviços de saúde, principalmente diante da aus

  6. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider

    Directory of Open Access Journals (Sweden)

    Nidhi Mehrotra

    2011-02-01

    Full Text Available Ware G Kuschner, Sunayana Reddy, Nidhi Mehrotra, Harman S PaintalDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USAAbstract: Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1 the emergence of a novel nicotine delivery system known as the electronic (e- cigarette; and 2 new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS. The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room

  7. Emerging issues in paediatric health research consent forms in Canada: working towards best practices.

    Science.gov (United States)

    Dove, Edward S; Avard, Denise; Black, Lee; Knoppers, Bartha M

    2013-01-30

    Obtaining a research participant's voluntary and informed consent is the bedrock of sound ethics practice. Greater inclusion of children in research has led to questions about how paediatric consent operates in practice to accord with current and emerging legal and socio-ethical issues, norms, and requirements. Employing a qualitative thematic content analysis, we examined paediatric consent forms from major academic centres and public organisations across Canada dated from 2008-2011, which were purposively selected to reflect different types of research ethics boards, participants, and studies. The studies included biobanking, longitudinal studies, and gene-environment studies. Our purpose was to explore the following six emerging issues: (1) whether the scope of parental consent allows for a child's assent, dissent, or future consent; (2) whether the concepts of risk and benefit incorporate the child's psychological and social perspective; (3) whether a child's ability to withdraw is respected and to what extent withdrawal is permitted; (4) whether the return of research results includes individual results and/or incidental findings and the processes involved therein; (5) whether privacy and confidentiality concerns adequately address the child's perspective and whether standard data and/or sample identifiability nomenclature is used; and (6) whether retention of and access to paediatric biological samples and associated medical data are addressed. The review suggests gaps and variability in the consent forms with respect to addressing each of the six issues. Many forms did not discuss the possibility of returning research results, be they individual or general/aggregate results. Forms were also divided in terms of the scope of parental consent (specific versus broad), and none discussed a process for resolving disputes that can arise when either the parents or the child wishes to withdraw from the study. The analysis provides valuable insight and evidence into

  8. Emerging issues in paediatric health research consent forms in Canada: working towards best practices

    Directory of Open Access Journals (Sweden)

    Dove Edward S

    2013-01-01

    Full Text Available Abstract Background Obtaining a research participant’s voluntary and informed consent is the bedrock of sound ethics practice. Greater inclusion of children in research has led to questions about how paediatric consent operates in practice to accord with current and emerging legal and socio-ethical issues, norms, and requirements. Methods Employing a qualitative thematic content analysis, we examined paediatric consent forms from major academic centres and public organisations across Canada dated from 2008–2011, which were purposively selected to reflect different types of research ethics boards, participants, and studies. The studies included biobanking, longitudinal studies, and gene-environment studies. Our purpose was to explore the following six emerging issues: (1 whether the scope of parental consent allows for a child’s assent, dissent, or future consent; (2 whether the concepts of risk and benefit incorporate the child’s psychological and social perspective; (3 whether a child’s ability to withdraw is respected and to what extent withdrawal is permitted; (4 whether the return of research results includes individual results and/or incidental findings and the processes involved therein; (5 whether privacy and confidentiality concerns adequately address the child’s perspective and whether standard data and/or sample identifiability nomenclature is used; and (6 whether retention of and access to paediatric biological samples and associated medical data are addressed. Results The review suggests gaps and variability in the consent forms with respect to addressing each of the six issues. Many forms did not discuss the possibility of returning research results, be they individual or general/aggregate results. Forms were also divided in terms of the scope of parental consent (specific versus broad, and none discussed a process for resolving disputes that can arise when either the parents or the child wishes to withdraw from the

  9. The Infectious Diseases Society of America emerging infections network: bridging the gap between clinical infectious diseases and public health.

    Science.gov (United States)

    Pillai, Satish K; Beekmann, Susan E; Santibanez, Scott; Polgreen, Philip M

    2014-04-01

    In 1995, the Centers for Disease Control and Prevention granted a Cooperative Agreement Program award to the Infectious Diseases Society of America to develop a provider-based emerging infections sentinel network, the Emerging Infections Network (EIN). Over the past 17 years, the EIN has evolved into a flexible, nationwide network with membership representing a broad cross-section of infectious disease physicians. The EIN has an active electronic mail conference (listserv) that facilitates communication among infectious disease providers and the public health community, and also sends members periodic queries (short surveys on infectious disease topics) that have addressed numerous topics relevant to both clinical infectious diseases and public health practice. The article reviews how the various functions of EIN contribute to clinical care and public health, identifies opportunities to further link clinical medicine and public health, and describes future directions for the EIN.

  10. Assessing the Capacity of the US Health Care System to Use Additional Mechanical Ventilators During a Large-Scale Public Health Emergency.

    Science.gov (United States)

    Ajao, Adebola; Nystrom, Scott V; Koonin, Lisa M; Patel, Anita; Howell, David R; Baccam, Prasith; Lant, Tim; Malatino, Eileen; Chamberlin, Margaret; Meltzer, Martin I

    2015-12-01

    A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use. We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level. Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning. The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems' capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need.

  11. Objectives and actions of Public Health Authorities in external radiological emergency

    International Nuclear Information System (INIS)

    Herrera V, L.; Aguilar P, M.C.

    1991-01-01

    Here are discussed actions and objectives that the public health authorities could think about uncontrolled liberation of radioactive materials. The approaches on the more convenient actions to continue are established upon assimilating the Chernobyl experience. We will enumerate problems that, they could arise with the foregone actions in order to diminish the population detriment. In the face of the uncontrolled liberation of radioactive material in the Nuclear power plant of Laguna Verde, Veracruz, classified like external radiological emergency, the objective of these serious authorities reduce the deleterious effect to the health of the inhabitants around the CNLV, due to the radioactive material liberated to the atmosphere. In consequence, it is necessary carry out actions of protection for the population affected directly by the external irradiation, for the contamination deposited on inhabited areas, cultivation zones, shepherding, manufacturing and farms. The early actions or immediate are in order to limit deterministic damages to the population and give attendance to people with radio lesions. And the intermediate or they of recuperation are in order to maintain for under an acceptable value the risk to the population due to radiation stochastic effects. In the recuperation phase the plan of water and foods control should consider: foods destined to the self consume in the affected region for the liberation and foods processed for the sale or exportation. We will discuss the stage in a mediate phase after the evacuation of the population. The general tasks could be: 1. Actions in order to impede the contamination propagation. 2. Sampling of waters and foods, contamination situation and its quantification. And acceptance quality in elaborated foods. 3. Safeguard of the material and polluted areas. 4. Election of the actions to continue in function of the reference levels and the comparison of the risk of several alternatives. (Author)

  12. Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district.

