The latest medical research on Paramedicine
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Request AccessPolitics, policy and action: lessons from rural GP advocacy in Ireland.
Rural and Remote HealthIreland has one of the most rural populations in Europe. Rurality presents challenges when accessing health services but should not be perceived as problematic and in need of a structural fix. Structural urbanism where health care is viewed as a commodity for individuals, rather than an infrastructure for populations, innately favours larger urban populations and has detrimental outcomes for rural health. In this article we present a brief account of advocacy led by rural GPs, their communities, and the political and policy implications of their efforts.
In the period 2010-2016, Irish rural general practices were struggling for viability. Two key financial supports, distance coding and the Rural Practice Allowance, were withdrawn. This directly contributed to the founding of the 'No Doctor No Village' public campaign, following which the Rural Practice Allowance took shape as the Rural Support Practice Framework and was expanded to cover a larger number of rural practices. The World Rural Health Conference in June 2022 at the University of Limerick invited over 600 expert delegates who contributed to the authorship of the Limerick Declaration, a blueprint for advancing rural health in Ireland and internationally. This created a new momentum in advocacy for Irish rural general practice, which has drawn financial investments, sparked research interest building capacity for a pipeline to train rural general practitioners.
Local voices have driven monumental change in the Irish healthcare context. For these communities, the policy and politics of rural health are mere tools to maintaining or restoring their way of life. The biggest lesson to be learned is that unrelenting community commitment, when supported by the capacity to advocate, can influence politics and policy to generate sustainable outcomes and thriving communities.
Development of the Nurse Competency Assessment Scale in Disaster Management and Psychometric Testing.
Disaster Prevention & ManagementThe aim of this study was to develop the Nurse Competency Assessment Scale in Disaster Management (NCASDM) and to conduct psychometric evaluation.
It is a scale development study. Research data were collected between January and May 2023. In the sample of the study, as stated in the literature, it was aimed to reach at least 10 times the number of draft scale items (n = 600). The psychometric properties of the scale were tested with 697 nurses working in four different hospitals. A three-stage structure was used in the analysis of data: (1) creating the item pool, (2) preliminary evaluation of items, (3) refining of the scale and evaluation of psychometric properties. The content validity, construct validity, internal consistency, and temporal stability of the scale were evaluated according to the scale development guidelines.
The scale items were obtained from online, semi-structured, in-depth individual interviews conducted with nurses who experienced disasters or worked in disasters. The content validity index of the scale was found to be 0.95. According to the exploratory factor analysis, it was found that the scale consisted of 43 items and two subscales, and the subscales explained 79.094% of the total variance. The compliance indices obtained as a result of confirmatory factor analysis were acceptable and at good levels.
The NCASDM was found to be a psychometrically valid and reliable measurement tool. It can be used to evaluate the competency of nurses related to disaster management.
Challenges in Snakebite Management in India: Insights from a Physician Survey with Special Focus on Kerala and treatment of bites by Hump-nosed Pit Vipers (Hypnale spp.).
Wilderness and Environmental MedicineIndia has a high incidence of snakebite-related mortality, making effective snakebite management crucial. This study aimed to explore current practices, challenges, and opportunities for improvement in snakebite management across India.
A cross-sectional survey was conducted among physicians in India covering aspects such as scope of practice, snake identification, first aid measures, institutional management, and specific management practices for hump-nosed pit viper (Hypnale hypnale) bites. The survey included 37 questions across 5 sections, with data collected via emails, professional networks, and online platforms. Statistical analysis was performed using SPSS Statistics 23 (IBM Corp, Armonk, NY), and manual thematic analysis was applied to open-ended responses.
The survey revealed a discrepancy between physicians' confidence and accuracy in snake identification, with some still reporting outdated first aid and treatment practices. Despite recognizing the importance of snake species identification, a significant portion of respondents incorrectly identified the snakes. The study highlighted variability in institutional practices for snakebite management, such as administering prophylactic antibiotics and tetanus prophylaxis and monitoring periods for asymptomatic patients. In managing H hypnale viper bites, a demand for specific guidelines and a monovalent antivenom was evident because the current polyvalent antivenom is ineffective for this species.
