Octogenarian Motor Vehicle Collisions: Injury Patterns Matter

Introduction. Motor vehicle collision (MVC) is the second most common mechanism of injury among octogenarians and is on the rise. These “oldest old” trauma patients have much higher mortality rates than expected. This study examined potential factors influencing this increased mortality including comorbidities, medications, injury patterns, and hospital interventions. Methods. A 10-year retrospective review was conducted of patients aged 80 and over who were injured in a MVC. Data collected included patient demographics, comorbidities, medication use prior to injury, collision details, injury severity and patterns, hospitalization details, outcomes, and discharge disposition. Results. We identified 239 octogenarian patients involved in a MVC. Overall mortality was 18.8%. We recognized an increased mortality for specific injury patterns, patients injured in a rural setting, and those who were transfused, intubated, or admitted to the ICU. We found no correlation between mortality and medications or comorbidities. Conclusions. The high mortality rate for octogenarian patients involved in a MVC is related to injury severity, type of injury, and in-hospital complications, and not due to comorbidities and prior medications.

GENDER AND REGIONAL DISPARITIES IN EMERGENCY ARRHYTHMIA PROCEDURES DURING COVID-19 LOCKDOWN

Objectives: Worldwide reduction in emergency procedures has been observed during the current COVID-19 pandemic. The effects of the pandemic and its associated lockdown on arrhythmia related emergency procedures is not known. This study was done to see the effects of the COVID-19 pandemic lockdown on provision of emergency arrhythmia procedures and to identify vulnerable patient groups that may be disproportionately affected during lockdown. Methodology: Data for patients requiring emergency intracardiac devices including temporary and permanent pacemakers was collected from three public sector hospitals of Sindh, Pakistan, for the COVID-19 lockdown period of March to May 2020. This was compared to the data for the same period for 2019. Results: Patients presenting during lockdown decreased by 32.8% (from 250 to 168) compared to the same period without lockdown. The decline was across all emergency procedures considered. There was a more than fivefold reduction in the number of patients in patients from outside the metropolitan area of the hospital (64.3%) compared to those residing within the city (12.5%) (p=0.001). There was a trend showing women to be more effected, with the percentage decline in women being statistically significant in the rural setting (-93.8% vs. -52.9%, p=0.043). All age groups were equally affected (p=0.152). Conclusion: A marked reduction in the number of patients who presented for emergency intra cardiac devices and TPM procedures was seen during COVID-19 lockdown. The patients who presented from outside the city of the hospital and women in rural setting were significantly more effected.

Household food insecurity is associated with child’s dietary diversity score among primary school children in two districts in Ghana

Background: Dietary diversity is generally considered as a good indicator of nutrient adequacy and is influenced by various factors at the national, household, and individual levels. Objective: The present study sought to determine the relationships between household food insecurity, primary caregivers’ nutrition knowledge, and dietary diversity of school-aged children in Ghana. Methods: This forms part of a longitudinal study conducted in the Ayawaso West Municipal district in Accra (urban setting) and the Upper Manya Krobo district (rural setting) in Ghana. Data were collected from a total of 116 caregiver-child dyads using 24-h dietary recall and a short version of the US 12-month Household Food Security Survey Module. Nutrition knowledge and sociodemographic data were obtained using a structured questionnaire. Multivariable logistic regression was used to check for factors associated with children’s dietary diversity. Results: Majority of households reported food insecurity, with a higher percentage of insecure households located in the rural area (88.9% vs. 46.5%, P ≤ 0.0001), compared to the urban setting. Diet diversity among the study children was low, with a mean (standard deviation [SD]) of 5.8 (2.1) out of 14 food groups. Children living in food insecure households were three times more likely to have received low diverse diet compared to those from food secure households (adjusted odds ratio [OR] =3.3, 95% confidence interval [CI]: 1.4–8.0). Caregivers’ nutrition knowledge was, however, not related to children’s dietary diversity. Discussion and conclusion: Household food insecurity was a main predictor of dietary diversity among school-age children in this study. Thus, caregiver knowledge in nutrition may not be enough, particularly in the presence of food insecurity to guarantee adequate nutrition for school-aged children.

Edinburgh Postnatal Depression Scale (EPDS) for screening for depression in the first year post delivery in a low-resourced rural setting in Kenya

Postnatal depression is one of the most common mental disorders among postnatal mothers and may have severe consequences for mothers and their children. Locally validated screening tools that can be self- or lay interviewer-administered are required to identify at-risk women, especially in settings with no mental health specialists. This study aimed to assess the validity and reliability of a culturally adapted version of the Edinburgh Postnatal Depression Scale (EPDS) in a local dialect (Kamba) in a Kenyan setting. Trained research assistants administered the local-language version of self-report scales (EPDS) to a sample of 544 Kamba-speaking women. The same scale was re-administered to the same research participants two weeks later by the same research assistants. The test scores were compared with an external ‘gold standard’ according to the DSM-IV criteria Mini-International Neuropsychiatric Interview for adults (MINI-Plus). The EPDS had an area under the curve (AUC) of 0.867 with 95% C.I of 0.836 to 0.894, with a cut-off point of ≥11, sensitivity of 81.0% (95% C.I 70.6–89.0) and specificity of 82.6% (95% CI 78.8–85.9). The positive predictive value (PPV) and negative predictive value (NPV) were 44.1% and 96.2%, respectively. The internal reliability was 0.852 and the test-retest reliability was 0.496. The EPDS showed good utility in detecting depressive disorder in Kamba-speaking postnatal women. It does not have to be administered by mental health workers (who are few in low- and middle-income countries); rather, this can be done by a trained lay interviewer.

