Life-threatening Health Conditions Research Articles

Exploring how 'wish-granting' interventions foster wellbeing for children with life-threatening health conditions and their families: A qualitative study.

Wish-granting is a form of positive psychological intervention that seeks to promote child wellbeing by fulfilling a wish of their choice. This study aimed to explore families' experiences of receiving wish-granting interventions to understand how wishes impact wellbeing. Fifty in-depth semi-structured interviews were carried out with 22 families (23 parents, 17 young people); seven charity volunteers; and five health professionals, recruited from the United Kingdom. Interviews were transcribed verbatim and analysed using a thematic framework approach. Findings suggest wishes improve wellbeing by increasing positive emotion; by broadening families' horizons; by providing an alternative focus; and by fostering opportunities for togetherness. To grow and maintain impact, consideration should be given to developing strategies that increase anticipation; keep wish memories alive; encourage children to make wishes that stretch their perceived limitations; and facilitate families to share their experiences and 'give back' to the community.

Optimalisasi Kesadaran Kesehatan Warga Desa Sarirogo dengan Sosialisasi Hidup Sehat dan Implementasi Medical Check-up

This study aims to thoroughly explore the role of medical check-ups in maintaining the basic physical health of the residents of Sarirogo Village, with a particular focus on the prevention of non-communicable diseases, which have been on the rise in the area. The background of this research is based on the fact that there is a high prevalence of non-communicable diseases, such as hypertension, diabetes, and cardiovascular diseases, that often go undetected in their early stages. This is primarily due to a lack of public awareness about the importance of regular health checkups, as well as limited access to adequate healthcare services. As a result, delayed diagnoses exacerbate the overall health conditions within the community. This study employs a qualitative approach using a literature review method to analyze sources from relevant scientific journals. These sources serve as the theoretical foundation to understand the relationship between the frequency of medical check-ups and the prevention of chronic disease progression. The findings of this study highlight the significant role that medical check-ups play in the early detection of various potentially life-threatening health conditions, thereby preventing the development of more serious illnesses. Based on these findings, this research emphasizes the urgent need to enhance the accessibility of regular medical check-up services for the residents of Sarirogo Village, alongside the necessity to raise collective awareness about the benefits of routine health screenings.

Late mortality and chronic health conditions in long-term survivors of nasopharyngeal cancers: The 20-year follow-up of territory-wide Hong Kong Nasopharyngeal Cancer Survivor Study (HKNPCSS).

12045 Background: The survival rate of patients with nasopharyngeal cancer (NPC) has significantly improved in the last decade. However, there are only a few studies that have quantified the long-term morbidity and mortality that follow NPC treatment. This study aims to analyze the chronic health conditions, all-cause mortality, and cause-specific mortality among NPC survivors. Methods: The Hong Kong NPC Survivor Study (HKNPCSS) is a retrospective cohort study conducted across all six oncology centers in Hong Kong. It included longitudinal follow-up of 5-year survivors diagnosed with NPC between 1997 to 2015. We compared the standardized mortality ratio (SMRs) of 7893 survivors to a matched population in terms of age, sex, and calendar year. We also calculated the frequencies of chronic conditions of 7893 survivors and 23679 healthy individuals with matched age, sex, and date of cohort entry. Chronic health conditions were classified using the Common Terminology Criteria for Adverse Events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for chronic health conditions. Results: The mean age of NPC survivors was 49.1 years, while healthy individuals had a mean age of 50.5 years. Among the 7893 NPC survivors, the 20-year cumulative all-cause mortality was 34.0% (95% CI, 29.1%-38.9%), with 1668 (59.9%) of 2785 deaths attributed to health-related causes. The SMR for NPC survivors compared to the general population was 3.81 (95% CI, 3.67-3.95), with the highest SMRs observed for pulmonary (SMR: 6.18, 95% CI, 5.73-6.64) and cardiovascular (SMR: 2.12, 95% CI, 1.90-2.36) causes. Among the survivors, 59.2% (n=4674) had severe, life-threatening, or fatal (grade 3-5) health conditions, with a 20-year cumulative incidence of 59.0% (95% CI, 56.4%-61.5%). The adjusted hazard ratio (HR) of grade 3-5 chronic condition in NPC survivors, compared to healthy cohorts, was 7.02 (95% CI, 6.64-7.42). Gastrointestinal (HR: 20.7), hearing, visual, and nasal (HR: 15.4), and neurological (HR: 8.39) conditions had the highest risks. Intensity modulated radiotherapy (IMRT), compared to non-IMRT, was associated with reduced risks of all-cause mortality (HR: 0.83, 95% CI, 0.74-0.91) and a trend towards reduced grade 3-5 chronic health conditions (HR: 0.89, 95% CI, 0.75-1.05). Conclusions: Even 20 years after diagnosis, NPC survivors still face increased risks of late mortality and morbidity. The findings emphasize the need for a comprehensive survivorship program to improve outcomes for NPC survivors.

