Enhancing disaster response of emergency medical teams through “TEAMS 3.0” training package—Does the multidisciplinary intervention make a difference?

BackgroundIn the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management.MethodsTo enhance the provision of EMT’s field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary “TEAMS 3.0” project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training.ResultsThe results from all the trainings suggest an improvement for both teams’ self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment.ConclusionThus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities

Identification of an Escherichia coli operon required for formation of the O-antigen capsule

Escherichia coli produces polysaccharide capsules that, based on their mechanisms of synthesis and assembly, have been classified into four groups. The group 4 capsule (G4C) polysaccharide is frequently identical to that of the cognate lipopolysaccharide O side chain and has, therefore, also been termed the O-antigen capsule. The genes involved in the assembly of the group 1, 2, and 3 capsules have been described, but those required for G4C assembly remained obscure. We found that enteropathogenic E. coli (EPEC) produces G4C, and we identified an operon containing seven genes, ymcD, ymcC, ymcB, ymcA, yccZ, etp, and etk, which are required for formation of the capsule. The encoded proteins appear to constitute a polysaccharide secretion system. The G4C operon is absent from the genomes of enteroaggregative E. coli and uropathogenic E. coli. E. coli K-12 contains the G4C operon but does not express it, because of the presence of IS1 at its promoter region. In contrast, EPEC, enterohemorrhagic E. coli, and Shigella species possess an intact G4C operon.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92199/1/174504.pd

Violence-related injury of children in Israel: age-dependent pattern

OBJECTIVE: To characterize the population of children hospitalized as a result of violence. METHODS: This retrospective study used data from the Israeli National Trauma Registry on patients aged 0-17 years hospitalized for trauma during 1998-2006. Of 65 430 patients, 2060 (3.1%) had violence-related injuries. Descriptive statistics and bivariate analysis were used to characterize injury patterns and multivariate analysis was used to identify factors associated with severe injury. FINDINGS: Half the victims of violence < 18 years of age were 15-17 years old. Most were boys. Violence-related trauma occurred more often than other trauma in the street, at school or in a public place or leisure facility, but less often at home. Unarmed brawling and stabbing were the most common types of violence. Brawling affected Jewish children more, while non-Jewish children were more often injured by firearms. The boundaries of age groups with different injury rates corresponded to the "institutional" childhood stages of the Israeli educational system: the violence-related injury rate dropped after the first year of life, stayed low during kindergarten, rose slightly during elementary school and rose steeply during secondary and high school. The percentage of males increased with each age group. The street became more dangerous with age, while school and home became safer. Adolescents aged 15-17 years, newborn infants and those injured by firearms had the highest risk of severe injury. CONCLUSION: Age and type of violence were the most important predictors of violence frequency and severity. Ethnicity lost importance when adjusted by these factors. Further research on their influence on violence-related injury is needed

Pupil behaviour on school buses and potential risk factors for injury: an observational study

OBJECTIVE: To observe pupil behaviour on school buses in Israel and identify hazards as a basis for improving school bus safety. METHODS: Data on student, bus driver and chaperone behaviours and on hazards associated with school buses, bus loading zones and bus stops were collected during an observational study conducted on school buses in rural communities in Israel. This report focuses on observations of student behaviour during school bus rides. Future reports will discuss the other findings. Student behaviours were assessed by means of c² tests and logistic regression models. FINDINGS: Observations were made on 362 rides on 125 buses on which 11 000 pupils travelled to and from school. Seatbelt use among the pupils was limited: on 23% of the rides all pupils fastened seatbelts, while on 42% none did. Seatbelt use was more frequent among primary school pupils than among older pupils. Pupil behaviours, such as rowdiness, noisiness, conflicts between pupils and not remaining seated were observed. These and other unsafe behaviours were more frequent on afternoon bus rides (odds ratio, OR: 3.2, 95% confidence interval, CI: 2.1-5.3), on routes with 5+ bus stops (OR: 4.1; 95% CI: 2.5-6.5) and on rides with primary school pupils (OR: 1.8; 95% CI: 1.2-2.9). CONCLUSION: Without enforcement, government regulations and seatbelt availability on school buses are not enough to ensure seatbelt usage among pupils. Bus drivers cannot be expected to enforce seatbelt use and deal with pupil misconduct while also driving safely. Innovative strategies for improving pupil behaviour on school buses are needed to increase pupil safety

The danger of non-exhaustive quality measures: requiring hip fracture repair surgery within 48 hours – a case study

Abstract Quality measures are widely used globally in order to measure clinical performance and organizational efficiency of the healthcare systems. However, in a race to achieve certain numerically defined goal, the more important purpose of any organizational step being aimed at improving clinical outcomes could be overshadowed. The introduction of the requirement to perform most hip fracture surgeries in the first 48 h of hospitalization by the Israeli Ministry of Health (IMOH) provides an interesting example of the complexity of this phenomenon. In 2004, the IMOH decided that hospitals would receive the full DRG payment for hip fractures operations only in cases in which the operation is performed within 48 h of hospitalization. In 2013, the IMOH proceeded to designate the proportion of less than 48 h surgeries as an official quality parameter for comparing hospital performance. Despite the widely acknowledged and proven clinical benefit of earlier surgery for hip fracture patients, the desired proportion of such surgeries in a given population is not easily defined for a given population, as a significant number of patients may be unsuited for immediate surgery due to medical instability, having a serious co-morbidity or receiving anticoagulant treatment. Rushing these patients to surgery can be therefore expected to have a negative effect on their outcomes, and the subsequent increase in hip fracture mortality recorded in Israel after 2013 may be a result of that. This example suggests that designating an organizational quality measure without adjusting it for the patient’s medical condition may make it too inaccurate to guide healthcare policy

Public conformism with health regulation is crumbling as COVID-19 becomes a chronic threat: Repeated Cross-sectional Studies

Abstract Background The purpose of this study is to analyze the long terms trends in public attitudes toward the COVID-19 pandemic and compliance with self-quarantine regulations. Methods Repeated cross-sectional studies looking into data collected from nationally representative samples (N = 2568) of the adult population in Israel at five points in time representing the five morbidity waves of the COVID-19 pandemic. This study examined public trust in Israeli health regulations, levels of public panic, feelings of personal worry, and compliance with health regulations, specifically self-quarantine. Results Public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value of nearly 75% measured in March 2020. While reported worry is steadily reducing, the perception of public panic is increasing. In earlier rounds, public compliance with self-quarantine was reported close to 100%; however, it has dropped to 38% by January 2022 when compensation is not assumed. Regression analysis suggests that trust is a major predictor of compliance with health regulations. Conclusions The “fifth wave” of the COVID-19 pandemic brought about an all-time low in public trust in health regulations. The Israeli public, normally a highly compliant one, is showing signs of crumbling conformity