Children in a disaster: health protection and intervention

Children are disproportionately affected by disasters. They have greater physiological, psychological and sociological vulnerabilities, often exacerbated by the fact that their unique needs can be overlooked during relief efforts. This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for children, consideration of paediatric casualties during planning exercises and teaching scenarios, and the requirement for paediatric equipment and medications cannot be overemphasised. While provision of paediatric care may not be the primary role of an individual healthcare worker or their broader team, it still remains their ethical and often legal duty to plan for and deliver care for children when responding to a disaster. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Individual Healthcare and Socially Constructed Identities: Cases of Women Suffering from Cardiovascular Diseases (CVDs)

Study aims at examining socio-cultural factors in the form of personal perception of the respondents towards Cardiovascular Diseases (CVDs) and the resultant impact of this perception on the CVDs management regimen of the respondents. Social construction of illness is used to investigate these factors. Entire data were collected at Superspeciality Hospital, Jammu (India) and 41 personal interviews were conducted. Field research also consisted of observations which was done by employing purposive sampling method. Results demonstrate that factors like inability to carry out household chores, financial constraints, lethargy etc. have a bearing on the care seeking behavior of the respondents. Women constantly juggle between maintaining family equilibrium and maintaining their health. Socially constructed image of a healthy woman is somewhat difficult to achieve even if technologies of the self and anatomo-politics come into play because gendered nature of healthcare in India makes it difficult for these women to prioritize their health needs.

Non-fatal gunshot injuries during criminal acts in Mexico, 2013–2019

IntroductionAs the volume of firearms (legal and illegal) in Mexico grows, gun violence has become a major public health challenge. While studies have focused on gun-related homicides and robberies, there is a dearth of research addressing non-fatal gunshot injuries. At the same time, official government sources report limited information and undercount these injuries.ObjectiveThe objective of this article is threefold. First, to provide data of non-fatal gunshot injuries sustained during crimes in Mexico; second, to estimate their initial individual healthcare costs; finally, to compare those costs to those resulting from other forms of injuries. This article contributes to discussions on gun violence in Mexico and its impact on public health.MethodsWe analysed Mexico’s National Crime Victimization Survey from 2014 to 2020.FindingsWe estimated that there were approximately 150 415 non-fatal gunshot injuries during crimes perpetrated from 2013 to 2019. We found that most non-fatal criminal gunshot injuries occur during a robbery and that victims tend to be men and young people between 18 and 35 years of age. Most of these injuries occur in urban areas and public spaces. While non-fatal gun-related injuries are not as common during crimes as other non-fatal injuries, their initial individual healthcare expenses are significantly higher. Crimes involving gun-related injuries reported an average expense of 16 643 pesos and crimes involving other forms of injuries reported an average of 1281 pesos. This discrepancy highlights the health burden associated with gun violence.

Anti-membrane and anti-spike antibodies are long-lasting and together discriminate between past COVID-19 infection and vaccination

The consequences of past COVID-19 infection for personal health and long-term population immunity are only starting to be revealed. Unfortunately, detecting past infection is currently a challenge, limiting clinical and research endeavors. Widely available anti-SARS-CoV-2 antibody tests cannot differentiate between past infection and vaccination given vaccine-induced anti-spike antibodies and the rapid loss of infection-induced anti-nucleocapsid antibodies. Anti-membrane antibodies develop after COVID-19, but their long-term persistence is unknown. Here, we demonstrate that anti-membrane IgG is a sensitive and specific marker of past COVID-19 infection and persists at least one year. We also confirm that anti-receptor binding domain (RBD) Ig is a long-lasting, sensitive, and specific marker of past infection and vaccination, while anti-nucleocapsid IgG lacks specificity and quickly declines after COVID-19. Thus, a combination of anti-membrane and anti-RBD antibodies can accurately differentiate between distant COVID-19 infection, vaccination, and naive states to advance public health, individual healthcare, and research goals.

The Evaluation of Cultural Competence in Healthcare

The article seeks to stimulate dialogue about the evaluation of cultural competence in healthcare. The first part of the paper presents the different attempts to measure cultural competence in the field of healthcare and critically analyses the problems that arise concerning the use of instruments that measure the cultural competence of health providers. The second part of the article focuses on the evaluation process of the first cultural competence educational programme for healthcare workers in Slovenia, serving as an example to demonstrate the importance of complementing quantitative methods with qualitative ones and to emphasize the need to shift the focus from measuring the cultural competence of individual healthcare workers to the evaluation of educator performances, patient perspectives, and the cultural competence of healthcare institutions as a whole.

Neutrality on assisted dying: A personal view

Medical bodies should take a neutral stance on the issue of assisted dying and should not be publicly opposed to or support any change in legislation that may allow assisted dying for terminally ill, mentally competent adults [1]. At the heart of the case of neutrality is the principle that the decriminalization of assisted dying should be a matter for society as a whole to decide, using parliamentary processes. No particular group within it should have a disproportionate influence on this decision. On the other hand, individual healthcare professionals, as responsible citizens, are entitled, perhaps obliged, to express their views about the ethical and clinical case for a law allowing assisted dying for the terminally ill.

Preparedness and response of a tertiary hospital to the COVID-19 pandemic in Nigeria: challenges, opportunities and lessons

Africa was the last continent to be affected by the COVID-19 pandemic. Much of the discourse on Africa's response captured in scientific journals revolves around nations, public health agencies and organizations, but little is documented about how individual healthcare facilities have fared. This article reports the challenges faced in a tertiary hospital in Nigeria, including space constraints, diagnostic challenges, shortages in personal protective equipment and health worker infections. The opportunities and strengths that aided the response are also highlighted. The lessons learned will be useful to similar facilities. More information about health facility response at various levels is needed to comprehensively assess Africa's response to the pandemic.

Patient safety in the operating theatre

In connection with medical services provided, many patients are exposed to harm that may lead to permanent health impairment, hospitalisation, extended hospital stay or even death. Adverse events are reported and are the result of a complex nature of current healthcare systems, in which effective therapy and treatment outcomes of every patient depend on numerous factors, and not only on competencies of individual healthcare professionals. Individual healthcare professionals can contribute to improving the safety of care by establishing respectful relationships with patients, following procedures, learning from mistakes, and communicating effectively with other members of the therapeutic team. This also decreases costs associated with reduction of harm sustained by patients. Reporting and analysis of errors may help identify major factors that have contributed to their occurrence. In order to consider changes that could prevent errors, at first it is necessary to learn about factors that led to them. An operating theatre is the heart of every hospital. It is where complex and highly specialized surgical procedures are performed in line with state-of-the-art procedures and applicable standards. It is also where employees of various wards meet to perform their crucial tasks that save lives. Patient’s well-being is a paramount value for a therapeutic team working in the operating theatre. The main goal of surgical nurse is, in turn, to ensure a holistic and individual approach to the patient in accordance with applicable law, procedures and recommendations.