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Problem To control the increasing spread of coronavirus disease 2019 (COVID-19), the government of Thailand enforced the closure of public and business areas in Bangkok on 22 March 2020. As a result, large numbers of unemployed workers returned to their hometowns during April 2020, increasing the risk of spreading the virus across the entire country. Approach In anticipation of the large-scale movement of unemployed workers, the Thai government trained existing village health volunteers to recognize the symptoms of COVID-19 and educate members of their communities. Provincial health offices assembled COVID-19 surveillance teams of these volunteers to identify returnees from high-risk areas, encourage self-quarantine for 14 days, and monitor and report the development of any relevant symptoms. Local setting Despite a significant and recent expansion of the health-care workforce to meet sustainable development goal targets, there still exists a shortage of professional health personnel in rural areas of Thailand. To compensate for this, the primary health-care system includes trained village health volunteers who provide basic health care to their communities. Relevant changes Village health volunteers visited more than 14 million households during March and April 2020. Volunteers identified and monitored 809 911 returnees, and referred a total of 3346 symptomatic patients to hospitals by 13 July 2020. Lessons learnt The timely mobilization of Thailand's trusted village health volunteers, educated and experienced in infectious disease surveillance, enabled the robust response of the country to the COVID-19 pandemic. The virus was initially contained without the use of a costly country-wide lockdown or widespread testing. Probleme Pour lutter contre la propagation croissante de la maladie a Coronavirus (COVID-19), le gouvernement de Thailande a ordonne la fermeture des espaces publics et commerciaux a Bangkok le 22 mars 2020. Par consequent, de nombreux travailleurs au chomage sont retournes dans leurs contrees natales au cours du mois d'avril 2020, augmentant le risque de dissemination du virus dans l'ensemble du pays. Approche En prevision de ces vastes mouvements de travailleurs au chomage, le gouvernement thailandais a forme des volontaires de la sante deja presents dans les villages afin qu'ils puissent detecter les symptomes de la COVID-19 et sensibiliser les membres de leur communaute. Les bureaux provinciaux de la sante ont constitue des equipes de surveillance de la COVID-19 composees de ces volontaires en vue d'identifier les personnes revenant des zones a haut risque, d'encourager le respect d'une quarantaine spontanee de 14 jours, mais aussi de controler et signaler l'apparition de tout symptome suspect. Environnement local Malgre un renforcement recent du contingent de soignants dans le but de repondre aux objectifs de developpement durable, la penurie de professionnels de sante subsiste dans les regions rurales de la Thailande. Pour y remedier, le systeme de soins de sante primaires fait appel a des volontaires specialement formes dans les villages, qui prodiguent des soins de base aux membres de leur communaute. Changements significatifs Les volontaires de sante dans les villages ont rendu visite a plus de 14 millions de foyers en mars et avril 2020. Ils ont identifie et suivi 809 911 rapatries et oriente un total de 3346 patients symptomatiques vers les hopitaux au 13 juillet 2020. Lecons tirees La mobilisation rapide de volontaires de sante fiables dans les villages thailandais, formes et habitues a surveiller les maladies infectieuses, a permis au pays de reagir avec fermete a la pandemie de COVID-19. Dans un premier temps, la Thailande a pu maitriser le virus sans imposer un confinement couteux sur tout le territoire ni recourir a une campagne de depistage a grande echelle. Situacion Para controlar la creciente propagacion de la enfermedad por Coronavirus (COVID-19), el gobierno de Tailandia impuso el cierre de las zonas publicas y comerciales de Bangkok el 22 de marzo de 2020. Como resultado, un gran numero de trabajadores desempleados regresaron a sus ciudades de origen durante abril de 2020, lo que aumento el riesgo de propagacion del virus en todo el pais. Enfoque En prevision del movimiento a gran escala de trabajadores desempleados, el gobierno tailandes formo a los voluntarios sanitarios de las aldeas existentes para que reconocieran los sintomas de la COVID-19 y educaran a los miembros de sus comunidades. Las oficinas provinciales de salud formaron equipos de control de la COVID-19 con estos voluntarios para identificar a los que regresaban de las zonas de alto riesgo, fomentar la autocuarentena durante 14 dias y controlar e informar sobre la aparicion de cualquier sintoma relevante. Marco regional A pesar de la importante y reciente ampliacion del personal sanitario para alcanzar las metas de los objetivos de desarrollo sostenible, sigue habiendo escasez de personal sanitario profesional en las zonas rurales de Tailandia. Para compensar esta carencia, el sistema de atencion primaria de salud incluye voluntarios sanitarios formados en las aldeas que prestan atencion sanitaria basica a sus comunidades. Cambios importantes Los voluntarios sanitarios de las aldeas visitaron mas de 14 millones de hogares durante marzo y abril de 2020. Los voluntarios identificaron y controlaron a 809.911 repatriados, y remitieron a los hospitales a un total de 3.346 pacientes sintomaticos hasta el 13 de julio de 2020. Lecciones aprendidas La oportuna movilizacion de los voluntarios sanitarios de confianza de las aldeas tailandesas, formados y con experiencia en el control de enfermedades infecciosas, permitio la solida respuesta del pais a la pandemia de la COVID-19. En un principio, el virus se contuvo sin necesidad de recurrir a un costoso bloqueo en todo el pais ni a pruebas generalizadas, Introduction Thailand reported the first case of Coronavirus disease 2019 (COVID-19) on 13 January 2020. On 3 March 2020, the Thai government initiated a mandatory 14-day quarantine for all travellers [...]

