Incidence Of Crises Research Articles

Shifting Paradigms in the Pathophysiology and Treatment of Carcinoid Crisis.

Carcinoid crisis is a potentially fatal condition characterized by various symptoms, including hemodynamic instability, flushing, and diarrhea. The incidence of carcinoid crisis is unknown, in part due to inconsistency in definitions across studies. Triggers of carcinoid crisis include general anesthesia and surgical procedures, but drug-induced and spontaneous cases have also been reported. Patients with neuroendocrine tumors (NETs) and carcinoid syndrome are at risk for carcinoid crisis. The pathophysiology of carcinoid crisis has been attributed to secretion of bioactive substances, such as serotonin, histamine, bradykinin, and kallikrein by NETs. The somatostatin analog octreotide has been considered the standard of care for carcinoid crisis due to its inhibitory effect on hormone release and relatively fast resolution of carcinoid crisis symptoms in several case studies. However, octreotide's efficacy in the treatment of carcinoid crisis has been questioned. This is due to a lack of a common definition for carcinoid crisis, the heterogeneity in clinical presentation, the paucity of prospective studies assessing octreotide efficacy in carcinoid crisis, and the lack of understanding of the pathophysiology of carcinoid crisis. These issues challenge the classical physiologic model of carcinoid crisis and its common etiology with carcinoid syndrome and raise questions regarding the utility of somatostatin analogs in its treatment. As surgical procedures and invasive liver-directed therapies remain important treatment modalities in patients with NETs, the pathophysiology of carcinoid crisis, potential benefits of octreotide, and efficacy of alternative treatment modalities must be studied prospectively to develop an effective evidence-based treatment strategy for carcinoid crisis.

Impacts of COVID-19 on the Catch of Small-Scale Fishers and Their Families Due to Restriction Policies in Davao Gulf, Philippines

COVID-19 was declared a global pandemic by the World Health Organization in 2020 with countries putting up several measures to mitigate and flatten the curve of hospitalizations and death from travel bans to home confinements and local lockdowns. This pandemic created health and economic crises, leading to increased incidence of poverty and food crisis especially on both agriculture and the fisheries in many developing nations including the Philippines. The specific objectives of this study were to assess the impact of COVID-19 restrictions on the catch per unit effort (CPUE) of small-scale fishers and to determine what factors could influence the volume of their catch during this time of pandemic. Moreover, this also investigated the impact of COVID-19 restrictions to fishers and their families. To do that we surveyed N = 200 small-scale fishers around the Davao gulf using semi-structured questionnaire and inquired on the impact of the COVID-19 to their fishing operation, catch, fishing costs, and their families. The collected socioeconomic variables, including emotional responses to the pandemic were then related to the CPUE and the volume of catch. The results show that fishers were highly affected by the pandemic due to the lockdown policy imposed in the fishing villages during the earlier phases of restrictions by the government. Fishers were affected in terms of the volume of their catch, also fishing costs, and emotionally as they were also frustrated due to the impacts of the hard lockdown. The restricted fishing access was found to have important and major set-back on the fishing operations of fishers and the same was experienced also by the middlemen given the low fish price and reduced mobility of the fish traders. COVID-19 also impacted the fishers, and their families through lack of mobility, food inadequacy, travel restrictions and their children’s education.

Pulse rate and blood pressure changes during low-irradiance PDT compared with conventional PDT in the treatment of facial actinic keratoses: A retrospective study.

