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Self-harm remains a serious public health concern, not least because of its strong link with suicide. Twenty-five years ago we lamented the deficits in UK services, research and policy. Since then, there has not been nearly enough effective action in any of these three domains. It is time for action.
There are a number of candidates as useful outcomes in self-harm research – repetition of self-harm; symptom states; quality of life, social participation. Repetition of self-harm has been the predominant choice of researchers, not least because of its status as a risk for eventual suicide. Use of alternatives would respond to the preferences of study participants, but there are substantial methodological constraints. Nonetheless more attention could be given to the use of outcomes other than repetition. Another option is to broaden the approach to evaluation design, incorporating advances in the use of observational data either alone or linked to data from trials.
Use of social media by people with mental health problems, and especially those who are prone to self-harm, has potential advantages and disadvantages. This poses a dilemma about how and by how much the form and content of social media sites should be regulated. Unfortunately, participation in the public debate about this dilemma has been restricted and high-profile discussion of necessary action has been focused almost entirely on how much suppression of content is justified. Professional bodies, including the Royal College of Psychiatrists, should be doing much more than they are to shape how the debate is conducted.
There is growing evidence for both the need to manage work–life conflict and the opportunity for mentors to advise their mentees on how to do this in an academic research environment.
A multiphase approach was used to develop and implement an evidence-informed training module to help mentors guide their mentees in issues of work–life conflict. Analysis of existing data from a randomized controlled trial (RCT) of a mentor training curriculum (n = 283 mentor/mentee dyads) informed the development of a work–life mentoring module which was incorporated into an established research mentor training curriculum and evaluated by faculty at a single academic medical center.
Only 39% of mentors and 36% of mentees in the RCT indicated high satisfaction with the balance between their personal and professional lives. The majority (75%) of mentors and mentees were sharing personal information as part of the mentoring relationship which was significantly associated with mentees’ ratings of the balance between their personal and professional lives. The effectiveness of the work–life module was assessed by 60 faculty mentors participating in a mentor training program at an academic medical center from 2013 to 2017. Among the respondents to the post-training survey, 82.5% indicated they were very/somewhat comfortable addressing work–life issues with their mentees as a result of the training, with significant improvements (p = 0.001) in self-assessments of mentoring skill in this domain.
Our findings indicate that a structured training approach can significantly improve mentors’ self-reported skills in addressing work–life issues with their mentees.
Research into patient suicide indicates that it has an impact on the psychiatrists involved, but leaves a number of unanswered questions about which elements of the experience are most likely to cause problems, who is most at risk, what is the clinical or professional significance of any effect on the psychiatrist and how other professionals are affected. Despite these uncertainties, it is clear that a response is needed, with three bodies responsible in different ways for coordinating one: the relevant mental health trust, as employer; the Royal College of Psychiatrists, as the professional representative body; and the National Confidential Inquiry into Suicide and Safety in Mental Health, as mediator of social and professional impact.
Patan Hospital, located in Kathmandu Valley, Nepal is a 400-bed hospital that has a long history of responding to natural disasters. Hospital personnel have worked with the Ministry of Health (MOH) and the World Health Organization (WHO) to develop standardized disaster response plans that were implemented in multiple hospital systems after the earthquake of 2015. These plans focused primarily on traumatic events but did not account for epidemics despite the prevalence of infectious diseases in Nepal.
To develop and test a robust epidemic/pandemic response plan at Patan Hospital in Kathmandu that would be generalizable to other hospitals nationwide.
Using the existing disaster plan in conjunction with public health and disaster medicine experts,we developed an epidemic response plan focusing on communication and coordination (between the hospital and MOH, among hospital administration and staff), logistics and supplies including personal protective equipment (PPE), and personnel and hospital incident command (IC) training. After development, we tested the plan using a high-fidelity, real-time simulation across the entire hospital and the hospital IC using actors and in conjunction with the MOH and WHO. We adjusted the plan based on lessons learned from this exercise.
Lessons learned from the high-fidelity simulation included the following: uncovering patient flow issues to avoid contamination/infection; layout issues with the isolation area, specifically accounting for donning/doffing of PPE; more sustained duration of response compared to a natural disaster with implications for staffing and supplies; communication difficulties unique to epidemics; need for national and regional surveillance and inter-facility planning and communication. We adjusted our plan accordingly and created a generalizable plan that can be deployed at an inter-facility and national level.
We learned that this process is feasible in resource-poor hospital systems. Challenges discovered in this process can lead to better national and system-wide preparedness.
The community-based integrated management of newborn and childhood illness (CBIMNCI) training package has been widely used throughout Nepal. Adding a component of disaster response and management to this program would greatly impact the community, and could improve the knowledge and skills of community workers for the management of children during a disaster.
Describe the development and implementation of a community-based training for children in disasters.
Using expertise from emergency and pediatric emergency physicians, pediatricians, and psychiatrists, we developed a two-day training and facilitator manual covering topics such as trauma, resuscitation, burn, drowning, disaster, nutrition, and care of the newborn. The information and manuals were presented to the Nepal Division of Child Health for approval. Four pilot trainings were conducted in Bardia and Bardibas in Nepal in September 2017, including knowledge and skill-based sessions. Knowledge was tested pre- and post-training using multiple choice questions (MCQ) and self-reflections. Skills were evaluated by direct observation and marked using a Likert scale. Confidence was assessed using a confidence matrix before and after the course. Overall feedback was taken at the end of the session.
Of 82 participants, 74 participants from four trainings were included for analysis. Post-test Cronbach’s alpha for MCQ was 0.82 and the confidence matrix was 0.86. Mean score for the pre-test MCQ was 6.12 (SD 2.22) compared to the post-test mean of 10.97 (SD 2.97), which was a statistically significant improvement (p<0.05). Trainees reported that the trauma teaching was helpful. They felt that it improved confidence regarding trauma and disasters.
