Trusting the evidence in evidence-based practice: use of fetal fibronectin testing for threatened preterm labour in remote far North Queensland

Background: Threatened preterm labour is a common reason for medical transfer from remote communities, however many transferred women do not deliver preterm. A tool for prediction of preterm birth such as fetal fibronectin may reduce transfers and the related social and economic costs. Aim: To review the use of fetal fibronectin testing in women transferred for threatened preterm labour from Cape York to Cairns Hospital between 2011 and 2015 and determine the role testing could play in reducing transfers and associated costs. Materials/methods: Royal Flying Doctor Service and Cairns Hospital records were accessed with women transferred solely for threatened preterm labour included in the study. Fetal fibronectin testing, hospital admission, outpatient stays and birth outcome data was collated and analysed. The National Hospital Cost Data Collection, round 19 was used to assign costs. Results: Forty-seven women were included in the study however only 20 underwent fetal fibronectin testing. Transfer of 30 women who had either a negative test or were not tested but delivered at term resulted in 41 inpatient nights and 443 excess outpatient nights, costing an estimated A$61,579. Aeromedical transfers were estimated to cost a further$151,500. Conclusion: Adherence to clinical guidelines and greater availability and use of fetal fibronectin testing in Cape York has the potential to reduce aeromedical transfers for threatened preterm labour. Substantial inpatient and excess outpatient stays could be avoided with associated reduction in health system and social costs. Strategies to improve adherence to guidelines and increase access to testing are required

Menstrual hygiene management in disasters: the concerns, needs, and preferences of women and girls in Vanuatu

In disaster settings, women and girls face additional challenges in safely managing menstruation with confidence and dignity. Assessing women’s and girls’ needs and preferences at country level prior to a disaster assists Red Cross National Societies with preparedness planning and development of local menstrual hygiene management (MHM) kits for pre-positioning. This study, conducted in Vanuatu, examined the experiences, concerns, needs, and preferences of women and girls in managing menstruation in disasters. Participants trialled one of four different sanitary products included in a MHM kit. Absorbency, security of fit, and odour were the main determinants of product acceptability. Water supply and safe disposal options influenced the preference for either reusable or disposable products. Access to sanitary products, distribution processes, water supply, and privacy were key concerns. Detailed recommendations within this paper will support the Vanuatu Red Cross in decision making and programming for MHM in disaster preparedness and response

Unintended pregnancy, options counselling & abortion care content in undergraduate nursing text books used in three Queensland universities

Background: Nurses and midwives are on the frontline of sexual and reproductive health care and in many other health care settings where women faced with an unintended pregnancy may present. They can play a fundamental role in responding to unintended pregnancy, options counselling and abortion care and although ideally positioned to interact with women, they may not be well prepared to discuss these health matters. Little is known about the education around unplanned pregnancy, options counselling and abortion care provided in undergraduate nursing and midwifery training programs. The first phase of our study will examine whether and to what extent these topics are covered in nursing and midwifery text books used in three Queensland universities. Methods: Quantitative and qualitative content analysis of unplanned pregnancy, options counselling and abortion care content in nurse and midwifery text books will be conducted using a textbook evaluation tool. Results: in progress Conclusion: Evidence-based content in nursing and midwifery education is crucial for the development of confident and competent practitioners comfortable with providing quality care to women with an unplanned pregnancy, including options counselling and abortion care. Examination of content in undergraduate nursing and midwifery texts is the first step in the development of recommendations for curricular reform and expansion. This study is particularly timely given the recent decriminalization of abortion in Queensland and upscaling of public sector abortion services

Relationships Among Stress Measures, Risk Factors, and Inflammatory Biomarkers in Law Enforcement Officers

Law enforcement officers suffer higher morbidity and mortality rates from all causes than the general population. Cardiovascular disease (CVD) accounts for a significant portion of the excess illness, with a reported prevalence as high as 1.7 times that of the general population. To determine which occupational hazards cause this increased risk and morbidity, it is imperative to study law enforcement officers before they retire. The long-range goal of our research is to reduce the incidence of CVD-related illness and death among aging law enforcement officers. The purpose of the present study was to measure pro- and anti-atherogenic inflammatory markers in blood samples from law enforcement officers (n = 71) and determine what types of occupation-related stress correlate with differences in these markers. For each outcome variable of interest, we developed separate regression models. Two groups of potential predictors were examined for inclusion in the models. Selected measures of stress were examined for inclusion in the models, in addition to general covariates, such as gender, ethnicity, years in law enforcement, and body mass index. Our results revealed statistically significant relationships between several physiologic variables and measures of stress

