Health

Sean M Kivlehan, Amy Allen, Olha Viun, Dmitry A Makarov, Daniel Schnorr, Sonny Patel, Sergii A Ryzhenko, Phuong Pham, and Timothy B Erickson. 6/14/2022. “Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study.” BMJ Open. Read PublicationAbstract

Objective: Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course.

Design: Pretest/post-test quasi-experimental study.

Setting: Mechnikov Hospital in Dnipro, Ukraine.

Participants: Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%).

Interventions: The 5-day WHO-ICRC BEC course.

Primary and secondary outcome measures: Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes.

Results: Participant knowledge assessment scores improved from 19 (IQR 15–20) to 22 (IQR 19–23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1–2.8) to 2.9 (IQR 2.5–3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time.

Conclusions: This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.

6/15/2022. “Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19.” PLOS Water. Read PublicationAbstract

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices—for example, hand hygiene—are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

Valerie A. Dobiesz, Madeline Schwid, Roger D. Dias, Benjamin Aiwonodagbon, Baraa Tayeb, Adrienne Fricke, Phuong Pham, and Timothy B. Erickson. 4/2022. “Maintaining Health Professional Education During War: A Scoping Review.” Medical Education. Read PublicationAbstract

Purpose: War negatively impacts health professional education when healthcare is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarize the research.

Methods: We conducted a scoping review between June 20, 2018, and August 2, 2018. The search was restricted to English publications including peer reviewed publications without date ranges involving war and health professional education (medical school, residency training, and nursing school), with interventions described to maintain educational activities. Two independent reviewers completed inclusion determinations and data abstraction. Thematic coding was performed using an inductive approach allowing dominant themes to emerge. The frequency of barrier and intervention themes and illustrative quotes were extracted. Articles were divided into modern/postmodern categories to permit temporal and historical analysis of thematic differences.

Results: Screening identified 3,271 articles, with 56 studies meeting inclusion criteria. Publication dates ranged from 1914-2018 with 16 unique wars involving 17 countries. The studies concerned medical students (61.4%), residents (28.6%) and nursing students (10%). Half involved the modern era and half the postmodern era. Thematic coding identified 5 categories of barriers and targeted interventions in maintaining health professions education during war: curriculum, personnel, wellness, resources, and oversight, with most involving curriculum and personnel. The distribution of themes among various health professional trainees was similar. The frequency and specifics changed temporally reflecting innovations in medical education and war, with increased focus on oversight and personnel during the modern era and greater emphasis on wellness, curriculum, and resources during the postmodern era.

Conclusions: There are overarching categories of barriers and targeted interventions in maintaining health professional education during war which evolve over time. These may serve as a useful framework to strategically support future research and policy efforts.

Sonny S. Patel and Timothy B. Erickson. 3/2022. “The new humanitarian crisis in Ukraine: Coping with the public health impact of hybrid warfare, mass migration, and mental health trauma.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

One of the largest mass movements of displaced people from their homelands in recent history must be recognized and assisted by the Free World. The unprovoked Russian attacks on Ukraine during February-March 2022 will leave long-lasting devastating effects on millions of innocent victims. Nations worldwide, especially NATO member countries, will need to intervene to ameliorate the situation. This letter describes major public health issues apart from the COVID-19 pandemic that are emerging concerns, such as shortages of healthcare professionals, chronic care treatments and health prevention services, disinformation communication campaigns affecting the healthcare infrastructure, and the generational impact of the conflict on people’s mental health. A global response and public health support need immediate action including humanitarian assistance, food security, clean water supplies, adequate shelter, and safe transportation out of the active military zones.

HHI Resilient Communities. 3/2022. Symposium Report: The Impacts of the COVID-19 Pandemic on Vulnerable Communities in the Philippines.Abstract

The COVID-19 pandemic has caused the loss of millions of lives, disrupted the global economy, and created secondary impacts on livelihoods, education, and mental health across the globe. No country or economic group has been immune to the direct impacts of the pandemic, but marginalized communities are particularly vulnerable to the secondary impacts including some public health measures like extended lockdowns. Marginalized populations are those excluded from mainstream social, economic, educational, political, and/or cultural life. They can be excluded or discriminated due to multiple factors such as their race, ethnicity, age, gender identity, sexual orientation, disability, religion, language, and/or displacement, among others. The Harvard Humanitarian Initiative's (HHI) Resilient Communities Program sought to understand how vulnerable or marginalized communities in the Philippines experienced COVID-19, and how communities coped and adapted in response to direct and indirect effects of COVID-19, including public health measures. To do this, HHI invited Filipino authors exploring this central question to submit papers for consideration to be selected to present and share in a symposium. In addition to its research objectives, the symposium sought to connect researchers and practitioners to create a network of professionals dedicated to serving the needs of marginalized communities in the country.

