Emergency Health Services Research Articles

Продолжительность жизни и здоровье городского и сельского населения региона в условиях пандемии Covid-19 (на примере Республики Коми)

The article is devoted to the comparative assessment of the health state and strategies of self-preservation behavior of urban and rural population as factors to increase life expectancy.
 Changes in the life expectancy of urban and rural population of Russia and the Komi Republic in the first year of the COVID-19 pandemic, the dynamics of cause-specific mortality, the mortality rate from coronavirus infection are considered.
 The sociological survey has found out that self-assessment of health in rural areas is lower, there are practically no differences in the prevalence of chronic diseases, but there is a higher percentage of overweight people in rural areas, with high blood pressure and glucose in blood.
 In addition to the lack of access to emergency and high-tech health services and the less common preventive model of self-preservation behaviour in association with the healthcare system, the low life expectancy of rural population is determined by double and heavy employment, resulting from low living standards, as well as increased levels of consumption and the quality of alcohol products, that cause high mortality from external causes and are an additional health risk factor, leading to significant mortality from circulatory system diseases.

Clustering of Environmental Parameters and the Risk of Acute Myocardial Infarction.

The association between days with similar environmental parameters and cardiovascular events is unknown. We investigate the association between clusters of environmental parameters and acute myocardial infarction (AMI) risk in Singapore. Using k-means clustering and conditional Poisson models, we grouped calendar days from 2010 to 2015 based on rainfall, temperature, wind speed and the Pollutant Standards Index (PSI) and compared the incidence rate ratios (IRR) of AMI across the clusters using a time-stratified case-crossover design. Three distinct clusters were formed with Cluster 1 having high wind speed, Cluster 2 high rainfall, and Cluster 3 high temperature and PSI. Compared to Cluster 1, Cluster 3 had a higher AMI incidence with IRR 1.04 (95% confidence interval 1.01–1.07), but no significant difference was found between Cluster 1 and Cluster 2. Subgroup analyses showed that increased AMI incidence was significant only among those with age ≥65, male, non-smokers, non-ST elevation AMI (NSTEMI), history of hyperlipidemia and no history of ischemic heart disease, diabetes or hypertension. In conclusion, we found that AMI incidence, especially NSTEMI, is likely to be higher on days with high temperature and PSI. These findings have public health implications for AMI prevention and emergency health services delivery during the seasonal Southeast Asian transboundary haze.

Frequency of admission to prehospital emergency medical services and satisfaction level of prehospital emergency care during active chemotherapy

Objective: In this study, we aimed to investigate the frequency of admission to prehospital emergency medical services (PEMS) and the satisfaction level of prehospital medical care in cancer patients during the chemotherapy process. Material and Methods: A total of 218 patients receiving active chemotherapy were included in the study. A personal information form and the 112 Emergency Health Services Patient Satisfaction Scale (EHSPSS) were used to collect data. Sociodemographic characteristics and data on admission to PEMS were compared, Results: Among the patients, 162 (74.3%) had visited EMS in the previous three months. Ninety-eight (60.5%) patients had visited EMS as outpatients, and 64 (39.5%) patients had arrived via PEMS. The PEMS admission rate of patients who visit EMS from rural areas (71.9%) was significantly higher than that of patients who visit from urban areas (p < 0.001). The total satisfaction score was determined to be 89±18.1 points. According to these scores, it could be interpreted that the satisfaction rate of the patients was high. Regarding the dimension scores, the ambulance staff and emergency call center staff scores were high, while the care provided in the venue and ambulance technical equipment scores were above moderate Conclusion: Patients receiving active chemotherapy frequently visit EMS. Although these patients mostly visited EMS as outpatients, the rate of patients who visited EMS with PEMS was substantial. The PEMS patient satisfaction rate was found to be high among active chemotherapy patients. High patient satisfaction is a prominent patient-centered indicator in measuring the quality of care

Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study

The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the U.S. This longitudinal cohort study used insurance claims data from 57,732 adolescents who had at least one well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression to similar adolescents who were not screened for depression during the well-visit. Outcomes were examined over two-year follow-up and included emergency department use and inpatient hospitalizations for depression-related reasons, mental health-related reasons, and any reason as well as medically-treated suicidal behaviors. Log-binomial regression models were used to examine associations between depression screening and each outcome in the matched sample. Heterogeneity of associations by sex was examined with interaction terms. Being screened for depression was not consistently associated with emergency department use (depression-related reasons: RR = 1.00, 95% CI = 0.76–1.30; mental health-related reasons: RR = 1.02, 95% CI = 0.80–1.29; any reason: RR = 0.96, 95% CI = 0.83–1.11), inpatient hospitalizations (depression-related reasons: RR = 1.05, 95% CI = 0.84–1.31; mental health-related reasons: RR = 1.16, 95% CI = 1.00–1.33; any reason: RR = 1.05, 95% CI = 0.99–1.12), or medically-treated suicidal behaviors (RR = 0.83, 95% CI = 0.51–1.36). Associations were similar in magnitude among male and female adolescents. The results of this study suggest that depression screening, as it is currently practiced in the U.S., may not deter avoidable health services use among adolescents.

COVID-19 Pandemi Döneminde Acil Servis Çalışanlarında Mesleki Kaygının Değerlendirilmesi

Amaç: Covid-19, tüm dünyada insanlar ve sağlık çalışanları üzerinde kaygı oluşturmuştur. Medyada paylaşılan ölüm ve vaka sayılarındaki artış kaygıyı artırmış, özellikle sağlık çalışanlarının meslekleri ile ilişkili kaygı duymalarına neden olmuştur. Tanımlayıcı kesitsel türde olan bu araştırma bir eğitim araştırma hastanesi acil servis çalışanlarının Covid-19 pandemisi döneminde mesleki kaygılarını belirleyip ona bağlı değişkenleri analiz ederek literatüre katkı sağlamak amacı ile yapılmıştır. Gereç ve Yöntemler: Araştırmanın evrenini bir Eğitim Araştırma Hastanesinin acil servis çalışanları oluşturdu. Veriler araştırma evreninin %83.9’una ulaşılarak toplanmıştır. Araştırmanın verileri “Acil Servis Çalışanı Bilgi Formu” ve “Acil Sağlık Çalışanları İçin Mesleki Kaygı Ölçeği” kullanılarak, Google formlar üzerinden hazırlanan çevirim içi anket yöntemi ile elde edilmiştir. Bulgular: Araştırmaya katılanların yaş ortalaması 33.71±8.13, acil serviste çalışma ortalaması 7.90±6.89 yıl olduğu belirlendi. Katılımcıların %86.2’sinin Covid-19 pozitif hasta ile temas ettiği ve %31.9’unun sekiz saatten daha uzun temas ettiği, %90.4’ünün pandemi döneminde işle ilgili kaygı duyduğu, %21.3’ünün pandemi döneminde işi bırakmayı istediği saptandı. Acil sağlık hizmeti sunan personelin mesleki kaygı ölçeği toplam puan ortalaması 77.29±16.12 olarak belirlendi. Araştırmaya katılan kadın çalışanların, bekar olanların, çocuk sahibi olmayanların, nöbet ile çalışanların, doktor ve hemşirelerin, pandemi döneminde işle ilgili kaygı duyanların mesleki kaygı ölçeği puan ortalaması yüksek olup, aradaki farklılık istatistiksel olarak anlamlı bulundu (p<0.05). Sonuç: Acil servis çalışanlarının mesleki kaygı düzeyinin orta düzeyde olduğu saptandı. Doktor ve hemşirelerin yaşadıkları mesleki kaygı düzeyi arasında fark olmamasına rağmen diğer meslek gruplarına göre mesleki kaygıları yüksek bulunmuştur. Doktor ve hemşirelerin daha yüksek mesleki kaygıya sahip olmasının nedeni hasta bakımında daha fazla zaman geçirmesi ile açıklanabilir. Acil serviste çalışan sağlık çalışanlarının mesleki kaygıları için gerekli desteğin yönetimsel olarak verilerek çözümlenmesi gereken öncelikli konular arasında yer almasını önermekteyiz.

