Small area analysis methods in an area of limited mapping : exploratory geospatial analysis of firearm injuries in Port-au-Prince, Haiti

Background: The city of Port-au-Prince, Haiti, is experiencing an epidemic of firearm injuries which has resulted in high burdens of morbidity and mortality. Despite this, little scientific literature exists on the topic. Geospatial research could inform stakeholders and aid in the response to the current firearm injury epidemic. However, traditional small-area geospatial methods are difficult to implement in Port-au-Prince, as the area has limited mapping penetration. Objectives of this study were to evaluate the feasibility of geospatial analysis in Port-au-Prince, to seek to understand specific limitations to geospatial research in this context, and to explore the geospatial epidemiology of firearm injuries in patients presenting to the largest public hospital in Port-au-Prince. Results: To overcome limited mapping penetration, multiple data sources were combined. Boundaries of informally developed neighborhoods were estimated from the crowd-sourced platform OpenStreetMap using Thiessen polygons. Population counts were obtained from previously published satellite-derived estimates and aggregated to the neighborhood level. Cases of firearm injuries presenting to the largest public hospital in Port-au-Prince from November 22nd, 2019, through December 31st, 2020, were geocoded and aggregated to the neighborhood level. Cluster analysis was performed using Global Moran’s I testing, local Moran’s I testing, and the SaTScan software. Results demonstrated significant geospatial autocorrelation in the risk of firearm injury within the city. Cluster analysis identified areas of the city with the highest burden of firearm injuries. Conclusions: By utilizing novel methodology in neighborhood estimation and combining multiple data sources, geospatial research was able to be conducted in Port-au-Prince. Geospatial clusters of firearm injuries were identified, and neighborhood level relative-risk estimates were obtained. While access to neighborhoods experiencing the largest burden of firearm injuries remains restricted, these geospatial methods could continue to inform stakeholder response to the growing burden of firearm injuries in Port-au-Prince

Perceptions of Antibiotic Therapy Among Nursing Home Residents: Perspectives of Caregivers and Residents in a Mixed Exploratory Study

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents’ behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes

Perceptions of Antibiotic Therapy Among Nursing Home Residents: Perspectives of Caregivers and Residents in a Mixed Exploratory Study

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents’ behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes

Perceptions and Experiences of the COVID-19 Pandemic amongst Frontline Nurses and Their Relatives in France in Six Paradoxes: A Qualitative Study

International audienceDue to their frontline position to fight the coronavirus disease 2019 (COVID-19), the professional and personal life of nurses was severely disrupted. To understand and describe their lived experiences and perceptions during the pandemic’s first wave in France, we interviewed 49 nurses, including 16 nursing students, and 48 of their family members from June to July 2020. Using a purposeful sampling, the semi-structured interviews were scripted according to Abric’s method with probing questions. The interview analysis led to the identification of six paradoxical perceptions concerning the pandemic’s consequences: the Silence Paradox, the Hero Paradox, the Workforce Paradox, the Learning Paradox, the Symbolic Exchange Paradox, and the Uncertainty Paradox. However, despite different experiences, the nurses perceived their frontline position both as a burden jeopardizing their safety and well-being and as a spotlight of nurses’ tough working conditions. Indeed, because they were in the frontline position, nurses and nursing students were psychologically vulnerable, even more so when they felt alone and inadequately protected. Besides, their families were vulnerable too, as they were also exposed to the consequences of the nurses’ frontline engagement. Thus, to preserve their safety and well-being, institutions should also provide them with better organizational support and inclusive leadership, without neglecting their families