Accelerated aging among survivors of childhood leukemia and lymphoma: Estimates of early onset and excess morbidity from the COMPASS model.

10028 Background: Cohort studies have detected an increased risk of accelerated aging among survivors of childhood cancer but the timing and magnitude are not known. Methods: To predict the clinical course of diseases of aging— cancer and cardiovascular disease — among survivors of childhood leukemia and lymphoma compared to the general population, we developed the Cancer Outcomes Microsimulation: Pediatric and Adolescent SurvivorShip (COMPASS) model. The model simulates 8 severe, disabling or life-threatening chronic health conditions (CHCs), including 4 subsequent cancers (breast, colorectal, glial tumors, sarcomas) and 4 cardiovascular diseases (heart failure, myocardial infarction/coronary artery disease, valvular disease, stroke), and excess mortality risks among survivors diagnosed between 1970 and 1999 over the course of their lifetimes. Treatment-related risks varied by patient characteristics (sex, age at diagnosis, diagnosis) and treatment exposures (chemotherapy, radiation dose) and were based on data from the Childhood Cancer Survivor Study (CCSS). Age-related risks and competing mortality were based on national databases (SEER, NHLBI, CDC Wonder). We used model calibration to identify parameter sets that generated outcomes consistent with observed data. Model outcomes included cumulative CHC risk. For comparisons to the general population, age-, sex, and diagnosis year-matched individuals who faced only age-related risks were simulated. Results: Among survivors representative of CCSS participants, the model estimated that 45% of leukemia and 65% of lymphoma survivors will develop at least 1 of the 8 CHCs by age 65. Compared to the estimated 20% cumulative risk for the general population, this represented a two- to three-fold excess morbidity risk among survivors. The age at which 20% of survivors developed at least 1 CHC was 51 years for leukemia and 42 years for lymphoma, suggesting an early onset of 14 and 21 years compared to the general population. Outcomes varied by diagnosis and treatment era due to competing risk changes. Among leukemia survivors diagnosed in the 1990s vs. 1970s, cumulative late recurrence mortality by age 40 (11% to 1%) declined. This combined with a reduction in radiation exposure (79% to 24%) resulted in a greater proportion living into adulthood and developing CHCs by age 65 (38% to 48%). In contrast, among lymphoma survivors, the proportion projected to develop a CHC by age 65 remained stable during the same period (62% to 65%) as late recurrence mortality risk declined (8% to 1%), but almost half still received radiation (90% to 49%). Conclusions: Despite improvements in therapy, leukemia and lymphoma survivors are projected to experience CHC early onset and excess morbidity, underscoring the importance of prevention-focused survivorship care and continued efforts to develop more targeted therapies.