Conventional photodynamic therapy (c-PDT) is a highly effective treatment for actinic keratoses. Besides pain as the main side effect, blood pressure (BP) increases and hypertensive crises may occur during treatment. Reducing the irradiation intensity while keeping the total dose constant (low-irradiance PDT) can achieve a clinically relevant reduction in pain. This study aimed to evaluate the influence of li-PDT on the BP and pulse (PR) during therapy and the incidence of post-interventional hypertension compared with c-PDT. We retrospectively analyzed the treatment data of 79 patients (39 c-PDT and 40li-PDT). BP and PR measurements were performed in all patients before PDT, at mid-exposure, and immediately after PDT. In addition, the pain was assessed by using the visual analog scale. Patients treated with li-PDT reported significantly lower pain than those receiving c-PDT (p<.0005). Additionally, they showed less systolic (SBP) and diastolic (DBP) BP increase (∆SBP: p<.0005, ∆DBP: p=.015) and overall lower absolute BP values (SBP: p<.0005, DBP: p=.008) compared with c-PDT. They were also significantly less likely to develop post-interventional hypertension (p=.037) or higher stages of arterial hypertension. Regarding PR, there was no difference in absolute values between both groups, but the increase from onset to half irradiation duration was significantly higher in c-PDT (p=.013). Li-PDT is an excellent option to reduce the elevation of arterial BP and decrease the incidence of post-interventional hypertension and hypertensive crisis. This finding has considerable relevance, especially with the risk profile of many PDT patients in mind (advanced age and cardiovascular history).

Экстренная психологическая помощь в системе образования: современное состояние

Scientific interest in providing emergency psychological assistance in crisis situations is based on a practical request, since a crisis incident poses a threat to life and health. The paper presents an analysis of the provision of emergency psychological assistance in the education system. The sample consisted of 3 groups of respondents (12048 individuals) from 75 subjects of the Russian Federation. Specially designed questionnaires were used to obtain information on certain indicators from different sources. The study assessed the state of the infrastructure, collected information on staffing, identified conditions that have a negative impact on the quality and availability of psychological first aid.. According to the results of the study, quality criteria were identified and the directions and measures necessary for the provision of emergency psychological assistance were determined. It is concluded that the effectiveness of psychological assistance in crisis situations depends on the availability of qualified specialists and educational work with teachers and parents to develop skills for early detection of a crisis situation.

\u201cThe More You Do, the More Comfortable You Feel\u201d: the Police Hostage and Crisis Negotiator Journey

Hostage and crisis negotiators are specialist police officers utilised internationally by police forces to resolve hostage and crisis incidents. Whilst the role has been heavily documented in some parts of the world (namely the United States of America), there is a lack of literature relating to the organisational and operational processes and procedures in place for police negotiators in the United Kingdom. Equally, there is limited research that has explored the experiences of negotiators who perform an essential function within a variety of life-or-death situations with a view to understanding how officers transition from trainee to qualified negotiators. This paper outlines the development of a grounded theoretical model that depicts the “hostage and crisis negotiator journey,” as represented by English negotiators. Interviews were conducted with 15 negotiators from nine police forces in England and a conceptual model was developed including five primary, 12 secondary, and 32 tertiary categories. The negotiator journey is chronologically recounted by means of the five main primary categories identified: (1) ‘Why? Reasons for entering (and remaining within) the negotiator world’, (2) ‘Who and how? The negotiator profile and selection’, (3) ‘Negotiator training’, (4) ‘Operational negotiator roles’, and (5) ‘Negotiator welfare and support’. This paper demonstrates one of the first attempts to empirically map the processes and procedures in place for negotiators in England and the findings are discussed in line with their potential implications for police policy and practice.

Functional evaluation of anterolateral thigh flap and forearm flap for repairing defects after oropharyngeal cancer