Research priorities in emergency general surgery (EGS): a modified Delphi approach

BackgroundEmergency general surgery (EGS) patients account for more than one-third of admissions to hospitals in the National Health Service (NHS) in England. The associated mortality of these patients has been quoted as approximately eight times higher than that of elective surgical admissions. This study used a modified Delphi approach to identify research priorities in EGS. The aim was to establish a research agenda using a formal consensus-based approach in an effort to identify questions relevant to EGS that could ultimately guide research to improve outcomes for this cohort.MethodsThree rounds were conducted using an electronic questionnaire and involved health care professionals, research personnel, patients and their relatives. In the first round, stakeholders were invited to submit clinical research questions that they felt were priorities for future research. In rounds two and three, participants were asked to score individual questions in order of priority using a 5-point Likert scale. Between rounds, an expert panel analysed results before forwarding questions to subsequent rounds.ResultsNinety-two EGS research questions were proposed in Phase 1. Following the first round of prioritisation, forty-seven questions progressed to the final phase. A final list of seventeen research questions were identified from the final round of prioritisation, categorised as condition-specific questions of high interest within general EGS, emergency colorectal surgery, non-technical and health services research. A broad range of research questions were identified including questions on peri-operative strategies, EGS outcomes in older patients, as well as non-technical and technical influences on EGS outcomes.ConclusionsOur study provides a consensus delivered framework that should determine the research agenda for future EGS projects. It may also assist setting priorities for research funding and multi-centre collaborative strategies within the academic clinical interest of EGS.

Nutritional and immunisation status of children visiting hospital during COVID-19 pandemic in Kathmandu, Nepal

Background: The coronavirus disease-2019 (COVID -19) outbreak and lockdown measures have given challenges related to food production, food supply chain, indulgence in low healthy processed food, lack of public transportation, difficulties in accessing emergency and regular health services. Nepal already has high burden of child mortality (39 deaths per 1000 live births) and this pandemic situation has put children at greater risk of facing hunger, malnutrition, lack of routine immunisation, communicable disease outbreak, and many more psychological as well as physical health issues. Objectives: This study identifies nutritional status and gap in routine vaccination in children during COVID-19 pandemic thereby help in modelling action plan to prevent an outpouring in malnutrition and vaccine preventable infections in children. Methods: This is a hospital-based analytical cross-sectional study done among 138 children of ages one to 59 months old from 1st January 2021 to 1st August 2021 attending paediatric clinic of KMCTH. Results: In this study, 20 (14.4%) of the children were stunted, 23 (16.6%) were wasted and 15 (10.8%) were categorised under undernutrition, three (2.2%) were overweight and three (2.2%) were obese. There were significantly more male children stunted than female (p-value = 0.005). Thirty-five (33.3%) of less than 15 months children were reported to have delay of more than two weeks in routine immunisation of children. A significant delay of more than four weeks was observed in 29 (27.6%). Conclusion: Indirect impact of COVID-19 pandemic in children like malnutrition and gap in routine vaccination needs to be addressed seriously in Nepal.

Emergency Department Use by Women Experiencing Homelessness in Los Angeles, California, USA.

Background:This article reports on the use of hospital Emergency Departments (EDs) in women experiencing homelessness in Los Angeles, California. Women 18 years of age or older were recruited from homeless day centers in Los Angeles to participate in this study.Materials and Methods:A self-report questionnaire on health status, demographics, and emergency service use was completed by study participants.Results:In this study of women experiencing homelessness, 64% utilized the ED within the past year. The mean number of ED use was 3.63 (range 0–20) visits in the past year. Higher frequency visits were significantly associated with several mental health conditions (p = 0.016), physical disability (p = 0.001), and traumatic brain injury (p = 0.013).Conclusions:The physical and psychological impacts of the homelessness experience can be enormous, affecting the homeless individually and collectively. Study findings may help to understand how to improve services that support and meet the needs of women experiencing homelessness such as patient and family-centered care and trauma-informed care in the ED.

The effect of the covid-19 pandemic on the psychological status of 112 emergency health services personnel

The effect of the covid-19 pandemic on the psychological status of 112 emergency health services personnel

Evolution of Acute Respiratory Distress Syndrome in Emergency and Critical Care: Therapeutic Management before and during the Pandemic Situation.

