Science and Public Health Principles Used to Reduce Road Deaths

An editorial in a previous issue of this journal falsely claims that the US government’s efforts to reduce road fatalities are not based on science. It says that, as a result, the United States has fallen behind other countries in road death prevention.A large body of research and evaluation informed federal and state safety programs from the outset.Evans’s comparisons of death trends among countries without adjustment for changes in relevant risk factors or specification of the injury reduction policies among the countries tell us nothing about the causes of the declines or the effects of specific ameliorative efforts.In an article1 and editorial2 on motor vehicle fatalities, Evans asserts that science was ignored in efforts to reduce motor vehicle injuries in the United States. He writes that difference in reductions in motor vehicle deaths among countries is a result of a differential emphasis on driver behavior and vehicle factors in the causation of road fatalities. In fact, he ignores the sound science that informed motor vehicle safety standards, state law enforcement and behavior change programs in countermeasure choice. His data tell us nothing about the factors that influence trends in deaths among different countries.     

Examining the Influence of Antenatal Care Visits and Skilled Delivery on Neonatal Deaths in Ghana

Background

Many Sub-Saharan African countries may not achieve the Millennium Development goal of reducing child mortality by 2015 partly due to the stalled reduction in neonatal deaths, which constitute about 60 % of infant deaths. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the affordability and accessibility concerns of maternal healthcare on neonatal mortality.

Objective

This study bridges this research gap as it aims to investigate whether the number of antenatal visits and skilled delivery are associated with the risk of neonatal deaths in Ghana.

Methods

Using individual level data of women in their reproductive years from the 2008 Demographic and Health Survey, the study employs an instrumental variable strategy to deal with the potential endogeneity of antenatal care visits.

Results

Estimates from the instrumental variable estimation show that antenatal care visits reduce the risk of neonatal death by about 2 %, while older women have an approximately 0.2 % higher risk of losing their neonates than do younger women.

Conclusion

Findings suggest that women who attend antenatal visits have a significantly lower probability of losing their babies in the first month of life. Further, results show that women’s age significantly affects the risk of losing their babies in the neonatal stage. However, the study finds no significant effect of skilled delivery and education on neonatal mortality.     

优质护理在新生儿窒息复苏后护理中应用的效果观察

目的探讨优质护理方式在新生儿窒息复苏后护理中的应用效果。方法选择我院2013年4月至2014年4月收治的78例窒息复苏新生患儿,分为两组各39例。对照组采用常规护理模式,观察组在常规护理基础上加用优质护理措施,对比两组患儿护理后病情的变化、生命质量以及NBNA评分变化。结果两组护理后的生命质量均有明显改善,观察组患儿生命质量各项指标改善程度显著高于对照组(P<0.05);观察组护理后NBNA评分显著高于对照组(P<0.05)。结论在新生儿窒息复苏后采用优质护理服务模式,可以提升新生儿的生命质量,改善新生儿呼吸状况,促进新生儿早日康复。     

新生儿窒息与新法复苏的体会

目的总结恩平市人民医院新生儿窒息的原因及新法复苏方法与效果，探索提高新生儿窒息的复苏水平。方法对296例新生儿窒息与新法复苏进行回顾分析。结果296例新生儿窒息经新法复苏，成功抢救286例，死亡6例，放弃治疗4例，成功率96．6％。结论新生儿窒息经新法复苏，即国际公认的ABCDE法，抢救成功率高。     

新生儿重症监护病房热带假丝酵母菌感染病例对照研究

目的研究新生儿重症监护病房(NICU)热带假丝酵母菌感染的危险因素及临床特点,为早期诊断和积极治疗提供依据。方法用回顾性病例对照研究的方法,对10例热带假丝酵母菌感染者(病例组)与同期非感染者(对照组)30例进行对照分析研究。结果极低体重、入院时白细胞值低和中性粒细胞绝对值低、使用经皮中央静脉置管,持续气道正压通气呼吸机、使用3种抗菌药物是早产儿感染热带假丝酵母菌的危险因素;临床表现同一般的感染症状,无特殊性,病例组住院天数明显长于对照组;尽早诊断和积极治疗均痊愈,预后良好,无一例死亡。结论对NICU极低出生体重早产儿,存在以上危险因素感染热带假丝酵母菌危险性增加,加深医院感染管理科专职人员监测,尽早发现热带假丝酵母菌感染至关重要,尽早诊断、积极的治疗和预防控制措施是影响预后与控制病例增加的重要因素。     