Objective:To investigate the oropharyngeal function recovery of oropharyngeal squamous cell carcinoma repaired by anterolateral thigh flap and forearm flap. Methods:Retrospective study between September 2016 and September 2020 complete line 37 cases of oropharyngeal cancer postoperative soft tissue defect of femoral anterolateral flap or forearm flap to repair the patient data, in which 22 cases, using the forearm skin flap to repair 15 cases with femoral anterolateral flap, flap survival rate of preparation, compare the two groups, the incidence of vascular crisis, The functions of swallowing, speech, and velopharyngeal closure were evaluated. Results:21 cases of forearm flaps survived, and 1 case had vascular crisis. After surgical exploration, the contralateral forearm flaps survived transplantation. Fourteen anterolateral femoral flaps survived, 2 flaps had vascular crisis, and 1 flap survived after thrombus removal. The other one was repaired with pectoralis major myocutaneous flap for necrosis. Swallowing, speech, palatopharyngeal closure and other functions of the patients after the two kinds of flap repair had higher satisfaction. Conclusion:Forearm flap and anterolateral thigh flap are good choices for soft tissue defect after oropharyngeal cancer, Must act according to the special details choice appropriate therapeutic schedule.

Extreme events in a forced BVP oscillator: Experimental and numerical studies

In this work, we report the existence of extreme events in the well known Bonhoeffer-van der Pol (BVP) oscillator under the excitation of a periodically forced voltage. Extreme events refer to the sudden and random increase in the amplitude of one or more of the state variables of the dynamical system and arise because of the incidence of interior crises or the presence of discontinuous boundaries or intermittency. We have chosen this system because of the fact that it has spawned several systems modelling neuronal dynamics such as Hindmarsh-Rose (HR) and Hodgkin-Huxley (HH) models. Our investigations involve both laboratory experiments and numerical simulations. We have obtained time plots, phase portraits, Poincaré maps, bifurcation graphs, Lyapunov exponents and signal to noise ratio (SNR) to study the general dynamics and to confirm the presence of extreme events, we have used statistical measures such as phase slip analysis, distribution functions for both experimental and numerical data. To the best of our knowledge, we believe that it is for the first time that the occurrence of extreme event has been reported using both real time experimental and numerical studies on this forced BVP system.

Repair of common arterial trunk: palliation and delayed correction as a viable alternative strategy in selected patients.

OBJECTIVESPrimary repair of common arterial trunk (CAT) is burdened by high mortality rates, especially in the presence of multiple risk factors. Timing, possible palliative methods, optimal management of associated cardiac lesions and handling of a poor preoperative state are still under discussion.METHODSWe retrospectively analysed all patients who underwent surgery for CAT in our institution between 2008 and November 2020. We included 22 patients, 11 of whom received primary correction (PC) and 11 of whom underwent initial palliation by partial repair, leaving the ventricular septal defect open and connecting the right ventricle to the pulmonary arteries with a small valveless right ventricle-to-pulmonary artery conduit. A delayed correction (DC) was performed after 11.5 ± 3.6 months.RESULTSThe overall operative mortality was 4.5%; 1 patient (affected by severe truncal valve stenosis and presenting in a poor state preoperatively) in the DC group died after palliation. The incidence of postoperative pulmonary hypertensive crisis was significantly higher in the PC group (P = 0.027). No patient from either group required postoperative extracorporeal support. Survival rates after 6 years differed slightly (PC group, 90%; DC group, 70%; log-rank = 0.270).CONCLUSIONSPC of CAT remains an optimal surgical approach for patients with an expected low mortality. However, our data support palliation and DC as a suitable alternative strategy, especially in the presence of significant risk factors like interrupted aortic arch, poor preoperative condition or complex surgical anatomy.

EDUCATION, SECURITY AND HEALTH CHALLENGES IN COVID 19 NIGERIA: REFLECTING ON THE ROLE OF ALMAJIRAI

African countries have been severely harmed by terrorism, insurgency, secession, instability, violence and religious crises since the beginning of the 21st century. Countries are on the verge of collapse, wars engulf society, and instability remains a recurring experience since the collapse of colonial rule and subsequent independence from African nations. The increasing incidence of the insecurity crisis in Nigeria is worrying enough to emphasize that the West African regional organizations that have legal responsibility for insecurity management have not been able to adequately address this issue. Nigeria's security challenges seem to be getting worse, threatening the fundamental development and health and education challenges of our nation especially for you almajiri. National security has become a troubling and challenging issue. Therefore, the main purpose of this study is to prove the truth of the existence of a negative correlation between the transmission of covid19, education and other related hazards by the almajiri system. This study uses qualitative research methods with several analytical techniques and several ways of collecting data. This study resulted in recommendations for constitutional reform. Primary and secondary data collection sources are used to provide direction and give credence to the originality of this work and recommendations will be offered for policy makers to consider future steps.

