Observational study on the efficiency of Neonatal Emergency Transport in reducing mortality and morbidity indexes in Sicily

In these last 25 years, the Neonatal Emergency Transport (NET) service has been widely improved in Italy. To date, all National areas are covered by a NET service; 53 NET centers have been activated in all the Italian territory. Herein, the authors present an observational study to evaluate the rate of infantile mortality after introduction of NET in Sicily, and to study the efficiency of this service in reducing these rates of mortality in vulnerable neonates, transported from primary care birth centers to tertiary facilities to undergo to specialized NICU assistance. All neonates who required an emergency transport by NETS were included. No exclusions criteria were applied. Demographic and regional infantile mortality data, expressed as infant mortality rate, were selected by the official government database (ISTAT- National Statistic Institute—http://www.istat.it). All data were respectively divided into three groups: data concerning transport, clinical condition, and mortality of the transported patients. We transported by NET 325 neonates. The analysis of the infant mortality rate (per 1.000 live births) in Catania from 2016 to 2018 was reduced compared to the same rate calculated before NETS activation (4.41 index before 2016 vs 4.17 index after 2016). These data showed an increase in other provinces (Enna, Caltanissetta, and Agrigento). 61% of neonates showed a respiratory disease. During the study period the proportion of neonates with a Mortality Index for Neonatal Transportation—MINT < 6 has been reduced, while there was an increase of neonates with higher Transport Risk Index of Physiologic Stability-TRIPS score results. The slight decrease of infantile mortality in Catania during the first three years after introduction of NET follows the same trend of all Italian territories, showing the importance of this service in reducing infantile mortality.

Demand- and supply-side factors affecting utilisation and provision of maternal health services under the free maternal health care policy in one municipality in Northern Ghana

BackgroundA free maternal health care policy was introduced in Ghana in 2008 to cater for the health needs of pregnant women for the reduction of maternal deaths. Experiences from other regions and countries show that demand- and supply-side factors often affect the success of such policies although this is unknown in this context. The study aimed to assess demand- and supply-side factors affecting the utilisation and provision of services during pregnancy under the policy. MethodsA convergent parallel mixed methods study was undertaken, collecting quantitative and qualitative data. The study was carried out in the Kassena-Nankana East Municipality in Ghana. Questionnaire were used to collect data from women (n=406) who utilised services during pregnancy. Focus group discussions with women (n=10) and in-depth interviews with midwives and nurses (n=25) were also conducted. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were audio-recorded, transcribed and coded using themes and sub-themes. ResultsBoth demand- and supply-side factors impacted the use and provision of services. Distance and time to facilities challenged the use of services. Supply-side factors such as laboratory services, equipment, drugs and supplies were not adequately available. Antenatal, childbirth and postnatal services were carried out together in the same rooms at the community-based health planning and services (CHPS) compounds. Emergency transport was also unavailable for referral of emergencies. ConclusionDemand- and supply-side factors were reported to impede the use and provision of services. Government and stakeholders should prioritise building as well as expanding the infrastructure of CHPS compounds. Emergency transport for women should also be provided. These together may contribute to improving the use and provision of services, leading to a reduction in maternal deaths and achievement of universal health coverage.

Air Emergency Transport under COVID-19: Impact, Measures, and Future

The COVID-19 pandemic caused by SARS-CoV-2 dominated the year 2020 and has an unprecedented impact on global air transport. This paper tries to make an overall review on the interaction of air transport and the COVID-19 pandemic. Although the confirmed cases were first reported in China, the origin of the pandemic remains uncertain. China was the first country to control the COVID-19 pandemic, and domestic air traffic recovers at a fast pace. Compared to 2019 level, world scheduled capacity, passengers carried, and revenues for 2020 were reduced by 50%, 60%, and $371 billion, respectively. Compared with domestic passenger traffic, international passenger traffic reduces more seats, passengers, and revenues. Because air transport contributes to economic growth, many countries or regions provide aviation bailout. The US provides most direct aid, while China mostly provides policy measures. In the post-COVID-19 period, IATA suggests that accepting vaccinated passengers is the best practice to reopen borders. Air cargo will play an important role in the distribution of COVID-19 vaccines. Meanwhile, air transport should be more digitalized, sustainable, and responsible in the future.

