Healthcare Barriers for Congolese Refugee Children in Louisville, KY: Parental Perception and Narratives through Focus Group Discussions

Background: There are up to 3500 refugees who resettle in Kentucky annually with 66% of refugee children originating from the Democratic Republic of the Congo. Little is known about the barriers to healthcare perceived by Congolese parents. This information can direct interventions to improve the care of these children. Methods: Focus group discussions (FGD) were used to allow families to share personal anecdotes, compare experiences, and encourage discussion between group members. Between August 2018 to May 2020, three FGDs were conducted with Congolese parents who have at least one child ≤18 years old. An interpreter was utilized for each session to allow participants to communicate in their preferred language. FGDs were recorded, transcribed, and analyzed by three research members using qualitative content analysis to generate frequent themes. Results: A total of 3 focus groups were performed with a total of 13 participants. The majority of participants were female (85%), have lived in Louisville for less than 2 years (54%) and are currently unemployed (38%). Content analysis of the three focus groups discussions reveal three major themes of healthcare barriers: transportation, language, and provider-related factors. Sub-themes include heavy reliance on public transportation despite access to cars, confusion about emergency service utilization, language barriers outside of the traditional healthcare space, long wait times, and re-traumatization during encounters with providers. Conclusions: Although parents report a wide variety of obstacles for their children, future interventions in Louisville should focus on improving transportation, language barriers, and parental experiences with providers

Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014.

BACKGROUND: Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization's development of a new global approach to classifying perinatal deaths. METHODS: A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. RESULTS: Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35-.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. CONCLUSIONS: The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.The Mater Research Institute, University of Queensland, AustraliaThis is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12884-016-1071-

Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system.

BACKGROUND: To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system. METHODS: Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic. RESULTS: None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %). CONCLUSIONS: There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with "ease of use" among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system.The Mater Research Institute of the University of Queensland, AustraliaThis is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12884-016-1040-

Characteristics of a global classification system for perinatal deaths: a Delphi consensus study.

BACKGROUND: Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. Instead, multiple, disparate systems are in use world-wide. This inconsistency hinders accurate estimates of causes of death and impedes effective prevention strategies. The World Health Organisation (WHO) is developing a globally-acceptable classification approach for perinatal deaths. To inform this work, we sought to establish a consensus on the important characteristics of such a system. METHODS: A group of international experts in the classification of perinatal deaths were identified and invited to join an expert panel to develop a list of important characteristics of a quality global classification system for perinatal death. A Delphi consensus methodology was used to reach agreement. Three rounds of consultation were undertaken using a purpose built on-line survey. Round one sought suggested characteristics for subsequent scoring and selection in rounds two and three. RESULTS: The panel of experts agreed on a total of 17 important characteristics for a globally-acceptable perinatal death classification system. Of these, 10 relate to the structural design of the system and 7 relate to the functional aspects and use of the system. CONCLUSION: This study serves as formative work towards the development of a globally-acceptable approach for the classification of the causes of perinatal deaths. The list of functional and structural characteristics identified should be taken into consideration when designing and developing such a system.This project was initially undertaken as part of the Harmonized Reproductive Health Registries project through the Norwegian Institute of Public Health in Partnership with the Mater Medical Research Institute, Brisbane, Australia, and in collaboration with the Department of Reproductive Health and Research, WHO.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by BioMed Central

第1058回千葉医学会例会・整形外科例会

81 included systems and selected features. (DOCX 59.8 kb

Left ventricle and systemic air embolism after percutaneous lung biopsy

Background: Systemic arterial air embolism following a percutaneous transthoracic lung biopsy is a rare but known complication, with current literature reporting an incidence of 0.01–0.45%. A prompt diagnosis of arterial air embolism is important as complications resulting from migration of air to the systemic circulation with correspondent complications. Case report: A 60-year-old female who presented for an elective percutaneous lung biopsy of an incidentally found pulmonary nodule. The procedure was performed, following the completion of the procedure the patient experiment syncopal symptoms and was diagnosed by CT scan with Left ventricular air embolism, subsequently transferred to Intensive care unit for medical attention, she was placed on right lateral decubitus Trendelenburg for 24 hours and administer 100% oxygen via a nonrebreather mask. Repeat chest CT the following day revealed complete resolution of her intracardiac free air. Conclusion: Although systemic arterial air embolism remains a rare complication of percutaneous lung biopsies, recognition prevents potential mortality which can develop due to neurological and cardiac complications. Close vigilance in the intensive care unit is recommended and hyperbaric chamber when appropriate

Evaluating Perception of Child Health and Safety Needs in a Community Through the Perspective of Caregivers and Physicians

Objective: To identify and compare child health and safety concerns in the community from the perspective of physicians and caregivers in Louisville. Design: We administered surveys to physicians and caregivers who were asked to list, via open-ended questions, the top three health or safety concerns they had for children in three separate age groups (≤ 3, 4-11, and ≥12 years old). Four reviewers assigned responses to a pre-specified category/subcategory through a schematic designed by the study team and a fifth reviewer addressed any discrepancies and assigned final categories. Agreement in assigning overall categories was measured using Fleiss Kappa and descriptive statistics were used to characterize the responses. Setting: Surveys were administered to caregivers who attended community events in Park Duvalle, a lower socioeconomic neighborhood in Louisville whose residents are predominantly black. Surveys were simultaneously administered to physicians throughout the University of Louisville/Norton Healthcare system. Participants: A total of 41 caregivers with at least one child and 43 physicians were surveyed in this study. Results: Overall categorical agreement between reviewers was k = 0.839, indicating good agreement on assignment. Injury/violence was identified by both caregivers and physicians as the top concern for children across all age groups. Wide variation was found when analyzing specific injury/violence subcategories, with caregivers more worried about household safety (17-40%) and gangs/unsafe neighborhoods (10-50%) while physicians were more concerned about sleep safety (36%), domestic violence (8-27%), and unintentional injury (10-20%). Conclusions: Survey administration was a feasible method of comparing health and safety concerns among caregivers and physicians. We identified injury/violence as the top health and safety concern across all age groups in our community but noted variation on the specific type of injury/violence. Replication of our study methodology in other neighborhoods may allow for improved comparison of caregiver and physician concerns

Classification systems for causes of stillbirth and neonatal death, 2009–2014: an assessment of alignment with characteristics for an effective global system

Abstract Background To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system. Methods Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic. Results None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %). Conclusions There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with “ease of use” among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system

PathFinder 2015

担当教員:GAITANIDIS IOANNIS平成27年度(2015)教養展開科目(国際コア関連),授業コード:G15N6160