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Gang members engage in many high-risk sexual activities that may be associated with psychiatric morbidity. Victim-focused research finds high prevalence of sexual violence towards women affiliated with gangs.
To investigate associations between childhood maltreatment and psychiatric morbidity on coercive and high-risk sexual behaviour among gang members.
Cross-sectional survey of 4665 men 18–34 years in Great Britain using random location sampling. The survey oversampled men from areas with high levels of violence and gang membership. Participants completed questionnaires covering violent and sexual behaviours, experiences of childhood disadvantage and trauma, and psychiatric diagnoses using standardised instruments.
Antisocial men and gang members had high levels of sexual violence and multiple risk behaviours for sexually transmitted infections, childhood maltreatment and mental disorders, including addictions. Physical, sexual and emotional trauma were strongly associated with adult sexual behaviour and more prevalent among gang members. Other violent behaviour, psychiatric morbidity and addictions accounted for high-risk and compulsive sexual behaviours among gang members but not antisocial men. Gang members showed precursors before age 15 years of adult preference for coercive rather than consenting sexual behaviour.
Gang members show inordinately high levels of childhood trauma and disadvantage, sexual and non-sexual violence, and psychiatric disorders, which are interrelated. The public health problem of sexual victimisation of affiliated women is explained by these findings. Healthcare professionals may have difficulties promoting desistance from adverse health-related behaviours among gang members whose multiple high-risk and violent sexual behaviours are associated with psychiatric morbidity, particularly addictions.
Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendly environment in Mexico. A total of nine key informants from seventeen stakeholder organisations were selected based on their in-depth knowledge of the breastfeeding environment in Mexico and were individually interviewed using Net-Map methodology. This participatory interview technique combines stakeholder mapping, social network analysis and influence mapping to identify relevant stakeholders. Participants identified a total of fifty-five stakeholders shaping breastfeeding programmes and policies through four domains of influence: commands (n 32 stakeholders), dissemination (n 40), funding (n 35) and technical assistance (n 37). The Federal Ministry of Health emerged as the most influential stakeholder of breastfeeding policy and programming decisions in Mexico among all domains of influence. The Ministry of Finance and Public Credit as well as the National Institute of Public Health were identified as additional key stakeholders providing funding and technical assistance to the Federal Ministry of Health, respectively. Engaging identified key stakeholders can generate a multisectoral commitment to breastfeeding and strengthen the breastfeeding-friendly environment in Mexico.
Within out-of-hospital emergencies, Primary Health Care (PHC) pediatricians will likely be the first to provide health care at the scene of a life-threatening emergency (LTE) in children. Pediatricians should be trained to initially intervene, safely and effectively the LTEs, including the activation of Emergency Medical Systems (EMS), an adequate stabilization of patients and transport to the hospital.
The aims of this study are to know the training received for out-of-hospital LTEs by PHC pediatricians of the Principality of Asturias (Spain) and the perception they have about their own theoretical knowledge and practical skills in a series of emergency procedures used in LTEs; also, to analyze the differences according to the geographical context of their work.
This was a cross-sectional, descriptive, and observational study of a sample of 27 PHC pediatricians from PHC Service of Asturias, Spain, from among the total of 88 pediatricians who make up the staff of pediatricians, conducted from April through May 2019. The survey was designed ad hoc using the Curriculum in Primary Care Pediatrics (CPCP) proposed by the European Confederation of Primary Care Pediatricians (ECPCP; Europe), which indicates the theoretical and practical procedures that must be acquired by the PHC pediatricians. It is composed of 30 procedures or techniques employed in LTEs using a 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to 10 (“Maximum”).
There are significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
Asturian pediatricians are generally well-prepared to solve LTEs with a few exceptions. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills in LTEs is heterogeneous, with differences according to the scope of work.
This article presents new evidence and analysis on age heaping—a proxy for numeracy and therefore for human capital—in New Spain during the Enlightenment. Human capital plays an important role in economic growth and welfare. It is also one of the dimensions of inequality. Our results are at odds with many of the usual assumptions on which most Mexicanist historiography is based. Age heaping levels of males and females and ethnic groups across locations in Central New Spain are estimated and compared through ad hoc indicators with other countries. We infer that a more empirical emphasis on the institutional legacy of the viceregal period and more attention to human capital since pre-Conquest times will benefit the progress of Hispanic American economic history.