The survey emphasizes the need for improved training in snake identification, standardized treatment protocols, and the development of region-specific antivenoms. It emphasizes the necessity of updating guidelines to address the unique challenges of snakebite management in India, particularly for species not covered by existing antivenoms.
Navigating Concurrent Disasters: Lessons learned from a Hospital Evacuation Amidst a Pandemic and an Earthquake.
Disaster Prevention & ManagementThe concurrent challenges of the COVID-19 pandemic and a significant earthquake in Izmir on October 30, 2020, presented a unique scenario for disas...
Questionnaire Survey on Stockpiling Medicines for Disasters in Pharmacies in Gifu City in Anticipation of Nankai Trough Earthquake.
Disaster Prevention & ManagementIn recent years, Japan has experienced a series of earthquakes and torrential rain disasters in various regions, and in Gifu City, there is concern about the possibility ofNankai Trough earthquakes in the near future. However, pharmacists' awareness of disaster preparedness and status of drug stockpiles in pharmacies are not clearly outlined.
A survey on disaster prevention and stockpiling was conducted in 286 pharmacies in Gifu City. Data were collected from August to the end of October 2022. A simple aggregate was used in the study.
The response rate was 66.8% (191 pharmacies). Among them, 9.9% (19 pharmacies) had stockpiles of medicines for disasters, in which 33.3% of the medicines needed in the early stages of a disaster were above the average overall stockpiling rate. In addition, 2.1% (4 pharmacies) selected medicines according to national or prefectural manuals, and 96.3% (184 pharmacies) preferred to have the "national or local government" bear the cost of stockpiling.
This study allowed us to understand the stockpiling situation of pharmacies in Gifu City in event of a disaster such as the Nankai Trough earthquake, which is likely to occur in the future. Based on these results, it is necessary to consider measures for disaster stockpiling.
Notification, Viewing the Body, and Social and Cultural Considerations After Traumatic Death: A Systematic Literature Review.
Disaster Prevention & ManagementWe conducted a systematic review of the medical, nursing, forensic, and social science literature describing events and processes associated with w...
Urgent Warning: Evidence-Based Concerns Regarding Mass Gathering Events During Arbaeen in Hazardous Weather Conditions.
Disaster Prevention & ManagementThe Arbaeen ceremony is the largest annual mass gathering in the world, attracting millions of Muslim pilgrims each year. However, the event takes ...
Medical Access and Care Continuity: Qualitative Assessments of Patients with Breast Cancer and Family Members' Experiences Following the 2011 Triple Disaster in Fukushima, Japan.
Disaster Prevention & ManagementWhile studies have examined the effects of large-scale disasters on disaster-vulnerable individuals, these analyses may not capture the full impact. This study qualitatively explored the impacts of the March 2011 Fukushima triple disaster on patients with breast cancer and their families, aiming to highlight the importance of incorporating family narratives to grasp the full effect of large-scale disasters.
Utilizing the medical records from two hospitals, deceased patients with breast cancer from the disaster period were identified. Relatives were interviewed using a semi-structured approach. Thematic analysis was conducted via the Braun and Clarke method and Taguette transcription software.
Interviews with seven family members of six patients revealed three main themes: the family's caregiving burden and their deepened bonds with the patient, the patients' extensive medical challenges and their physical and mental decline, and the shared confusion during the disaster due to resource shortages and evacuation dilemmas.
This study uncovered significant infrastructural issues such as reduced medical support and the heavy caregiving load on families, amidst some strengthened relationships during a time of crisis. Future research should investigate these issues across various disaster contexts, and proactive measures should be implemented to prevent exacerbation of these challenges.
Pagers Explosion: Challenges of the Emergency Preparedness Plan.
Disaster Prevention & ManagementOn September 17, 2024, an unforeseen attack due to the Pagers Explosion targeting a military party in Lebanon left more than 2750 casualties. A tot...
COVID-19 Prevention Practices and Vaccine Acceptability Among Hispanic and Non-Hispanic Households in an Agricultural Community-Washington, 2020.
Disaster Prevention & ManagementTo investigate COVID-19 disparities between Hispanic/Latino persons (H/L) and non-H/L persons in an agricultural community by examining behavioral and demographic differences.
