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Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.
BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted
Ultrasonic, Volumetric and Viscometric Study of Molecular Interactions in Binary Mixtures of 2,2,4-trimethyl Pentane with n-hexane and Cyclohexane at 308 K
How Can Health Systems Research Reach the Worst-Off? A Conceptual Exploration
Background:
Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined.
Methods and Results:
By applying existing work on disadvantage from political philosophy, the paper demonstrates that (at least) two options exist for how to define the worst-off upon whom equity-oriented health systems research should focus: those who are worst-off in terms of health or those who are systematically disadvantaged. The paper describes in detail how both concepts can be understood and what metrics can be relied upon to identify worst-off countries and research populations at the sub-national level (groups, communities). To demonstrate how each can be used, the paper considers two real-world cases of health systems research and whether their choice of country (Uganda, India) and research population in 2011 would have been classified as amongst the worst-off according to the proposed concepts.
Conclusions:
The two proposed concepts can classify different countries and sub-national populations as worst-off. It is recommended that health researchers (or other actors) should use the concept that best reflects their moral commitmentsânamely, to perform research focused on reducing health inequalities or systematic disadvantage more broadly. If addressing the latter, it is recommended that they rely on the multidimensional poverty approach rather than the income approach to identify worst-off populations
Exploring ethical considerations for the use of biological and physiological markers in population-based surveys in less developed countries
BACKGROUND: The health information needs of developing countries increasingly include population-based estimates determined by biological and physiological measures. Collection of data on these biomarkers requires careful reassessment of ethical standards and procedures related to issues of safety, informed consent, reporting, and referral policies. This paper reviews the survey practices of health examination surveys that have been conducted in developed nations and discusses their application to similar types of surveys proposed for developing countries. DISCUSSION: The paper contends that a unitary set of ethical principles should be followed for surveys around the world that precludes the danger of creating double standards (and implicitly lowers standards for work done in developing countries). Global ethical standards must, however, be interpreted in the context of the unique historical and cultural context of the country in which the work is being done. Factors that influence ethical considerations, such as the relationship between investigators in developed and developing countries are also discussed. SUMMARY: The paper provides a set of conclusions reached through this discussion and recommendations for the ethical use of biomarkers in populations-based surveys in developing countries
In vitro characterisation of low-cost synthetic meshes intended for hernia repair in the UK
Purpose: Low-cost meshes (LCM) were repurposed for the repair of hernias in the developing world. In vivo studies have shown LCM to have comparable results to commercial meshes (CM) at a fraction of the cost. However, little has been done to characterise the mechanical and biocompatible properties of LCM, preventing its clinical use in the UK. The objectives of the research are to assess mechanical and ultrastructural properties of two UK-sourced low-cost meshes (LCM) and the characterisation of the LCMs in vitro biocompatibility. Methods: Mechanical properties of the two LCM were measured through uniaxial tensile test and ultrastructure was evaluated with Scanning Electron Microscopy. LIVE/DEAD Viability/Cytotoxicity Assay kit and alamarBlue were used to assess cellular viability and proliferation, respectively. Images were acquired with a fluorescence microscope and analysed using ImageJ (NIH, USA). Results: LCM1 and LCM2 were both multifilament meshes, with the first having smaller pores than the latter. LCM1 exhibited significantly higher tensile strength (p < 0.05) than LCM2 but significantly lower extensibility (p < 0.0001), while Youngâs Modulus of the two samples was not significantly different. No significant difference was found in the cellular viability and morphology cultured in LCM1 and LCM2 conditioned media. Metabolic assay and fluorescence imaging showed cellular attachment and proliferation on both LCMs over 14Â days. Conclusion: The characterisation of the two UK-sourced LCMs showed in vitro biocompatibility and mechanical and ultrastructural properties comparable to the equivalent CM. This in vitro data represents a step forward for the feasibility of adopting LCM for surgical repair of hernias in the UK.