Apprendre en inter-professionnalité à partir de l’expérience de patients-mentors

Context: Informal and hidden curricula as well as the positivist paradigm partly explain the decline in empathy observed among health students. They also generate epistemic inequities that are exerted on patients but also between health professionals. An interprofessional program involving patient-mentors was set up as part of the initial training of health students to improve this situation. Objective: The aim was to assess whether it made it possible to achieve this objective and to characterize the explanatory mechanisms in order to identify the active ingredients of the program. Methods: Forty-five health students from six different training courses were brought together in small groups on four occasions with a patient-mentor. The qualitative study combined individual and group interviews as well as written responses to a questionnaire. Results and discussion: These meetings acted as a trigger for transformational learning. The students became aware of some of their prejudices and limitations, which should foster more horizontal relationships with patients and other health professionals. The self-management of the groups, the fact that the number of participants in these groups was relatively small, the multiple encounters with a patient outside of care, and the suggested themes for discussion, enabled the updating of learning mechanisms. The latter refer to decentration, humility, non-judgment and closeness which were actualized in these groups. The development of autonomous thinking and the consideration of their own feelings can be seen as intermediate effects. The final effects are the development of embodied knowledge of the patient-centered approach and an increased sense of responsibility. Both dimensions are manifested in new resolutions and new professional practices. Conclusion: The study explains the learning processes of the students in teaching of this order. But it also shows that transformational learning is still possible at this stage of their studies.Contexte : Les curriculums informels et cachés ainsi que le paradigme positiviste expliquent en partie la baisse de l’empathie observée auprès des étudiants en santé. Ils génèrent aussi des injustices épistémiques qui s’exercent sur les patients mais aussi entre professionnels de santé. Un programme interprofessionnel mobilisant des patients-mentors a été mis en place dans le cadre de la formation initiale d’étudiants en santé pour améliorer cet état de fait. Objectif : Il s’agissait d’évaluer s’il permettait d’atteindre cet objectif et d’en caractériser les mécanismes explicatifs afin de repérer les ingrédients actifs du programme. Méthodes : Quarante-cinq étudiants en santé issus de six filières de formation différentes ont été réunis en petits groupes à quatre reprises avec un patient-mentor. L’étude qualitative a mêlé entretiens individuels et collectifs et réponses écrites à un questionnaire. Résultats et discussion : Ces rencontres ont opéré comme l’élément déclencheur à la base d’apprentissages transformationnels. Les étudiants ont pris conscience de certains de leurs préjugés et de leurs limites, ce qui devrait favoriser des relations plus horizontales avec les patients et avec les autres professionnels de santé. L’autogestion des groupes, le fait que le nombre de participants à ces groupes soit relativement réduit, les rencontres multiples avec un patient en dehors des soins, les thèmes de discussion suggérés, ont permis l’actualisation des mécanismes d’apprentissages. Ces derniers renvoient à la décentration, à l’humilité, au non-jugement et à la proximité qui se sont actualisés dans ces groupes. Le développement de pensées autonomes et la prise en compte de leurs propres ressentis peuvent être vus comme des effets intermédiaires. Les effets finaux portent sur l’élaboration de savoirs incarnés au niveau de l’approche centrée sur le patient et sur un sens de responsabilité accru. Ces deux dimensions se manifestent par de nouvelles résolutions et de nouvelles pratiques professionnelles. Conclusion : L’étude permet d’expliquer les processus d’apprentissages des étudiants dans le cadre des programmes de cet ordre. Mais aussi, elle témoigne du fait que des apprentissages transformationnels sont encore possibles à ce stade de leurs études

Mastering the Shape and Composition of Dendronized Iron Oxide Nanoparticles To Tailor Magnetic Resonance Imaging and Hyperthermia

The current challenge in the field of nano-medicine is the design of multifunctional nano-objects effective both for the diagnosis and treatment of diseases. Here, dendronized FeO1-x@Fe3-xO4 nanoparticles with spherical, cubic, and octopode shapes and oxidized Fe3-xO4 nanocubes have been synthesized and structurally and magnetically characterized. Strong exchange bias properties are highlighted in core shell nanoparticles (NPs) due to magnetic interactions between their antiferromagnetic core and ferrimagnetic shell. Both in vitro relaxivity measurements and nuclear magnetic resonance (NMR) distribution profiles have confirmed the very good in vitro magnetic resonance imaging (Mm) properties of core shell and cubic shape NPs, especially at low concentration. This might be related to the supplementary anisotropy introduced by the exchange bias properties and the cubic shape. The high heating values of core shell NPs and oxidized nanocubes at low concentration are attributed to dipolar interactions inducing different clustering states, as a function of concentration. In vivo MRI studies have also evidenced a clustering effect at the injection point, depending on the concentration, and confirmed the very good in vivo MRI properties of core shell NPs and oxidized nanocubes in particular at low concentration. These results show that these core shell and cubic shape dendronized nano-objects are very suitable to combine MRI and hyperthermia properties at low injected doses

Mastering the Shape and Composition of Dendronized Iron Oxide Nanoparticles To Tailor Magnetic Resonance Imaging and Hyperthermia

The current challenge in the field of nanomedicine is the design of multifunctional nano-objects effective both for the diagnosis and treatment of diseases. Here, dendronized FeO_1–<i>x</i>@Fe_3–<i>x</i>O₄ nanoparticles with spherical, cubic, and octopode shapes and oxidized Fe_3–<i>x</i>O₄ nanocubes have been synthesized and structurally and magnetically characterized. Strong exchange bias properties are highlighted in core–shell nanoparticles (NPs) due to magnetic interactions between their antiferromagnetic core and ferrimagnetic shell. Both <i>in vitro</i> relaxivity measurements and nuclear magnetic resonance (NMR) distribution profiles have confirmed the very good <i>in vitro</i> magnetic resonance imaging (MRI) properties of core–shell and cubic shape NPs, especially at low concentration. This might be related to the supplementary anisotropy introduced by the exchange bias properties and the cubic shape. The high heating values of core–shell NPs and oxidized nanocubes at low concentration are attributed to dipolar interactions inducing different clustering states, as a function of concentration. <i>In vivo</i> MRI studies have also evidenced a clustering effect at the injection point, depending on the concentration, and confirmed the very good <i>in vivo</i> MRI properties of core–shell NPs and oxidized nanocubes in particular at low concentration. These results show that these core–shell and cubic shape dendronized nano-objects are very suitable to combine MRI and hyperthermia properties at low injected doses