In September 2020, we conducted Community Assessments for Public Health Emergency Response in Wenatchee and East Wenatchee, Washington, to evaluate differences between H/L and non-H/L populations in COVID-19 risk beliefs, prevention practices, household needs, and vaccine acceptability. We produced weighted sample frequencies.
More households from predominately H/L census blocks (H/L-CBHs) versus households from predominately non-H/L census blocks (non-H/L-CBHs) worked in essential services (79% versus 57%), could not telework (70% versus 46%), and reported more COVID-19 cases (19% versus 4%). More H/L-CBHs versus non-H/L-CBHs practiced prevention strategies: avoiding gatherings (81% versus 61%), avoiding visiting friends/family (73% versus 36%), and less restaurant dining (indoor 24% versus 39%). More H/L-CBHs versus non-H/L-CBHs needed housing (16% versus 4%) and food assistance (19% versus 6%). COVID-19 vaccine acceptance in H/L-CBHs and non-H/L-CBHs was 42% versus 46%, respectively.
Despite practicing prevention measures with greater frequency, H/L-CBHs had more COVID-19 cases. H/L-CBHs worked in conditions with a higher likelihood of exposure. H/L-CBHs had increased housing and food assistance needs due to the pandemic. COVID-19 vaccine acceptability was similarly low (<50%) between groups.
COVID-19 Pandemic Preparedness and Response in Latin American Countries: Scoping Review and Analysis Based on World Health Organization Standards.
Disaster Prevention & ManagementTo describe COVID-19 pandemic preparedness and response in 6 countries during 2020 and 2021.
A literature search was conducted in MEDLINE, Web of Science, Epistemonikos, LILACS, and Google Scholar regarding the measures adopted to face the COVID-19 pandemic; the checklist of the international World Healths Organization's (WHO) guide "COVID-19 Strategic Preparedness and Response Plan" was applied.
Most countries coordinated their response at the central level with the establishment of management teams and the activation of emergency operations centers for the coordination of the response to the pandemic. The capacity to perform epidemiological surveillance activities such as early case detection, contact tracing, and real-time monitoring of data was exceeded. There was low capacity in laboratory infrastructure, specialized human talent, and deployment of molecular testing for SARS-CoV-2 detection.
This is the first review that addresses the importance of documenting how well-prepared countries in the region were to face a pandemic such as COVID-19 taking into account WHO standards and guidelines. In Latin America, the literature showed reports of heterogeneous responses to the pandemic, a gap in the literature on laboratory and diagnostic pillar activities, and a lack of literature reporting on epidemiological surveillance pillar activities in Argentina, Chile, and Ecuador.
Management Of Psychiatric Emergencies and Associated Comfort Among EMS Physicians in Lombardy, Italy: A Cross-Sectional Study.
Disaster Prevention & ManagementThe aims of this study were to explore the knowledge of EMS physicians (EMSPs) on the legal aspects related to the management of prehospital psychiatric emergencies, assess their degree of comfort, and measure their perceived communication skills.
A survey was distributed to the 376 EMSPs working in the prehospital setting in Lombardy, Italy. Knowledge of medico-legal aspects was measured through multiple-choice questions; the Comfort Score (CS) and perceived Communication Skills Score (CSS) were calculated using Likert Scale questions. CS ranged from 11 points (lowest) to 44 (highest); CSS ranged from 8 points (lowest) to 32 (highest).
A total of 272 EMSPs answered the survey (RR= 72.3%); 45.2% were women. Mean age was 45.76 years (SD 8.8). Mean percentage of correct knowledge test answers was 52.4 (SD 12.3); 81.3% believed to have little knowledge of the Italian legislation regarding this topic. Mean CS was 29.3 (SD 5.5); mean CSS was 19.1 (SD 3.9). A higher percentage of correct answers in the knowledge test was associated with lower CS (P = 0.019). Higher self-appraised knowledge of the Italian legislation was associated with higher CS (P < 0.001) and higher CSS (P < 0.001).
These findings should prompt policy makers to ensure proper training and support for EMSPs in the matter of prehospital psychiatric emergency management.