Sepsis is a life-threatening organ dysfunction caused by a dysregulated response to an infection that requires early intervention. Prehospital sepsis screening tools have not yet been widely evaluated for their performance in clinical practice. To evaluate the ability of the Prehospital Early Sepsis Detection (PRESEP) score and the Miami Sepsis Score to predict sepsis in prehospital settings. This retrospective analysis included patients with diseases of internal cause who were transported by emergency medical services (EMS) to the hospital and hospitalized between January and June 2020. Data were extracted from the medical and EMS records. The primary outcome was sepsis diagnosis within 48 h of admission. The predictive abilities of the scores were assessed using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated at cutoff values derived using Youden's index. Data from 354 patients were analyzed. The AUC for the PRESEP score was 0.83 (95% confidence interval [CI] 0.79–0.88) while that for the Miami Sepsis Score was 0.80 (0.75–0.85). The sensitivity, specificity, positive LR, and negative LR for the PRESEP score (cutoff was 5) were 0.83 (0.73–0.90), 0.68 (0.62–0.73), 2.59 (2.12–3.16), and 0.25 (0.15–0.40), respectively, and those for the Miami Sepsis Score (cu-off was 3) were 0.81 (0.71–0.89), 0.65 (0.59–0.71), 2.33 (1.93–2.83), and 0.30 (0.19–0.46), respectively. Due to their relatively good predictive abilities to detect septic patients and simplicities, the PRESEP and Miami Sepsis Scores could be used for screening patients for sepsis in prehospital settings. Further prospective validation and evaluation of effect on clinical outcomes are needed. [ABSTRACT FROM AUTHOR]

A COVID-19 patient surge in Japan from July to September 2021 caused a mismatch between patient severity and bed types because hospital beds were fully occupied and patient referrals between hospitals stagnated. Japan's predominantly private healthcare system lacks effective mechanisms to coordinate healthcare providers to address the mismatch. To address the surge, in August 2021, Tokyo Saiseikai Central Hospital started a scheme to exchange patients with other hospitals to mitigate the mismatch. In this article, we outline a retrospective observational study using medical records from a tertiary care medical center that treated severe COVID-19 cases. We describe daily patient admissions to our hospital's COVID-19 beds from July to September 2021, and compared the moving average of daily admissions before and after the exchange scheme was introduced. Bed occupancy reached nearly 100% in late July when the patient surge began and continued to exceed 100% in August when the surge peaked. However, the average daily admission did not decrease in August compared with July: the median daily admission (25th to 75th percentile) during each period was 2 (1 to 2.5) in late July and 3 (2 to 4) in August. The number of patients referred in from secondary care hospitals and the number of patients referred out was balanced in August. During the patient surge, the exchange scheme enabled the hospital to maintain and even increase the number of new admissions despite the bed shortage. Coordinating patient referrals in both directions simultaneously, rather than the usual 1-way transfer, can mitigate such mismatches. [ABSTRACT FROM AUTHOR]