    Science.gov (United States)

    Thwala, Siphiwe Bridget Pearl; Blaauw, Duane; Ssengooba, Freddie

    2018-01-01

    Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (pfacilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions.

  13. Using the Grade Approach to Support the Development of Recommendations for Public Health Interventions in Radiation Emergencies

    International Nuclear Information System (INIS)

    Carr, Z.; Clarke, M.; Akl, E.A.; Schneider, R.; Murith, C.; Li, C.; Parrish-Sprowl, J.; Stenke, L.; Cui-Ping, L.; Bertrand, S.; Miller, C.

    2016-01-01

    The World Health Organization (WHO) guideline development policy requires that WHO guidelines be developed in a manner that is transparent and based on all available evidences, which must be synthesised and formally assessed for quality. To fulfil this requirement, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach of rating quality of evidence and grading strength of recommendations was applied when developing the WHO recommendations on public health interventions in radiation emergencies. The guideline development group (GDG) formulated 10 PICO (P: population; I: intervention; C: comparator; O: outcomes) questions to guide the development of recommendations on response interventions during the early/intermediate and late emergency phases and on risk communications for mitigating psycho-social impact of radiation emergencies. For each PICO question, an extensive evidence search and systematic review was conducted. The GDG then formulated the recommendations using the evidence to recommendation (E-2-R) decision-making matrix and evaluated the strength of each recommendation. (authors)

  14. Involuntary psychiatric attendances at an Australasian emergency department: A comparison of police and health-care worker initiated presentations.

    Science.gov (United States)

    Llewellin, Peter; Arendts, Glenn; Weeden, Jacqueline; Pethebridge, Andrew

    2011-10-01

    To identify any significant differences in the population of patients brought in to a hospital ED under involuntary mental health orders, based on whether the orders are initiated by police or health professionals. A retrospective analysis of consecutive presentations to a tertiary hospital ED with a co-located psychiatric emergency care centre over a 12 month period, with univariate and multivariate statistical comparisons. Two hundred and eighty-two patients (making 378 ED presentations) met the case definition and were analysed. Compared with patients on medical orders, patients on police orders had significantly more presentations related to violence, longer stays in ED and lower rates of admission to an inpatient bed, but were no more likely to require restraint or security intervention within the ED. Patients on police and medical orders differ considerably, but the impact of these differences on ED workload is small. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Mastitis associated with Prototheca zopfii - an emerging health and economic problem on dairy farms

    Directory of Open Access Journals (Sweden)

    Milanov Dubravka

    2016-12-01

    Full Text Available Increased incidence of protothecal mastitis has been recorded in several countries in the past ten years. The main goal of this article is to draw the attention of scientific and professional community to the emerging issue of mammary protothecosis. The article collates currently known facts about infection reservoirs, predisposing factors for the development of mastitis, clinical manifestations of the disease, and potential transmission routes within the herd as well as the measures for control and eradication. We would like to point out that identification of protothecal mastitis on a dairy farm is associated with a range of problems. Early detection of infected animals can be difficult because of predominantly subclinical course of early-stage infection, which easily spreads between cows via the milking system. Spontaneous recovery has not been recorded and infected cows typically develop chronic mastitis with granulomatous infiltration and progressive loss of functional parenchyma of the mammary gland. Substantial economic losses and health damages associated with mammary protothecosis strongly emphasise the need for developing effective prevention strategies aimed at control of the infection.

  16. The Emerging Role of the Chief Research Informatics Officer in Academic Health Centers.

    Science.gov (United States)

    Sanchez-Pinto, L Nelson; Mosa, Abu S M; Fultz-Hollis, Kate; Tachinardi, Umberto; Barnett, William K; Embi, Peter J

    2017-08-16

    The role of the Chief Research Informatics Officer (CRIO) is emerging in academic health centers to address the challenges clinical researchers face in the increasingly digitalized, data-intensive healthcare system. Most current CRIOs are the first officers in their institutions to hold that role. To date there is very little published information about this role and the individuals who serve it. To increase our understanding of the CRIO role, the leaders who serve it, and the factors associated with their success in their organizations. The Clinical Research Informatics Working Group of the American Medical Informatics Association (AMIA) conducted a national survey of CRIOs in the United States and convened an expert panel of CRIOs to discuss their experience during the 2016 AMIA Annual Symposium. CRIOs come from diverse academic backgrounds. Most have advance training and extensive experience in biomedical informatics but the majority have been CRIOs for less than three years. CRIOs identify funding, data governance, and advancing data analytics as their major challenges. CRIOs play an important role in helping shape the future of clinical research, innovation, and data analytics in healthcare in their organizations. They share many of the same challenges and see the same opportunities for the future of the field. Better understanding the background and experience of current CRIOs can help define and develop the role in other organizations and enhance their influence in the field of research informatics.

  17. A comparison between integrated risk assessment and classical health/environmental assessment: Emerging beneficial properties

    International Nuclear Information System (INIS)

    Sekizawa, Jun; Tanabe, Shinsuke

    2005-01-01

    Both humans and wildlife are exposed to various types of halogenated organic compounds such as polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDT), typically old chemicals, and tris(4-chlorophenyl) methane (TCPM) and brominated flame retardants, some new chemicals, simultaneously. Classical risk assessment has evaluated health and ecological risks independently by experts from different disciplines. Taking into considerations the recent concerns about endocrine disrupting chemicals and the progress of research in related areas, we integrated and assessed data on exposure and potential effects in humans and wildlife. Comparisons were made for organ concentrations, body burdens of several organochlorine compounds (OCs), metabolic capacities between humans and various wildlife. When we integrate the knowledge on effects and exposure in humans and in wildlife, new insights were suggested about similarities and/or differences in potential effects among various human populations living on different foods and having different body burdens. Combining existing information with emerging knowledge of mechanisms of actions on endocrine disrupting chemicals after exposure to above chemicals during early developmental stages will further elucidate potential risks from exposure to those chemicals

  18. Devolution's policy impact on non-emergency medical transportation in State Children's Health Insurance Programs.

    Science.gov (United States)

    Borders, Stephen; Blakely, Craig; Ponder, Linda; Raphael, David

    2011-01-01

    Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. The authors utilize data from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. Their findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues, as a number of states do not offer NEMT to their SCHIP populations while cutting services and leaving over $7 billion in federal matching funding unspent.