Is it time to stop being crude? Elderly mortality rates in a refugee camp in Maban County, South Sudan

Background: Mortality is a key indicator in defining and monitoring the scale and severity of a complex humanitarian emergency. While collection of age-disaggregated data is advised in guidelines such as the Sphere handbook, in practice data are rarely disaggregated beyond the under-5s. Despite widespread use of prospective mortality surveillance systems in complex emergencies, there are few guidelines on their implementation and limited evidence of their value. In 2012, 68,000 refugees from Sudan settled in Maban County, South Sudan. MSF introduced a community based surveillance system in Jamam camp to monitor mortality and reported causes of death. Observation of a high proportion of deaths in older refugees led to the adaptation of the surveillance system to collect age-specific mortality data. Here we describe the implementation, outcomes and lessons learnt

Para um desenvolvimento de competências interculturais

El grupo de Galapro “Intercomprensión e interculturalidad”, está compuesto por participantes de lenguas romances, en su mayoría formadores, que han decidido relacionar de alguna manera la intercomprensión entre las lenguas de una misma familia con cuestiones relacionadas con la diversidad de culturas y costumbres. El objetivo marcado es la realización de un artículo o trabajo que analice un aspecto concreto de la interculturalidad en una sesión del Chat de una plataforma anterior, denominada Galanet, donde se investigaba y ponía en práctica la intercomprensión. Concretamente, hemos decidido tratar las formas de la cortesía en este lugar y entre lenguas/culturas distintas. Pero para ello, presentaremos primero una serie de características que nos sitúen en esa nueva forma de comunicación que es el Chat. Tras los análisis concretos de distintos aspectos de la cortesía (traducción e interculturalidad, otros aspectos y las negaciones y sus respuestas) propondremos algunas aplicaciones didácticas posibles en base a todo lo estudiado. En concreto, ofrecemos un cuestionario para los participantes en chats de diversas lenguas para conocer las representaciones sobre la interculuralidad y la cortesía que manejan. Algunos de los objetivos de estas propuestas didácticas podrían ser: encontrar modos de potenciar la interculturalidad, conocer las costumbres y modos lingüísticos corteses y descorteses de otras culturas para evitar el conflicto, deconstruir mitos y anular estereotipos, etc. Los materiales utilizados para componer este artículo han sido en primer lugar, ejemplos de Chats extraídos de Galanet que trataban diferencias culturales y/o lingüísticas. Entre ellos tenemos, una sesión que se ocupaba de lo no verbal y lo gestual entre extranjeros, otra que trataba sobre los falsos amigos, un Chat denominado “Agua”, pero que se dedicaba a las interferencias entre lenguas romances y experiencias en el extranjero de los participantes y finalmente, el Chat “Comida” que es el que hemos elegido para realizar nuestro análisis y que incluye varios temas “interculturales” como el orden de las comidas o la forma de leer la hora. Además de esta base de datos que recopila ejemplos empíricos se han incluido en los foros otros artículos de carácter teórico, como aquel que trata las formas de gestionar el conflicto en los chats y foros , varias fichas de lectura tomadas de Galanet y Galapro y se nos ha animado a visitar los ficheros específicos de esta segunda plataforma que trataban sobre la intercomprensión

Contributions of Fire Refugia to Resilient Ponderosa Pine and Dry Mixed‐Conifer Forest Landscapes

Altered fire regimes can drive major and enduring compositional shifts or losses of forest ecosystems. In western North America, ponderosa pine and dry mixed‐conifer forest types appear increasingly vulnerable to uncharacteristically extensive, high‐severity wildfire. However, unburned or only lightly impacted forest stands that persist within burn mosaics—termed fire refugia—may serve as tree seed sources and promote landscape recovery. We sampled tree regeneration along gradients of fire refugia proximity and density at 686 sites within the perimeters of 12 large wildfires that occurred between 2000 and 2005 in the interior western United States. We used generalized linear mixed‐effects models to elucidate statistical relationships between tree regeneration and refugia pattern, including a new metric that incorporates patch proximity and proportional abundance. These relationships were then used to develop a spatially explicit landscape simulation model. We found that regeneration by ponderosa pine and obligate‐seeding mixed‐conifer tree species assemblages was strongly and positively predicted by refugia proximity and density. Simulation models revealed that for any given proportion of the landscape occupied by refugia, small patches produced greater landscape recovery than large patches. These results highlight the disproportionate importance of small, isolated islands of surviving trees, which may not be detectable with coarse‐scale satellite imagery. Findings also illustrate the interplay between patch‐scale resistance and landscape‐scale resilience: Disturbance‐resistant settings (fire refugia) can entrain resilience (forest regeneration) across the burn matrix. Implications and applications for land managers and conservation practitioners include strategies for the promotion and maintenance of fire refugia as components of resilient forest landscapes