Background and Objectives: Acute respiratory distress syndrome is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and blood. The causes can be varied, although since the COVID-19 pandemic began there have been many cases related to this virus. The management and evolution of ARDS in emergency situations in the last 5 years was analyzed. Materials and Methods: A systematic review was carried out in the PubMed and Scopus databases. Using the descriptors Medical Subject Headings (MeSH), the search equation was: “Emergency health service AND acute respiratory distress syndrome”. The search was conducted in December 2021. Quantitative primary studies on the care of patients with ARDS in an emergency setting published in the last 5 years were included. Results: In the initial management, adherence to standard treatment with continuous positive airway pressure (CPAP) is recommended. The use of extracorporeal membrane reduces the intensity of mechanical ventilation or as rescue therapy in acute respiratory distress syndrome (ARDS). The prone position in both intubated and non-intubated patients with severe ARDS is associated with a better survival of these patients, therefore, it is very useful in these moments of pandemic crisis. Lack of resources forces triage decisions about which patients are most likely to survive to start mechanical ventilation and this reflects the realities of intensive care and emergency care in a resource-limited setting. Conclusions: adequate prehospital management of ARDS and in emergency situations can improve the prognosis of patients. The therapeutic options in atypical ARDS due to COVID-19 do not seem to vary substantially from conventional ARDS.

Climatic and Hydrological Factors Affecting the Assessment of Flood Hazards and Resilience Using Modified UNDRR Indicators: Ayutthaya, Thailand

This research aims to investigate the effect of climatic and hydrological factors on flood hazards and assess flood resilience in Ayutthaya, Thailand, using the 10 essentials for making cities resilient modified by the United Nations Office for Disaster Risk Reduction (UNDRR). Flood resilience assessment was performed based on a multi-criteria decision-making approach or the analytical hierarchy process (AHP) of pairwise comparison. The results indicate that runoff is considered the most influential factor in flood hazards, followed by land use, rainfall, and historical flood events, sequentially. Regarding the flood incident management concept, a questionnaire survey (n = 552) was conducted to understand the impacts of flood on local communities. The findings reveal that 50% of respondents had never received any flood information or participated in training sessions on flood preparedness. Most reported their concerns about the inadequate supply of drinking water during a flood. Spearman’s correlation coefficient shows positive correlations between flood disaster relief payments, preparedness training, access to flood hazard mapping, emergency health services, and their flood preparation actions. According to the modified UNDRR indicators, the top three highest AHP values in building community resilience to flood hazards in Ayutthaya are flood risk scenario identification, the effectiveness of emergency flood disaster response, integrated urban planning, and disaster risk reduction. The policy implications of this research include the need for national authorities to better understand the role cities can play a vital role in supporting both national and international climate resilience frameworks, especially Thailand’s National Disaster Management Plan, the Sendai Framework for Disaster Risk Reduction (SFDRR), and the global Sustainable Development Goals (SDGs).

The impact of COVID-19 on social support perception and stress of prehospital care providers

BackgroundThis study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli. MethodsThis descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire. ResultsWe analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05). ConclusionsThe findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.

Evaluation of Systemic Thrombolytic Treatment in the Emergency Service in Unstable and Resuscitated Patients Due to Massive Pulmonary Embolism

Background: PE accounts for 3% of out-of-hospital cardiac arrest. In this case, treating patients with thrombolysis during resuscitation has been associated with better survival. Objective: The aim of this study is to evaluate the use of systemic thrombolytic in unstable and/or resuscitated patients who are evaluated in the red area in emergency service practice and who are diagnosed with massive pulmonary embolism with bedside examinations. Methods: This prospective study was designed on 17 patients who were transferred as unstable to the emergency service of a tertiary hospital by Emergency Health Services and/or who needed resuscitation due to non-shockable fatal rhythm disorder on admission and who underwent systemic thrombolysis due to the diagnosis of pulmonary embolism during resuscitation. Results: Of the 17 patients included in the study, 52.9% were discharged and improvement was detected in unstable vital findings in 47.1% patients after thrombolysis. Of the bedside examinations performed on admission, ECG showed T wave negativity at V1-4 deviations and P-pulmonale in 41.2% patients and ECHO showed right ventricle dilatation indicating right ventricle dysfunction in 82.4% patients. CTPA taken after stabilization showed thrombus at bilateral pulmonary artery in 88.2% patients. Conclusion: Cardiopulmonary arrest caused by PE is a life-threatening condition that requires urgent systemic thrombolysis. Patients who are evaluated as unstable or in need of resuscitation in the emergency service should be diagnosed quickly as a result of examinations performed at bed-side and thrombolytic treatment should be started.

