PREVENTION OF DENGUE HEMORRHAGIC FEVER THROUGH THE WASDEBANG (DENGUE HEMORRHAGIC FEVER ALERT) PROGRAM

The WasDeBang (Dengue Hemorrhagic Fever Alert) program which was held in Kalipecabean Village, Candi District, Sidoarjo Regency is a form of community service to reduce the incidence of Dengue Fever which often increases when facing the rainy season. The activity will be held on September 5, 2021, at the house of a resident in Kalipecabean village, Candi District, Sidoarjo Regency. The target is the residents of the Kalipecabean village, Candi District, Sidoarjo Regency, in this case especially the PKK (Family Welfare Empowerment) women. Prior to the implementation of these activities, there is a process of preparing activities for approximately 3 weeks before the activities are carried out, starting from determining the theme of the extension to applying for permits to the relevant parties. As a form of evaluation, the activity was attended by 26 PKK mothers, the participants took part in the activity with great enthusiasm, health promotion activities could run on time and smoothly.

Multiple drug arrests reported to the Maine Diversion Alert Program more frequently involved carisoprodol, amitriptyline, or quetiapine

Background: Much of the blame of the increasing death toll by drug overdoses has justifiably been attributed to the United States current opioid epidemic. However, nearly 80% of overdoses related to opioids involve another drug substance or alcohol. The objective of this study was to elucidate overrepresentation of drugs in polypharmacy arrests by identifying drugs that were more likely to be found in conjunction with other substances, using the drug arrest data provided by the Maine Diversion Alert Program (DAP). Methods: Single drug arrest and multiple drug arrest totals reported to the DAP were examined. Drugs involved in the arrests were classified by Drug Enforcement Administration Schedule (I-V or non-controlled prescription) and categorized into five drug families: hallucinogens, opioids, sedatives, stimulants, and miscellaneous. Multiple drug arrest totals were compared to single drug arrest totals to create a Multiple-to-Single Ratio (MSR) specific to each drug family and each drug. Chi-square approximations without Yates correction and two-tailed P values were used to determine statistical significance through GraphPad 2x2 contingency tables. Results: Over three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over-half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous family drugs were recorded with the highest Multiple-to-Single Ratio (1.51), followed by sedatives (1.09), stimulants (0.63), opioids (0.42), and hallucinogens (0.35). Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR values and therefore were the three most overrepresented drugs in polysubstance arrests. Conclusion: The abuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance in public health. In addition, common prescription drugs with lesser-known misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require more attention by medical providers for their ability to enhance the effects of other drugs or to compensate for undesired drug effects.

Abstract P165: Characteristics and Predictors of Mimics and Confirmed Strokes in a Stroke Alerts System at a Large Urban Medical Center

Background: Stroke alert systems provide rapid evaluation of suspected strokes to aid timely thrombolysis and mechanical thrombectomy. Given consequences of delayed or missed diagnosis, these systems are intentionally more sensitive than specific for confirmed stroke. However, substantial physician and hospital resources are involved. We sought to evaluate characteristics and predictors of stroke mimics and confirmed strokes in a large stroke alert program. Methods: The study is a retrospective investigation of the stroke alert system at the University of Colorado Hospital. Variables included patient, clinical, stroke and stroke alert characteristics, and outcome. Variables were compared for patients with confirmed stroke, and mimics. Results: Stroke alerts were evaluated in 125 patients over a one-month period in 2019. Median age was 60 years (IQR 47-72), 52% were female, 51% were white, and 24% black or African American. Median initial NIHSS score was 4 (IQR 1-11), and onset was outside the hospital in 70%. One third of stroke alerts were confirmed stroke or TIA, and 66% were mimics. Most stroke alerts were called by the departments of Emergency Medicine (78%), Medicine (10%) and Surgery (9%). The most common of more than 40 stroke alert symptoms and combinations were weakness (45%), aphasia (20%), altered mental status (16%) and facial droop or numbness (each 14%). Stroke mimics were more likely to be female (58% female vs. 41% male, OR 2.206, 95% CI 1.025-4.745, p=0.041), had better initial NIHSS scores [3 (IQR 1-9) mimics vs. 6 (IQR 2-15) stroke, p=0.015), and were more often discharged to home (77% mimics vs. 51% strokes, OR 2.051, 95% CI 1.269-3.316, p=0.004). Stroke onset location and service initiating stroke alert were not associated with confirmed stroke. Weakness was the only symptom associated with confirmed stroke (58% stroke vs. 37% mimics, OR 2.447, 95% CI 1.137-5.268, p=0.021). Conclusions: Of stroke alerts in our institution, two thirds were stroke mimics, and these were more likely to be female patients. Weakness as a stroke alert symptom, alone or with other symptoms, was associated with confirmed stroke. Additional study is warranted to improve specificity and optimize utilization of physician and hospital resources in stroke alert programs.

