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

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 commitments—namely, 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

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 $2001. Each of these interventions has been assessed for effectiveness in a LMIC in limited region, these effectiveness estimates have been used to form models of disability adjusted life years (DALYs) averted for various regions, taking account of regional differences in the baseline burden of injury. RESULTS: The interventions modeled in this paper have cost effectiveness ratios ranging from US$5 to $556 per DALY averted depending on region. Depending on local acceptability thresholds many of them could be judged cost-effective relative to interventions that are already adopted. Enhanced enforcement of traffic regulations is the most cost-effective interventions with an average cost per DALY of$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

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 Young’s 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 14 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.

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 injuries—including falls, drowning, burns, road traffic injuries — 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 research—conducted 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 “Saving of Lives from Drowning in Bangladesh.” 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

Implementation of a Matrix Crack Spacing Parameter in a Continuum Damage Mechanics Finite Element Model

Continuum Damage Mechanics (CDM) based progressive damage and failure analysis (PDFA) methods have demonstrated success in a variety of finite element analysis (FEA) implementations. However, the technical maturity of CDM codes has not yet been proven for the full design space of composite materials in aerospace applications. CDM-based approaches represent the presence of damage by changing the local material stiffness definitions and without updating the original mesh or element integration schemes. Without discretely representing cracks and their paths through the mesh, damage in models with CDM-based materials is often distributed in a region of partially damaged elements ahead of stress concentrations. Having a series of discrete matrix cracks represented by a softened region may affect predictions of damage propagation and, thus, structural failure. This issue can be mitigated by restricting matrix damage development to discrete, fiber-aligned rows of elements; hence CDM-based matrix cracks can be implemented to be more representative of discrete matrix cracks. This paper evaluates the effect of restricting CDM matrix crack development to discrete, fiber-aligned rows where the spacing of these rows is controlled by a user-defined crack spacing parameter. Initially, the effect of incrementally increasing matrix crack spacing in a unidirectional center notch coupon is evaluated. Then, the lessons learned from the center notch specimen are applied to open-hole compression finite element models. Results are compared to test data, and the limitations, successes, and potential of the matrix crack spacing approach are discussed