Determining the Level of Recognition of the Symptoms and Risks of Child Abuse and Neglect by the Health Personnel Working in 112 Emergency Health Services

Amaç: Bu araştırmanın amacı; 112 Acil Sağlık Hizmetlerinde çalışan personellerin karşılaştıkları vakalarda çocuk istismarı ve ihmalinin belirti ve risklerini tanıma düzeylerinin saptanmasıdır. Yöntem: Bu araştırma kesitsel türde bir araştırmadır. Bu çalışma için üniversitemizden gerekli etik kurul izni alınmıştır. 112 Acil sağlık hizmetlerinde çalışan sağlık personelleri araştırmanın evrenini oluşturmaktadır. Amaçlı örneklem bağlamında yapılan çalışmada, hastane öncesi 112 Acil sağlık hizmetlerinde görev yapan, ulaşılabilen ve çalışmaya katılmaya onay veren gönüllü sağlık personelleri, araştırmanın örneklemini oluşturmuştur (n=208). Araştırmada sosyodemografik veri formu ve “Çocuk İstismarı ve İhmalinin Belirti ve Risklerinin Tanılanması”na yönelik geliştirilen ölçek kullanılmıştır. Elde edilen veriler; Mann Whitney U Test ve Kruskal Wallis Test ile analiz edilmiştir. Bulgular: Araştırmaya 141 kadın, 67 erkek olmak üzere toplamda 208 acil sağlık hizmetleri personeli katılmıştır. Katılımcıların 129’ u evli, geri kalan 79’ u ise bekardır. Bu katılımcıların 64’ ü çocuk istismarı ve ihmali ile ilgili eğitim almışken, 144 katılımcı eğitim almamıştır. Çocuk İhmalinin Belirti ve Risklerini Tanılama Ölçek/Alt Ölçeklerinin güvenilirlik değerlerinin literatüre göre güvenilir seviyede olduğu belirlenmiştir. Sonuç: Elde edilen verilere göre çocuk istismar ve ihmalinin belirti ve riskleri konusunda hastane öncesi acil sağlık hizmeti sunan personelin farkındalığı yüksek olarak görülmüştür. Aynı zamanda sağlık memurlarının; doktorlar, acil tıp teknisyenleri ve paramediklere göre çocuktaki davranışsal belirtileri daha az fark edebildikleri belirlenmiştir. Tüm personelin belli aralıklarla güncel eğitimlere tabi tutulması ve bu eğitimlerin zorunlu olması neticesinde, personellerin çocuk istismarı ve ihmali konusunda farkındalık düzeyi artacağı düşünülmektedir.

How often do nurses suspect violence and domestic violence in local emergency medical communication centre? A cross-sectional study

Objective To assess the extent of violence that is revealed by screening at first contact with a local out-of-hours emergency medical communication centre (LEMC; Norwegian ‘Legevaktsentral’). Design Cross-sectional study. Setting Arendal LEMC, covering 10 municipalities in south-eastern Norway. All contacting patients (telephone or personal attendance) were asked by nurse whether the encounter was related to violence. Subjects All first patient encounters at Arendal LEMC. Main outcome measures Number and proportion of cases where the nurses suspected violence, both domestic violence and other violence. Incidence rate of violence, age and gender distribution of patients, time of day and reason for encounter. Results Violence was suspected in 336 of 103,467 first patient encounters (0.3%), of which 132 (0.1%) was domestic violence. Patients were female in 50.6% of all violence cases, and in 79% of domestic violence cases. Incidence rates were 137 per 100,000 person-years for all violence, and 53 for domestic violence. Conclusions This study indicates violence may be revealed in three of 1000 first encounters to an LEMC when nurses screen systematically for domestic or other violence. Key points Violence as underlying reason for encounter with primary care emergency health services is probably often not discovered by health personnel. • We examined how often nurses reveal violence upon first contact when systematically asking all patients. • Violence was suspected in 0.3% of cases, and domestic violence in 0.1%. • Among patients with disclosed domestic violence, 79% were female.

Understanding Societal Resilience-Cross-Sectional Study in Eight Countries.