Background: We examined whether the policy amendment from March 2017 for a cognitive screening test for older drivers at driver's license renewal was associated with the decreased risk of motor vehicle collisions for drivers and the increased risk of injuries for pedestrians and cyclists among older people. Methods: This was a controlled interrupted time‐series study. We used police‐reported data on the number of collisions as drivers and injuries as pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As the outcome measures, we used the ratio of the monthly number of collisions per population among drivers of three groups aged 75 years or older (75–79, 80–84, and ≥85 years), who were targeted or exposed by the policy, to that among drivers aged 70 to 74 years, who were unaffected or unexposed by the policy and would serve as controls. The ratio of pedestrian and cyclist injuries was also calculated, as previous studies have shown a concomitant increase in these injuries after the introduction of cognitive screening for driver's licenses. Results: During the study period, there were 602,885 collisions as drivers and 196,889 injuries as pedestrians and cyclists among people aged 70 years or older. After the policy amendment in March 2017, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were −3670 (95% confidence interval: −5125, −2104) and 959 (95% confidence interval: 24, 1834), respectively. Conclusions: Following the policy amendment, there was a decrease in motor vehicle collisions as drivers and an increase in road injuries as pedestrians and cyclists among older people. [ABSTRACT FROM AUTHOR]

This longitudinal observational study evaluated whether admission priorities given to children on waiting lists for out-of-home day-care centres (DCCs), determined as being either an early or late admission to DCCs, are determined by actual childcare needs and are assigned to children of disadvantaged families, in public DCCs in Pokhara, Nepal, between November 2003 and February 2006. Multivariate logistic regression analysis showed high caste, low household weekly income, and father's absence from the home were associated with children's early admission to DCCs; but maternal employment and availability of childcare support were not associated with admission priorities. Priorities given to children on DCC waiting lists were not fully based on deprivation and childcare need; caste/ethnicity may influence the prioritisation. Policies should explicitly prioritise those most in need and most deprived, possibly with regulations to reserve seats for those from low-caste/ethnic groups. (Contains 2 tables.)

Acute myocarditis is one of the common complications of coronavirus disease 2019 (COVID-19) with a relatively high case fatality. Here reported is a fulminant case of a 42-year-old previously healthy woman with cardiogenic shock and refractory cardiac arrest due to COVID-19-induced myocarditis who received veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) after 120 minutes of cardiopulmonary resuscitation (CPR). This is the first adult case of cardiac arrest due to COVID-19-induced myocarditis supported by ECMO that fully recovered with normal neurological functions. The success of the treatment course with full recovery emphasized the potential role of ECMO in treating these patients. [ABSTRACT FROM AUTHOR]

