Medical Districts Research Articles

Streptococcus pneumoniae in Medical Districts of Burkina Faso: Serotype Distribution and Antibiotic Susceptibility during 2010 to 2012

Introduction: Streptococcus pneumoniae is a highly virulent pathogen. Despite the recent introduction of vaccines in the program of prevention in Burkina Faso, treatment by antibiotics has remained in use. The aim of this study was to determine the serotypes implied in invasive pneumococcal infections and their resistance to antibiotics used for routine treatment in Burkina Faso. Methods: From March 2010 to December 2012, a total of 6,102 cerebrospinal fluid (CSF) and pleural fluid (PF) specimens were collected in Burkina Faso. The specimens were analyzed by latex agglutination assay, culture, and real time polymerase chain reaction (rt-PCR) for species identification. Serotyping was performed by rt-PCR and minimum inhibitory concentrations were determined by the E-test. Results: Among 562 S. pneumoniae strains identified from 6,102 specimens, 440 isolates were serotyped by rt-PCR. Serotypes 1 and 5 were the most common (50%); however, 70 (15.9%) strains were not detected by rt-PCR methodology. Among patients of less than 20 years of age, serotype 1 was the most frequent strain identified (9.3% to 13.2%). Ampicillin and ceftriaxone were the most active antibiotics in vitro against the strains identified. The rate of S. pneumoniae strains susceptible to chloramphenicol was 83%. Serotypes 1 (7/49) and 5 (5/7) were non-susceptible to chloramphenicol. Conclusion: Serotypes 1 and 5 were the common serotypes identified. Conjugate vaccines introduced in Burkina Faso should take in account these valences, to decrease the incidence of pneumococcal infections efficiently.

Urban planning approaches to the organization of a medical district

The article defines the direct connection between urbanization and the modern development of medicine as a complex of scientific directions for the development of high-tech medical care. The development of group forms of healthcare facilities as medical and urban complexes in world, Soviet and Russian urban planning practice and theory is presented. A modern trend in the development of innovative territorial formations of a medical organization within the boundaries of urbanized territories has been revealed. The concept of a medical area has been introduced. The object of the study is the medical district. The subject of the study is the spatial and territorial principles of the organization of the medical district. The lack of a spatial connection between medical facilities and the urban structure leads to a shortage of territorial growth and development of medical urban complexes, the unavailability of a comprehensive infrastructure for the development of medical science and practice. The research methodology is based on the definition of criteria for the selection of innovative territorial formations of the medical industry in the structure of urbanized territories. 60 medical districts were analyzed. The characteristic of the methodology for determining the planning options of the area, tested at 19 research sites, is presented. The main conclusions of the study are to determine the planning properties of the medical area. Based on the criteria and their characteristics, a systematization of medical districts has been compiled. A modern approach to the spatial organization of innovative territorial formations of the medical structure based on the collaboration of medical facilities and the integration of the medical district into the urban planning structure has been established. The approach of the urban planning organization of the formation of a medical district based on the territorial localization of medical facilities is revealed.

The association between demographic, economic, and medical resource factors and the inflow and outflow of critically ill emergency patients by medical service districts in South Korea

The association between demographic, economic, and medical resource factors and the inflow and outflow of critically ill emergency patients by medical service districts in South Korea

Less is more - The Finnish Prehospital Stroke Scale prospective validation

The current bifurcation of the acute stroke care pathway requires prehospital separation of strokes caused by large vessel occlusion. The first four binary items of the Finnish Prehospital Stroke Scale (FPSS) identify stroke in general, while the fifth binary item alone identifies stroke due to large vessel occlusion. The straightforward design is both easy for paramedics and statistically beneficial. We implemented FPSS based Western Finland Stroke Triage Plan, including medical districts of a comprehensive stroke center and four primary stroke centers. The prospective study population was consecutive recanalization candidates transported to the comprehensive stroke center within the first six months of implementing the stroke triage plan. Cohort 1 consisted of n=302 thrombolysis- or endovascular treatment candidates transported from the comprehensive stroke center hospital district. Cohort 2 comprised ten endovascular treatment candidates transferred directly to the comprehensive stroke center from the medical districts of four primary stroke centers. In Cohort 1, FPSS sensitivity for large vessel occlusion was 0.66, specificity 0.94, positive predictive value 0.70, and negative predictive value 0.93. Of the ten Cohort 2 patients, nine had large vessel occlusion, and one had an intracerebral hemorrhage. FPSS is straightforward enough to be implemented in primary care services to identify candidates for endovascular treatment and thrombolysis. When used by paramedics, it predicted two-thirds of large vessel occlusions with the highest specificity and positive predictive value reported to date.