Upaya Peningkatan Pengetahuan Melalui PenyuluhPeran Suami Sebagai Fasilitator Dalam Persiapan Proses Persalinan

Pada tahun 1999 sampai tahun 2000 pemerintah Indonesia telah mencanangkan program Suami Siaga yang bertujuan untuk meningkatkan peran serta suami. Program lain yang telah dicanangkan Pemerintah Indonesia adalah “Making Pregnancy Safer” dimana diharapkan partisipasi, pengetahuan dan keterlibatan suami dapat meningkat selama proses persalinan (Depkes RI, 2012). Kegiatan ini dilakukan dengan metode ceramah dan diskusi sehingga suami dapat memahami tentang pentingnya peran suami sebagai fasilitator. Pelaksanaan penyuluhan tentang upaya meningkatkan pengetahuan tentang pentingnya peran suami sebagai fasilitator dalam persiapan proses persalinan dilaksanankan pada pada suami yang mengantarkan ibu melakukan pemeriksaan kehamilan di BPM Ni Ketut Nuriasih. Suami diberikan lembar pre test tentang peran pendampingan yang diperlukan untuk menemani istri bersalin, kemudian suami diberikan leaflet dan dijelaskan peran yang seharusnya dilakukan nanti saat menemani istri bersalin. Pada tahap akhir suami kembali diberikan lembar post tes untuk mengukur tingkat pemahamannya. Hasilnya seluruh suami yang diberikan penjelasan tentang peran sebagai fasilitator dalam menemani istri bersalin seluruhnya mengerti, dibuktikan dengan adanya peningkatan pemahaman dari hasil pre test dan post test. Saran Bagi klinik klinik yang menangani persalinan sebaiknya dalam pemberian KIE persiapan persalinan suami juga diikut sertakan sehingga ibu dan suami semakin siap menghadapi proses persalinan.Keywords: Fasilitator; Penyuluhan; Peran Suami; PersalinanKnowledge Efforts Through Release About The Importance Of Husband Role As A Facilitator In Preparing The Labor ProcessAbstractSince 1999 to 2000 the Indonesian government had launched the Husband Alert program which aimed to increase the participation of husbands. Another program that has been launched by the Government of Indonesia is the "Making Pregnancy Safer" where it is expected that the participation, knowledge and involvement of the husband can increase during the birth process (MOH RI, 2012). But until now there are still many husbands who do not understand their role well. So it is necessary to make efforts to increase knowledge through counseling about the importance of the husband's role as a facilitator in the preparation of the labor process. Counseling about the importance of the husband's role as a facilitator in the preparation of the birth process is done by the lecture method using leaflet props. Evaluation was carried out before and after the provision of counseling material (pre and post test). Counseling was carried out for 15 days from 1 to 15 June 2018 to 28 husbands who took mothers to carry out ANC examinations. The results of the post-test showed 78.6% experienced an increase in knowledge about the importance of the husband's role as a facilitator while the other 21.4% did not experience an increase in knowledge about the importance of the husband's role as a facilitator. Increased knowledge about the importance of the husband's role as a facilitator in the preparation of the birth process is influenced by several factors. One of them is the age factor and level of education. Recommendations for clinics that handle childbirth, it should always be included in the provision of counseling preparation for childbirth by explaining the role that must be done so that mothers and husbands are more ready to face the labor process.Keywords: Counseling; Childbirth; Facilitator; Role of Husband.

