To investigate health-related quality of life and life satisfaction in children and adolescents treated for isolated congenital valvular aortic stenosis compared to healthy peers. Our second aim was to investigate the relationship between objectively measured physical activity, health-related quality of life and life satisfaction in the same group.

Forty-eight patients, 8–18 years of age, were recruited, as well as 43 healthy peers matched for age, gender and residential area. Health-related quality of life was assessed by the KIDSCREEN-52 self-report and parent proxy report, and life satisfaction was evaluated with the Satisfaction With Life Scale. Physical activity was measured with an accelerometer for 7 days. Sports participation was self-reported.

No differences in the health-related quality of life domains were found between patients and controls in the self-reports. In the proxy reports, parents of the adolescents rated their child’s autonomy lower than did the parents of the healthy controls. A negative relationship was found between moderate to vigorous physical activity, sports participation, life satisfaction and the psychological well-being domain in adolescent patients. In children there was a positive relationship between moderate physical activity and the physical and psychological well-being domains.

Overall, children and adolescents treated for valvular aortic stenosis reported similar life satisfaction and health-related quality of life as their healthy peers. The negative relationships between intense physical activity and sports participation with health-related quality of life and life satisfaction in adolescent patients might be explained by both physical and psychological factors in these teenagers with complex, lifelong heart disease.

The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia.

PHC has the potential to play a fundamental role in countries’ responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document – Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 – that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions.

The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia’s PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area). The data collected were analyzed to identify underlying challenges limiting PHC providers’ ability to effectively and efficiently respond to COVID-19 and maintain essential health services.

The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia’s national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges – at both the facility and health system level – that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

The aim of this study was to implement pediatric vertical evacuation disaster training and evaluate its effectiveness by using a full-scale exercise to compare outcomes in trained and untrained participants.

Various clinical and nonclinical staff in a tertiary care university hospital received pediatric vertical evacuation training sessions over a 6-wk period. The training consisted of disaster and evacuation didactics, hands-on training in use of evacuation equipment, and implementation of an evacuation toolkit. An unannounced full-scale simulated vertical evacuation of neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) patients was used to evaluate the effectiveness of the training. Drill participants completed a validated evaluation tool. Pearson chi-squared testing was used to analyze the data.

Eighty-four evaluations were received from drill participants. Forty-three (51%) of the drill participants received training and 41 (49%) did not. Staff who received pediatric evacuation training were more likely to feel prepared compared with staff who did not (odds ratio, 4.05; confidence interval: 1.05-15.62).

There was a statistically significant increase in perceived preparedness among those who received training. Recently trained pediatric practitioners were able to achieve exercise objectives on par with the regularly trained emergency department staff. Pediatric disaster preparedness training may mitigate the risks associated with caring for children during disasters.

On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR’s power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study’s objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time.

This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria’s landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years).

Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients’ age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively).

Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.

To compile a literature overview of physical activity in children with CHD and to critically evaluate the methodology used for physical activity assessment.

A review of the literature was performed using PubMed to identify studies examining accelerometer and subjectively assessed physical activity in children and adolescents with CHD.

A total of 15 studies were included (6 studies using subjective measures and 9 articles using accelerometers for the assessment of physical activity). The patients generally failed to meet the recommendations of physical activity. When compared to healthy controls, the results were widely divergent in the subjectively assessed measures and the accelerometer-based studies showed a tendency of no difference in physical activity. Neither subjective methods nor accelerometer-based studies reported any difference in physical activity in general, in relation to the severity of the heart disease.

Methodological variation and limitations in the assessment of physical activity largely explain the divergent results and the inability to establish differences in physical activity between children with CHD of different severity and compared to healthy controls. Methodological knowledge and guidelines are provided for improved assessment of physical activity using accelerometers in clinical research.

Treatment for major depressive disorder (MDD) is imprecise and often involves trial-and-error to determine the most effective approach. To facilitate optimal treatment selection and inform timely adjustment, the current study investigated whether neurocognitive variables could predict an antidepressant response in a treatment-specific manner.

In the two-stage Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) trial, outpatients with non-psychotic recurrent MDD were first randomized to an 8-week course of sertraline selective serotonin reuptake inhibitor or placebo. Behavioral measures of reward responsiveness, cognitive control, verbal fluency, psychomotor, and cognitive processing speeds were collected at baseline and week 1. Treatment responders then continued on another 8-week course of the same medication, whereas non-responders to sertraline or placebo were crossed-over under double-blinded conditions to bupropion noradrenaline/dopamine reuptake inhibitor or sertraline, respectively. Hamilton Rating for Depression scores were also assessed at baseline, weeks 8, and 16.

Greater improvements in psychomotor and cognitive processing speeds within the first week, as well as better pretreatment performance in these domains, were specifically associated with higher likelihood of response to placebo. Moreover, better reward responsiveness, poorer cognitive control and greater verbal fluency were associated with greater likelihood of response to bupropion in patients who previously failed to respond to sertraline.

These exploratory results warrant further scrutiny, but demonstrate that quick and non-invasive behavioral tests may have substantial clinical value in predicting antidepressant treatment response.

In September 2017, Hurricane Maria devastated Puerto Rico’s health care infrastructure. To meet the demands of ongoing primary care and medical emergencies, Federal Medical Shelters (FMS) were set up to serve local communities for the weeks after the hurricane. A team of health professionals from New York assisted federal authorities in the provision of healthcare in the FMS.

To describe the population of patients requesting medical care in the aftermath of Hurricane Maria at FMS Manati and to categorize the range of problems faced by patients after the hurricane, and examine how this changed longitudinally over the course of the operation.