Community-Academic Partnerships: A Report on the COVID Support Our Schools (SOS) Initiative.

The SARS-CoV-2 pandemic disrupted the delivery of education in our school systems and exacerbated pre-existing health and educational disparities. School administrators and staff from underserved communities struggled with continuously changing medical guidance, ensuring equitable education by virtual platforms, and re-opening schools safely. The Hackensack Meridian School of Medicine (HMSOM) partnered with statewide resource-limited school districts to create the COVID Support Our Schools (SOS) initiative. This consisted of a physician advisory board, medical student task forces, and community leaders. Numerous sessions were hosted by the COVID SOS team to answer questions, address community needs, and carry out initiatives to meet identified needs. Surveys, including Likert scale questions and open-ended feedback, were administered to all participating school districts. In total, 100% of respondents strongly agreed or agreed that the COVID SOS program was dedicated to community needs and provided timely support with necessary resources. Open-ended feedback described that the K-12 school districts valued our partnership as well as found the opportunity to engage with other districts informative and rewarding. The partnership between our academic medical institution and community school districts is mutually beneficial, providing an opportunity for medical student service learning as well as imparting medical expertise in times of need.

Состояние врачебной части медико-санитарной службы в сельских районах Акмолинской и Семипалатинской областей Степного края (1890-е — 1917 г.)

Based on published and unpublished sources the article analyzes the state of the health care system in the rural areas of Akmola and Semipalatinsk Regions of the Steppe Governor-General's Office at the turn of the 19th-20th centuries. After the activation of the resettlement movement the peasants settled the rural areas in the steppe actively, which led to the division of areas into medical districts and the creation of a system of rural-medical care. Doctors, medical assistants, and midwives began to provide medical care in county towns. In the course of their work, they encountered a number of problems, among which was the question of the discrepancy between the salary and the duties performed. These difficulties affected the quality and quantity of medical personnel in the rural areas of the Steppe Territory, where the staffing issue was acute. In addition, the situation related to the material and technical equipment of medical institutions remained difficult, since the lack of the necessary number of hospitals had a negative impact on the quality of medical care received by the residents.

Migrants by Sea

Undocumented migration to the United States often occurs through large bodies of water such as the Rio Grande River or the waters surrounding Florida. Crossing these aqueous borders is dangerous and results in fatalities. Currently, literature on undocumented border crosser (UBC) fatalities has focused on the Southwest. This study involved the creation of a Florida-border migrant profile to retrospectively screen decedents and begin establishing a migrant decedent population for the eastern border of the United States. An expected Florida-border migrant profile was constructed using biological, geographic, taphonomic, and material culture data based on the UBC and Florida migration literature. This profile was then used to screen cases from the five southernmost Floridian medical examiner districts that had been processed at the University of Florida C.A. Pound Human Identification Laboratory from 1972 to 2019, using a two-tiered protocol. Of 577 total cases, 25 cases passed both screenings as potential Florida-border migrants. The demographics were skewed toward adult males of African ancestry. This method illustrates how a successive screening approach can assist the medicolegal community in identifying potential migrants both retrospectively and moving forward, even in regions where the migrant source population also contributes to the local forensic population. The results of this analysis demonstrate the complexity of the challenge faced by forensic anthropologists and medicolegal personnel investigating forensic cases including migrants in the Miami border sector and that even a limited sample can illustrate the differences between Florida migrants and those recovered in other regions.

Система здравоохранения в Калмыцкой степи в начале ХХ в.