A Decision Support System Based on Degree-Days to Initiate Fungicide Spray Programs for Peach Powdery Mildew in Catalonia, Spain

The incidence of peach powdery mildew (PPM) on fruit was monitored in commercial peach orchards to i) describe the disease progress in relation to several environmental parameters and ii) establish an operating threshold to initiate a fungicide spray program based on accumulated degree-day (ADD) data. A beta-regression model for disease incidence showed a substantial contribution of the random effects orchard and year, whereas relevant fixed effects corresponded to ADD, wetness duration, and ADD considering vapor pressure deficit and rain. When beta-regression models were fitted for each orchard and year considering only ADD, disease onset was observed at 242 ± 13 ADD and symptoms did not develop further after 484 ± 42 ADD. An operating threshold to initiate fungicide applications was established at 220 ADD, coinciding with a PPM incidence in fruit around 0.05. A validation was further conducted by comparing PPM incidence in i) a standard, calendar-based program, ii) a program with applications initiated at 220 ADD, and iii) a nontreated control. A statistically relevant reduction in disease incidence in fruit was obtained with both fungicide programs, from 0.244 recorded in the control to 0.073 with the 220-ADD alert program, and 0.049 with the standard program. The 220-ADD alert program resulted in 33% reduction in fungicide applications.

County and Demographic Differences in Drug Arrests and Controlled Substance Use in Maine

Introduction: The Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine. Methods: All arrests (N=11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed. Results: The counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, where stimulants were most common. Medical distribution of opioids varied. With the exception of buprenorphine, which doubled, many prescription opioids like hydrocodone, fentanyl, and oxymorphone exhibited large (>50%) reductions. Methadone was the predominant opioid statewide (56.4% of the total MME) although there were sizeable differences (Presque Isle=8.6%, Bangor=78.9%) and this is likely impacted by use for SUD treatment. Amphetamine distribution increased by 67.9%. Conclusions: The DAP was useful to prevent information silos and enhance communication between law enforcement and health care providers. Maines DAP was a unique system to identify patients in need of additional treatment resources. The increase in prescription stimulants may warrant continued monitoring.

Abstract 295: Improving Response to Out-Of-Hospital Cardiac Arrest: Verified Responder Pilot Program

Background: Survival following out-of-hospital cardiac arrest (OHCA) decreases as the interval from collapse to CPR and defibrillation increases. Most OHCA events occur in private locations. Innovative approaches are needed to reduce response interval, especially into private locations. Methods: We undertook the Verified Responder Program in 5 United States communities during calendar year 2018, whereby off-duty EMS professionals volunteered and were equipped with Philips automated external defibrillators (AEDs). Volunteers were alerted using a geospatial smartphone application (PulsePoint) integrated with 9-1-1 dispatch to respond to nearby private and public suspected OHCA. The prospective study evaluated the frequency of verified responder alert, response, scene arrival, and initial care for OHCA occurring prior to EMS arrival. The investigation surveyed responder experience using a 5 point Likert scale. OHCA surveillance was assessed using the CARES registry. Results: The Verified Responder Program involved 593 volunteers equipped with 550 AEDs drawn from 5 EMS agencies covering a population of 1.3 million persons (Table 1). Of the 660 eligible OHCA events (483 private, 177 public), verified responders were alerted in 9.4% (n=62) of events. Among the 483 in a private location, responders were alerted in 10.4% (n=50), responded in 2.1% (n=10), arrived on scene in 1.7% (n=8), and provided initial care in 1.5% (n=7). Among the 177 in a public location, responders were alerted in 6.8% (n=12), responded in 3.4% (n=6), arrived on scene in 2.8% (n=5), and provided initial care in 1.1% (n=2). Overall, responders reported a highly favorable experience (4.5/5). None reported an adverse event. Conclusions: In this initial US-based experience of smartphone alert program for suspected OHCA in private or public locations, volunteer experiences were uniformly favorable. Volunteers were alerted, responded, and involved in a small fraction of OHCA.