Understanding “danger signs” in healthcare: A concept analysis

Introduction: Danger signs are specific indicators signaling potential serious or life-threatening health conditions, crucial for prompt intervention in healthcare settings. Recognizing these signs can be challenging due to variations in cultural perceptions and individual interpretations. Additionally, danger signs are context-dependent, requiring awareness and contextual analysis. This complexity is amplified when dealing with abstract or non-physical signs. Understanding and consistently applying the concept of danger signs is essential for effective healthcare delivery. Method: This paper utilized Walker and Avant's eight-step concept analysis method, offering a systematic and structured approach for defining and understanding concepts. The method promotes clarity, precision, and thorough exploration of the concept's relationships with others, enhancing comprehensive understanding within its context. Result: Conceptually, danger signs represent a broad array of indicators signaling potential harm or imminent risk. Through analysis, this paper defines danger signs operationally as objective, measurable cues that are context-dependent, indicating the presence of a potential negative outcome. Conclusion: This paper contributes to existing knowledge by identifying danger sign attributes, reducing ambiguity and facilitating clearer application in health specialties training. The enhanced clarity also allows for the development of more precise tools to assess competence in danger sign identification.

Management and Control of Legionella pneumophila Nosocomial Outbreak Risk in a Tertiary Level Pediatric Hospital

Abstract Background Legionnaires' disease is a rare cause of pneumonia in the pediatric population. Case reports are described in children with risk factors such as immunocompromised. Outbreaks are commonly associated with buildings or structures that have complex water systems like hospitals. The most likely sources of infection include water used for showering, cooling towers, respiratory therapy equipment, humidifiers and other health care devices. Clinical presentation does not distinguish from other respiratory infections, difficult access to rapid diagnostic methods and empirical antibiotic treatment not effective are all factors that delay diagnosis and subsequent control measures, leading to an increased spread risk. Methods A case of Legionnaires' disease was rapidly detected in an immunocompromised pediatric patient with nosocomial pneumonia using BIOFIRE® FILMARRAY® Pneumonia Plus Panel and urinary antigen. The Infection Control Committee was reported, initiating control and surveillance measures: hospital's water sources were studied and patients with nosocomial pneumonia with no etiological diagnosis were studied in the same way. Results L. pneumophila was isolated in a water tank's sample with the same restriction profile as the clinical sample. A water safety plan was implemented: the water tank's temperature was raised to 65°C and hyperchlorinated to maintain an adequate level of disinfectant. Control cultures were performed, all negative. No new cases were detected. Conclusions It is important to consider Legionella pneumophila as a potential agent of pneumonia in children since it can result in life-threatening health conditions and severe nosocomial outbreak infection. The incorporation of rapid molecular or antigen diagnostic techniques allow prompt diagnosis and treatment, as well as rapid environmental and clinical surveillance measures that can reduce morbidity and mortality. When detecting Legionella infection, it is essential to identify the environmental focus so as to prevent the development of new cases.

Examining equity of walking accessibility to green spaces: A case study of Islamabad

Parks, playgrounds, and other green spaces, in a region, help in promoting the active lifestyle of its residents. Pakistan has an emerging problem of obesity due to the inactive lifestyle of people, especially in urban areas. Obesity is considered a root cause of diseases like cardiovascular disease, type 2 diabetes, hypertension, and other life-threatening health conditions. The intensity of this problem can be reduced by providing amenities to the citizens to promote physical activities like walking and sports. Walking facilities and their impacts on the health and environment are usually ignored in Pakistan’s urban development and policymaking for public transportation. This results in an inequitable transportation system within an urban area considering the notions of vertical equity. This study examines the walking accessibility to green spaces from residential sectors of Islamabad city using spatial interaction/gravity model using impedance OD matrix based on the road network of the said region. The study area was divided into grids and spatial equity analysis was performed using the Lorenz curve and the Gini coefficient was used as a performance measure to describe the overall inequality across the community. This research will help urban planners and policymakers to prioritize the interventions to enhance societal equity by improving walking accessibility to green spaces across the region.