Introduction. The article discusses the urgent issue of the development of health care in Kalmyk uluses in the early 20th century. Its relevance is obvious, granted the scarce historiography in the field: very little has been published on the subject, some recent papers describing briefly and schematically medical care offered to the Kalmyk nomad. Purpose and objectives. The article aims to analyze how Kalmyk health care services were developed in the Astrakhan provinces. Accordingly, the authors undertake the analysis of a variety of prevalent diseases in the region, the state of medical and paramedical care, and the activities of hospital facilities during the period. Materials and methods. The research is based on a complex of general scientific and historical methods. The principles of historicism and systematism help approach the issue in its development and interaction with other structural elements of the life of the Kalmyk society. Importantly, an interdisciplinary approach and the chronological method contribute to drawing a coherent picture of the multilateral process. The work is based on archival sources introduced for the first time; these are mostly office records of the Department for Kalmyk Affairs kept in the National Archive of Kalmykia. Results. Based on the available materials, the study sheds light on the development of the health care system in the Kalmyk uluses of the Astrakhan province in the early 20th century. It highlights the stages of development, characteristics, and the structural elements of health care: health care personnel, facilities and material basis, scale of activities, prevalence of endemic diseases, and methods of their control. Conclusions. During the period under study, Kalmyk nomads were provided with a functioning health care system. The steppe was divided into four medical districts headed by doctors, each ulus (also a number of aimags) having paramedics with dispensary and pharmacy with free dispensing of medicine to the sick. The system was able to deal with major epidemic diseases in the region, as well as at times prevent them.

Vaccine wastage and cost saving after multi-dose vial policy implementation in Egypt: A success story

BackgroundPrevention of disease through vaccination is one of the greatest public health successes. The Expanded Program of Immunization (EPI) previous policy stated that all vaccines had opened for immunization session had to be discarded at the end of the session, regardless to the type of the vaccine or the number of doses remaining in the vial. To bring wastage rate down, the WHO multi-dose vial policy (MDVP) was introduced. It stated that multi dose liquid vaccine vials, from which one or more doses have been administered, may be used for subsequent immunization session up to 28 days in the recommended manufacture storage conditions provided that certain condition must be met. The EPI in Egypt had adopted the MDVP in 2016. The current study aimed to evaluate the impact of implementation MDVP on vaccine wastage rate in Alexandria, and to estimate the cost reduction after that policy. MethodsInformation regarding to vaccine doses consumed and children vaccinated were retrieved from medical districts and primary health care units for the period from January 1st 2014 to October 31st 2018. Interrupted time series design with control was conducted to determine the level change and trend change for the policy vaccines and for estimating the average cost saved after the policy. ResultsThe adoption of MDVP led to a significant reduction in the wastage rates of Pentavalent vaccine by 84.7%, DPT vaccine by 82.5% and OPV by 32%. Thus, by implementation of MDVP the estimated annual cost saved for the policy vaccine in all Egypt could be USD2,449,07995%CI826,076to12,219,869. ConclusionThe implementation of MDVP in Alexandria made a significant reduction in the vaccine wastage rate which led to a saving in vaccine requirement and by consequence a cost saved.

Out-of-Hospital Management of Diabetic Emergencies in Germany: Structural and Process Quality

To collect and analyse representative data of structural and process quality in the management of diabetic emergencies in Germany in 2020. A standardised questionnaire comprising detailed items concerning clinically relevant parameters on the structural and process quality of out-of-hospital management of diabetic emergencies was sent nationwide to medical directors of emergency medical service districts (EMSDs). Results were compared with those from a similar study conducted in 2001. The return rate of the questionnaires represented 126 EMSDs, serving a total population of > 40.1 million. Only 4% of ambulances carried glucagon (6% in 2001). In 2020, blood glucose determination increased significantly to 71% of all emergency interventions and to 29% of suspected cardiac emergencies (24% and 15%, respectively, in 2001). In 100% of EMSDs severe hypoglycaemia (SH) was treated by paramedics by administering intravenous dextrose before the arrival of a doctor compared to 63% in 2001. The potential value of nasal glucagon was acknowledged by 43% of responders. In selected patients, treatment of SH was conducted without hospital admission in 78% of EMDs (60% in 2001). Fifty-three percent of medical directors acknowledged the need for further training in diabetic emergencies (47% in 2001). Cooperation for medical education between emergency teams and a diabetes centre was reported by 14% (41% in 2001). Structural and process quality of the management of diabetic emergencies in Germany has improved considerably since 2001. Persisting deficiencies could be improved by providing better medical equipment in ambulances and ongoing education to the entire emergency teams.