  19. Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

    Science.gov (United States)

    Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

    2016-12-01

    This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

  20. The emerging role of bone marrow adipose tissue in bone health and dysfunction.

    Science.gov (United States)

    Ambrosi, Thomas H; Schulz, Tim J

    2017-12-01

    Replacement of red hematopoietic bone marrow with yellow adipocyte-rich marrow is a conserved physiological process among mammals. The extent of this conversion is influenced by a wide array of pathological and non-pathological conditions. Of particular interest is the observation that some marrow adipocyte-inducing factors seem to oppose each other, for instance obesity and caloric restriction. Intriguingly, several important molecular characteristics of bone marrow adipose tissue (BMAT) are distinct from the classical depots of white and brown fat tissue. This depot of fat has recently emerged as an active part of the bone marrow niche that exerts paracrine and endocrine functions thereby controlling osteogenesis and hematopoiesis. While some functions of BMAT may be beneficial for metabolic adaptation and bone homeostasis, respectively, most findings assign bone fat a detrimental role during regenerative processes, such as hematopoiesis and osteogenesis. Thus, an improved understanding of the biological mechanisms leading to formation of BMAT, its molecular characteristics, and its physiological role in the bone marrow niche is warranted. Here we review the current understanding of BMAT biology and its potential implications for health and the development of pathological conditions.

  1. Arthropod borne diseases in Italy: from a neglected matter to an emerging health problem

    Directory of Open Access Journals (Sweden)

    Roberto Romi

    2010-12-01

    Full Text Available In medical entomology, "Arthropod Borne Diseases", or "Vector Borne Diseases" (VBD are intended as a group of human and animal infections caused by different pathogen organisms (protozoa, helminthes, bacteria and viruses transmitted by the bite of a bloodsucking insect or arachnid. It is commonly known that the infectious diseases transmitted by Arthropods are mainly affecting tropical and subtropical countries, nevertheless some of them were or are still common also in the northern hemisphere, where they are usually maintained under control. VBD still represent some of the most important public health problems in the endemic areas but are becoming source of concern for developed countries too. Since the last decades of the past century, a number of VBD has been spreading geographically, being recorded for the first time in areas outside their original range. This phenomenon is strictly related to the peculiar epidemiological characteristics of these diseases, that are considered the most susceptible to climatic, environmental and socioeconomic changes. This article is a short overview of the VBD endemic and emerging in Italy. The possibility that some exotic vectors and/or pathogens could be introduced and become established in Italy is also discussed.

  2. Complex systems thinking in emergency medicine: A novel paradigm for a rapidly changing and interconnected health care landscape.

    Science.gov (United States)

    Widmer, Matthew A; Swanson, R Chad; Zink, Brian J; Pines, Jesse M

    2017-12-27

    The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system. The traditional approach to health care practice and improvement-reductionism-is not adequate for the complexity of the twenty-first century. Reductionist thinking will likely continue to produce unintended consequences and suboptimal outcomes. Complex systems thinking provides a perspective and set of tools better suited for the challenges and opportunities facing public health in general, and emergency medicine more specifically. This article introduces complex systems thinking and argues for its application in the context of emergency medicine by drawing on the history of the circumstances surrounding the formation of the specialty and by providing examples of its application to several practice challenges. © 2017 John Wiley & Sons, Ltd.

  3. EPPM and willingness to respond: the role of risk and efficacy communication in strengthening public health emergency response systems.

    Science.gov (United States)

    Barnett, Daniel J; Thompson, Carol B; Semon, Natalie L; Errett, Nicole A; Harrison, Krista L; Anderson, Marilyn K; Ferrell, Justin L; Freiheit, Jennifer M; Hudson, Robert; McKee, Mary; Mejia-Echeverry, Alvaro; Spitzer, James; Balicer, Ran D; Links, Jonathan M; Storey, J Douglas

    2014-01-01

    This study examines the attitudinal impact of an Extended Parallel Process Model (EPPM)-based training curriculum on local public health department (LHD) workers' willingness to respond to representative public health emergency scenarios. Data are from 71 U.S. LHDs in urban and rural settings across nine states. The study explores changes in response willingness and EPPM threat and efficacy appraisals between randomly assigned control versus intervention health departments, at baseline and 1 week post curriculum, through an EPPM-based survey/resurvey design. Levels of response willingness and emergency response-related attitudes/beliefs are measured. Analyses focus on two scenario categories that have appeared on a U.S. government list of scenarios of significant concern: a weather-related emergency and a radiological "dirty" bomb event (U.S. Department of Homeland Security, 2007). The greatest impact from the training intervention on response willingness was observed among LHD workers who had low levels of EPPM-related threat and efficacy perceptions at baseline. Self-efficacy and response efficacy and response willingness increased in intervention LHDs for both scenarios, with greater response willingness increases observed for the radiological "dirty" bomb terrorism scenario. Findings indicate the importance of building efficacy versus enhancing threat perceptions as a path toward greater response willingness, and suggest the potential applicability of such curricular interventions for boosting emergency response willingness among other cadres of health providers.

  4. Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires.

    Science.gov (United States)

    Navarro Moya, P; González Carrasco, M; Villar Hoz, E

    2017-09-06

    Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes. Furthermore, little emphasis has been placed on the protective factors involved. The main objective of the present study is to identify any existing differential exposure - for reasons of work setting (EMT and non-EMT) or of gender - to the various psychosocial risk and protective factors affecting the health of MT workers. Descriptive and transversal research with responses from 201 professionals. The scores obtained on the various psychosocial scales in our study - as indicators of future health problems - were more unfavourable for non-EMT workers than they were for EMT workers. Work setting, but not gender, was able to account for these differences. The scores obtained for the different psychosocial factors are generally more favourable for the professionals we surveyed than those obtained in previous samples. The significant differences observed between EMT and non-EMT personnel raise important questions regarding the organization of work in companies that carry out both services at the same time in the same territory. The relationships among the set of risk/protective factors suggests a need for further investigation into working conditions as well as a consideration of the workers' sense of coherence and subjective well-being as protective factors against occupational burnout syndrome.

  5. An Evidence Framework for Off-Patent Pharmaceutical Review (EFOR) for Health Technology Assessment in Emerging Markets.