The Richter Scale measures the magnitude of the seismic activity for an earthquake; however, it does not quantify the humanitarian need at the point of impact. This poses a challenge for humanitarian stakeholders in decision and policy making, especially in risk reduction, response, recovery, and reconstruction. The new disaster metrics tool titled “The YEW Disaster Severity Index” (DSI) was developed and presented at the 2017 World Congress of Disaster and Emergency Medicine, May 2017, Toronto, Canada. It uses a median score of three for vulnerability and exposure indicators, a median score percentage of 100%, and medium YEW DSI scoring of four to five as baseline, indicating the ability to cope within local capacity. Therefore, scoring more than baseline coping capacity indicates that external assistance is needed. This special real-time report was presented at the 2nd National Pre-Hospital Care Conference and Championship, October 2018, Malaysia.
The aim of this analysis is to present the real-time humanitarian impact and response to the 2018 earthquake and tsunami at Donggala and Palu, Sulawesi in Indonesia using the new disaster metrics YEW DSI. Based on the earthquake (measuring 7.7 on the Richter Scale) and tsunami at Donggala, the humanitarian impact calculated on September 29, 2018 scored 7.4 High in the YEW DSI with 11 of the total 17 indicators scoring more than the baseline coping capacity. The same YEW DSI score of 7.4 was scored on the earthquake and tsunami at Palu, with 13 of the total 17 indicators scoring more than baseline ability to cope within local capacity. Impact analysis reports were sent to relevant authorities on September 30, 2018.
Discussion & Conclusion:
A State of Emergency was declared for a national response, which indicated an inability to cope within the local capacity, shown by the YEW DSI. The strong correlation between the earthquake magnitude, intensities, and the humanitarian impact at Donggala and Palu reported could be added into the science of knowledge in prehospital care and disaster medicine research and practice. As a conclusion, the real-time disaster response was found to be almost an exact fit with the YEW DSI indicators, demonstrating the inability to cope within the local capacity.
Ethnic inequalities in health outcomes are often explained by socioeconomic status and concentrated poverty. However, ethnic disparities in psychotic experiences are not completely attenuated by these factors.
We investigated whether disparities are better explained by interactions between individual risk factors and place-based clustering of disadvantage, termed a syndemic.
We performed a cross-sectional survey of 3750 UK men, aged 18–34 years, oversampling Black and minority ethnic (BME) men nationally, together with men residing in London Borough of Hackney. Participants completed questionnaires covering psychiatric symptoms, substance misuse, crime and violence, and risky sexual health behaviours. We included five psychotic experiences and a categorical measure of psychosis based on the Psychosis Screening Questionnaire.
At national level, more Black men reported psychotic experiences but disparities disappeared following statistical adjustment for social position. However, large disparities for psychotic experiences in Hackney were not attenuated by adjustment for social factors in Black men (adjusted odds ratio, 3.24; 95% CI 2.14–4.91; P < 0.002), but were for South Asian men. A syndemic model of joint effects, adducing a four-component latent variable (psychotic experiences and anxiety, substance dependence, high-risk sexual behaviour and violence and criminality) showed synergy between components and explained persistent disparities in psychotic experiences. A further interaction confirmed area-level effects (Black ethnicity × Hackney residence, 0.834; P < 0.001).
Syndemic effects result in higher rates of non-affective psychosis among BME persons in certain inner-urban settings. Further research should investigate how syndemics raise levels of psychotic experiences and related health conditions in Black men in specific places with multiple deprivations.
Declaration of interest
K.B. is Editor in Chief of the British Journal of Psychiatry but played no part in the review and decision process.
The aim of this study was to describe individuals seeking care for injury at a major emergency department (ED) in southern Puerto Rico in the months after Hurricane Maria on September 20, 2017.
After informed consent, we used a modified version of the Natural Disaster Morbidity Surveillance Form to determine why patients were visiting the ED during October 16, 2017–March 28, 2018. We analyzed visits where injury was reported as the primary reason for visit and whether it was hurricane-related.
Among 5 116 patients, 573 (11%) reported injury as the primary reason for a visit. Of these, 10% were hurricane-related visits. The most common types of injuries were abrasions, lacerations, and cuts (43% of all injury visits and 50% of hurricane-related visits). The most common mechanisms of injury were falls, slips, trips (268, 47%), and being hit by/or against an object (88, 15%). Most injury visits occurred during the first 3 months after the hurricane.
Surveillance after Hurricane Maria identified injury as the reason for a visit for about 1 in 10 patients visiting the ED, providing evidence on the patterns of injuries in the months following a hurricane. Public health and emergency providers can use this information to anticipate health care needs after a disaster.