The indices of Morbidity and Mortality of acute pancreatitis as indicator of medical care condition on regional level

The high digital incidence rates of acute pancreatitis world-wide and the death rates from its destructive forms explain the great interest to this problem. Among diseases of gastrointestinal tract, this pathology is characterized by variety of clinical manifestations, frequent severe complications, difficult choice of proper tactics of treatment and severe prognosis of development of disease. The gallstone disease, alcohol abuse are among most common causes of development of disease. However, it is important to study statistical indices of prevalence and mortality of acute pancreatitis at the regional level. The purpose of study was to analyze incidence and mortality of acute pancreatitis in 2010-2018. The indices were analyzed in the region as a whole and as well as in the Medical Districts of the Republic of Bashkortostan. The incidence of acute pancreatitis had period of acute upraise in 2010 (86.5) and 2018 (76.6). At the same time, mortality since 2011 (4.7) was characterized by slight increasing and up to 2018 it almost doubled (8.1). The overall picture demonstrates increasing of mentioned indices in the region. In case of acute pancreatitis, mortality increased from 7.4 in 2010 to 10.5 in 2018. It can be explained by increasing incidence of destructive forms of disease, when severe and sometimes fatal complications often develop. In the republic nine medical districts were organized making possible to judge more clearly the change in morbidity and mortality depending on the territorial affiliation. The analysis of these statistical indices for medical districts demonstrated objectivity of assessing state of medical care. In particular districts (Birsk, Neftekamsk), timely retrospective assessment of morbidity and mortality rates of acute pancreatitis and the comprehensive measures resulted in their stabilization and even decreasing. A clear record of medical records, considering all sick and dead from acute pancreatitis, helps to improve organizational, preventive and therapeutic measures.

Organization of First Aid in the Arkhangelsk Region

Background The development and implementation of widespread training for rules, techniques and methods of providing first aid to the widest possible range of people will significantly reduce the level of disability and mortality among victims of road traffic accidents (RTAs).Aim of study To study the organization of first aid for the victims in the Arkhangelsk region.Material and methods Part 1. The journals of registration of attendance at classes with a trained contingent in the educational-methodical department of the School of Disaster Medicine of the Territorial Center for Disaster Medicine of the Arkhangelsk Region for the period from 01.01.2012 to 12.31.2018 are analyzed. Part 2. We selected 906 medical records of patients (003/u) affected by an accident on the federal highway M-8 “Kholmogory” and treated in hospitals of Arkhangelsk region, admitted acutely in period from 01.01.2012 till 31.12.2018. The study was conducted according to the criteria of retrospective continuous documentary observation. As a criterion of statistical significance, the probability of a random error of less than 5% (p<0.05) was applied using the correction for multiple comparisons (Bonferroni correction).Conclusion 1. The educational activities of the TCDH of the Arkhangelsk Region over a seven-year period are characterized by a significant increase in the total number of trained cadets (p<0.001); 2-fold increase in the number of trained motor vehicle drivers (p<0.001) and employees of Ministry of Emergency Situations and Russian Interior Ministry (p<0.001). 2. The first aid to injured in an accident on the federal highway M-8 Kholmogory in the Arkhangelsk Region was provided in 65 cases (7.2%); in almost 90% of cases, first aid was recorded in the Arkhangelsk and Severodvinsk medical districts of the Arkhangelsk region (p<0.001).

Road Centerline Data Accumulation for Rescue Workers Whose Expertise Is Not GIS.

The objective of this study is to provide road centerline data for professionals of disaster medicine areas who are often beginners in GIS use. Newly developed vector tile format data were converted into shapefile format data, then were organized as second level medical districts to which medical professionals are accustomed. Road centerline data in Japan is being prepared to release from Association for Promotion of Infrastructure Geospatial Information Distribution free of charge. Professionals of disaster medicine areas increased their accessibility of GIS. Logistic planning for evacuation activities and dispatching of rescue teams were improved.