Municipal social expenditures and maternal health disparities: a study of linked birth and hospitalisation records

BackgroundLocal government expenditures provide services and benefits that can affect health but the extent to which they are associated with narrowing or widening of racial/ethnic and socioeconomic disparities in health...

Levels of leptin, irisin, oxytocin and insulin in obese and normal weight Iraqi young men

Introduction and Aim: Obesity is a serious, life-threatening health condition that is prevalent in Iraq and the world as a whole. Since Leptin, irisin, oxytocin and insulin are proposed to play main roles in energy expenditure, glucose homeostasis, regulating body weight, reducing obesity and improving life expectancy so the aim of this study was to evaluate the concentrations of these anti-obesity hormones plus insulin resistance Materials and Methods: The study was conducted on 100 obese young men with a mean age of 29.95 years and fifty normal weight young men with a mean age of 28.44. Results: In obese men, the mean leptin concentration was 24.08±9.91 ng/ml which was significantly higher than in normal weight men 5.48 ng/ml. Serum irisin levels in obese men and normal weight were 8.9 ng/ml, 2.4 ng/ml respectively, and it was significantly higher in obese group in comparison to the normal weight group. The mean serum oxytocin concentration was significantly lower in obese group 6.41pg/ml in comparison to normal weight 29.55 pg/ml. Serum insulin levels in obese and normal weight were 19.55±5.56 and 3.64 micro lU/ml respectively and it was significantly higher in obese men. The mean fasting blood glucose concentration in obese men was 98.67mg/dl and it was significantly higher than in normal weight 84±9.85 mg/ml. Insulin resistance (HOMA IR) was significantly higher in obese men 6.6 than in normal weight 0.68. Conclusion: Serum levels of leptin, irisin, insulin, and insulin resistance are higher in obese young men, while oxytocin levels were noticeably low. Our study also shows that obesity increases the likelihood of insulin resistance.

Stroke health literacy: a narrative review of assessment tools and improvement strategies

Background: Stroke is a serious life-threatening health condition. Prevention, treatment, and rehabilitation for stroke rely heavily on stroke health literacy, which refers to health literacy regarding stroke and stroke literacy. Objectives: The objectives of this review were to investigate stroke health literacy and summarize into 3 main topics: 1) assessment tools for stroke health literacy; 2) stroke health literacy levels in various populations; and 3) strategies to improve stroke health literacy. Materials and methods: A comprehensive search of the English literatures published between 2011-2021 was conducted using PubMed and Scopus databases. All studies relevant to stroke health literacy regardless the study types were included. Results: Total of fourteen studies complied with the criteria were included in a review. As a results, nine assessment tools for stroke health literacy were found (four for health literacy and five for stroke literacy). Stroke health literacy was insufficient in the general population, the population at high risk for stroke, and patients with stroke. Some strategies to improve stroke health literacy were revealed, consisted of two stroke educational programs for patients with stroke and one educational program for the general population. Conclusion: To conclude, there is very limited knowledge about stroke health literacy in terms of assessment tool, and improvement strategy. Further research is needed in order to expand knowledge and increase comprehension regarding stroke health literacy, and thus improve preventive, curative, and rehabilitative outcomes.

Severe, life-threatening, and fatal chronic health conditions after allogeneic blood or marrow transplantation in childhood.