Watch the full symposium: https://www.youtube.com/watch?v=4zC1FzWRUuo

3/2022. Health Technologies and Innovations to Effectively Respond to the COVID-19 Pandemic. Lausanne: Frontiers Media SA.Abstract

The COVID-19 pandemic marks one of the greatest global challenges experienced this century. It has led to more than 20 million reported infections and caused more than 800 000 deaths world-wide. Despite attempts at lifting restrictions for lock-downs and seeking ways “back” to a “new normal”, we are far from a stable transition to a new normal life.

Digital Health solutions have already been used in many ways from tracking and tracing apps to deep learning for analysis of computerized tomography images or audio-based diagnosis and early symptom recognition. However, there are many technologies and innovations that remain unexploited with vast potential in improving the reliability, trustability, usability, and explainability of healthcare services: including the speed and quality of diagnosis, healthcare process and results. In addition, novel technology solutions and innovations to adapt processes and technologies are desperately needed. Further, there is a need for new regulatory pathways and processes for rapid testing, approval and integration of these new technologies into practice.

Many opportunities for the development and application of health technologies and digital health exist in the global fight against Coronavirus that concerns all of us.

In this light, this Research Topic aims to explore new approaches and scientific developments that enable and accelerate the adoption and diffusion of health technology innovations in health systems to improve the fight against the COVID-19 pandemic. The collection will bring together novel technologies, innovations and approaches, including studies and cases from a highly interdisciplinary point of view to harness strengths and perspectives of diverse experts.

Topic of interest include but are not limited to:

  1. Digital data
  2. E-health/M-health
  3. New production methods for rapid and flexible manufacturing at scale for:
  4. Digital health care
Phuong Pham, Manasi Sharma, Kennedy Kihangi Bindu, Pacifique Zikomangane, Rachel C. Nethery, Eric Nilles, and Patrick Vinck. 2/16/2022. “Protective Behaviors Associated With Gender During the 2018-2020 Ebola Outbreak in Eastern Democratic Republic of the Congo.” JAMA Network Open. Read PublicationAbstract

Importance: In 2018 to 2020, the Democratic Republic of the Congo experienced the world’s second largest Ebola virus disease (EVD) outbreak, killing 2290 individuals; women were disproportionately infected (57% of all cases) despite no evidence of differential biological EVD risk. Understanding how gender norms may influence exposure to EVD, intensity, and prognosis as well as personal protective behaviors against the virus is important to disease risk reduction and control interventions.

Objective: To assess whether men and women differ in personal protective behaviors (vaccine acceptance, health-seeking behaviors, physical distancing) and the mediating role of EVD information and knowledge, perceived disease risk, and social relations.

Design, Setting, and Participants: This cross-sectional, multistage cluster survey study of 1395 randomly selected adults was conducted in the Ebola-affected regions of North Kivu from April 20, 2019, to May 10, 2019. Path analyses were conducted using structural equation modeling to examine associations among study variables. Statistical analysis was conducted from August 2019 to May 2020.

Main Outcomes and Measures: The main behavioral outcomes of interest were (1) vaccine acceptance, (2) formal health care seeking, and (3) self-protective behaviors. The primary factor of interest was self-reported gender identity. We also assessed sociodemographic factors.

Results: Among the study’s 1395 participants, 1286 (93%) had Nande ethnicity and 698 (50%) were women; the mean (SD) age was 34.5 (13.1) years. Compared with female participants, male participants reported significantly higher levels of education, wealth, and mobile phone access. There were associations found between gender and all EVD preventive behavioral outcomes, with evidence for mediation through EVD knowledge and belief in rumors. Men reported greater EVD knowledge accuracy compared with women (mean [SE] score for men: 12.06 [0.13] vs women: 11.08 [0.16]; P < .001), and greater knowledge accuracy was associated with increases in vaccine acceptance (β = 0.37; P < .001), formal care seeking (β = 0.39; P < .001), and self-protective behaviors (β = 0.35; P < .001). Lower belief in rumors was associated with greater vaccine acceptance (β = −0.30; P < .001), and greater EVD information awareness was associated with increased adoption of self-protective behaviors (β = 0.23; P < .001).

Conclusions and Relevance: This survey study found gender differences in adopting preventive protective behaviors against EVD. These findings suggest that it is critical to design gender-sensitive communication and vaccination strategies, while engaging women and their community as a whole in any response to infectious disease outbreaks. Research on the potential link between gender and sociodemographics factors associated with disease risk and outcomes is needed.

Jocelyn Kelly, Emily Ausubel, Emma Kenny, Meredith Blake, Christine Heckman, Sonia Rastogi, and Vandana Sharma. 9/2021. “Measuring gender-based violence risk mitigation in humanitarian settings: results from a comprehensive desk review and systematic mapping.” BMJ Open. Read PublicationAbstract

Objectives: To systematically document measurement approaches used in the monitoring and evaluation of gender-based violence (GBV) risk mitigation activities, categorise the types of available literature produced by sector, identify existing tools and measures and identify knowledge gaps within the humanitarian sector.