    Science.gov (United States)

    Brixner, Diana; Kaló, Zoltán; Maniadakis, Nikos; Kim, Kyoo; Wijaya, Kalman

    2018-03-29

    This article introduces an Evidence Framework for Off-Patent Pharmaceutical Review (EFOR), which establishes value-based criteria in a template that manufacturers use to provide evidence showing how their products meet those criteria. Health authorities in emerging markets can then use the evidence presented in the EFOR to evaluate off-patent pharmaceuticals (OPPs) in a consistent, transparent, and evidence-based manner to support policy decisions, including pricing, reimbursement, formulary listing, and drug procurement. A literature search found no multi-criteria evidence framework for evaluating OPPs in emerging markets. An International Outcomes Research Board (IORB) of academia and industry experts conducted extensive research, meetings, and workshops to define high-priority criteria to incorporate into an evidence-based health technology assessment (HTA) tool using the multi-criteria decision analysis (MCDA) technique. The resulting framework was further tailored for country-specific needs in workshops in three emerging countries (Kazakhstan, Vietnam, and Indonesia). The IORB defined nine criteria four categories (Product, Manufacturing, Service, and Value Assessment), which OPP manufacturers can use to provide evidence for reimbursement and health policy decision making. Then the IORB developed the EFOR as a base case document, which can be adapted and used as a template by health authorities in emerging countries. Emerging countries have a significant need for an HTA tool that balances affordability with accurate evidence showing the value differentiation of OPPs. The value attributes in this setting often are different from those in developed markets, which emphasize new products and have high regulation and manufacturing standards. The EFOR is an easy-to-use, adaptable framework that emerging countries can use to increase the consistency, transparency, and effectiveness of drug decision making. The open source EFOR is available as Supplemental Materials

  6. Emerging and Reemerging Diseases in the World Health Organization (WHO) Eastern Mediterranean Region-Progress, Challenges, and WHO Initiatives.

    Science.gov (United States)

    Buliva, Evans; Elhakim, Mohamed; Tran Minh, Nhu Nguyen; Elkholy, Amgad; Mala, Peter; Abubakar, Abdinasir; Malik, Sk Md Mamunur Rahman

    2017-01-01

    The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a hotspot for emerging and reemerging infectious diseases and the need to prevent, detect, and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies, resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human-animal interaction. In EMR, several infectious disease outbreaks were detected, investigated, and rapidly contained over the past 5 years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen, cholera in Iraq, avian influenza A (H5N1) infection in Egypt, and dengue fever in Yemen, Sudan, and Pakistan. Dengue fever remains an important public health concern, with at least eight countries in the region being endemic for the disease. The emergence of MERS-CoV in the region in 2012 and its continued transmission currently poses one of the greatest threats. In response to the growing frequency, duration, and scale of disease outbreaks, WHO has worked closely with member states in the areas of improving public health preparedness, surveillance systems, outbreak response, and addressing critical knowledge gaps. A Regional network for experts and technical institutions has been established to facilitate support for international outbreak response. Major challenges are faced as a result of protracted humanitarian crises in the region. Funding gaps, lack of integrated approaches, weak surveillance systems, and absence of comprehensive response plans are other areas of concern. Accelerated efforts are needed by Regional countries, with the continuous support of WHO, to

  7. Emerging and Reemerging Diseases in the World Health Organization (WHO Eastern Mediterranean Region—Progress, Challenges, and WHO Initiatives

    Directory of Open Access Journals (Sweden)

    Evans Buliva

    2017-10-01

    Full Text Available The Eastern Mediterranean Region (EMR of the World Health Organization (WHO continues to be a hotspot for emerging and reemerging infectious diseases and the need to prevent, detect, and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies, resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human–animal interaction. In EMR, several infectious disease outbreaks were detected, investigated, and rapidly contained over the past 5 years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen, cholera in Iraq, avian influenza A (H5N1 infection in Egypt, and dengue fever in Yemen, Sudan, and Pakistan. Dengue fever remains an important public health concern, with at least eight countries in the region being endemic for the disease. The emergence of MERS-CoV in the region in 2012 and its continued transmission currently poses one of the greatest threats. In response to the growing frequency, duration, and scale of disease outbreaks, WHO has worked closely with member states in the areas of improving public health preparedness, surveillance systems, outbreak response, and addressing critical knowledge gaps. A Regional network for experts and technical institutions has been established to facilitate support for international outbreak response. Major challenges are faced as a result of protracted humanitarian crises in the region. Funding gaps, lack of integrated approaches, weak surveillance systems, and absence of comprehensive response plans are other areas of concern. Accelerated efforts are needed by Regional countries, with the continuous

  8. Restricting youth suicide: behavioral health patients in an urban pediatric emergency department.

    Science.gov (United States)

    Rogers, Steven C; DiVietro, Susan; Borrup, Kevin; Brinkley, Ashika; Kaminer, Yifrah; Lapidus, Garry

    2014-09-01

    Suicide is the third leading cause of death among individuals age 10 years to 19 years in the United States. Adolescents with suicidal behaviors are often cared for in emergency departments (EDs)/trauma centers and are at an increased risk for subsequent suicide. Many institutions do not have standard procedures to prevent future self-harm. Lethal means restriction (LMR) counseling is an evidence-based suicide prevention strategy that informs families to restrict access to potentially fatal items and has demonstrated efficacy in preventing suicide. The objectives of this study were to examine suicidal behavior among behavioral health patients in a pediatric ED and to assess the use of LMR by hospital staff. A sample of 298 pediatric patients was randomly selected from the population of behavioral health patients treated at the ED from January 1 through December 31, 2012 (n = 2,294). Descriptive data include demographics (age, sex, race/ethnicity, etc,), chief complaint, current and past psychiatric history, primary diagnosis, disposition, alcohol/drug abuse, and documentation of any LMR counseling provided in the ED. Of the 298 patients, 52% were female, 47% were white, and 76% were in the custody of their parents. Behavior/out of control was the most common chief complaint (43%). The most common diagnoses were mood disorder (25%) and depression (20%). Thirty-four percent of the patients had suicidal ideation, 22% had a suicide plan, 32% had documented suicidal behavior, and 25% of the patients reported having access to lethal means. However, only 4% of the total patient population received any LMR counseling, and only 15% of those with access to lethal means had received LMR counseling. Providing a safe environment for adolescents at risk for suicidal behaviors should be a priority for all families/caretakers and should be encouraged by health care providers. The ED is a key point of entry into services for suicidal youth and presents an opportunity to implement

  9. Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur

    Directory of Open Access Journals (Sweden)

    Yasuda Silvia

    2009-07-01

    Full Text Available Abstract Background There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. Methods A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Results Most patients were diagnosed with epilepsy (47% and psychosis (31% and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1–10.2 to 7.1 (95%CI 5.9–8.2 p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6–7.0 p Conclusion The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

  10. Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur.

    Science.gov (United States)

    Souza, Renato; Yasuda, Silvia; Cristofani, Susanna

    2009-07-21

    There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

  11. The SimpleMix study with biphasic insulin aspart 30: a randomized controlled trial investigating patient-driven titration versus investigator-driven titration.