Behavioral risk factors and clinical course of cardiovascular diseases and other noncommunicable diseases during quarantine in various regions of Russia

Aim. To assess the behavioral risk factors and the clinical course of cardiovascular diseases (CVDs) and other noncommunicable diseases (NCDs) during quarantine in various regions of Russia.Material and methods. This multicenter cohort cross-sectional study included 205 men and women from 6 Russian cities. Further, 4 of them (Saransk, Nizhny Novgorod, Penza, Ulyanovsk) were combined into one group — the Volga region. The study included men and women aged 30-69 years with one or more NCDs (hypertension, coronary artery disease with or without myocardial infarction, type 2 diabetes, chronic obstructive pulmonary disease/asthma and cancer in patients receiving chemotherapy and/or radiation therapy) who were self-isolated during coronavirus disease 2019 (COVID-19) pandemic. For all patients, a questionnaire was used, which included socio-demographic parameters, behavioral risk factors, status of the underlying disease, incidence of COVID-19 and its complications. Self-assessment of the state of health was carried out using the European Quality of Life Questionnaire.Results. In every third Muscovite, the intensity of physical activity decreased, and in the groups of patients from Omsk and the Volga region, it was 45% and 43%, respectively. An increase in meal frequency and an impairment of eating habits in Moscow and Omsk was noted in 18,2% and 18,7% of participants, while in Volga region subjects, these parameters were 2 times higher (42,4%). At the same time, no significant changes of alcohol consumption and smoking was revealed in the cohorts. Hypertensive crises during a pandemic were noted in all three subgroups, but more of them were recorded in the Volga region — in every third patient (p&lt; 0,05 compared to Moscow), in the Omsk group — in every fourth patient, and among Muscovites — no more than 5%. Clinical deterioration in patients with angina was noted in 15% of cases, while the smallest number was noted in Omsk subjects (5,3%), three times less than in other subgroups. Changes in intensity and regimen of hypoglycemic therapy were noted in patients from Omsk, while 30% of them (p&lt; 0,05 compared with the Volga region) increased the doses of medications taken. Chronic obstructive pulmonary disease was registered in the group with the largest number of Volga region patients — 14,1% (p&lt; 0,05 compared to Omsk), while 17% of patients in this group increased the dose of drugs. Any cancer was recorded in 13,6% of Muscovites, while in the other two groups — about 5%. The largest number of patients from the Volga region noted a health decline over the past year (30,8%), while every fifth patient from Omsk (19,6%) and 13,6% of Muscovites reported health changes.Conclusion. During quarantine and self-isolation, changes in dietary habits and physical activity decline were noted among patients with NCDs, while alcohol consumption and smoking remained practically unchanged. The change in clinical status was characterized by an increase in hypertensive crisis incidence, an increase in doses of antihypertensive and hypoglycemic medication. Depending on the region, the health decline was noted by 13-31% of patients with NCDs.