Evaluation of time factor of providing emergency medical care for victims of road traffic accidents on the federal highway M-8 “Kholmogory”

Relevance. Road traffic injuries, having the nature of a global epidemic, pose an urgent medical and social problem. Among victims of road traffic accidents, mortality is many times higher than that of victims who were injured under other circumstances. The survival of victims in road accidents depends on the timeliness, quality and capacity of emergency medical care, on the competence of care providers and on the effectiveness of the organization of this type of medical care at the prehospital stage.Intention – to estimate the time of providing emergency medical care for victims on the federal highway M-8 “Kholmogory” on the territory of the Arkhangelsk region.Methodology. The material of the study was a sample of 906 medical records (form 003/y) for victims of the road accidents, who were admitted to hospitals of Arkhangelsk region in the period from 01.01.2012 to 31.12.2018. Registered forms were selected according to the criteria of retrospective full-design documentary observation. Differences between the observation groups were considered statistically significant at level of p < 0.05 as adjusted for multiple comparisons (Bonferroni correction).Results and Discussion. Time factor of emergency medical care on the federal highway M-8 “Kholmogory” in 3 medical districts of the Arkhangelsk region was characterized. The ambulance teams arrived at the place of accident within 20 minutes in 30 (3.3 %) cases, from 21 to 40 minutes – in 345 (38.1 %) cases, from 41 to 60 minutes – in 299 (33 %) cases and over a period of more than 1 hour – in 232 (25.6 %) cases. There was no statistically significant difference in time of providing emergency medical care for victims with isolated, multiple and concomitant traumas.Conclusion. It was shown that in 74.4 % of cases (p < 0.001) ambulance arrived at the site of a road accident earlier than 60 minutes. The largest number of cases of providing emergency medical care exceeding 60 minutes was noted in the Arkhangelsk Medical District – 28.4 % (p < 0.013), and the lowest –in the Severodvinsk Medical District – 18.3 %. In more than a quarter (26 %) of cases the emergency medical care was provided for victims with polytrauma beyond the 60 minutes period, with most of them in the Arkhangelsk Medical District (p = 0.004).

P6370Epidemiology of arterial hypertension in one of the regions of Russia

Abstract Aim To study the dynamics of the prevalence, awareness, risk factors (RF) and treatment of arterial hypertension (AH) among men and women according to a survey of a representative sample of the population of the Ryazan region (RR) in 2007–2016. Materials and methods In 2002, as a part of the Russian epidemiological “EPOCH” study, a representative sample of the RR population (2098 people, average age 44.8±18.6 years) was formed and surveyed using step-by-step randomization of medical institutions, medical districts and apartments. A repeated survey of the sample was conducted in 2007 (1,760 people, response 83.9%) and in 2016 (1,497 people, response 85.1%). The AH group included persons with blood pressure ≥140/90 mmHg detected during the double measurement and with normal blood pressure while receiving antihypertensive therapy. In individuals with AH the risk factors were assessed: smoking, alcohol abuse, salt abuse, obesity, burdened family history, low physical activity. Results The prevalence of AH over the past 9 years has increased from 39.3% to 43.9%, p<0.001. The age-standardized prevalence of AH among women is higher than among men as in 2007 (42.1% versus 34.8%, p<0.001) and in 2016 (46.9% vs. 41.8%, p<0.05). Women's awareness about having AH increased from 83.9% to 88.9%, p<0.05, in men it decreased (84.0% against 77.4% in 2007, p>0.05). In the group of persons with AH, the more common risk factors are older age (56.8%), hereditary predisposition (58.9%), low physical activity (96.0%) and obesity (34.3%) compared with persons without AH (12.9%, 48.2%, 84.5% and 9.2%, respectively), they smoke less often (10.7% versus 23.2%) and use extra salt less often (29.5% against 38.4%), p<0.001. The number of patients taking antihypertensive drugs reached 91.2% against 84.0% in 2007, p<0.001. There was a decrease in the number of AH patients who: are treated intermittently (from 12.3% to 3.6%, p<0.001), who take drugs only when blood pressure is high (from 16.2% to 6.2%, p<0.001). The most frequently used antihypertensive drugs are still ACE inhibitors (64.8%), beta-blockers (48.9%), diuretics (42.5%), ARBs (29.2%) and calcium channel blockers (21.3%). The ratio of effectively treated AH patients increased in men from 14.6% to 27.8%, p<0.001, in women from 25.0% to 39.5%, p<0.001. A negative influence on the effectiveness of therapy was caused by smoking (RR 1.23; CI 1.11–1.37, p=0.005), salt abuse (RR 1.11; CI 1.06–1.23, p=0.04) and obesity (RR 1.16; CI 1.06–1.27, p=0.003). Conclusion Over the past nine years, the prevalence of hypertension in both the men and women has significantly increased in the Ryazan region. Increased treatment coverage and positive changes in drug therapy led to an increase in the number of effectively treated patients (from 21.4% to 35.5%, p<0.001). Obesity, smoking, salt abuse are associated with an increased risk of non-effectiveness of hypertension therapy.