A comprehensive assessment of morbidity after allogeneic bone marrow transplantation (BMT) performed in childhood remains understudied. Seven hundred eighty-nine allogeneic BMT recipients who had survived ≥2years after BMT performed between 1974 and 2014 at age <22years and 690 siblings completed a 255-item survey self-reporting sociodemographics and chronic health conditions. A severity score (grade 3 [severe], 4 [life-threatening], or 5 [fatal]) was assigned to the conditions using Common Terminology Criteria for Adverse Events, version 5.0. For the BMT cohort, the cumulative incidence of chronic health conditions was calculated as a function of time from BMT. Proportional subdistribution hazards models were used to determine predictors of grade 3-5 conditions. Logistic regression was used to estimate the risk of grade 3-4 conditions in BMT recipients who were alive at the time of this study compared with siblings. The median age at transplantation was 11.3years (range, 0.4-22.0 years), and the median length of follow-up was 11.7years (range, 2.0-45.3 years). The most prevalent primary diagnoses were acute lymphoblastic leukemia (30.7%), and acute myeloid leukemia/myelodysplastic syndrome (26.9%). At age 35years, the cumulative incidence of a grade 3-4 condition was 53.8% (95% CI, 46.7%-60.3%). The adjusted odds ratio of a grade 3-4 condition was 15.1 in survivors (95% CI, 9.5-24.0) compared with siblings. The risk of a grade 3-5 condition increased with age at BMT (hazard ratio [HR], 1.03; 95% CI, 1.01-1.05) and was higher among females (HR, 1.27; 95% CI, 1.02-1.59), patients who received total body irradiation (HR, 1.71; 95% CI, 1.27-2.31), and those reporting chronic graft-versus-host disease (HR, 1.38; 95% CI, 1.09-1.74). Two-year survivors of allogeneic BMT in childhood have an increased risk of grade 3-4 chronic health conditions compared with siblings, suggesting the need for long-term follow-up.

UNDERSTANDING COMMUNITY-LEVEL IMPACTS ON FOOD ALLERGY MANAGEMENT AND OUTCOMES VIA A NOVEL COMMUNITY SUPPORT SCALE

<h3>Introduction</h3> Food allergy (FA) is a costly, life-threatening health condition that disproportionately impacts racial/ethnic minority populations. Perceived community-level support for FA management may be an important determinant of FA management, outcomes and psychosocial burden. <h3>Methods</h3> In July 2021, English and/or Spanish-speaking adult FA patients/caregivers were recruited by community and patient advocacy organizations to an online, IRB-exempt survey about FA management, outcomes, and supports, including a novel 4-item FA community support scale (CSS). Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and reliability coefficients were used to assess the factor structure and psychometric properties of the CSS. Construct validity was evaluated by examining associations between mean scores and both the reported number of specific school community-level supports and the reported mean frequency of accessing specific helpful supports for FA management from family and friends. <h3>Results</h3> Surveys were completed by 5940 majority non-White or Hispanic participants. EFA of the community support measure suggested a one-factor solution including all four items. Measurement invariance was tested using CFA to assess the construct validity and comparability of the CSSacross white vs non-white groups. The application of nested CFA models to the CSS yielded good model fit and supported configural, metric, and partial scalar invariance across both groups. Mean scores were significantly positively correlated (p<.001) with other measures hypothesized a priori to be positively associated with perceived community support—evidence for construct validity. <h3>Conclusion</h3> Psychometric data from a large, diverse cohort of FA patients/caregivers supports the validity of a FA-community support scale.

Tracing the Progression of Sepsis in Critically Ill Children: Clinical Decision Support for Detection of Hematologic Dysfunction.

Background One of the major challenges in pediatric intensive care is the detection of life-threatening health conditions under acute time constraints and performance pressure. This includes the assessment of pediatric organ dysfunction (OD) that demands extraordinary clinical expertise and the clinician's ability to derive a decision based on multiple information and data sources. Clinical decision support systems (CDSS) offer a solution to support medical staff in stressful routine work. Simultaneously, detection of OD by using computerized decision support approaches has been scarcely investigated, especially not in pediatrics. Objectives The aim of the study is to enhance an existing, interoperable, and rule-based CDSS prototype for tracing the progression of sepsis in critically ill children by augmenting it with the capability to detect SIRS/sepsis-associated hematologic OD, and to determine its diagnostic accuracy. Methods We reproduced an interoperable CDSS approach previously introduced by our working group: (1) a knowledge model was designed by following the commonKADS methodology, (2) routine care data was semantically standardized and harmonized using openEHR as clinical information standard, (3) rules were formulated and implemented in a business rule management system. Data from a prospective diagnostic study, including 168 patients, was used to estimate the diagnostic accuracy of the rule-based CDSS using the clinicians' diagnoses as reference. Results We successfully enhanced an existing interoperable CDSS concept with the new task of detecting SIRS/sepsis-associated hematologic OD. We modeled openEHR templates, integrated and standardized routine data, developed a rule-based, interoperable model, and demonstrated its accuracy. The CDSS detected hematologic OD with a sensitivity of 0.821 (95% CI: 0.708–0.904) and a specificity of 0.970 (95% CI: 0.942–0.987). Conclusion We could confirm our approach for designing an interoperable CDSS as reproducible and transferable to other critical diseases. Our findings are of direct practical relevance, as they present one of the first interoperable CDSS modules that detect pediatric SIRS/sepsis-associated hematologic OD.