Researchers collected basic data of patients at presentation to the FMS. Descriptive analyses were performed of the patient population and nature of presenting illnesses. Chi-squared analysis was performed to compare the change over time of presenting complaints. Ethics approval was granted by Columbia University.

Data was collected for a two-week period approximately three weeks after the hurricane made landfall. The FMS saw 2,154 patients over a 14-day period. The population of patients (median age = 43 years [IQR 39 years]) assessed was bimodal in distribution, with one peak in children at 1 year. A second peak occurred at age 53 years. 60.2% of presenting complaints were infection- or chronic disease-related. Musculoskeletal complaints were the third most common. Chi-squared tests revealed no statistically significant change in the frequency of specific types of complaints between the start and end of data collection.

In the weeks after Hurricane Maria, infants and elderly were seen to predominantly seek medical care. Likely related to the collapse of the healthcare infrastructure, there was a high prevalence of infection-related and chronic medical conditions. The data support the need to focus resources to treat vulnerable populations, infectious issues, and chronic medical conditions.

In resource-constrained environments, appropriately employing triage in disaster situations is crucial. Although both case-based learning (CBL) and simulation exercises (SEs) commonly are utilized in teaching disaster preparedness to adult learners, there is no substantial evidence supporting one as a more efficacious methodology. This randomized controlled trial (RCT) evaluated the effectiveness of CBL versus SEs in addition to standard didactic instruction in knowledge attainment pertaining to disaster triage preparedness.

This RCT was performed during a one-day disaster preparedness course in Lucknow, India during October 2014. Following provision of informed consent, nursing trainees were randomized to knowledge assessment after didactic teaching (control group); didactic plus CBL (Intervention Group 1); or didactic plus SE (Intervention Group 2). The educational curriculum used the topical focus of triage processes during disaster situations. Cases for the educational intervention sessions were scripted, identical between modalities, and employed structured debriefing. Trained live actors were used for SEs. After primary assessment, the groups underwent crossover to take part in the alternative educational modality and were re-assessed. Two standardized multiple-choice question batteries, encompassing key core content, were used for assessments. A sample size of 48 participants was calculated to detect a ≥20% change in mean knowledge score (α=0.05; power=80%). Robustness of randomization was evaluated using X2, anova, and t-tests. Mean knowledge attainment scores were compared using one- and two-sample t-tests for intergroup and intragroup analyses, respectively.

Among 60 enrolled participants, 88.3% completed follow-up. No significant differences in participant characteristics existed between randomization arms. Mean baseline knowledge score in the control group was 43.8% (standard deviation=11.0%). Case-based learning training resulted in a significant increase in relative knowledge scores at 20.8% (P=0.003) and 10.3% (P=.033) in intergroup and intragroup analyses, respectively. As compared to control, SEs did not significantly alter knowledge attainment scores with an average score increase of 6.6% (P=.396). In crossover intra-arm analysis, SEs were found to result in a 26.0% decrement in mean assessment score (P < .001).

Among nursing trainees assessed in this RCT, the CBL modality was superior to SEs in short-term disaster preparedness educational translation. Simulation exercises resulted in no detectable improvement in knowledge attainment in this population, suggesting that CBL may be utilized preferentially for adult learners in similar disaster training settings.

AluisioAR, DanielP, GrockA, FreedmanJ, SinghA, PapanagnouD, ArquillaB. Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial. Prehosp Disaster Med. 2016;31(5):516–523.

The Medical Reserve Corps (MRC) is a national network of community-based volunteer groups created in 2002 by the Office of the United States Surgeon General (Rockville, Maryland USA) to augment the nation’s ability to respond to medical and public health emergencies. However, there is little evidence-based literature available to guide hospitals on the optimal use of medical volunteers and hesitancy on the part of hospitals to use them.

This study sought to determine how MRC volunteers can be used in hospital-based disasters through their participation in a full-scale exercise.

A full-scale exercise was designed as a “Disaster Olympics,” in which the Emergency Medicine residents were divided into teams tasked with completing one of the following five challenges: victim decontamination, mass casualty/decontamination tent assembly, patient triage and registration during a disaster, point of distribution (POD) site set-up and operation, and infection control management. A surge of patients potentially exposed to avian influenza was the scenario created for the latter three challenges. Some MRC volunteers were assigned clinical roles. These roles included serving as members of the suit support team for victim decontamination, distributing medications at the POD, and managing infection control. Other MRC volunteers functioned as “victim evaluators,” who portrayed the potential avian influenza victims while simultaneously evaluating various aspects of the disaster response. The MRC volunteers provided feedback on their experience and evaluators provided feedback on the performance of the MRC volunteers using evaluation tools.

Twenty-eight (90%) MRC volunteers reported that they worked well with the residents and hospital staff, felt the exercise was useful, and were assigned clearly defined roles. However, only 21 (67%) reported that their qualifications were assessed prior to role assignment. For those MRC members who functioned as “victim evaluators,” nine identified errors in aspects of the care they received and the disaster response. Of those who evaluated the MRC, nine (90%) felt that the MRC worked well with the residents and hospital staff. Ten (100%) of these evaluators recommended that MRC volunteers participate in future disaster exercises.

Through use of a full-scale exercise, this study was able to identify roles for MRC volunteers in a hospital-based disaster. This study also found MRC volunteers to be uniquely qualified to serve as “victim evaluators” in a hospital-based disaster exercise.

GistR, DanielP, GrockA, LinC, BryantC, KohlhoffS, RoblinP, ArquillaB. Use of Medical Reserve Corps Volunteers in a Hospital-based Disaster Exercise. Prehosp Disaster Med. 2016;31(3):259–262.

To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.

Longitudinal study.

Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.

Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.

Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.

Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.