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”
The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.
Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.
A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).
There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.
The Richter Scale measures the magnitude of a seismic occurrence, but it does not feasibly quantify the magnitude of the “disaster” at the point of impact in real humanitarian needs, based on United Nations International Strategy for Disaster Reduction (UNISDR; Geneva, Switzerland) 2009 Disaster Terminology. A Disaster Severity Index (DSI) similar to the Richter Scale and the Mercalli Scale has been formulated; this will quantify needs, holistically and objectively, in the hands of any stakeholders and even across timelines.
An agreed terminology in quantifying “disaster” matters; inconsistency in measuring it by stakeholders posed a challenge globally in formulating legislation and policies responding to it.
A quantitative, mathematical calculation which uses the median score percentage of 100% as a baseline, indicating the ability to cope within the local capacity, was used. Seventeen indicators were selected based on the UNISDR 2009 disaster definition of vulnerability and exposure and holistic approach as a pre-condition. The severity of the disaster is defined as the level of unmet needs. Thirty natural disasters were tested, retrospectively, and non-parametric tests were used to test the correlation of the DSI score against the indicators.
The findings showed that 20 out of 30 natural disasters tested fulfilled the inability to cope, within local capacity in disaster terminology. Non-parametric tests showed that there was a correlation between the 30 DSI scored and the indicators.
By computing a median fit percentage score of 100% as the ability to cope, and the correlation of the 17 indicators, in this DSI Scale, 20 natural disasters fitted into the disaster definition. This DSI will enable humanitarian stakeholders to measure and compare the severity of the disaster objectively, as well as enable future response to be based on needs.
YewYY, Castro DelgadoR, HeslopDJ, Arcos GonzálezP. The Yew Disaster Severity Index: A New Tool in Disaster Metrics. Prehosp Disaster Med. 2019;34(1):8–19.
The goal of this study was to find out the training received in Urgent and Emergency Medicine (UEM) by the Primary Health Care (PHC) physicians of Asturias (Spain), as well as their perception of their own theoretical knowledge and practical skills in a series of procedures employed in life-threatening emergencies (LTEs), and also to analyze the differences according to the geographical area of their work.
This was a cross-sectional survey of PHC physicians using an ad hoc survey of a sample of 213 physicians in Asturias regarding their self-perception of theoretical knowledge and practical skills in techniques used in LTEs by areas of work (rural, suburban, and urban). The interview was conducted by mail from April through May 2017. The data processing has used absolute and relative frequencies, as well as central tendency parameters and dispersion parameters. The estimates for the entire population have been made using confidence intervals for the mean of 95%. In the comparison of parameters, the differences between parameters with a probability of error less than five percent (P<.05) have been considered significant. For the comparison of means between the different techniques in the different areas of work, ANOVA was used.
With respect to the training of physicians, in general, for managing emergencies, both at the regional level and by areas of work (rural, suburban, and urban), none of the sets analyzed attained five points. By areas of work, it was the suburban region where there was a greater average general level of knowledge. There were significant differences in the average theoretical knowledge and the average practical skills in the procedures studied according to the different areas of work. The greater number of significant differences was between the urban and suburban regions and within the urban area.
It’s necessary to ensure an adequate homogeneity of the levels of theoretical knowledge and practical skills of PHC physicians in order to guarantee the equity of provision of health care in emergencies in different geographical areas.
Cernuda MartínezJA, Castro DelgadoR, Ferrero FernándezE, Arcos GonzálezP. Self-Perception of Theoretical Knowledge and Practical Skills by Primary Health Care Physicians in Life-Threatening Emergencies. Prehosp Disaster Med. 2018;33(5):508–518.
In this work, the stopping power of a partially ionized helium plasma due to its free and bound electrons is analyzed for an electron temperature and density in which local thermal equilibrium (LTE) or non-local thermal equilibrium (NLTE) regimes can be possible. In particular by means of collisional-radiative models, the average ionization of the plasma as well as the abundances of different helium species (HeI, HeII, and HeIII) are analyzed in both LTE and NLTE thermodynamic states. The influence of this ionization and of the different ion abundances on the stopping power of the helium plasma is shown to be quite significant. Finally, our theoretical model is compared with experimental results on slowing down of swift argon ions in helium plasma.