Breaking the Sound of Silence: Explication in the Use of Strategic Silence in Crisis Communication

Crises present organizations with the “rhetorical exigency” to enact control. Silence is not an option. This study, as the first empirical examination of Le et al’s (2019) seminal study on silence in crisis communication, examines, first, if silence can be strategically used as a bona fide strategy; second, under what circumstances should silence be broken; and third, when silence is broken, how it affects (a) organizational reputation, (b) societal risk perception, and (c) the publics’ crisis information sharing intention. An online experiment was conducted using a nationally representative sample in the United States. Participants were recruited in 2019 via a Qualtrics panel. The stimuli used in this study consisted of two components: (1) an explanation about a fictitious company; and (2) two types of silence breaking (forced vs. planned) embedded in each stimulus accordingly after the same crisis incident. Four hypothesis were conceptualized. They were all supported. Collectively, they showed that the effect of silence-breaking type on crisis information sharing intention was mediated by societal risk perception, which is conditioned by participants’ level of perceived organizational reputation. Silence, or failure to fill the information vacuum, has not been an option to consider thus far as it suggests the organization is “not in control.” However, this study suggests the types of silence organizations can adopt and the modes the organizational silence can be broken. It provides a new lens for organizations to engage in business communication.

Global geographic differences in healthcare utilization for sickle cell disease pain crises in the CASiRe cohort

BackgroundSickle cell disease (SCD) is characterized by frequent, unpredictable pain episodes and other vaso-occlusive crises (VOCs) leading to significant healthcare utilization. VOC frequency is often an endpoint in clinical trials investigating novel therapies for this devastating disease. ProcedureThe Consortium for the Advancement of Sickle Cell Research (CASiRe) is an international collaboration investigating clinical severity in SCD using a validated questionnaire and medical chart review standardized across four countries (United States, United Kingdom, Italy and Ghana). ResultsThis study, focused on pain crisis incidence and healthcare utilization, included 868 patients, equally represented according to age and gender. HgbSS was the most common genotype. Patients from Ghana used the Emergency Room/Day Hospital for pain more frequently (annualized mean 2.01) than patients from other regions (annualized mean 1.56 U.S.; 1.09 U.K.; 0.02 Italy), while U.K. patients were hospitalized for pain more often (annualized mean: U.K. 2.98) than patients in other regions (annualized mean 1.98 U.S.; 1.18 Ghana; Italy 0.54). Italy's hospitalization rate for pain (annualized mean: 0.57) was nearly 20 times greater than its emergency room/day hospital only visits for pain (annualized mean: 0.03). When categorized by genotype and age, similar results were seen. ConclusionsGeographic differences in pain crisis frequency and healthcare utilization may correlate with variable organization of healthcare systems among countries and should be considered regarding trial design, endpoints, and analysis of results when investigating novel agents for clinical benefit.

PD07-11 THERMAL ABLATION FOR ADRENAL METASTASES: A POOLED META-ANALYSIS AND SYSTEMATIC REVIEW OF 11 STUDIES WITH 339 PATIENTS

You have accessJournal of UrologyAdrenal (PD07)1 Sep 2021PD07-11 THERMAL ABLATION FOR ADRENAL METASTASES: A POOLED META-ANALYSIS AND SYSTEMATIC REVIEW OF 11 STUDIES WITH 339 PATIENTS Run-Qi GUO, and Xiao-Guang LI Run-Qi GUORun-Qi GUO More articles by this author , and Xiao-Guang LIXiao-Guang LI More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001975.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Thermal ablation (TA) has been reported to be safe and effective in the treatment of various malignancies. Although TA is available in the treatment of adrenal metastases (AM), the data are still limited. The aim of this study was to systematically evaluate the efficacy, outcomes and safety of TA for AM. METHODS: We did a systematic review and meta-analysis to aggregate the clinical outcomes of patients with AM treated with TA. We searched PubMed, EMBASE, and the Cochrane Library for studies published between January 2001 and January 2021, reporting the use of TA for AM. Proportionality with 95% confidence intervals (CIs) were performed using STATA version 14.0. RESULTS: Our search returned 301 studies, of which 48 were assessed for full-text eligibility. 11 studies, reporting on 339 patients with AM, were eligible for systematic review and included in the meta-analysis. The technical success rate 100% (99%-100%).The local tumor control rate (95% CI) at 1, 2, 3, and 5 years was 85% (81%-88%), 79% (73%-85%), 71% (61%-82%), and 63% (54%-72%). The overall survival at 1, 2, 3, and 5 years was 74% (67%-82%), 50% (38%-64%), 35% (29%-42%), and 27% (18%-36%). The major complication rate and the incidence of hypertensive crisis were 6.8% (3.2%-10.4%) and 30.2% (11.8%-48.6%). CONCLUSIONS: TA is an efficacious method of treating AM, with reliable tumor control rates and overall survival. Randomized controlled trials should further evaluate the safety and efficacy of TA in this setting. Source of Funding: This study is supported by Scientific Research Starting Foundation for PhD/MD under Grant BJ-2019-135 and Scientific Research Foundation for Central Health Care under Grant 2020YB10 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e110-e112 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Run-Qi GUO More articles by this author Xiao-Guang LI More articles by this author Expand All Advertisement Loading ...

