Child drowning prevention in the Philippines: the beginning of a conversation

This study describes a process to explore factors which contribute to child-drowning deaths and allows the development of appropriate strategies to prevent similar deaths in a selected site in the Northern Philippines. Data collection techniques used in obtaining baseline data include: review of drowning mortality records; key informant interviews; focus group discussions; and community walk-throughs. Risk factors identified which could or did contribute to drowning events were: proximity to bodies of water; inadequate child supervision; lack of information/awareness of prevention strategies; and lack of drowning prevention programme(s). Measures on how to prevent drowning deaths were explored and initial interventions were implemented through a committee convened by the community. These interventions include: community education sessions; capability building measures; redesigning of community wells; development of playpens; and use of barriers. Community engagement is a crucial element in the development and implementation of any health programme. This study demonstrates that by engaging and working with the community action occurs, however, there is a need to conduct further evaluation activities to determine if the actions by the community continued beyond the project and have resulted in a decrease in drowning. One of the strengths of the process described is that it is culturally appropriate and site-specific and allows the community to find the solutions itself. Exploration and delivery of further projects in larger areas is required to reduce drowning in the Philippines. An imperative is the evaluation which will provide valuable information on whether barriers are a sustainable and acceptable means of prevention to the community in the long term

Échographie trans-œsophagienne tridimensionnelle temps réel en cardiologie interventionnelle

RésuméL’échocardiographie est devenue en quelques années un outil indispensable en salle de cathétérisme pour le guidage de procédures interventionnelles percutanées. L’introduction récente de l’échographie transœsophagienne tridimensionnelle (ETO 3D) temps réel représente une avancée majeure, apportant une visualisation véritablement anatomique des structures cardiaques, un meilleur repérage spatial et un guidage plus précis par rapport aux techniques bidimensionnelles (2D) conventionnelles [1-3]. Cette mise au point illustre l’apport de cette technique au cours des procédures percutanées.SummaryEchocardiography has emerged during the recent years as an essential tool in the catheterization laboratory for the guidance of percutaneous interventions. To that regard, recent introduction of real time three dimensional transœsophageal echocardiography has represented a real breakthrough, providing true anatomic visualization of cardiac structures, enhanced spatial relationship analysis, and more precise guidance than conventional bidimensional techniques. This short review illustrates the benefit of this technique during percutaneous cardiac interventions

Évolution dans le temps et déterminants de l’entrée dans la filière de prise en charge « idéale » de l’infarctus aigu du myocarde. Étude EFIM

International audienceIntroductionAcute myocardial infarction outcome is strongly related to time of reperfusion. Since 2006, an early call to the SAMU is recommended. However, many patients escape this “ideal” way.ObjectiveTo study the evolution and determinants of entry into the “ideal” chain of care.MethodsAnalysis of the data of a prospective register of 8 SAMUs and 39 Mobiles Intensive Care Units in Île-de-France. Inclusion: patient with ST-elevated myocardial infarction with (STEMI) of less than 24 hours managed in prehospital settings. Criteria: age, gender, call by general practitioners (GP), management time, coronary reperfusion decision. Analysis by district characterized by: position vs. Paris, overall population, population over 75 years, median income, number of physicians and GP per inhabitant.ResultsIn all, 21,821 patients included from 2003 to 2015, 16,980 (78 %) men, 4783 (22 %) women, mean age 62 ± 14 years. MG's call decreased from 20 % (2003) to 8 % (2015) (P < 0.0001 Cochran-Armitage). Management time was significantly shorter: 76 vs. 173 min in case of a direct call to the SAMU (P < 0.0001 Wilcoxon). The MG call increased significantly with the rate of doctors (R2 = 0.5; P = 0.04) and GP (R2 = 0.6; P = 0.03) per million inhabitants, but was independent of other criteria.ConclusionThe direct call to the SAMU reduced the time of care of STEMI patients. Initial GP contact must be further reduced to favor access to the “lucky way”