EQUID MILK IS A SOURCE OF PROBIOTIC BACTERIA WITH POTENTIAL IN CARIES REDUCTION AND PRESERVATION OF PERIODONTAL HEALTH

Dental caries and periodontitis are the most common diseases of the oral cavity and can develop into life-threatening health conditions. Both diseases are multifactorial chronic diseases in which pathogenic microorganisms play an important role in disease progression. Several studies suggest that probiotics may play an important role in preventing of such diseases. In this study, lactic acid bacteria isolated from mare and donkey milk were evaluated for their potential as dental probiotics. The ability to survive and form biofilms in the oral cavity, as well as the antimicrobial and coaggregative abilities against cariogenic streptococci and periodontitis-related P. gingivalis and A. actinomycetemcomitans were investigated. Two L. plantarum strains showed high probiotic potential. Together with high aggregation and antimicrobial activity, investigated strains displayed the ability to prevent biofilm formation of the tested pathogens. Our results suggest that there are several ways to exert antimicrobial activity and that the tested probiotic characteristics are strain-dependent. This study characterizes for the first time naturally occurring bacteria from mare and donkey milk for use in the preservation of dental health. Equid milk appears to be a potent new source of probiotic bacteria that can be used to reduce or prevent dental disease.

Improvements in life expectancy among childhood cancer survivors: Uneven gains and remaining challenges.

10050 Background: Childhood cancer survivors are at risk for shortened lifespan. Projections of life expectancy (LE) by diagnosis can provide benchmarks for assessing improvements over time. Methods: We developed a simulation model to project risk for common, life-threatening chronic health conditions (CHCs; heart failure, myocardial infarction, valvular disease, stroke, secondary breast cancer, colorectal cancer, glial tumors, sarcomas) and excess mortality among 5-year survivors, based on patient characteristics (sex, age at diagnosis, diagnosis) and treatment exposures (chemotherapy, radiation dose). Risk was estimated using statistical models and Childhood Cancer Survivor Study data. Age-related CHC risks (SEER, NHLBI) and competing mortality (CDC Wonder) were based on national databases. We used model calibration to identify parameter sets that generated outcomes consistent with observed data. Model outcomes included conditional LE and 10-year survival probability at age 40. For comparisons to the general population, we simulated age-, sex-, and diagnosis year-matched individuals who faced only competing mortality rates. Results: Among a cohort representative of the CCSS (mean diagnosis age, 7.4 yrs), compared to the general population, the gap in LE among survivors diagnosed in the 1970s vs. 1990s decreased from 17 yrs (25%) to 11 yrs (17%). Changes in LE among survivors diagnosed in the 1990s vs. 1970s varied by diagnosis, with leukemia, lymphoma, and CNS tumor survivors estimated to live an additional 8 to 11 yrs (Table). In contrast, considerably smaller gains were estimated for sarcoma and renal tumor survivors (1–3 yrs) and a loss for neuroblastoma (-3 yrs). Among survivors who reached age 40, the probability of surviving an additional 10 years increased from 89% to 92% between 1970s vs. 1990s, with the greatest gains for lymphoma and CNS tumors. Conclusions: Although temporal changes in pediatric oncology are projected to result in LE gains among survivors, considerable variation is projected across diagnoses. These findings highlight the uneven success of improving treatments for all cancers. [Table: see text]