Background: Earlier administration of intravenous recombinant tissue-type plasminogen activator (rtPA) and mechanical thrombectomy (MT) improves the neurological prognosis of patients with acute ischemic stroke (AIS). We introduced a new protocol that includes head and chest computed tomography (CT) and magnetic resonance imaging (MRI)/ magnetic resonance angiography (MRA) for all patients, which is quite different from previously evaluated protocols. This study aimed to examine whether this protocol could contribute to the prompt therapeutic intervention of AIS.Methods: This is a retrospective observational study analyzing patients with AIS who were transported to our hospital by ambulance between January 2015 and November 2021. An AIS initial treatment protocol was introduced in April 2020, under which, CT and MRI/MRA imaging were performed in all patients, and the indication for rtPA and MT were determined. The participants were divided into those who were treated before and after the protocol introduction (conventional treatment and protocol groups, respectively). The time from hospital arrival to the start of rtPA administration (door-to-needle time: DNT) and the time from hospital arrival to the start of endovascular treatment (door-to-puncture time: DPT) were compared between the groups.Result: A total of 121 patients were analyzed, wherein 63 patients received rtPA (18 in the conventional treatment group and 45 in the protocol group) and 98 patients received MT (32 in the conventional treatment group and 66 in the protocol group). The median DNT was 97.0 (IQR 49.0-138.0) min vs. 56.5 (IQR 41.0-72.0) min (p < 0.001) for the conventional treatment and the protocol groups, respectively. The median DPT was 129.0 (IQR 62.0-196.0) min vs. 55.0 (IQR 40.5-69.5) min (p < 0.001), respectively. Moreover, DNT was achieved within 60 min in 5.6% vs. 69.9% (p < 0.001) and DPT within 90 min in 25.0% vs. 85.7% (p < 0.001), respectively.Conclusion: The introduction of a protocol, including CT/MRI imaging, significantly shortened DNT and DPT. [ABSTRACT FROM AUTHOR]

Objective To estimate post-traumatic stress disorder (PTSD) symptoms in those injured and not injured by landmines or unexploded ordnance (UXO)' in rural Lao People's Democratic Republic and to determine whether the perception of social support was associated with PTSD symptom severity. Methods A community survey was conducted among 190 people injured by landmines or UXO and 380 age-, sex- and neighbourhood-matched non-injured individuals in the Sepone district of Savannakhet Province, the part of the Lao People's Democratic Republic most heavily bombed during theViet Nam War. Using the Harvard Trauma Questionnaire and the Medical Outcomes Study Social Support Survey, trained health-care workers conducted face-to-face interviews to assess PTSD symptoms and level of perceived social support. Multiple linear regression was performed to explore the association between social support and other factors and PTSD. Findings The prevalence of PTSD was higher among the injured (10%) than among the non-injured (4%), but the level of perceived social support was not significantly different between the two groups. A higher level of perceived social support was associated with milder symptoms of PTSD. Women, older people and those with a formal education were more often and more severely affected by PTSD. Conclusion The perception of strong social support might help to alleviate the symptoms of PTSD among people injured by landmines or UXO in rural parts of the Lao People's Democratic Republic. Psychosocial interventions should be incorporated in assistance for the injured because they have more severe and longer-lasting symptoms of PTSD than the non-injured. Objectif Estimer les symptomes de stress post-traumatiques (PTSD) chez les blesses et non blesses par des mines ou des munitions non explosees en milieu rural en Republique Democratique Populaire Lao et determiner si la perception de l'aide sociale a ete associee avec la severite des symptomes du stress post-traumatique. Methodes Une enquete communautaire a ete menee aupres de 190 personnes blessees par des mines ou des munitions non explosees et de 380 individus non blesses apparies selon l'age, le sexe et le quartier dans le district de Sepone de la Province de Savannakhet, la partie de la Republique Democratique Populaire Lao la plus lourdement bombardee pendant la Guerre du Viet Nam. En utilisant le Questionnaire de Harvard relatif auxTraumatismes vecus et l'Enquete sur l'Aide Sociale de l'Etude des Consequences Medicales, des travailleurs de la sante qualifies ont mene des entretiens en face-a-face pour evaluer les symptomes du stress post-traumatique et le niveau de l'aide sociale recue. Une regression lineaire multiple a ete effectuee afin d'etudier l'association entre l'aide sociale et d'autres facteurs et le stress post-traumatique. Resultats La prevalence du stress post-traumatique est plus elevee chez les blesses (10%) que chez les non-blesses (4%), mais le niveau de l'aide sociale recue n'etait pas significativement differente entre les deux groupes. Un niveau plus eleve d'aide sociale recue a ete associe a des symptomes plus legers de stress post-traumatique. Les femmes, les personnes agees et les personnes ayant beneficie d'un enseignement scolaire sont plus souvent et plus durement touchees par le stress post-traumatique. Conclusion La perception d'une aide sociale elevee pourrait aider a soulager les symptomes de stress post-traumatique chez les personnes blessees par des mines ou des munitions non explosees dans les regions rurales de la Republique Democratique Populaire Lao. Les interventions psychosociales devraient etre incorporees a l'assistance aux blesses car ils ont des symptomes plus graves et plus durables de stress post-traumatique que les non-blesses. Objetivo Calcular los sintomas del trastorno de estres postraumatico en personas heridas y no heridas por minas antipersona o artefactos sin detonar (UXO) en las zonas rurales de la Republica Democratica Popular Lao y determinar si la percepcion del apoyo social estuvo asociada con la gravedad de los sintomas delTEPT. Metodos Se llevo a cabo una encuesta comunitaria entre 190 heridos por minas antipersona o UXO y 380 personas no heridas emparejadas por edad, sexo y vecindario del distrito de Sepone en la provincia de Savannakhet, la zona de la Republica Democratica Popular Lao que sufrio el bombardeo mas intenso durante la Guerra de Viet Nato. Por medio del cuestionario para evaluar el estres traumatico de Harvard y la encuesta Medical Outcomes Study Social Support Survey, un equipo de personal sanitario formado realizo entrevistas presenciales para evaluar los sintomas del TEPT y el nivel de apoyo social percibido. Se realizo una regresion lineal multiple para examinar la asociacion entre el apoyo social y otros factores con el TEPT. Resultados La prevalencia del TEPT fue mas alta entre los heridos (10%) que entre las personas que no sufrieron heridas (4%), sin embargo, el nivel de apoyo social percibido no vario significativamente entre ambos grupos. Un mayor apoyo social percibido estuvo asociado con unos sintomas menos graves del TEPT. Las mujeres y las personas mayores o con una buena educacion se vieron afectadas con mayor frecuencia y gravedad por el TEPT. Conclusion La percepcion de un apoyo social fuerte podria ayudar a aliviar los sintomas del TEPT entre los heridos por minas antipersona o UXO en las zonas rurales de la Republica Democratica Popular Lao. Deberian integrarse intervenciones psicosociales como asistencia a los heridos, ya que sus sintomas deTEPT se manifiestan con mas gravedad y duracion que los de las personas que no han sufrido heridas., Introduction Landmines and unexploded ordnance (UXO) cause great suffering among civilian populations around the world. As of October 2012, 71 states and six other territories were suspected of being--and confirmed [...]