Abstract P244: Scleroderma Renal Crisis Among Systemic Sclerosis Patients; A Large Cohort Study From The United States National Emergency Department Database.

Background: Literature regarding trends for incidence and mortality of Scleroderma renal crisis (SRC) in systemic sclerosis (SSc) within the United States (US) emergency departments (ED) is limited. Objective: To study the trends for incidence and mortality of SRC among SSc patient encounters within the US EDs. Methods: Data from the national emergency department sample (NEDS) constitutes 20% sample of hospital-owned EDs and in-patient sample in the United States. All ED encounters were included in the analysis. Major complications related to each ED encounter were obtained by using ICD codes. A Linear p-trend was used to assess the trends. Results: Of the total 180,435 ED encounters with a diagnosis of SSc in NEDS for the years 2009-2014, 771 (4.27/1,000) (mean age of 59.6 ± 15.5 years, 75.4% females) patients were recorded with SRC. A total of 32 (4.1%) patients had died during these ED hospital encounters. The SSc with SRC subgroup was associated with higher rates of life-threatening complications when compared to SSc without the SRC subgroup. Cerebrovascular complications include acute ischemic stroke 44 (5.6%). Cardiac complications include new-onset atrial fibrillation 62 (8%), conduction block 13 (1.6%) and acute onset heart failure 186 (24.1%). Other complications include pulmonary arterial hypertension 122 (15.8%), respiratory failure 212 (27.5%), and deep vein thrombosis 36 (4.7%). The yearly trend for the incidence of SRC every 1,000 ED SSc encounters in the United States increased over the study years from 2.11/1,000 in 2009 to 5.79/1,000 in 2014 (linear p-trend 0.002). The yearly trend for the mortality related to SRC in the United States remained steady over the study years 2009-2014 (linear p-trend 0.3187). Conclusion: SRC is a relatively rare medical emergency among patients with SSc. Although there has been a significant rise in the incidence of SRC among SSc patients over the study years, mortality rates had remained steady. Proper management of the underlying risk factors can prevent the development of SRC and associated complications. Keywords: Systemic sclerosis, Scleroderma renal crisis, pulmonary hypertension, deep vein thrombosis.

Who spoils the barrel? Negative spillover effect on competitor brands during food crises

Despite an increase in food crisis incidents and their negative influence, little attention has been paid to spillover effects from food crises on competitor brands. Thus, this study examined reciprocal spillover effects (horizontal and vertical) from food crises on competitors' brands depending on the directionality of spillover and association strength. In order to test the reciprocal spillover effects on competitor brands, this study employed an experimental design using restaurant brands’ food crises. The results indicated that a stronger negative spillover was found among high equity brands (High to High compared to Low to Low) and when association strength was high rather than low. Interestingly, the results also showed a spillover effect from low equity brands to high equity brands (Low to High compared to High to Low), supporting the power of a small apple to spoil the whole barrel. These results enhanced the field’s understanding of spillover effects in the restaurant industry and suggested the need for pre-crisis communication strategies.