Economic evaluation of the OSAC randomised controlled trial:oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care

ObjectiveTo estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo.DesignCost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work.SettingFifty-four National Health Service (NHS) general practices in England.Participants398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days.Interventions2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets.Outcome measuresQuality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up.Results198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean ‘profit’ to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms.ConclusionsThe use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms.Trial registration numbersEudraCT 2012-000851-15 and ISRCTN57309858; Pre-results

Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial

Importance: Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics. Corticosteroids are increasingly used but without sufficient evidence. Objective: To assess the effects of oral corticosteroids for acute lower respiratory tract infection in adults without asthma. Design, Setting, and Participants: Multicenter, placebo-controlled, randomized trial (July 2013 to final follow-up October 2014) conducted in 54 family practices in England among 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment and with no history of chronic pulmonary disease or use of asthma medication in the past 5 years. Interventions: Two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once daily for 5 days. Main Outcomes and Measures: The primary outcomes were duration of moderately bad or worse cough (0 to 28 days; minimal clinically important difference, 3.79 days) and mean severity of symptoms on days 2 to 4 (scored from 0 [not affected] to 6 [as bad as it could be]; minimal clinically important difference, 1.66 units). Secondary outcomes were duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and adverse events. Results: Among 401 randomized patients, 2 withdrew immediately after randomization, and 1 duplicate patient was identified. Among the 398 patients with baseline data (mean age, 47 [SD, 16.0] years; 63% women; 17% smokers; 77% phlegm; 70% shortness of breath; 47% wheezing; 46% chest pain; 42% abnormal peak flow), 334 (84%) provided cough duration and 369 (93%) symptom severity data. Median cough duration was 5 days (interquartile range [IQR], 3-8 days) in the prednisolone group and 5 days (IQR, 3-10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P = .36 at an α = .05). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, −0.20; 95% CI, −0.40 to 0.00; P = .05 at an α = .001). No significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or nonserious adverse events. There were no serious adverse events. Conclusions and Relevance: Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity

A review of the ecological value of Cusuco National Park an urgent call forconservation action in a highly threatened Mesoamerican cloud forest

Cloud forests are amongst the most biologically unique, yet threatened, ecosystems in Mesoamerica. We summarize the ecological value and conservation status of a well-studied cloud forest site: Cusuco National Park (CNP), a 23,440 ha protected area in the Merendón mountains, northwest Honduras. We show CNP to have exceptional biodiversity; of 966 taxa identified to a species-level to date, 362 (37.5%) are Mesoamerican endemics, 67 are red-listed by the IUCN, and at least 49 are micro-endemics known only from the Merendón range. CNP also provides key ecosystem services including provision of drinking water and downstream flood mitigation, as well as carbon sequestration, with an estimated stock of 3.5 million megagrams of carbon in 2000. Despite its ecological importance, CNP faces multiple environmental threats and associated stresses, including deforestation (1,759 ha since 2000 equating to 7% of total forest area), poaching (7% loss of mammal relative abundance per year), amphibian declines due to chytridiomycosis (70% of species threatened or near-threatened), and climate change (a mean 2.6 °C increase in temperature and 112 mm decrease in rainfall by 2100). Despite conservation actions, including community ranger patrols, captive-breeding programmes, and ecotourism initiatives, environmental degradation of CNP continues. Further action is urgently required, including reinforcement and expansion of ranger programmes, greater stakeholder engagement, community education programmes, development of alternative livelihood projects, and legislative enforcement and prosecution. Without a thorough and rapid response to understand and mitigate illegal activities, the extirpation and extinction of species and the loss of vital ecosystem services are inevitable in the coming decades