    Science.gov (United States)

    Gao, Yan; Luquez, Cecilia; Lynggaard, Helle; Andersen, Henning; Saboo, Banshi

    2014-12-01

    The study aimed to confirm the efficacy, through non-inferiority, of patient-driven versus investigator-driven titration of biphasic insulin aspart 30 (BIAsp 30) in terms of glycemic control assessed by HbA1c change. SimpleMix was a 20 week, open-label, randomized, two-armed, parallel-group, multicenter study in five countries (Argentina, China, India, Poland, and the UK). Patients with type 2 diabetes were randomized into either patient-driven or investigator-driven BIAsp 30 titration groups. Non-inferiority of patient-driven vs. investigator-driven titration based on change in HbA1c from baseline to week 20 could not be demonstrated. Mean (SE) estimated change from baseline to week 20 was -0.72 (0.08)% in the patient-driven group and -0.97 (0.08)% in the investigator-driven group; estimated difference 0.25% (95% CI: 0.04; 0.46). Estimated mean change (SE) in fasting plasma glucose from baseline to week 20 was similar between groups: -0.94 (0.21) mmol/L for patient-driven and -1.07 (0.22) mmol/L for investigator-driven (difference non-significant). Both treatment arms were well tolerated, and hypoglycemic episode rates were similar between groups, with a rate ratio of 0.77 (95% CI: 0.54; 1.09; p = 0.143) for all hypoglycemic episodes and 0.78 (95% CI: 0.42; 1.43; p = 0.417) for nocturnal hypoglycemic episodes. Non-inferiority of patient-driven versus investigator-driven titration with regard to change from baseline to end-of-treatment HbA1c could not be confirmed. It is possible that a clinic visit 12 weeks after intensification of treatment with BIAsp 30 in patients with type 2 diabetes inadequately treated with basal insulin may benefit patient-driven titration of BIAsp 30. A limitation of the study was the relatively small number of patients recruited in each country, which does not allow country-specific analyses to be performed. Overall, treatment with BIAsp 30 was well tolerated in both treatment groups.

  12. A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care

    Directory of Open Access Journals (Sweden)

    Roberto G. Lucchini

    2017-01-01

    Full Text Available Abstract Background The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. Methods Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i exposure assessment; ii exposed populations; iii health surveillance; iv follow-up and research outputs; v observed physical and mental health effects; vi treatment and benefits; and vii outreach activities. Results Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1 Know who was there; 2 Have public health input to the disaster response; 3 Collect health and needs data rapidly; 4 Take care of the affected; 5 Emergency preparedness; 6 Data driven, needs assessment, advocacy. Conclusions Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of

  13. A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care.

    Science.gov (United States)

    Lucchini, Roberto G; Hashim, Dana; Acquilla, Sushma; Basanets, Angela; Bertazzi, Pier Alberto; Bushmanov, Andrey; Crane, Michael; Harrison, Denise J; Holden, William; Landrigan, Philip J; Luft, Benjamin J; Mocarelli, Paolo; Mazitova, Nailya; Melius, James; Moline, Jacqueline M; Mori, Koji; Prezant, David; Reibman, Joan; Reissman, Dori B; Stazharau, Alexander; Takahashi, Ken; Udasin, Iris G; Todd, Andrew C

    2017-01-07

    The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.

  14. The Emergency Treatment And The Stj's Vision On The Waiver Of Grace For The Health Care Plans

    Directory of Open Access Journals (Sweden)

    Eduardo Cambi

    2016-12-01

    Full Text Available The aim of this study is to understand the rules on waiting periods of private health care in Brazil and the need for their dismissal in case of emergency treatments. It analyzes the right to health as a fundamental social right, highlighting the treatment given to it by the Federal Constitution of 1988. Addresses the changing profile of private autonomy as a result of the constitutionalization of civil law and its submission to fundamental rights. Finally, contextualize the decisions of the High Court of Justice to demonstrate the illegality of Resolution No. 13 of the Council of Supplementary Health.

  15. Health Care Personnel’s Awareness, Attitudes and Implementations About Emergency Contraception and other Family Planning Procedures

    Directory of Open Access Journals (Sweden)

    Gül PINAR

    2005-09-01

    Full Text Available OBJECTIVE: The purpose of this study is to determine health care personnel’s awareness, attitudes and implementations about emergency contraception and other family planning procedures Design: 50 physicians and 100 nurses, who had accepted to participate in the questionnaire, Setting: Ankara Etlik Maternity Hospital Interventions: Questionnaire was performed amoung 50 physicians and 100 nurses, who had accepted to participate. In the questionnaire, in addition to questions developed by researchers which focus on sociodemographic backgrounds of the health care personnel, questions aiming at revealing awareness, attitudes and implementations about emergency contraception and other family planning procedures. Main outcome measures: Data were analyzed by SPSS. A x_ test was used and percent were determined. The threshold of significance was defined as p\tplanning procedures of the health care personnel.

  16. An RCT Investigating Patient-Driven Versus Physician-Driven Titration of BIAsp 30 in Patients with Type 2 Diabetes Uncontrolled Using NPH Insulin.

    Science.gov (United States)

    Chraibi, Abdelmjid; Al-Herz, Shoorook; Nguyen, Bich Dao; Soeatmadji, Djoko W; Shinde, Anil; Lakshmivenkataraman, Balasubramanian; Assaad-Khalil, Samir H

    2017-08-01

    The aim of this study was to confirm the efficacy of patient-driven titration of BIAsp 30 in terms of glycemic control, by comparing it to physician-driven titration of BIAsp 30, in patients with type 2 diabetes in North Africa, the Middle East, and Asia. A 20-week, open-label, randomized, two-armed, parallel-group, multicenter study in Egypt, Indonesia, Morocco, Saudi Arabia, and Vietnam. Patients (n = 155) with type 2 diabetes inadequately controlled using neutral protamine Hagedorn (NPH) insulin were randomized to either patient-driven or physician-driven BIAsp 30 titration. The noninferiority of patient-driven compared to physician-driven titration with respect to the reduction in HbA1c was confirmed. The estimated mean change in HbA1c from baseline to week 20 was -1.27% in the patient-driven arm and -1.04% in the physician-driven arm, with an estimated treatment difference of -0.23% (95% confidence interval: -0.54; 0.08). After 20 weeks of treatment, the proportions of patients achieving the target of HbA1c titration arms; the proportions of patients achieving the target of ≤6.5% were also similar. Both titration algorithms were well tolerated, and hypoglycemic episode rates were similar in both arms. Patient-driven titration of BIAsp 30 can be as effective and safe as physician-driven titration in non-Western populations. Overall, the switch from NPH insulin to BIAsp 30 was well tolerated in both titration arms and led to improved glycemic control. A limitation of the study was the relatively small number of patients recruited in each country. ClinicalTrials.gov NCT01589653. Novo Nordisk A/S, Denmark.