Surfactant Treatment of Late Preterm Infants during Emergency Transport: A Retrospective, Observational Study

<b><i>Background:</i></b> In late preterm infants born in nontertiary hospitals, the occurrence of respiratory distress syndrome requires postnatal transport. This study aimed to investigate the impact of the timing of surfactant administration in late preterm infants needing postnatal transport. <b><i>Methods:</i></b> This is a retrospective study evaluating surfactant administration in late preterm infants during emergency transports by the Eastern Veneto Neonatal Emergency Transport Service between January 2005 and December 2019. The outcome measures included short-term clinical complications, stabilization time, oxygen concentration, duration of mechanical ventilation and noninvasive respiratory support, length of hospital stay, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis. <b><i>Results:</i></b> Surfactant was administered to 155/303 neonates (51.1%) at 3 different time points: at a referring hospital (50 neonates), when the transport team arrived (25 neonates), or at a referral hospital (80 neonates). Stabilization time was longer in neonates receiving surfactant by the transport team (adjusted mean difference 17 min, 95% confidence interval, 4–29 min; <i>p</i> = 0.01). Decrease in oxygen concentrations during the transport was larger in neonates receiving surfactant at a referring hospital (adjusted mean difference −11%, 95% confidence interval, −15 to −3%; <i>p</i> = 0.01). The other outcome measures were not statistically different according to the timing of surfactant administration. <b><i>Conclusions:</i></b> In late preterm infants with respiratory distress needing postnatal transfer, stabilization time was longer when the first surfactant was administered by the transport team, but such delay did not affect safety and clinical outcomes.

Interhospital transport of children with bronchiolitis by a statewide emergency transport service

OBJECTIVE: To investigate the rate of interhospital emergency transport for bronchiolitis and intensive care admission following the introduction of high flow nasal cannula and standardised paediatric observation and response charts. DESIGN: Retrospective cohort study. SETTING: A statewide paediatric intensive care transport service and its two referral paediatric intensive care units (PICUs) in Victoria, Australia. PARTICIPANTS: Children less than 2 years old emergently transported with bronchiolitis during two time periods: 2008–2012 and 2015–2019. MAIN OUTCOME MEASURES: Incidence rates of bronchiolitis transport episodes, PICU admissions and respiratory support. RESULTS: 802 children with bronchiolitis were transported during the study period, 233 in the first period (2008–2012) and 569 in the second period (2015–2019). The rate of interhospital transport for bronchiolitis increased from 32.9 to 71.8 per 100 000 children aged 0–2 years. The population-adjusted rate of PICU admission increased from 16.2 to 36.6 per 100 000 children aged 0–2 years. Metropolitan hospitals were the predominant referral source and this increased from 60.1% of transports to 78.6% (P < 0.001). In children admitted to a PICU, the administration of high flow nasal cannula during transport increased significantly from 1.7% to 75.9% (P < 0.001) and a concomitant reduction in continuous positive airway pressure and mechanical ventilation occurred (40–12.4% and 27–6.9% respectively; P < 0.001). The proportion of mechanical ventilation as well as PICU and hospital length of stay decreased over time. CONCLUSIONS: The population-adjusted rate of interhospital transport and admission to the PICU for bronchiolitis increased over time. This occurred despite a lower rate of non-invasive and invasive mechanical ventilation during transport and in the PICU.

Heat health risk assessment analysing heatstroke patients in Fukuoka City, Japan

Background Climate change, as a defining issue of the current time, is causing severe heat-related illness in the context of extremely hot weather conditions. In Japan, the remarkable temperature increase in summer caused by an urban heat island and climate change has become a threat to public health in recent years. Methods This study aimed to determine the potential risk factors for heatstroke by analysing data extracted from the records of emergency transport to the hospital due to heatstroke in Fukuoka City, Japan. In this regard, a negative binomial regression model was used to account for overdispersion in the data. Age-structure analyses of heatstroke patients were also embodied to identify the sub-population of Fukuoka City with the highest susceptibility. Results The daily maximum temperature and wet-bulb globe temperature (WBGT), along with differences in both the mean temperature and time-weighted temperature from those of the consecutive past days were detected as significant risk factors for heatstroke. Results indicated that there was a positive association between the resulting risk factors and the probability of heatstroke occurrence. The elderly of Fukuoka City aged 70 years or older were found to be the most vulnerable to heatstroke. Most of the aforementioned risk factors also encountered significant and positive associations with the risk of heatstroke occurrence for the group with highest susceptibility. Conclusion These results can provide insights for health professionals and stakeholders in designing their strategies to reduce heatstroke patients and to secure the emergency transport systems in summer.