TOPOI – A method for analysing settlement units and their linkages in an urban–rural fabric

Many years, urbanisation research has largely focused the development of urban agglomerations and megacity regions, whereas less attention was paid on the development of medium-sized cities, small towns, villages, or rural areas. Yet many interrelations and spatial linkages between urban and rural areas exist. In this paper, we present a novel method called ‘TOPOI’ for the integrated analysis and description of settlement units in an urban–rural setting. The TOPOI-method enhances the understanding of the built environment by clustering and describing settlement units of similar characteristics with view to their physical form, function, and connectivity. The method is built on known planning parameters, but does not limit the analysis of settlement units to their administrative boundaries. Based on 11 indicators, 13 TOPOI-classes were identified in two exemplary study regions revealing new insights into urban–rural settlement types. This allows a better understanding of urban–rural linkages and therefore opens up new pathways for a more sustainable development.

Testing the Accuracy of a Bedside Screening Tool Framework to Clinical Records for Identification of Patients at Risk of Malnutrition in a Rural Setting: An Exploratory Study

This study aimed to explore the diagnostic accuracy of the Patient-Generated Subjective Global Assessment (PG-SGA) malnutrition risk screening tool when used to score patients based on their electronic medical records (EMR), compared to bedside screening interviews. In-patients at a rural health service were screened at the bedside (n = 50) using the PG-SGA, generating a bedside score. Clinical notes within EMRs were then independently screened by blinded researchers. The accuracy of the EMR score was assessed against the bedside score using area under the receiver operating curve (AUC), sensitivity, and specificity. Participants were 62% female and 32% had conditions associated with malnutrition, with a mean age of 70.6 years (SD 14.9). The EMR score had moderate diagnostic accuracy relative to PG-SGA bedside screen, AUC 0.74 (95% CI: 0.59–0.89). The accuracy, specificity and sensitivity of the EMR score was highest for patients with a score of 7, indicating EMR screen is more likely to detect patients at risk of malnutrition. This exploratory study showed that applying the PG-SGA screening tool to EMRs had enough sensitivity and specificity for identifying patients at risk of malnutrition to warrant further exploration in low-resource settings.

Discrimination Against People With HIV and AIDS in the Workplace

The main thrust of the chapter was to explore the discrimination experienced by people living with HIV and AIDS (PLHIV) in the workplace in Lagos State. A purposive sample of 80 PLHIV was selected from two local government areas (LGAs) of Lagos state: Epe, a rural setting, and Lagos Mainland, an urban one. Secondary data were obtained from internet sources while primary data were collected through structured interviews September 2005–April 2006. Data were analyzed using SPSS versions 11 and 13. Data between and within the rural and urban areas were also analyzed comparatively. The results indicate that PLHIV experienced instant dismissal from offices, mandatory HIV tests, alienation, denial of promotion, and exclusion from insurance schemes. This indicates that PLHIV's rights were violated. The study recommends intensive HIV education and enforcement of national HIV policy and international legal instruments in the workplace to protect PLHIV's rights.

Exploring Vhavenda Indigenous Food Practices and Knowledge Contributions to Food (in)security

This chapter considers VhaVenda indigenous knowledge about foods, its production, and its consumption as a way of exploring indigenous-based solutions to food insecurity. External and internal factors contributing to food insecurity are discussed, beginning with an overview of the current state of food insecurity globally and then locally. Subsequently, the chapter discusses the impact of the COVID-19 pandemic on food security levels in both urban and rural settings within a single population. Specific attention is given to the rural setting of Thohoyandou Venda, drawing attention to its challenges and solution-possibilities with particular focus on subsistence farming and home gardening as aspects in VhaVenda culture. Finally, the authors provide a catalogue of indigenous food sources and agricultural practices thereby exploring local knowledge as a possible mechanism to combat food insecurity in the contemporary period.

How Women Entrepreneurs Impact

In this chapter, a case study of women entrepreneurs provides the avenue to understand the challenges of poverty reduction and social change at the grassroots level, particularly in rural areas. This case is first among three cases that are worth noting in this book because this case exemplifies women entrepreneurs in a rural setting, where they mobilize groups of women to transform their household and community, to help impoverished Tanzanian rural women increase earnings and autonomy through nonfarm business. From these perspectives and lessons garnered, there is a tacit but general agreement that women's economic role at the local level is critical for development and that women entrepreneurs are a great resource in the Sub-Saharan Africa region.