  17. Perspectives of emergency department staff on the triage of mental health-related presentations: Implications for education, policy and practice.

    Science.gov (United States)

    Gerdtz, Marie F; Weiland, Tracey J; Jelinek, George A; Mackinlay, Claire; Hill, Nicole

    2012-10-01

    To explore ED staff perceptions of the factors that influence accuracy of triage for people with mental health problems. This qualitative learning needs analysis used a descriptive exploratory design. Participants were Australian emergency nurses and doctors. We used a criterion-based sampling approach. Recruitment was facilitated by the College of Emergency Nursing Australasia and the Australasian College for Emergency Medicine. A semi-structured interview schedule was developed. Telephone interviews were conducted, audio recorded and transcribed verbatim. Thematic analysis was used to identify factors perceived to affect triage outcomes and to explore strategies to optimise the accuracy of triage assessments. Thirty-six staff participated (16 nurses and 20 doctors). Four major factors were perceived to influence accuracy. These were: environmental factors (physical structure, time pressures, activity levels, and interruptions), policy and education (guidelines, training and resources), staff factors (knowledge, experience, attitudes) and patient factors (police presence, patient behaviour, clinical condition). Differences of opinion were expressed by emergency doctors about the validity of the time to treatment objectives included in the Australasian Triage Scale for mental health presentations, and the utility of the scale to differentiate urgency for psychiatric conditions. Clinical guidelines and training have been developed to support the use of the Australasian Triage Scale. Further evaluation of the application of this scale to assess mental health problems is indicated. Additional work is also required to reduce variance in urgency assignment based on staff knowledge and attitudes about the causes, assessment and early management of psychiatric disorders. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  18. The role of the Swiss EIR Health Physics Division in the national and the Institute's radiological emergency organizations

    International Nuclear Information System (INIS)

    Nagel, E.; Brunner, H.

    1986-01-01

    Owing to the geographical concentration in Switzerland of the activities related to radioactivity (power plants, research, industry, transport) in a relatively small region between the Alps and the Rhine, it was a logical consequence to centralize the emergency organization for nuclear accidents in this area. Since 1984 the Swiss emergency organization has had an operational, well-equipped national emergency control centre. In the handling of radiation accidents the new organization can call on specialized laboratories and make use of experience and material from over the whole country. Of these facilities the Federal Institute for Reactor Research (EIR) is of major importance due to its activities and experience in research and radiation protection. Its Health Physics Division takes an active part in the emergency organization of the EIR itself. Both its well-equipped radioanalytical laboratory and trained personnel are at the disposal of the national emergency organization. Frequent training of the whole emergency organization and parts of it have improved preparedness. The evaluation of the exercises always reveals new problems to be solved in which rapid action and safe communications are of major importance. (author)

  19. Persistent polar depletion of stratospheric ozone and emergent mechanisms of ultraviolet radiation-mediated health dysregulation.

    Science.gov (United States)

    Dugo, Mark A; Han, Fengxiang; Tchounwou, Paul B

    2012-01-01

    Year 2011 noted the first definable ozone "hole" in the Arctic region, serving as an indicator to the continued threat of dangerous ultraviolet radiation (UVR) exposure caused by the deterioration of stratospheric ozone in the northern hemisphere. Despite mandates of the Montreal Protocol to phase out the production of ozone-depleting chemicals (ODCs), the relative stability of ODCs validates popular notions of persistent stratospheric ozone for several decades. Moreover, increased UVR exposure through stratospheric ozone depletion is occurring within a larger context of physiologic stress and climate change across the biosphere. In this review, we provide commentaries on stratospheric ozone depletion with relative comparisons between the well-known Antarctic ozone hole and the newly defined ozone hole in the Arctic. Compared with the Antarctic region, the increased UVR exposure in the Northern Hemisphere poses a threat to denser human populations across North America, Europe, and Asia. In this context, we discuss emerging targets of UVR exposure that can potentially offset normal biologic rhythms in terms of taxonomically conserved photoperiod-dependent seasonal signaling and entrainment of circadian clocks. Consequences of seasonal shifts during critical life history stages can alter fitness and condition, whereas circadian disruption is increasingly becoming associated as a causal link to increased carcinogenesis. We further review the significance of genomic alterations via UVR-induced modulations of phase I and II transcription factors located in skin cells, the aryl hydrocarbon receptor (AhR), and the nuclear factor (erythroid-derived 2)-related factor 2 (Nrf2), with emphasis on mechanism that can lead to metabolic shifts and cancer. Although concern for adverse health consequences due to increased UVR exposure are longstanding, recent advances in biochemical research suggest that AhR and Nrf2 transcriptional regulators are likely targets for UVR

  20. Water Security, Climate Forcings and Public Health Impacts in Emerging Regions

    Science.gov (United States)

    Serman, E. A.; Akanda, A. S.; Craver, V.; Boving, T. B.

    2014-12-01

    Our world is rapidly urbanizing, with more than 80% of world's population is expected to be living in a city by the end of the century. A majority of these nations are rapidly urbanizing due to massive rural-to-urban migratory trends, with rapid development of unplanned urban settlements, or slums, with lack of adequate water or sanitation facilities and other municipal amenities. With global environmental change, natural disasters will expose millions more to drought, floods, and disease epidemics, and existing vulnerabilities will worsen. At the same time, rapid urbanization and fast changing land-use leads to widespread damage of infrastructure by stormwater, especially in lowlands and economically poor areas. The factor that consistently stands out among different cities from both the developed and the developing worlds is that the slums are typically the most vulnerable to water related natural hazards and climatic threats, such as water scarcity and quality issues in drought conditions, or water and sanitation breakdown and stormwater contamination problems. Onsite or decentralized water, wastewater and stormwater treatment as well as point-of-use water treatment options can be an economic, safe, and reliable alternative to conventional large-scale treatment especially, in urban fringes as well as rural areas. These systems can be designed to fit communities in terms of their economic, cultural, environmental, and demographic resources. As part of this study, we develop a database of urban water quality and quantity indices such as with urban land-use, water usage, climate, and socio-economic characteristics in various emerging regions in the world. We analyze past and current data to identify and quantify long-term trends and the impacts of large-scale climatic and anthropogenic changes on urban hydrology and health impacts. We specifically focus on five major cities from distinct groups of countries and geographies: Providence, RI, USA from the developed

