Systematic review: Do commercial tourniquets have potential to be a life-saving intervention for ambulance services?

Background: Globally, terrorist attacks have major impact because of high rates of mortality and severe injury. Compression with direct pressure may be time-consuming in limb exsanguination and accelerate onset of haemorrhagic shock. Tourniquet applications have undergone scrutiny over a long period, but recently tourniquets have been developed and modified for effective and efficient use in prehospital settings to mitigate adverse effects. Objectives: This systematic review aimed at examining commercial tourniquets that demonstrated efficacy for use in prehospital services. Methods: Six search engines (ScienceDirect, Ovid, PubMed, SAGE, SpringerLink, Taylor & Francis) were used and articles of which 14 were selected for data analysis. Results: The findings were not sufficiently conclusive to pinpoint whether one tourniquet application was superior overall; however, Combat Application Tourniquet appeared to be better than other commercial tourniquets in terms of occlusion of distal blood flow, easy and quick self-application and fewer complications. Conclusion: In prehospital settings, ambulance personnel should not hesitate to apply tourniquets when encountering critical circumstances in which they must choose between saving life and potential complications

Effects of Clinical Placements on Paramedic Students’ Learning Outcomes

Background: Clinical placements are of major importance in students’ learning processes through creating supportive environments and fostering independence into paramedic professional roles. The study aimed to explore whether clinical experiences in out-of-hospital emergency services affected students’ learning outcomes and satisfaction. Methods: A retrospective study was carried out using preceptors’ evaluations (n=160) and students’ feedback forms (n=21). Descriptive and non-parametric inferential statistics were used to analyse quantitative items, and open-ended questions were analysed using content analysis. Results: Findings showed that more than 70% of students were satisfied with the quality of preceptors and the fieldwork atmosphere. Preceptors reported that students’ clinical skills across all categories improved significantly in the last two weeks of training. Qualitative data indicated that students displayed appropriate behaviour and professional socialisation and were keen to learn, and demonstrated competence in paramedicskills. Conclusion: A supportive atmosphere and positive student–preceptor relationships are key attributes for clinical placements if students are to accomplish learning outcomes in out-ofhospital environments

Reliability and vailidity of self-reported questionnaires related to adolescent violence and consequences, Thailand

In Thailand physical violence among male adolescents is considered a significant public health issue, although there has been little published research into the aetiology and functions of violence in Thai youth. Research in this area has been hampered by a lack of psychometrically sound tools that have been validated to assess problem behaviours in Asian youth. The purpose of this paper is to provide validity and reliability data on an instrument to measure violence in Thai youth. In this study, reliability and validity data for a sample of adolescent Thai youth are reported for the Communities That Care Youth Survey (CTC-YS), a measure of risk and protective factors for violent behaviour, and the STAXI-II, a measure of angry experience and expression. The findings showed overall high internal consistency for both questionnaires, and there was evidence of construct validity. It is concluded that these measures are appropriate for use in research that seeks to investigate youth violence among adolescents in Thailand

Influence of socioeconomic factors on daily life activities and quality of life of Thai elderly

Background: The increasing number of older people is a significant issue in Thailand, resulted in growing demands of health and social welfare services. The study aim was to explore the influence of socioeconomic factors on activities of daily living and quality of life of Thai seniors. Design and methods: Using randomised cluster sampling, one province was sampled from each of the Central, North, Northeast and South regions, then one subdistrict sampled in each province, and a household survey used to identify the sample of 1678 seniors aged 60 years and over. The Mann-Whitney U-test and binary logistic regression were used to compare and determine the association of socioeconomic variables on quality of life and activities of daily living. Results: The findings showed that sociodemographic and socioeconomic factors were significantly related to functional capacity of daily living. Education levels were strongly associated with daily life activities, with 3.55 adjusted ORs for respondents with secondary school education. Gender was important, with females comprising 61% of dependent respondents but only 47% of independent respondents. Seniors with low incomes were more likely to be anxious in the past, present and future and less likely to accept death in the late stage, with 1.40 Adjusted ORs (95%CI: 1.02-1.92), and 0.72 (95%CI: 0.53-0.98), respectively. However, they were more likely to engage in social activities. Conclusions: While socioeconomic factors strongly indicated the functional capacity to live independently, a good quality of life also required other factors leading to happiness and life satisfaction

Exploring family and community involvement to protect Thai youths from alcohol and illegal drug abuse

Youth substance abuse is widely recognized as a major public health issue in Thailand. This study explores family and community risk and protective factors relevant to alcohol and illegal drug misuse in 1,778 Thai teenagers. Strong family attachment and a family history of antisocial behaviors were strongly associated with nearly all forms of substance abuse, with adjusted odds ratios ranging from 5.05 to 8.45. Community disorganization was strongly associated with self-reported substance use, although involvement in prosocial activities acted as a protective factor. The findings suggest that interventions that promote family cohesion and encourage community involvement may have considerable benefits in reducing substance abuse in Thai adolescents

Assessing effectiveness of aggression replacement training at a technical college in Thailand