Design: Systematic mapping and in-depth review.

Data sources: Pubmed, Global Health, PsychInfo, ReliefWeb, OpenGrey (grey literature), Google Scholar, Web of Science (Social Science Index)

Eligibility criteria: a structured search strategy was systematically applied to 17 databases as well as registers, websites and other resources to identify materials published between 1 January 2005 and 15 May 2019.

Data extraction and synthesis: Those resources that met the inclusion criteria underwent a comprehensive full-text review. A detailed matrix was developed and key data from each resource were extracted to allow for the assessment of patterns in thematic areas.

Results: A total of 2108 documents were screened. Overall, 145 documents and 112 tools were reviewed, representing 10 different humanitarian sectors. While numerous resources exist, many lack sufficient information on how to monitor outputs or outcomes of GBV risk mitigation activities. There is also limited guidance on how to integrate the measurement of GBV risk mitigation into existing monitoring and evaluation frameworks. Those reports that aimed to measure GBV risk mitigation activities mostly employed qualitative methods and few measured the impact of a GBV risk mitigation with robust research designs.

Conclusions: Recent efforts to adapt humanitarian response to COVID-19 have highlighted new and existing challenges for GBV risk mitigation. There is a significant gap in the evidence base around the effectiveness of GBV risk mitigation across all sectors. Understanding and strengthening measurement approaches in GBV risk mitigation remains a critical task for humanitarian response.

Indi Trehan, Sean M. Kivlehan, Kamna S. Balhara, Joseph Bonney, Braden J. Hexom, Amelia Y. Pousson, Nana Serwaa A. Quao, Megan M. Rybarczyk, Anand Selvam, Benjamin D. Nicholson, Nidhi Bhaskar, Torben K. Becker, and Global Emergency Medicine Literature Review (GEMLR) Group. 7/2021. “Global Emergency Medicine: A Scoping Review of the Literature from 2020.” Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine. Read PublicationAbstract

Objective: To identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research and review articles in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature.

Methods: A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review team to identify those that met our criteria of original research or review articles in the domains of Disaster and Humanitarian Response, Emergency Care in Resource-Limited Settings, and Emergency Medicine Development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization.

Results: The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year’s search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted original research, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving Emergency Care in Resource-Limited Settings again constituted most of the articles in this year’s review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques.

Conclusions: The number of studies relevant to global EM identified by our search was very similar to last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to Disaster and Humanitarian Response. The number of COVID-19-related articles is likely to continue to increase in subsequent years.

Indi Trehan, Sean M. Kivlehan, Kamna S. Balhara, Joseph Bonney, Braden J. Hexom, Amelia Y. Pousson, Nana Serwaa A. Quao, Megan M. Rybarczyk, Anand Selvam, Benjamin D. Nicholson, Nidhi Bhaskar, Torben K. Becker, and Global Emergency Medicine Literature Review (GEMLR) Group. 7/2021. “Global Emergency Medicine: A Scoping Review of the Literature from 2020.” Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine. Read PublicationAbstract

Objective: To identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research and review articles in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature.

Methods: A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review team to identify those that met our criteria of original research or review articles in the domains of Disaster and Humanitarian Response, Emergency Care in Resource-Limited Settings, and Emergency Medicine Development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization.

Results: The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year’s search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted original research, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving Emergency Care in Resource-Limited Settings again constituted most of the articles in this year’s review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques.

Conclusions: The number of studies relevant to global EM identified by our search was very similar to last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to Disaster and Humanitarian Response. The number of COVID-19-related articles is likely to continue to increase in subsequent years.

Agnes Usoro, Benjamin Aiwonodagbon, Jonathan Strong, Sean Kivlehan, Babatunde A. Akodu, and Ayobami Olufadeji. 8/2021. “Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: a qualitative appraisal.” BMJ Open. Read PublicationAbstract

Emergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.

The participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.

Luissa Vahedi, Jessica Anania, and Jocelyn Kelly. 8/2021. Gender-Based Violence and COVID-19 in Fragile Settings: A Syndemic Model. Read PublicationAbstract
The long-standing pandemic of gender-based violence has been worsened by COVID-19 and related containment measures, particularly in fragile settings marked by conflict, poverty, and weak infrastructure. At the same time, the implementation of gender-insensitive COVID-19 control policies can exacerbate the community transmission of COVID-19. These interactions form a syndemic—two or more pandemics whose interactions compound the severity of each. This report identifies the key avenues through which these two pandemics have synergistic effects and offers recommendations for mitigating their impact.
Sonny S. Patel, Oleksii Sukhovii, Oleksandr Zvinchuk, Julian H. Neylan, and Timothy Erickson. 2021. “Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine.” Journal of Emergency Management. Read PublicationAbstract

Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo–Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.

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