  1. Ergot alkaloid intoxication in perennial ryegrass (Lolium perenne): an emerging animal health concern in Ireland?

    Science.gov (United States)

    Canty, Mary J; Fogarty, Ursula; Sheridan, Michael K; Ensley, Steve M; Schrunk, Dwayne E; More, Simon J

    2014-01-01

    Four primary mycotoxicosis have been reported in livestock caused by fungal infections of grasses or cereals by members of the Clavicipitaceae family. Ergotism (generally associated with grasses, rye, triticale and other grains) and fescue toxicosis (associated with tall fescue grass, Festuca arundinacea) are both caused by ergot alkaloids, and referred to as 'ergot alkaloid intoxication'. Ryegrass staggers (associated with perennial ryegrass Lolium perenne) is due to intoxication with an indole-diperpene, Lolitrem B, and metabolites. Fescue-associated oedema, recently described in Australia, may be associated with a pyrrolizidine alkaloid, N-acetyl norloline. Ergotism, caused by the fungus Claviceps purpurea, is visible and infects the outside of the plant seed. Fescue toxicosis and ryegrass staggers are caused by Neotyphodium coenophalium and N. lolii, respectively. Fescue-associated oedema has been associated with tall fescue varieties infected with a specific strain of N. coenophialum (AR542, Max P or Max Q). The name Neotyphodium refers to asexual derivatives of Epichloë spp., which have collectively been termed the epichloë fungi. These fungi exist symbiotically within the grass and are invisible to the naked eye. The primary toxicological effect of ergot alkaloid involves vasoconstriction and/or hypoprolactinaemia. Ingestion of ergot alkaloid by livestock can cause a range of effects, including poor weight gain, reduced fertility, hyperthermia, convulsions, gangrene of the extremities, and death. To date there are no published reports, either internationally or nationally, reporting ergot alkaloid intoxication specifically associated with perennial ryegrass endophytes. However, unpublished reports from the Irish Equine Centre have identified a potential emerging problem of ergot alkaloid intoxication with respect to equines and bovines, on primarily perennial ryegrass-based diets. Ergovaline has been isolated in varying concentrations in the herbage of a

  2. The Staff Observation Aggression Scale - Revised (SOAS-R) - adjustment and validation for emergency primary health care.

    Science.gov (United States)

    Morken, Tone; Baste, Valborg; Johnsen, Grethe E; Rypdal, Knut; Palmstierna, Tom; Johansen, Ingrid Hjulstad

    2018-05-08

    Many emergency primary health care workers experience aggressive behaviour from patients or visitors. Simple incident-reporting procedures exist for inpatient, psychiatric care, but a similar and simple incident-report for other health care settings is lacking. The aim was to adjust a pre-existing form for reporting aggressive incidents in a psychiatric inpatient setting to the emergency primary health care settings. We also wanted to assess the validity of the severity scores in emergency primary health care. The Staff Observation Scale - Revised (SOAS-R) was adjusted to create a pilot version of the Staff Observation Scale - Revised Emergency (SOAS-RE). A Visual Analogue Scale (VAS) was added to the form to judge the severity of the incident. Data for validation of the pilot version of SOAS-RE were collected from ten casualty clinics in Norway during 12 months. Variance analysis was used to test gender and age differences. Linear regression analysis was performed to evaluate the relative impact that each of the five SOAS-RE columns had on the VAS score. The association between SOAS-RE severity score and VAS severity score was calculated by the Pearson correlation coefficient. The SOAS-R was adjusted to emergency primary health care, refined and called The Staff Observation Aggression Scale - Revised Emergency (SOAS-RE). A total of 350 SOAS-RE forms were collected from the casualty clinics, but due to missing data, 291 forms were included in the analysis. SOAS-RE scores ranged from 1 to 22. The mean total severity score of SOAS-RE was 10.0 (standard deviation (SD) =4.1) and the mean VAS score was 45.4 (SD = 26.7). We found a significant correlation of 0.45 between the SOAS-RE total severity scores and the VAS severity ratings. The linear regression analysis showed that individually each of the categories, which described the incident, had a low impact on the VAS score. The SOAS-RE seems to be a useful instrument for research, incident-recording and management

  3. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  4. A Complex Interplay: Cognitive Behavioural Therapy for Severe Health Anxiety in Addison's Disease to Reduce Emergency Department Admissions.

    Science.gov (United States)

    Daniels, Jo; Sheils, Elizabeth

    2017-07-01

    Addison's disease (AD) is a rare chronic illness caused by adrenocortical insufficiency. Due to the pivotal role of the regulating hormone cortisol in AD, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety in endocrinological disorders, however there is a paucity of research examining the complex interplay between AD and anxiety. This paper describes a single case study of a patient with severe health anxiety and co-morbid AD. The aims of the study were to establish if standard cognitive behavioural therapy for health anxiety in AD can lead to a reduction in psychological distress, and whether this approach is an effective intervention for the reduction of Emergency Department admissions. A single case design was used, with pre- and post-measures of health anxiety, general anxiety and depression. Data on Emergency Department admissions prior to and following treatment were used to assess change in this domain. Reliable and clinically significant reductions were seen across all measures, from severe to sub-clinical levels. There was a complete amelioration of Emergency Department admissions in the 12 months following completion of treatment. This preliminary study provides a sound rationale for further research into AD complicated by anxiety. Findings support the clinical utility of the cognitive behavioural therapy model for complex presentations of AD, offering a potential treatment option where anxiety is elevated and interfering with self-management and leading to high levels of health service use.

  5. Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand

    Directory of Open Access Journals (Sweden)

    Denise Blake

    2016-11-01

    Full Text Available Opioid Substitution Treatment (OST is a harm reduction strategy enabling opiate consumers to avoid withdrawal symptoms and maintain health and wellbeing. Some research shows that within a disaster context service disruptions and infrastructure damage affect OST services, including problems with accessibility, dosing, and scripts. Currently little is known about planning for OST in the reduction and response phases of a disaster. This study aimed to identify the views of three professional groups working in Aotearoa/New Zealand about OST provision following a disaster. In-depth, semi-structured interviews were conducted with 17 service workers, health professionals, and emergency managers in OST and disaster planning fields. Thematic analysis of transcripts identified three key themes, namely “health and wellbeing”, “developing an emergency management plan”, and “stock, dose verification, and scripts” which led to an overarching concept of “service continuity in OST preparedness planning”. Participants viewed service continuity as essential for reducing physical and psychological distress for OST clients, their families, and wider communities. Alcohol and drug and OST health professionals understood the specific needs of clients, while emergency managers discussed the need for sufficient preparedness planning to minimise harm. It is concluded that OST preparedness planning must be multidisciplinary, flexible, and inclusive.