The impact of structured diabetes education on glycemic control during Ramadan fasting in diabetic patients in Beni Suef, Egypt

AimsRamadan is a holy month for the Muslim community. Fasting Ramadan is directed by a systematic alteration in eating habits, sleeping times, and daily physical activities that optimize blood glucose levels. This study aims to evaluate the effects of structured education on safe fasting among diabetic patients. MethodsThis study included diabetic patients with eligibility for the Ramadan fast. The control group included 494 patients who received standard diabetes education, while the intervention group included 407 patients who attained structured diabetes education. The patients were required to register their responses following the written, structured questionnaires before and after Ramadan fasts. In addition, patients were advised to keep a log of their hypoglycemic episodes. ResultThis study showed that structured diabetes education improved the blood glucose levels/glycemic control and outcomes of patients during their Ramadan fasting. The structured diabetes education helped reduce the incidence of hypoglycemic events and hyperglycemic crises. It also increased the acceptance and frequency of blood sugar level measurements among patients during Ramadan. ConclusionThe standard diabetes management plan should include structured diabetes education measures to improve outcomes effectively. The providers should screen the patients with diabetes before Ramadan and educate them to improve their safe fasting practices.

Nurse’s Experience In Playing Role As Assistance Pregnant Women In Semarang

Abstract. The Assistance of pregnant women aims to reduce the incidence of crisis and complications of pregnancy that cause maternal death. This study aims to determine the description of the main duties of nurses in assisting pregnant women using OSOC (One Student One Client) aproach in Semarang. This study aims to determine the main duties of nurses in assisting pregnant women using OSOC (One Student One Client) aproach in Semarang. The design of this study is qualitative with a phenomenological approach. The number of samples for Focus Group Discussion (FGD) was 4 nurses participants. Triangulation participants were 2 midwifes and 1 community health workers.This study shows nurses are still not optimal in carrying out their role in assisting pregnant women because they work in the outpatient health centers within the scope of the treatment center and the implementation of assistance policies for pregnant women does not fully support the nurses. Nurses do not get the main duties structurally assisting pregnant women but still carry out their duties in public health care. This research shows that nurses are able to become partners of pregnant women in assistance.&#x0D;

Global Geographic Differences in Healthcare Utilization for Sickle Cell Disease Pain Crises in the CASiRe Cohort

Background: Sickle cell disease (SCD) is characterized by frequent, unpredictable pain episodes and other vaso-occlusive crises (VOCs) leading to significant healthcare utilization. VOC frequency is often an endpoint in clinical trials investigating novel therapies for this devastating disease. Procedure: The Consortium for the Advancement of Sickle Cell Research (CASiRe) is an international collaboration investigating clinical severity in SCD using a validated questionnaire and medical chart review standardized across four countries (United States, United Kingdom, Italy and Ghana). Results: This study, focused on pain crisis incidence and healthcare utilization, included 868 patients, equally represented according to age and gender. HgbSS was the most common genotype. Patients from Ghana used the Emergency Room/Day Hospital for pain more frequently (annualized mean 2.01) than patients from other regions (annualized mean 1.56 U.S.;1.09 U.K.; 0.02 Italy), while U.K. patients were hospitalized for pain more often (annualized mean: U.K. 2.98) than patients in other regions (annualized mean 1.98 U.S.; 1.18 Ghana; Italy 0.54). Italy’s hospitalization rate for pain (annualized mean: 0.57) was nearly 20 times greater than its emergency room/day hospital only visits for pain (annualized mean: 0.03). When categorized by genotype and age, similar results were seen. Conclusions: Geographic differences in pain crisis frequency and healthcare utilization may correlate with variable organization of healthcare systems among countries and should be considered regarding trial design, endpoints, and analysis of results when investigating novel agents for clinical benefit. Funding: This study was supported in part by research funding from Grant # NIMHD T37MD001425 to AC. Declaration of Interest: A Campbell: research funding and consultancy from Global Blood Therapeutics (GBT), Novartis; and consultancy for bluebird bio; D Manwani: research funding from Grifols; consultancy for Novartis, Pfizer, Global Blood Therapeutics; B Andemariam: consultancy for Bluebird bio, CRISPR/Vertex, Forma Therapeutics, Global Blood Therapeutics, Hemanext, Novartis, NovoNordisk, Cyclerion, Terumo, Roche, Sanofi-Genzyme; research funding from Global Blood Therapeutics, Imara, Novartis; B Inusa: education funding from Novartis AstraZeneca, Global Blood Therapeutics, Celgene, Vertex; C Strunk: consultancy for Global Blood Therapeutics, Forma Therapeutics, Novartis and Medunik USA; R Colombatti: research funding from Global Blood Therapeutics, BlueBird Bio; consultancy for Novartis, Addmedica, NovoNordisk; C Piccone: consultancy for Global Blood Therapeutics and Novartis; W Zempsky: consultancy for Glycomimetics and GlaxoSmithKleine. No disclosures to declare from the other co-authors. Ethical Approval: This study received IRB approval at each institution.