Youth violence is a significant public health issue in Thailand where most people who are injured are vocational college students. There is a need to identify methods whereby such violence can be prevented. We trialed a group program in a technical college in Thailand with 23 students who received a modified version of aggression replacement training. We then compared their results with those of 24 students who did not receive any intervention or preintervention at 1 and 3 month followups. Although we found little evidence supporting the effectiveness of the intervention, participants in the intervention group suggested in the followup in-depth interviews that they felt more able to avoid or ignore provocation, and that they thought more about the consequences of aggressive behavior than they did prior to the intervention

Impact of comorbid substance use and infectious and non-communicable diseases in a cross-sectional study, Thailand

Background: Substance use has been recognized as increasing risk for concomitant infectious and non-communicable diseases (NCDs), which has contributed to poor treatment outcomes and a social burden, particularly in low-middle income countries. This study aimed at investigating effects of comorbid substance use and infectious and NCDs on psychological, suicidal behaviors and cognitive assessments. Methods: In a cross-sectional study, 141 participants were recruited from six wards in one rehabilitation center and data consisting of demographic and personal characteristics and three self-administered instruments were obtained. Descriptive statistics, Mann–Whitney U test and binary logistic regression were used for data analysis. Results: Findings showed that participants’ age and reasons for hospitalization were significantly related to comorbid substance use, χ2(48) = 97.348, p < .05, and χ2(60) = 84.790, p < .05, respectively. Compared with methamphetamine dependence, participants with concomitant methamphetamine psychosis were five times more likely to develop severe anxiety disorders (OR = 5.00, 95% CI = 1.16–21.45) but there were no significant differences for suicidal behaviors and cognitive impairment. Conclusions: Because of severe anxiety symptoms, treatment for users with comorbid methamphetamine and psychosis should be closely monitored to increase therapeutic effects

Influence of coping, self-esteem and social support on undergraduate students' emotional distress

Purpose Emotional distress, which includes stress, anxiety and depression, is considered a substantial mental health problem among university students because of its effects on academic achievement and well-being. The purpose of this paper is to examine levels of emotional distress, self-esteem, social support and coping methods and predicted emotional distress in undergraduate students across year levels in two semesters. Design/methodology/approach A cross-sectional study was conducted in a regional university with 117 and 118 students, respectively, the majority of whom were from the Faculty of Science. Announcements posted on the university website in two semesters were used to recruit convenience samples of participants who completed a battery of four self-administered questionnaires online. Findings Findings showed significant differences across year levels for emotional distress total (F(2, 107)=3.90, p=0.02), and social support total (F(2, 107)=3.57, p=0.03), especially in semester 1. Almost all maladaptive coping approaches led to risk of heightened emotional distress in both semester cohorts, ranging from using self-distraction (adjusted OR=4.54) to denial (adjusted OR=32.05). Interestingly, the use of active coping and high self-esteem appeared as risk factors rather than protective factors for mental distress, adjusted ORs=11.27 and 8.46, respectively. Originality/value Although adaptive coping skills did not alleviate students' mental distress, encouraging students to use adaptive coping and social support may help students face the challenges of university life

An exploration of violence against paramedics, burnout and post-traumatic symptoms in two Australian ambulance services

Purpose: Violence directed at ambulance paramedics has attracted increasing public attention because of its major negative impact on the physical and psychological well-being of victims and productivity of organisations. The purpose of this paper is to explore the prevalence of violent incidents, contributing factors, burnout and post-traumatic symptoms among paramedics. Design/methodology/approach: A cross-sectional survey was distributed in two ambulance services in Tasmania and South Australia, with self-administered instruments completed online. In total, 48 respondents completed questionnaires. Findings: There were no significant differences between sites in timing of violent incidents, consequences of traumatic events or organisation provision. Surprisingly, over 90 per cent of paramedics had not been pushed, slapped, beaten, scratched or spat on in the previous month. There was a statistically significant difference between genders for being yelled at or verbally abused (p=0.02). When considering burnout, female paramedics showed significantly higher levels of emotional exhaustion t(37)=–2.32, p=0.02 and lower levels of career satisfaction than their male counterparts, t(37)=3.32, p=0.00. Originality/value: Although prevalence rates of violent incidents seemed lower than expected, policy interventions to encourage female paramedics to display their professional identities and steps to enhance well-being and safety while on duty should be considered

A pilot study of Vipassana meditation with female drug users at a rehabilitation centre, Thailand

Purpose - Substance abuse has become a major health issue in Thailand, contributing to high numbers of premature deaths and requiring considerable expenditure on treatment and rehabilitation programs. The purpose of this paper is to explore use of Vipassana meditation to reduce depression and improve empathy and self-awareness in drug dependent women at a rehabilitation centre. Design/methodology/approach - Mixed methods were employed. Data were collected in a randomised controlled trial and focus group interviews with 24 intervention subjects and 22 controls. Findings - Findings showed no significant differences in depression, empathy or mindfulness levels between intervention and control groups, but intervention subjects had a small decline in depression at one-month follow up. The focus group interviews showed that drug users had developed self-awareness, moral values and greater understanding of right and wrong acts. Originality/value - Findings suggest that Vipassana meditation which is cultural appropriate for Thai culture and religion, should be incorporated into treatments in rehabilitation centres to increase successful outcomes