A large collection of maize macro-specimens has been gathered from archaeological sites across the American continent, but only a few have been directly dated by accelerator mass spectrometry (AMS). We recently conducted two new excavations in several rock shelters of Tehuacán valley (San Marcos, Coxcatlán, and Purrón) and uncovered 132 non-manipulated macro-specimens of maize suitable for morphological and paleogenomic analysis, including many complete cobs, stalks, internodes, and leaves. Direct AMS dates for 43 samples found in San Marcos or Coxcatlán confirm the previously reported chronologies for these sites. By contrast, a cob found in Purrón was dated to 3060±30 before present (3360–3180 cal BP) (2σ), demonstrating that maize was present at that site at least 1500 calendar years earlier than previously expected, and suggesting that other specimens of similar age are still likely to be found in the southeastern region of the Tehuacán valley. A global comparison of macro-specimen chronology across the continent shows that the current archaebotanical record does not yet reflect the chronology of dispersal from central Mexico to northern or southern regions, opening the possibility for finding the missing links in subsequent expeditions within Mexico and Central America.
In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands.
An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated.
In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients).
A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.
The current work reports the effect of particle size on the rheological behavior of polymer modified asphalt PMA. The modified asphalt was generated with AC-20 asphalt precursor provided by Pemex Salamanca and Solprene® 416 provided by Dynasol Mexico. Solprene® 416 is a SBS star-type copolymer with 4 poly(b-styrene-b-butadiene) arms and Mw = 2.36X105 g/gmole. Modified asphalt samples were prepared with 3 wt % of SBS via hot mix process. Mixing time and temperature were kept constant at 4h and 180 °C. This study also varied the agitation in the mixing process: 500, 1000 and 1500 rpm. All PMAs shown sphere-shaped polymer particles as observed via fluorescent microscopy using a Carl Zeiss KS-300 system. Base asphalt and PMAs were also characterized through rheological measurements using a TA Instruments AR-G2 rheometer. Shear viscosity (η) and tan δ data shown that the flow resistance of the PMA increases as the size its polymer particles decreases. Since the size of the polymer particles decreases with the increase of the stirring speed, it is concluded that the stirring speed of the process determines the size of the polymer particles and so the mechanical resistance of the PMA.
This paper attempts to establish a debate between alternative views of living standards in Spanish America during the viceregal period. Since 2009, a growing literature has shared a «common language» based on a similar, though not identical, methodology. As never before, this «new generation» of studies is built upon long series of quantitative data and international comparisons of nominal wages and prices which, in some cases, cover the whole Early Modern Era. Part of this literature also complements the examination of economic welfare using height as an indicator of biological welfare. Inequality is also quantitatively approached in one of the works discussed. In spite of significant similarities, some methodological differences lead to contrasting results. For the sake of simplicity, the relevant literature is divided into two views: «pessimism» and «optimism». It is my contention that the latter is more consistent with the available evidence.
This work deals with the effect of the concentration of microsphere of silicon oxide (MS) in SBS-modified asphalt.
A series of blends having 2, 4, 6, 8 and 10 % w/w of MS were prepared from a SBS-modified asphalt having 3 % weight/weight of SBS and known amount of MS. Samples were characterized by fluorescence microscopy, to get an idea of the polymer distribution in the blend; and by conventional tests such as penetration, soft point, density and viscosity, to investigate on the thermo-mechanical resistance of such a blends. It was observed that an increase in the MS resulted in a decreased of the soft point and density, an increased the viscosity, and did no affect the penetration of the sample. Therefore, it was concluded that SBS-MS-modified asphalt is an interesting material for producing polymer-modified asphalt layers.
We present an exceptional data set acquired with the Vacuum Tower Telescope (Tenerife, Spain) covering the pre-flare, flare, and post-flare stages of an M3.2 flare. The full Stokes spectropolarimetric observations were recorded with the Tenerife Infrared Polarimeter in the He i 1083.0 nm spectral region. The object under study was active region NOAA 11748 on 2013 May 17. During the flare the chomospheric He i 1083.0 nm intensity goes strongly into emission. However, the nearby photospheric Si i 1082.7 nm spectral line profile only gets shallower and stays in absorption. Linear polarization (Stokes Q and U) is detected in all lines of the He i triplet during the flare. Moreover, the circular polarization (Stokes V) is dominant during the flare, being the blue component of the He i triplet much stronger than the red component, and both are stronger than the Si i Stokes V profile. The Si i inversions reveal enormous changes of the photospheric magnetic field during the flare. Before the flare magnetic field concentrations of up to ~1500 G are inferred. During the flare the magnetic field strength globally decreases and in some cases it is even absent. After the flare the magnetic field recovers its strength and initial configuration.