Mental health consequences of long-term stays in refugee camps: preliminary evidence from Moria

BackgroundEver since the implementation of the EU-Turkey deal, most refugees that enter Greece via sea are confined to the island on which they arrive until their asylum claims are adjudicated, where they generally reside in camps. Some of these camps have detention-like characteristics and dire living conditions, such as Moria camp on the island of Lesbos, Greece. Aid-organizations have stated that the situation in camp Moria deteriorates the mental health of its inhabitants and there is qualitative evidence to support this. This study explores the quantitative relationship between the incidence of acute mental health crises and the length of stay in the camp.MethodsA cross-sectional study was conducted using routinely collected data on 856 consultations of 634 different patients during 90 nights at an emergency clinic in Moria camp. Logistic regression analysis was used to explore whether the length of stay in the camp was predictive of the occurrence of an acute mental health crisis.ResultsOf the 634 patients, the majority were men (59·3%), the average age was 23·2 years [0–71], and 24·3% was < 18 years. 25·5% (n = 218) of consultations were related to mental health problems; 17·0% (n = 37) of these met the study’s case definition of an acute mental health crisis. Such crises were positively associated with the length of stay in the camp (p = 0·011); the odds ratio of a mental health crisis increases with 1·03 for every 10% increase in days of residence in the camp. This is notable when considering the average length of stay in the camp is 71 days.ConclusionThis study offers quantitative support for the notion that the adverse conditions in Moria camp deteriorate the mental health of its inhabitants as suggested in qualitative research. Although this study does not provide evidence of causality, it is likely that the poor and unsafe living conditions, challenging refugee determination procedures, and a lack of mental health services in the camp are significant contributing factors. We urgently call for Europe’s policymakers to honour the ‘51 Geneva refugee convention and terminate the neglectful situation on the Greek archipelago.

Evaluation of College Students’ Emergency Response Capability Based on Questionnaire-TOPSIS Innovative Algorithm

With the development of our society, the diversity of the university environment has been increased. The complexity of the diversified university environment also greatly increases the frequency of campus crisis incidents. Therefore, how to evaluate the emergency response ability of college students and how to take effective response measures have become problems that need urgent attentions. In this study, the evaluation of college students’ emergency response capability based on the questionnaire-TOPSIS innovative algorithm is conducted. Firstly, the questionnaire method is used to analyze the current situation of college students’ ability of emergency response, and then a comprehensive evaluation is made using the TOPSIS innovative algorithm. The results of the ranking of emergency response ability are as follows: excellent &gt; good &gt; undergraduate &gt; graduate &gt; inferior. Secondly, the reasons for the lack of ability of emergency response to students based on the evaluation results are studied intensively. Finally, the development countermeasures for college students’ emergency response ability training are put forward.