Taxonomy of Interventions to Reduce Acute Care Transfers From Long-term Care Homes: A Systematic Scoping Review

ObjectiveTo develop a taxonomy of interventions aimed at reducing emergency department (ED) transfers and/or hospitalizations from long-term care (LTC) homes.DesignA systematic scoping review.Setting and participantsPermanent LTC home residents.MethodsExperimental and comparative observational studies were searched in MEDLINE, CINAHL, Embase Classic + Embase, the Cochrane Library, PsycINFO, Social Work Abstracts, AMED, Global Health, Health and Psychosocial Instruments, Joanna Briggs Institute EBP Database, Ovid Healthstar, and Web of Science Core Collection from inception until March 2020. Forward/backward citation tracking and gray literature searches strengthened comprehensiveness. The Mixed Methods Appraisal Tool was used to assess study quality. Intervention categories and components were identified using an inductive-deductive thematic analysis. Categories were informed by 3 intervention dimensions: (1) “when/at what point(s)” on the continuum of care they occur, (2) “for whom” (ie, intervention target resident populations), and (3) “how” these interventions effect change. Components were informed by the logistical elements of the interventions having the potential to influence outcomes. All interventions were mapped to the developed taxonomy based on their categories, components, and outcomes. Distributions of components by category and study year were graphically presented.ResultsNinety studies (25 randomized, 23 high quality) were included. Six intervention categories were identified: advance care planning; palliative and end-of-life care; onsite care for acute, subacute, or uncontrolled chronic conditions; transitional care; enhanced usual care (most prevalent, 31% of 90 interventions); and comprehensive care. Four components were identified: increasing human resource capacity (most prevalent, 93%), training or reorganization of existing staff, technology, and standardized tools. The use of technology increased over time. Potentially avoidable ED transfers and/or hospitalizations were measured infrequently as primary outcomes.Conclusions and ImplicationsThis proposed taxonomy can guide future intervention designs. It can also facilitate systematic reviews and precise effect size estimations for homogenous interventions when outcomes are comparable.     

产科保健新模式——阶段性责任制健康教育的可行性

目的探讨实施阶段性责任制健康教育对提高产科质量的促进作用。方法针对孕产妇的心理需求,制定产妇住院期间不同阶段的健康教育内容以及产科健康教育实施表,再造宣教流程,选择2009年2—6月的住院产妇1500例为观察组。选择2008年6月—2009年1月住院的产妇1500名为对照组,按照常规进行产科健康教育,对其住院资料进行分析。观察组在住院的全过程责任到人,落实和接受情况由宣教者及受教育者双方签名,并采用自行设计的产妇住院全程意见征询表进行调查,对阶段性责任健康教育的各项内容掌握程度进行评估,比较2组产妇相关知识及技能掌握情况,护患纠纷发生率、护理投诉及护理满意度。结果观察组产妇健康教育知识中的合理饮食、自我监护、分娩时配合母乳喂养技巧、伤口护理、婴儿护理、异常识别掌握情况明显优于对照组,差异均有统计学意义（χ2=58.01、94.28、94.73、37.50、58.36、41.04、91.34,均P〈0.01）。观察组无护理投诉、纠纷发生,满意度达（98.66%）,与对照组比具差异有统计学意义（P〈0.01）。结论围生期应用阶段性责任制健康教育可显著提高教育质量和效果,提升母婴生活质量,在临床实践中切实可行,值得推广。     

An Integrated Randomized Intervention to Reduce Behavioral and Psychosocial Risks: Pregnancy and Neonatal Outcomes