Which Traumas Proliferate and Intensify COVID-19 Stressors? The Differential Role of Pre- and Concurrent Continuous Traumatic Stressors and Cumulative Dynamics in Two Communities: USA and Syria

Using the continuous traumatic stress type III paradigm, the current study aimed to explore the proliferation of previous and concurrent continuous type III traumas to COVID-19 stressors. In two samples from the USA (N = 745) and the Syrian internally displaced (N = 891), we used COVID-19 stressors and cumulative trauma measures. Childhood adversities and intersected discrimination predicted higher COVID-19 stressors in the American sample. Intergroup conflict, intersected discrimination, and chronic, life-threatening health conditions predicted higher COVID-19 stressors in the Syrian sample. Cumulative trauma in both samples predicted higher COVID-19 stressors and accounted for slightly higher variance. The conceptual and clinical implications were discussed.

Racial inequities in emergency department wait times for pregnancy-related concerns.

Emergency department care is common among US pregnant women. Given the increased likelihood of serious and life-threatening pregnancy-related health conditions among Black mothers, timeliness of emergency department care is vital. The objective of this study was to evaluate racial/ethnic variations in emergency department wait times for receiving obstetrical care among a nationally representative population. The study used pooled 2016-2018 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of emergency department visits. Regression models were estimated to determine whether emergency department wait time was associated with the race/ethnicity of the perinatal patient. Adjusted models controlled for age, obesity status, insurance type, whether the patient arrived by ambulance, triage status, presence of a patient dashboard, and region. There were a total of 821 reported pregnancy-related visits in the National Hospital Ambulatory Medical Care Survey sample of emergency department visits. Of those 821 visits, 40.6% were among White women, 27.7% among Black women, and 27.5% among Hispanic women. Mean wait times differed substantially by race/ethnicity. After adjusting for potential confounders, Black women waited 46% longer than White women with emergency department visits for pregnancy problems (p < .05). Those reporting another race waited 95% longer for pregnancy problems in the emergency department than White women (p < .05). Findings from this study document significant racial/ethnic differences in wait times for perinatal emergency department care. Although inequities in wait times may emerge across the spectrum of care, documenting the factors influencing racial disparities in wait times are critical to promoting equitable perinatal health outcomes.

Epidemiological Aspects of Parasitic Diseases of the Respiratory System Mimicking the Clinical Picture of Respiratory Infections: A Review

Introduction: Acute respiratory infections are one of the most common human diseases and are caused by many pathogens, while helminths receive undeservedly little attention in the structure of respiratory disorders. Meanwhile, the course of helminthiases of the respiratory system is disguised as a disease of nonparasitic etiology, with such manifestations as low-grade fever, dyspnea, cough, pleurisy, bronchitis, being therefore misdiagnosed and inadequate treated with serious consequences. In this review, we point out similar symptoms of bronchopulmonary pathologies associated with respiratory infections and parasitic diseases. Objective: To give a comparative characteristic of the clinical picture of pulmonary helminthiases and acute respiratory infections. Materials and methods: We analyzed literary sources on medical parasitology and helminth biology published in 1900–2021, found in the Web of Science, PubMed, Scopus, Elsevier, Springer and Google Scholar databases. In addition, were reviewed fifteen published case reports of pulmonary parasitoses. Results: We considered the life cycles of flatworms and roundworms belonging to 10 genera including Paragonimus, Taenia, Echinococcus, Ascaris, Toxocara, Ancylostoma, Necator, Strongyloides, Metastrongylus, and Dirofilaria, and summarized data on the respiratory symptoms of parasitic diseases, pathogenesis in the organism of the definitive host, and routes of entry. Conclusion: This review presents a comparative description of helminthiasis with mixed pathogenesis, mimicking the clinical picture of respiratory infections. To avoid inadequate treatment, we recommend supplementing a carefully collected medical history with a differential diagnosis of parasitic diseases for diseases of nonparasitic etiology (allergic and chronic systemic diseases, viral, bacterial infections). It is the early diagnosis of helminthiasis that prevents a life-threatening health condition, severe operations, and further long-term rehabilitation of patients.