Adding this training to current CBIMNCI can be an effective tool to reach out to primary health care workers, and provide further knowledge and skills on care of children during a disaster or humanitarian crisis.
OBJECTIVES/SPECIFIC AIMS: Cesarean delivery is typically performed in the extremely preterm period (23 to 28 weeks) when the fetus is in breech presentation to avoid the potential risk of head entrapment by an insufficiently dilated cervix during a vaginal delivery. Assessment of the prevalence of extremely preterm breech cesarean delivery would help to appropriately guide future clinical interventions designed to increase the feasibility of vaginal delivery for this sub-group of patients. METHODS/STUDY POPULATION: We performed a cross-sectional study of the 2106 U.S. National Vital Statistics birth certificate database to estimate the prevalence of cesarean deliveries performed during the period of gestation from 23 to 28 weeks with a fetus in breech presentation. RESULTS/ANTICIPATED RESULTS: An analysis of the total births in the 2016 registry (3,945,875) was performed. The gestational age was limited to the target range of 23 0/7 to 27 6/7 weeks. Multiple gestation deliveries were excluded. This yielded 16,092 births of which 4,849 were noted to have breech presentation. The proportion of cesarean deliveries performed for singleton breech fetuses at this gestational range was 87% (4,203/4,849). DISCUSSION/SIGNIFICANCE OF IMPACT: The probability of undergoing a cesarean delivery for an extremely preterm fetus in breech presentation is notably higher (87%) when compared to an overall cesarean delivery rate of 31.9%. Specific interventions to allow for vaginal delivery in this particular sub-group of the obstetric population would be useful to reduce maternal morbidity by increasing vaginal deliveries. Future work will attempt to address innovative solutions to prevent head entrapment by the cervix in this particular population and ultimately avoid cesarean delivery.
Global sustainability challenges and their impact on society have been well-documented in recent years, such as more intense extreme weather events, environmental degradation, as well as ecosystem and biodiversity loss. These challenges require a united effort of scientists from multiple disciplines with stakeholders, including government, non-government organizations, corporate industry, and members of the general public, with the aim to generate integrated knowledge with real-world applicability. Yet, there continues to be challenges for these types of collaboration. In this commentary, we describe processes of collective unlearning that serve to decenter academia in collaborations leading to a more equitable positioning of practitioners engaged in collaborative global sustainability research.
Natural disasters have a significant impact on the health sector. On April 25, 2015, Nepal was struck by a 7.8 magnitude earthquake. The aim of the study was to compare patient volumes and clinical conditions presenting to the emergency department pre- and post-earthquake.
A retrospective study was done at Patan Hospital Emergency Department in Kathmandu, Nepal. Volume, demographics, and patient diagnoses were collected for 4 months post-disaster and compared with cases seen the same months the year before the disaster to control for seasonal variations.
After the 2015 Nepal earthquake, 12,180 patients were seen in the emergency department. This was a significant decrease in patient volume compared with the 14,971 patients seen during the same months in 2014 (P=0.04). Of those, 5496 patients (4093 pre-disaster and 1433 post-disaster) had a chief complaint or diagnosis recorded for analysis. An increase in cardiovascular and respiratory cases was seen as well as an increase in psychiatric cases (mostly alcohol related) and cases of anemia. There was a decrease in the number of obstetrics/gynecology, infectious disease, and poisoning cases post-earthquake.
Understanding emergency department utilization after the earthquake has the potential to give further insight into improving disaster preparedness plans for post-disaster health needs. (Disaster Med Public Health Preparedness. 2019;13:211–216).
Ever since Plato discovered that the best way to record the brilliance of the philosopher Socrates was to set down his teacher's imaginary conversations in the Academy, conversational question and answer has been humankind's primary teaching tool. Over the millennia, Socratic Dialogue has been celebrated, reinvented, deconstructed— even lampooned— in a long tradition stretching back through Monty Python, Samuel Beckett, Laurence Sterne, Isaac Walton, Shakespeare and others.
But Alfredo Behrens's timely book must surely represent a new landmark in this ever- growing dialectical genre of “Socratic variations.” His mission is to advance our cultural understanding of Latin America and the home- baked spirit of its business and political leadership models, by means of the imaginary dialogues of two fictional heroes from the pampas. They are cowboys who in these parts are named Gauchos. If you want to name their style, you might call it “magical realism meets management theory.” Yet The Gaucho Dialogues is more than a study of organizational behavior, seen through a Latino lens. It hitches a ride on literature and history too.
The first intention of the writer— an academic teaching business leadership— may be to lay bare the reasons why empirical Anglo- Saxon management methods seem so often doomed to failure when adopted south of the Rio Grande. Yet— most intriguingly for our own times— the writer uses Latin America as a chilling case study in how nationalist, right- wing populism can take root and corrupt any society. He shows too, how political leaders everywhere can seize and hold power by appealing to darker emotional forces driving voters. So this critical examination of Latin America's political foundations— which have made this region both the alma mater and “patient zero” of destructive populism— is doubly relevant in an age in which voters in Northern Hemisphere democracies have begun to greedily devour these very same ideas.
Behrens brings to life Martin Fierro— all mustachioed machismo, knife- wielding bravura and homespun wisdom from the campsite— by pillaging the eponymous 1872 work of José Hernández, Argentina's poet laureate of Gaucho culture. Fierro's less fiery counterpart and imaginary interlocutor is the more educated Don Segundo Sombra, a literary figure created half a century later by Ricardo Güiraldes, also an Argentine writer who but for his untimely death might have achieved the status of an Hispanic Rudyard Kipling.