Aim: The aim of this study was to determine why bystanders did not use formal Emergency Medical Services (EMS) or conduct cardiopulmonary resuscitation (CPR) on the scene for out-of-hospital cardiac arrest (OHCA) patients in Hanoi, Vietnam. Methods: This was a prospective, observational study of OHCA patients admitted to five tertiary hospitals in the Hanoi area from June 2018 through January 2019. The data were collected through interviews (using a structured questionnaire) with bystanders. Results: Of the 101 patients, 79% were aged <65 years, 71% were men, 79% were witnessed to collapse, 36% were transported to the hospital by formal EMS, and 16% received bystander CPR at the scene. The most frequently indicated reason for not using EMS by the attendants was "using a private vehicle or taxi is faster" (85%). The reasons bystanders did not conduct CPR at the scene included "not recognizing the ailment as cardiac arrest" (60%), "not knowing how to perform CPR" (33%), and "being afraid of doing harm to patients" (7%). Only seven percent of the bystanders had been trained in CPR. Conclusion: The information revealed in this study provides useful information to indicate what to do to increase EMS use and CPR provision. Spreading awareness and training among community members regarding EMS roles, recognition of cardiac arrest, CPR skills, and dispatcher training to assist bystanders are crucial to improve the outcomes of OHCA patients in Vietnam. [ABSTRACT FROM AUTHOR]

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the "severe" group or the "mild-to-moderate" group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received "active cooling + rehydration" and patients who received "rehydration only," with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness. [ABSTRACT FROM AUTHOR]