  6. Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand

    Science.gov (United States)

    Blake, Denise; Lyons, Antonia

    2016-01-01

    Opioid Substitution Treatment (OST) is a harm reduction strategy enabling opiate consumers to avoid withdrawal symptoms and maintain health and wellbeing. Some research shows that within a disaster context service disruptions and infrastructure damage affect OST services, including problems with accessibility, dosing, and scripts. Currently little is known about planning for OST in the reduction and response phases of a disaster. This study aimed to identify the views of three professional groups working in Aotearoa/New Zealand about OST provision following a disaster. In-depth, semi-structured interviews were conducted with 17 service workers, health professionals, and emergency managers in OST and disaster planning fields. Thematic analysis of transcripts identified three key themes, namely “health and wellbeing”, “developing an emergency management plan”, and “stock, dose verification, and scripts” which led to an overarching concept of “service continuity in OST preparedness planning”. Participants viewed service continuity as essential for reducing physical and psychological distress for OST clients, their families, and wider communities. Alcohol and drug and OST health professionals understood the specific needs of clients, while emergency managers discussed the need for sufficient preparedness planning to minimise harm. It is concluded that OST preparedness planning must be multidisciplinary, flexible, and inclusive. PMID:27834915

  7. The proportion of work-related emergency department visits not expected to be paid by workers' compensation: implications for occupational health surveillance, research, policy, and health equity.

    Science.gov (United States)

    Groenewold, Matthew R; Baron, Sherry L

    2013-12-01

    To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits. A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys. Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression. A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation. Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications. © Health Research and Educational Trust.

  8. Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe.

    Science.gov (United States)

    Twomey, Michèle; Šijački, Ana; Krummrey, Gert; Welzel, Tyson; Exadaktylos, Aristomenis K; Ercegovac, Marko

    2018-03-12

    Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM) introduced a standardized triage process at the Clinical Centre of Serbia (CCS). This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

  9. Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe

    Directory of Open Access Journals (Sweden)

    Michèle Twomey

    2018-03-01

    Full Text Available Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM introduced a standardized triage process at the Clinical Centre of Serbia (CCS. This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

  10. Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients

    Directory of Open Access Journals (Sweden)

    Brian Y. Choi, MD, MPH

    2016-03-01

    Full Text Available Introduction: A disproportionate number of individuals with human immunodeficiency virus (HIV have mental health and substance-use disorders (MHSUDs, and MHSUDs are significantly associated with their emergency department (ED visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21-34, 35-49, 50-64, and 65+ years. Methods: We used the 2012 Nationwide Emergency Department Sample (NEDS dataset (unweighted n=23,244,819 ED events by patients aged 21+, including 115,656 visits by patients with HIV. Multinomial and binary logistic regression analyses, with “treat-and-release” as the base outcome, were used to examine associations between ED outcomes and MHSUDs among visits that included a HIV diagnosis in each age group. Results: Mood and “other” mental disorders had small effects on ED-to-hospital admissions, as opposed to treat-and-release, in age groups younger than 65+ years, while suicide attempts had medium effects (RRR=3.56, CI [2.69-4.70]; RRR=4.44, CI [3.72-5.30]; and RRR=5.64, CI [4.38- 7.26] in the 21-34, 35-49, and 50-64 age groups, respectively. Cognitive disorders had mediumto-large effects on hospital admissions in all age groups and large effects on death in the 35-49 (RRR=7.29, CI [3.90-13.62] and 50-64 (RRR=5.38, CI [3.39-8.55] age groups. Alcohol use disorders (AUDs had small effects on hospital admission in all age groups (RRR=2.35, 95% CI [1.92-2.87]; RRR=2.15, 95% CI [1.95-2.37]; RRR=1.92, 95% CI [1.73-2.12]; and OR=1.93, 95% CI [1.20-3.10] in the 21-34, 35-49, 50-64, and 65+ age groups, respectively. Drug use disorders (DUDs had small-to-medium effects on hospital admission (RRR=4.40, 95% CI [3.87-5.0]; RRR=4.07, 95% CI [3.77-4.40]; RRR=4.17, 95% CI [3.83-4.55]; and OR=2.53, 95% CI [2.70- 3.78] in the 21-34, 35-49, 50-64, and 65+ age groups, respectively. AUDs and DUDs were also significantly related to

  11. Emerging practices of faith-based organisations addressing human resources for health

    NARCIS (Netherlands)

    Dieleman, M.A.; Hilhorst, Thea; Utrera, Jose; Olivier, J; Wodon, Q

    2012-01-01

    Adequate health system performance and achieving the Millennium Development Goals for health, requires that qualified health care providers are available and can perform adequately. However, there is a critical shortage of health care providers in sub-Saharan Africa, and this crisis is hitting

  12. Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

    Science.gov (United States)

    Househ, Mowafa; Yunus, Faisel

    2014-01-01

    Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

  13. Communicating with the workforce during emergencies: developing an employee text messaging program in a local public health setting.

    Science.gov (United States)

    Karasz, Hilary N; Bogan, Sharon; Bosslet, Lindsay

    2014-01-01

    Short message service (SMS) text messaging can be useful for communicating information to public health employees and improving workforce situational awareness during emergencies. We sought to understand how the 1,500 employees at Public Health--Seattle & King County, Washington, perceived barriers to and benefits of participation in a voluntary, employer-based SMS program. Based on employee feedback, we developed the system, marketed it, and invited employees to opt in. The system was tested during an ice storm in January 2012. Employee concerns about opting into an SMS program included possible work encroachment during non-work time and receiving excessive irrelevant messages. Employees who received messages during the weather event reported high levels of satisfaction and perceived utility from the program. We conclude that text messaging is a feasible form of communication with employees during emergencies. Care should be taken to design and deploy a program that maximizes employee satisfaction.

  14. How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization

    OpenAIRE

    Naowarut Charoenca; Nipapun Kungskulniti; Jeremiah Mock; Stephen Hamann; Prakit Vathesatogkit

    2015-01-01

    Background: Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure.Objective: In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health.De...

  15. Child and Adolescent Emergency and Urgent Mental Health Delivery Through Telepsychiatry: 12-Month Prospective Study.

    Science.gov (United States)

    Roberts, Nasreen; Hu, Tina; Axas, Nicholas; Repetti, Leanne

    2017-10-01

    The significant gap between children and adolescents presenting for emergency mental healthcare and the shortage of child and adolescent psychiatrists constitutes a major barrier to timely access for psychiatric assessm