While biomedical risks contribute to poor pregnancy and neonatal outcomes in African American (AA) populations, behavioral and psychosocial risks (BPSR) may also play a part. Among low income AA women with psychosocial risks, this report addresses the impacts on pregnancy and neonatal outcomes of an integrated education and counseling intervention to reduce BPSR, as well as the contributions of other psychosocial and biomedical risks. Subjects were low income AA women ≥18 years living in the Washington, DC, metropolitan area and seeking prenatal care. Subjects (n = 1,044) were screened for active smoking, environmental tobacco smoke exposure (ETSE), depression, or intimate partner violence (IPV) and then randomized to intervention (IG) or usual care (UCG) groups. Data were collected prenatally, at delivery, and postpartum by maternal report and medical record abstraction. Multiple imputation methodology was used to estimate missing variables. Rates of pregnancy outcomes (miscarriage, live birth, perinatal death), preterm labor, Caesarean section, sexually transmitted infection (STI) during pregnancy, preterm birth (<37 weeks), low birth weight (<2,500 g), very low birth weight (<1,500 g), small for gestational age, neonatal intensive care unit (NICU) admission, and >2 days of hospitalization were compared between IG and UCG. Logistic regression models were created to predict outcomes based on biomedical risk factors and the four psychosocial risks (smoking, ETSE, depression, and IPV) targeted by the intervention. Rates of adverse pregnancy and neonatal outcomes were high and did not differ significantly between IG and UCG. In adjusted analysis, STI during the current pregnancy was associated with IPV (OR = 1.41, 95% CI 1.04–1.91). Outcomes such as preterm labor, caesarian section in pregnancy and preterm birth, low birth weight, small for gestational age, NICU admissions and >2 day hospitalization of the infants were associated with biomedical risk factors including preexisting hypertension and diabetes, previous preterm birth (PTB), and late initiation of prenatal care, but they were not significantly associated with active smoking, ETSE, depression, or IPV. Neither the intervention to reduce BPSR nor the psychosocial factors significantly contributed to the pregnancy and neonatal outcomes. This study confirms that biomedical factors significantly contribute to adverse outcomes in low income AA women. Biomedical factors outweighed psychosocial factors in contributing to adverse pregnancy and neonatal outcomes in this high-risk population. Early identification and management of hypertension, diabetes and previous PTB in low income AA women may reduce health disparities in birth outcomes.     

Structured Care Protocols to Reduce Behavior That Challenges in People With Dementia: A Systematic Review

ObjectivesPeople with dementia often express behavior that challenges, such as agitation and aggression. Structured care protocols aim to identify common causes of behavior and facilitate the selection of appropriate treatments. The protocols comprise different steps including specific assessments and related nonpharmacologic and pharmacologic treatments. We aim to assess the effects of such protocols to reduce behavior that challenges.DesignSystematic review according to the methods of Cochrane and registered in PROSPERO (CRD42020155706).Setting and ParticipantsPeople with dementia living in nursing homes.MethodsThe systematic search (September 2020) included databases (MEDLINE, CINAHL, Cochrane Library) and other sources. Two reviewers independently performed the study selection, data extraction, and quality assessment for all included studies. A narrative synthesis was conducted owing to the small number of studies and the heterogeneity of instruments.ResultsFour studies with 596 participants were included. Three studies compared a version of the Serial Trial Intervention, with control groups receiving education about behavior that challenges. One study compared 2 versions of the intervention. The methodologic quality was moderate. For behavior that challenges, there was little to no effect of structured care protocols (4 studies). Two studies found little to no effect on pain and quality of life. Structured care protocols may reduce discomfort (2 studies). None of the studies reported adverse effects. The certainty of evidence was low to moderate. Implementation fidelity of the structured care protocols was limited, although this was not assessed in all of the studies.Conclusion and ImplicationsStructured care protocols seem not to be more beneficial than education for reducing behavior that challenges or pain, but may reduce discomfort in people with dementia in nursing homes. Based on the small number of studies, the results should be interpreted with caution. Further research should focus on the feasibility and implementation of structured care protocols.