Prehospital care providers' decision to transport the patient with a suicide attempt refusing care in the Cape Town Metropole, Western Cape: A survey based on the Mental Healthcare Act of 2002

Includes bibliographical referencesAnecdotally incidents of inappropriate refusal of treatment or transportation by patients referred to hospital under the Mental Healthcare Act of 2002 have been noted. There is little documented about the knowledge and understanding of prehospital providers of the mental healthcare act, their responsibilities and the issues around patient competence and refusal of care. The transportation of patients presenting with a suicide attempt who have not yet been formally assessed for involuntary admission poses a particular problem. Aim: To determine the knowledge of prehospital providers with respect to the transport of patients presenting with suicide attempts and the mental health act and to describe their management of cases where these patients may refuse treatment. Methods: A cross-sectional survey and including open ended questions of 100 prehospital providers in the Western Cape both public and private. The questionnaire will include knowledge testing, vignettes describing patient management and open-ended questions regarding their opinions on suicidal patients. Simple descriptive statistics will be used for the knowledge test. Qualitative data will be coded using a grounded theory approach. Discussion: The findings of the study will be used to determine provider knowledge and attitudes regarding the prehospital management of patients presenting with suicide attempts. Recommendations will be made for provincial EMS guidelines and the results will be disseminated in an article for publication

Panel 2: Art Law and Blockchain

Panel presentation on Art Law and Blockchain at 2019 AELJ Spring Symposium: Digital Art & Blockchain

Attitudes of prehospital providers on transport decision-making in the management of patients with a suicide attempt refusing care: A survey based on the Mental Health Care Act of 2002

Background: Given the frequency of suicidal patients making attempts prior to a completed suicide, emergency access to mental health care services could lead to significant reduction in morbidity and mortality for these patients. Aim: To describe the attitudes of prehospital providers and describe transport decision-making around the management of patients with a suicide attempt. Setting: Cape Town Metropole. Methods: A cross-sectional, vignette-based survey was used to collect data related to training and knowledge of the Mental Health Care Act, prehospital transport decision-making and patient management. Results: Patients with less dramatic suicidal history were more likely to be discharged on scene. Few respondents reported the use of formal suicide evaluation tools to aid their decision. Respondents displayed negative attitudes towards suicidal patients. Some respondents reported returning to find a suicidal patient dead, while others reported patient attempts at suicide when in their care. Eighty per cent of respondents had no training in the management of suicidal patients, while only 7.0% had specific training in the Mental Health Care Act. Conclusion: A critical lack in the knowledge, training and implementation of the Mental Health Care Act exists amongst prehospital providers within the Western Cape. A further concern is the negative feelings towards suicidal patients and the lack of commitment to transporting patients to definitive care. It is essential to urgently develop training programmes to ensure that prehospital providers are better equipped to deal with suicidal patients

Shape alterations in the striatum in chorea-acanthocytosis

Chorea-acanthocytosis (ChAc) is an uncommon autosomal recessive disorder due to mutations of the VPS13A gene, which encodes for the membrane protein chorein. ChAc presents with progressive limb and orobuccal chorea, but there is often a marked dysexecutive syndrome. ChAc may first present with neuropsychiatric disturbance such as obsessive-compulsive disorder (OCD), suggesting a particular role for disruption to striatal structures involved in non-motor frontostriatal loops, such as the head of the caudate nucleus. Two previous studies have suggested a marked reduction in volume in the caudate nucleus and putamen, but did not examine morphometric change