\u201cIt was one of those complicated cases\u201d: health practitioners\u2019 perspectives and practices of providing end-of-life care for people with profound intellectual and multiple disability

BackgroundDue to developments in health and social care, people with profound intellectual and multiple disability (PIMD) are living longer than ever before, meaning they are increasingly experiencing life-threatening health conditions requiring palliative care. Little is known about providing end-of-life care for people with PIMD. The aim of this study was to explore health practitioners’ perspectives and practices relating to end-of-life decision-making and planning for people with PIMD.MethodsSeven in-depth semi-structured interviews were conducted with health practitioners employed in a range of hospital and community services throughout Melbourne, Australia. Questions were designed to gather information about their experience, perceptions, and attitudes relating to people with PIMD during and at the end of their life. Each interview, ranging from 40 to 60 min in length, was audio recorded and transcribed. Inductive thematic analysis was used to analyse the data.ResultsFour main themes emerged: limited participation, bias, dignity, and quality of death. Health practitioners indicated that people with PIMD are frequently excluded from participating in decision-making related to end-of-life care. Participants discussed reasons for this exclusion including challenges with communication and cognition. Participants reported a need for additional support and guidance in providing care for people with PIMD at the end of life. Professional and family bias played a role in end-of-life decision-making for people with PIMD. Participants reported a disproportional focus by palliative care practitioners on physical as opposed to emotional and spiritual well-being for patients with PIMD at the end of life. Finally, participants reported that people with PIMD generally did not die in specialised palliative care settings, but in segregated supported living environments.ConclusionsDue to negative perceptions of a person with PIMD’s decision-making capacity, people with PIMD are likely to be assessed as unable to express choice and preference regarding end-of-life care and are offered limited opportunity to be involved in their own end-of-life care. This research provides guidance for the development of training and professional development relating to people with PIMD at the end of life. It is hoped that this will increase the accessibility of end-of-life services for people with PIMD, ensuring that a respectful and dignified death can be a reality for all humankind regardless of disability.

Future roles of artificial intelligence in early pain management of newborns

The advent of increasingly sophisticated medical technology, surgical interventions, and supportive healthcare measures is raising survival probabilities for babies born premature and/or with life‐threatening health conditions. In the United States, this trend is associated with greater numbers of neonatal surgeries and higher admission rates into neonatal intensive care units (NICU) for newborns at all birth weights. Following surgery, current pain management in NICU relies primarily on narcotics (opioids) such as morphine and fentanyl (about 100 times more potent than morphine) that lead to a number of complications, including prolonged stays in NICU for opioid withdrawal. In this paper, we review current practices and challenges for pain assessment and treatment in NICU and outline ongoing efforts using Artificial Intelligence (AI) to support pain‐ and opioid‐sparing approaches for newborns in the future. A major focus for these next‐generation approaches to NICU‐based pain management is proactive pain mitigation (avoidance) aimed at preventing harm to neonates from both postsurgical pain and opioid withdrawal. AI‐based frameworks can use single or multiple combinations of continuous objective variables, that is, facial and body movements, crying frequencies, and physiological data (vital signs), to make high‐confidence predictions about time‐to‐pain onset following postsurgical sedation. Such predictions would create a therapeutic window prior to pain onset for mitigation with non‐narcotic pharmaceutical and nonpharmaceutical interventions. These emerging AI‐based strategies have the potential to minimize or avoid damage to the neonate's body and psyche from postsurgical pain and opioid withdrawal.