An unusual case of spontaneous bladder perforation with associated autodialysis of the ensuing urinary ascites
Spontaneous rupture of the urinary bladder is a rare occurrence, and when encountered it is a diagnostic challenge. We present an unusual case of urinary bladder rupture in a patient with severe cerebral palsy who initially presented with localized abdominal pain and during admission developed generalized peritonitis caused by bladder rupture. In this case, the patient had none of risk factors associated with urinary bladder
Modeling the cost effectiveness of injury interventions in lower and middle income countries: opportunities and challenges
BACKGROUND: This paper estimates the cost-effectiveness of five interventions that could counter injuries in lower and middle income countries(LMICs): better traffic enforcement, erecting speed bumps, promoting helmets for bicycles, promoting helmets for motorcycles, and storing kerosene in child proof containers. METHODS: We adopt an ingredients based approach to form models of what each intervention would cost in 6 world regions over a 10 year period discounted at both 3% and 6% from both the governmental and societal perspectives. Costs are expressed in local currency converted into US 5 to 64 CONCLUSION: Injury counter measures appear to be cost-effective based on models. More evaluations of real interventions will help to strengthen the evidence basis
Modelling human factors in perceptual multimedia quality: On the role of personality and culture
Perception of multimedia quality is shaped by a rich interplay between system, context, and human factors. While system and context factors are widely researched, few studies in this area consider human factors as sources of systematic variance. This paper presents an analysis on the influence of personality (Five-Factor Model) and cultural traits (Hofstede Model) on the perception of multimedia quality. A set of 144 video sequences (from 12 short movie excerpts) were rated by 114 participants from a cross-cultural population, producing 1232 ratings. On this data, three models are compared: a baseline model that only considers system factors; an extended model that includes personality and culture as human factors; and an optimistic model in which each participant is modeled as a random effect. An analysis shows that personality and cultural traits represent 9.3% of the variance attributable to human factors while human factors overall predict an equal or higher proportion of variance compared to system factors. In addition, the quality-enjoyment correlation varied across the movie excerpts. This suggests that human factors play an important role in perceptual multimedia quality, but further research to explore moderation effects and a broader range of human factors is warranted
A Million Person Household Survey: Understanding the Burden of Injuries in Bangladesh
Ninety percent of lives claimed by injuries occur in low- and middle-income countries. This special issue, A Million Person Household Survey: Understanding the Burden of Injuries in Bangladesh, aims to assess these injuriesâincluding falls, drowning, burns, road traffic injuries â to inform efforts to reduce the burden they cast on millions of people and families in a low income country. This issue offers a unique collection of research on the epidemiology of fatal and non-fatal injuries in Bangladesh. Based on a survey of more than one million people, this researchâconducted by the International Injury Research Unit, Department of International Health at the Johns Hopkins Bloomberg School of Public Health and two Bangladesh partners, the Center for Injury Prevention and Research and the International Center for Diarrheal Disease Research, Bangladesh with funding from Bloomberg Philanthropies, was part of a large-scale, population-based, child-drowning prevention project called âSaving of Lives from Drowning in Bangladesh.â The project tested the large-scale effectiveness and cost-effectiveness of evidence-based interventions to reduce drowning related deaths for children less than five years of age (reported elsewhere). We hope this data will be useful to researchers, students, practitioners and national decision makers
Measuring the health of populations: explaining composite indicators
Indicators that summarise the health status of a population and that provide comparable measures of a population disease burden are increasingly vital tools for health policy decision making. Decisions concerning health systems across the world are greatly affected by changes in disease profiles and population dynamics, and must develop the capacity to respond to such changes effectively within the resources of each nation. Decisions must be based on evidence of the patterns of diseases, their risk factors and the effectiveness of alternative interventions. This paper focuses on the main approaches used for developing summary measures that include mortality and morbidity occurring in a population. It discusses the rationale for composite measures and reviews the origins of each main approach. The paper also examines methodological differences among these approaches making explicit the value choices that each entails, outlines the advantages and limitations of each measure, and shows how they relate to one another
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