COSMOS-Europe : a European network of cosmic-ray neutron soil moisture sensors

We thank TERENO (Terrestrial Environmental Observatories), funded by the Helmholtz-Gemeinschaft for the financing and maintenance of CRNS stations. We acknowledge financial support by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) of the research unit FOR 2694 Cosmic Sense (grant no. 357874777) and by the German Federal Ministry of Education of the Research BioökonomieREVIER, Digitales Geosystem – Rheinisches Revier project (grant no. 031B0918A). COSMOS-UK has been supported financially by the UK’s Natural Environment Research Council (grant no. NE/R016429/1). The Olocau experimental watershed is partially supported by the Spanish Ministry of Science and Innovation through the research project TETISCHANGE (grant no. RTI2018-093717-BI00). The Calderona experimental site is partially supported by the Spanish Ministry of Science and Innovation through the research projects CEHYRFO-MED (grant no. CGL2017-86839- C3-2-R) and SILVADAPT.NET (grant no. RED2018-102719-T) and the LIFE project RESILIENT FORESTS (grant no. LIFE17 CCA/ES/000063). The University of Bristol’s Sheepdrove sites have been supported by the UK’s Natural Environment Research Council through a number of projects (grant nos. NE/M003086/1, NE/R004897/1, and NE/T005645/1) and by the International Atomic Energy Agency of the United Nations (grant no. CRP D12014). Acknowledgements. We thank Peter Strauss and Gerhab Rab from the Institute for Land and Water Management Research, Federal Agency for Water Management Austria, Petzenkirchen, Austria. We thank Trenton Franz from the School of Natural Resources, University of Nebraska–Lincoln, Lincoln, NE, United States. We also thank Carmen Zengerle, Mandy Kasner, Felix Pohl, and Solveig Landmark, UFZ Leipzig, for supporting field calibration, lab analysis, and data processing. We furthermore thank Daniel Dolfus, Marius Schmidt, Ansgar Weuthen, and Bernd Schilling, Forschungszentrum Jülich, Germany. The COSMOS-UK project team is thanked for making its data available to COSMOS-Europe. Luca Stevanato is thanked for the technical details about the Finapp sensor. The stations at Cunnersdorf, Lindenberg, and Harzgerode have been supported by Falk Böttcher, Frank Beyrich, and Petra Fude, German Weather Service (DWD). The Zerbst site has been supported by Getec Green Energy GmbH and Jörg Kachelmann (Meteologix AG). The CESBIO sites have been supported by the CNES TOSCA program. The ERA5-Land data are provided by ECMWF (Muñoz Sabater, 2021). The Jena dataset was retrieved at the site of The Jena Experiment, operated by DFG research unit FOR 1451.Peer reviewedPublisher PD

Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

Preparedness for paediatric cardiopulmonary resuscitation amongst medical doctors working in primary health care facilities in Cape Town, South Africa

Background: Cardiopulmonary resuscitation (CPR) is the principal medical intervention used to reduce the high mortality associated with the cardiorespiratory arrest. There is a paucity of literature on the preparedness for paediatric cardiopulmonary resuscitation (pCPR) amongst doctors in Cape Town. This study aimed to assess the preparedness for pCPR of doctors working in Western Cape Provincial Government primary health care facilities (PHCFs) in Cape Town with regard to knowledge, confidence and doctors’ knowledge of equipment availability.Methods: A cross-sectional study using a questionnaire to collect quantitative data from a sample of 206 doctors working in Cape Town PHCFs.Results: The questionnaire was completed by 173 doctors (84% response rate). The majority (81.8%) had not undergone pCPR training (Paediatric Advanced Life Support or Advanced Paediatric Life Support). Basic life support was done by 88.3%: 28% greater than two years ago. The average pCPR knowledge score was 61% (standard deviation [s.d.]: 20.3, range: 8.3% – 100%). Doctors in their community service and internship years had significantly higher knowledge scores compared to grade 3 Medical officers (p = 0.001 and p = 0.010, respectively). Eleven per cent had performed pCPR 10 times in the past year; 20% had never performed pCPR and 35% did not feel confident performing pCPR. More than 35% of doctors were uncertain about the availability of equipment in their facility.Conclusion: Doctors working in Cape Town PHCFs have poor knowledge, have low confidence levels and are poorly prepared to perform pCPR. Urgent attention needs to be given to ensuring formal pCPR training and acquaintance with equipment availability and location in Cape Town PHCFs.