Health Expect

BACKGROUND: The patient has always been at the centre of the evidence-based medicine model. Case-based critical reviews, such as best-evidence topics, however, are incomplete reflections of the evidence-based medicine philosophy, because they fail to consider the patient's perspective. We propose a new framework, called the 'Shared Decision Evidence Summary' (ShaDES), where the patient's perspective on available treatment options is explicitly included. METHODS: Our framework is grounded in the critical appraisal of a clinical scenario, and the development of a clinical question, including patient characteristics, compared options and outcomes to be improved. Answers to the clinical question are informed by the literature, the evaluation of its quality and its potential usefulness to the clinical scenario. Finally, the evidence synthesis is presented to the patient to facilitate the formulation of an evidence-informed decision about the treatment options. KEY RESULTS: Using three similar but contrasted clinical scenarios of patients with low back pain, we illustrate how considering the patient's preferences on the proposed treatment options impact the bottom line, a synthetic formulation of the answer to the focused question. ShaDES includes clinical and psychosocial components, transformed in a searchable question, with a full search strategy. CONCLUSIONS: ShaDES is a practical framework that may facilitate clinical decisions adapted to psychological, social and other relevant non-clinical characteristics of patients

Reducing Marginalization of Fishermen through Participatory Action Research in the Zambezi Valley, Zimbabwe

Equitable sharing of fishing resources has been the major source of tension between Zambezi Valley communities and the Zimbabwe government authorities since the 1950s following the Kariba Dam-induced resettlement. Using participatory action research, it was found that the fishing license system and criminalization of fishermen were the major sources of tension between fishermen and government authorities. Engaging with government authorities to address these tensions, fishermen were recognized as partners in the fishing industry. The conclusion was that enhancing community agencies through participatory action research would be fundamental towards creating socially just and equitable arrangements that could emancipate marginalized communities from abject poverty

PLoS One

Driving anger may vary across countries due to culture. This might affect driver behavior, which, in turn, impacts the driving outcomes. This study aims to investigate the relationship between socio-demographic variables, driving anger, and the self-reported aberrant behavior among Lebanese drivers and to determine which anger dimension is linked to driving behavior. A cross-sectional study was conducted among eligible Lebanese drivers from all Lebanese governorates. Data were collected using an anonymous Arabic self-reported questionnaire that included demographic information, driving-related variables, and two scales: the Driver Behavior Questionnaire (DBQ) and the Driver Anger Scale (DAS). Four hierarchical regressions were performed taking the DBQ subscales as the dependent variable and the DAS subscales as independent variables. Out of 1102 surveyed drivers, 68.4% were males, having a mean age of 34.6 ± 12.3 years and an average driving experience of 13.5 ± 10.8 years. DBQ, DAS, and their subscales showed good reliability. Older age and female gender were negatively associated with the tendency of committing aggressive violations. However, being a professional driver and increasing annual mileage were positively associated with a higher tendency to commit aggressive violations. In addition to these factors, a higher educational level was found associated with a lower risk of driver's involvement in traffic violations. However, increased driving experience was associated with a higher tendency to commit aggressive violations. Reported driving errors were also found positively associated with older age, increasing mileage, and being a professional driver. However, larger driving experience and higher education were found protectors from erroneous behavior. Hierarchical regression showed that anger prompted by hostile gesture, discourtesy, police presence, traffic obstruction, and slow driving were positively associated with aggressive violations. All the DAS subscales were found to be positively associated with ordinary violations. traffic obstruction was also found associated with a higher tendency of drivers to commit lapses, as well as anger, which originated from police presence and slow driving which were found also positively associated with errors. Driver anger dimensions were found positively associated with aberrant driver behavior. To overcome road anger, there is a need to train drivers on coping strategies to restrain aberrant driving behavior

Predicting drowning from sea and weather forecasts: development and validation of a model on surf beaches of southwestern France

OBJECTIVE: To predict the coast-wide risk of drowning along the surf beaches of Gironde, southwestern France. METHODS: Data on rescues and drownings were collected from the Medical Emergency Center of Gironde (SAMU 33). Seasonality, holidays, weekends, weather and metocean conditions were considered potentially predictive. Logistic regression models were fitted with data from 2011 to 2013 and used to predict 2015-2017 events employing weather and ocean forecasts. RESULTS: Air temperature, wave parameters, seasonality and holidays were associated with drownings. Prospective validation was performed on 617 days, covering 232 events (rescues and drownings) reported on 104 different days. The area under the curve (AUC) of the daily risk prediction model (combined with 3-day forecasts) was 0.82 (95% CI 0.79 to 0.86). The AUC of the 3-hour step model was 0.85 (95% CI 0.81 to 0.88). CONCLUSIONS: Drowning events along the Gironde surf coast can be anticipated up to 3 days in advance. Preventative messages and rescue preparations could be increased as the forecast risk increased, especially during the off-peak season, when the number of available rescuers is low

Nat. Hazards Earth Syst. Sci.