ОХРАНА МАТЕРИНСТВА И ДЕТСТВА В УКРАИНСКИХ ГУБЕРНИЯХ РОССИЙСКОЙ ИМПЕРИИ В ПЕРВОЙ ПОЛОВИНЕ ХІХ В.: НОВЫЕ ПОДХОДЫ И АЛЬТЕРНАТИВНЫЕ РЕШЕНИЯ

Several documents preserved in the archives of Kyiv (Ukraine) investigate the origins of mother and child protection in the Ukrainian lands that were part of the Russian Empire. This paper analyses, with reference to the first half of the 19th century, the historical, social and legal circumstances that influenced the establishment of the institution of motherhood and childhood protection. It also details several questions, important for our own times, such as the functioning of medical districts, the funding of medical institutions, the organisation of doctors and paramedics, the relations between doctors and local administration, etc.&nbsp

出生地から総合・地域周産期母子医療センターへの運転時間と周産期アウトカムの関係性及びそれを踏まえた拠点病院の配置に関する検討(二次医療圏単位の解析)

出生地から総合・地域周産期母子医療センターへの運転時間と周産期アウトカムの関係性及びそれを踏まえた拠点病院の配置に関する検討(二次医療圏単位の解析)

妊産婦の住所地から総合・地域周産期母子医療センターへの運転時間と妊産婦死亡率との関係性（二次医療圏単位の分析）

妊産婦の住所地から総合・地域周産期母子医療センターへの運転時間と妊産婦死亡率との関係性（二次医療圏単位の分析）

地理情報システムを用いた全国分娩取扱医療機関から総合・地域周産期母子医療センターまでの搬送時間の検討（二次医療圏単位の解析）

地理情報システムを用いた全国分娩取扱医療機関から総合・地域周産期母子医療センターまでの搬送時間の検討（二次医療圏単位の解析）

岡山県健診受診者の慢性腎臓病 （CKD） 認知度 ～2015年度～

Public education programs about chronic kidney disease (CKD) have been performed in Okayama, Japan for the past 10 years. The present study investigated the perception of CKD in a general population in Okayama. In October and November 2015, a questionnaire survey was distributed by 12 medical centers in five medical districts in Okayama prefecture. A total of 7,022 respondents who underwent their physical checkup at these centers answered the questionnaire. In response to a questionnaire item asking about the respondent's familiarity with the term “CKD,” only 4% of the respondents answered “know it well” and 10% answered “unfamiliar.” In contrast, in response to a questionnaire item asking about the respondent's familiarity with “chronic kidney disease,” 27% answered “know it well” and 38% answered “unfamiliar.” The leading avenue by which the respondents learned about CKD/chronic kidney disease was television, followed by newspapers, magazines, and a family doctor or nurse. The leading component which the respondents considered essential for the diagnosis of CKD/chronic kidney disease was proteinuria. A stratified analysis demonstrated a higher recognition of “CKD” or “chronic kidney disease” in the medical districts in northern Okayama prefecture compared to southern Okayama prefecture. These results indicated that the awareness of CKD in Okayama prefecture is still inadequate. Many people did not appear to realize that the term “CKD” represents “chronic kidney disease”. Further continuous public education efforts are required to enlighten people about CKD/chronic kidney disease.