Civilian populations that are more prepared for emergencies are more resilient. Ample research has been carried out over the last three decades to identify the factors that contribute to public readiness to emergencies and disasters and enhance societal resilience. However, the analysis did not achieve an in-depth comprehension of the types of contributing factors, namely, contextual vs. target aspects. A cross-sectional study that explored attitudinal factors among civilian populations took place during the months of January–February 2021. Diverse representative samples (N ≥ 500 each) of adults from eight countries (Italy, Romania, Spain, France, Sweden, Norway, Israel, and Japan) were engaged. The primary outcomes of this study were individual and societal resilience as well as emergency preparedness. The results suggest that in most countries, levels of trust are relatively high for emergency services and health services, and relatively low for politicians. In the overall sample, the individual preparedness index, which delineates the compliance with general household adjustment recommendation for emergencies, averaged at 4.44 ± 2.05SD (out of 8). Some variability was observed between countries, with some countries (e.g., Spain, Norway, and Italy) reporting higher preparedness rates than others (e.g., Japan). In the overall sample, levels of individual resilience were mediocre. Multivariate analysis showed that the following variables are predictors of societal resilience: trust (β = 0.59), social norms and communality (β = 0.20), individual resilience (β = 0.05), individual preparedness (β = 0.04), risk awareness (β = 0.04), and age (β = 0.03). The results of this study show that there are commonalities and differences between societies across Europe and beyond concerning societal resilience at large, including preparedness, individual resilience, and risk perception. Despite socio-cultural driven differences, this study shows that societies share varied characteristics that may contribute toward a common model for assessing societal resilience and for explaining and predicting resilience and readiness.

Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain

BackgroundThere are concerns about high levels of demand for emergency health services. The aim was to identify the characteristics of the British population with a tendency to contact emergency medical...

Ultrasonography Use in Emergency Health Services

Ultrasonography Use in Emergency Health Services

Correlates of unscheduled and emergency clinical contact in a cohort of patients treated for psychosis

Psychosis has the highest economic burden among mental disorders worldwide. Our retrospective chart-based review aimed to identify factors that predict unscheduled clinical contact for patients with psychosis attending an outpatient psychiatry clinic. Participants consisted of patients with a primary diagnosis of a psychotic disorder being followed for one consistent calendar year at the clinic. The primary outcome was the frequency of unscheduled and emergency clinical contact (phone-based nursing services, visits to the emergency department, or hospitalizations to the inpatient psychiatry ward) as a reflection of psychiatric morbidity and level of care need. The sample consisted of 331 patients, mostly diagnosed with schizophrenia (43.5%) or schizoaffective disorder (30.8%). Logistic regression analyses showed that participants who used any emergency service were significantly more likely to be females, to have comorbid obsessive-compulsive disorder, and to be prescribed two or more antipsychotics. In conclusion, individuals with psychosis following on an outpatient basis might require emergency health services at a point during their treatment. A small minority seems to require unscheduled clinical contact, and an even smaller number will require admission. Early identification of those more likely to require more frequent or intensive care can help organize services more effectively. • Individuals with psychosis might require emergency health services during treatment. • In one year follow-up, 49.9% of participants used at least one unscheduled service. • Females, schizoaffective diagnosis, and comorbid OCD increased unscheduled services. • Oral antipsychotic prescription and polypharmacy increased unscheduled services.

Research on public health crisis early warning system based on context awareness.

BACKGROUND: With the continuous expansion of urban scale and the increasing concentration of population, public health crisis has become an important part of urban residents’ health management. The outbreak of the COVID-19 pandemic in Wuhan in 2020 has sounded the alarm.OBJECTIVE: With the government at all levels to carry out the construction of urban Internet of things and information internet, the Internet backbone network has been built, deployed a large number of sensors, and collected a large number of urban situation data.METHODS: In this paper, situational awareness technology is introduced into public health emergency services.RESULTS: By constructing ontology, situational data and residents’ health data are integrated. Through key technologies such as situational data collection, data fusion and data mining, real-time perception of environmental conditions of public health emergency scene is realized, and situational data fusion and situational information reasoning model are constructed.CONCLUSIONS: The model is applied to the public health crisis emergency simulation system to verify the effectiveness of the model.