International audienceThe two primary causes of surf zone injuries (SZIs) worldwide, including fatal drowning and severe spinal injuries, are rip currents (rips) and shore-break waves. SZIs also result from surfing and bodyboarding activity. In this paper we address the primary environmental controls on SZIs along the high-energy meso-macro-tidal surf beach coast of southwestern France. A total of 2523 SZIs recorded by lifeguards over 186 sample days during the summers of 2007, 2009 and 2015 were combined with measured and/or hindcast weather, wave, tide, and beach morphology data. All SZIs occurred disproportionately on warm sunny days with low wind, likely because of increased beachgoer numbers and hazard exposure. Relationships were strongest for shore-break- and rip-related SZIs and weakest for surfingrelated SZIs, the latter being also unaffected by tidal stage or range. Therefore, the analysis focused on bathers. More shore-break-related SZIs occur during shore-normal incident waves with average to below-average wave height (significant wave height, Hs = 0.75-1.5 m) and around higher water levels and large tide ranges when waves break on the steepest section of the beach. In contrast, more rip-related drownings occur near neap low tide, coinciding with maximised channel rip flow activity, under shore-normal incident waves with Hs > 1.25 m and mean wave periods longer than 5 s. Addi- tional drowning incidents occurred at spring high tide, presumably due to small-scale swash rips. The composite wave and tide parameters proposed by Scott et al. (2014) are key controlling factors determining SZI occurrence, although the risk ranges are not necessarily transferable to all sites. Summer beach and surf zone morphology is interannually highly variable, which is critical to SZI patterns. The upper beach slope can vary from 0.06 to 0.18 between summers, resulting in low and high shore-break-related SZIs, respectively. Summers with coast-wide highly (weakly) developed rip channels also result in widespread (scarce) rip-related drowning incidents. With life risk defined in terms of the number of people exposed to life threatening hazards at a beach, the ability of morphodynamic models to simulate primary beach morphology characteristics a few weeks or months in advance is therefore of paramount importance for predicting the primary surf zone life risks along this coast

Trials

BACKGROUND: Recent data suggest that 10-20% of injury patients will suffer for several months after the event from diverse symptoms, generally referred to as post-concussion-like symptoms (PCLS), which will lead to a decline in quality of life. A preliminary randomized control trial suggested that this condition may be induced by the stress experienced during the event or emergency room (ER) stay and can be prevented in up to 75% of patients with a single, early, short eye movement desensitization and reprocessing (EMDR) psychotherapeutic session delivered in the ER. The protocol of the SOFTER 3 study was designed to compare the impact on 3-month PCLS of early EMDR intervention and usual care in patients presenting at the ER. Secondary outcomes included 3-month post-traumatic stress disorder, 12-month PCLS, self-reported stress at the ER, self-assessed recovery expectation at discharge and 3 months, and self-reported chronic pain at discharge and 3 months. METHODS: This is a two-group, open-label, multicenter, comparative, randomized controlled trial with 3- and 12-month phone follow-up for reports of persisting symptoms (PCLS and post-traumatic stress disorder). Those eligible for inclusion were adults (>/=18 years old) presenting at the ER departments of the University Hospital of Bordeaux and University Hospital of Lyon, assessed as being at high risk of PCLS using a three-item scoring rule. The intervention groups were a (1) EMDR Recent Traumatic Episode Protocol intervention performed by a trained psychologist during ER stay or (2) usual care. The number of patients to be enrolled in each group was 223 to evidence a 15% decrease in PCLS prevalence in the EMDR group. DISCUSSION: In 2012, the year of the last national survey in France, 10.6 million people attended the ER, some of whom did so several times since 18 million visits were recorded in the same year. The SOFTER 3 study therefore addresses a major public health challenge. TRIAL REGISTRATION: Clinical Trials. NCT03400813 . Registered 17 January 2018 - retrospectively registered

Prescription Medicines and the Risk of Road Traffic Crashes: A French Registry-Based Study

Using three nationwide databases in France, Ludivine Orriols, Emmanuel Lagarde, and colleagues provide evidence that prescribed medicines contribute to the risk of experiencing a road traffic crash

Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan

<p>Abstract</p> <p>Background</p> <p>Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI) for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED) datasets on an interurban road section in Pakistan.</p> <p>Methods</p> <p>The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS), and five hospital EDs in Karachi during 2008 (Jan to Dec) were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants) and outcome (died or injured). Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets.</p> <p>Results</p> <p>A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs) than in ambulance (10 per 100 RTIs) and hospital ED records (9 per 100 RTIs). Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs) than in ambulance (17 per 100 RTIs) and hospital ED records (43 per 100 RTIs). Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients.</p> <p>Conclusions</p> <p>Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.</p

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity.

BACKGROUND: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. MAIN BODY: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. CONCLUSION: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system