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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]

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.)

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 [...]