Table of Contents
Editorial in Global Health
The challenges of climate change, migration and conflict in pursuit of the Sustainable Development Goals: A call to responsible and responsive policy makers
Author: Francesco Chirico1
1MD, Health Service Department, State Police, Ministry of Interior, Italy.
Keywords: Climate change; global health; health policy; refugees; sustainable development.
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Viewpoint Article in Global Health and Development
Tracking health-related Sustainable Development Goals (SDGs) in Nepal
Authors: Meghnath Dhimal1#, Mandira Lamichhane Dhimal2#, KhemBahadur Karki3, Doreen Montag4, David A. Groneberg5, Ulrich Kuch6
1 Ph.D., Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal and Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
2 Ph.D. Candidate, Faculty of Social Sciences, Goethe University, Frankfurt am Main, Germany and Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
3 Ph.D. Candidate, Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal and Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
4 D. Phil., Queen Mary University London, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
5 Ph.D., Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
6 Ph.D., Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
# Equal contribution
Sustainable Development Goals (SDGs) comprise of 17 goals and 169 targets. All SDGs are interlinked to produce synergetic effects and emphasize health in all policies. Among the 17 Goals, Goal 3 has a central focus on health, which is underpinned by 13 targets. The other 16 goals are also directly or indirectly related to health and will contribute to achieving the associated targets for Goal 3. The ambitious SDG agenda and their progress can be tracked by measuring numerous goals, targets, and indicators. The main objective of this paper is to provide an overview about how health- related SDGs and their targets and indicators are being tracked in the national context of Nepal. Adequate investment in research for knowledge generation, capacity building and innovation, and continous research communication among policy makers, researchers and external development partners will contribute to tracking the progress of SDGs in Nepal.
Keywords: Global health; Nepal; research; Sustainable Development.
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Original Article in Anesthesiology
Sustaining reductions in postoperative nausea and vomiting after evidence-based practice initiative: A success story
Authors: Christopher A Smith1, Richard E Haas2
1 D.N.P., CRNA, Anesthesia Associates of York and Department of Anesthesia, WellSpan Health, York Hospital, York, USA.
2 Ph.D., CRNA, York College of Pennsylvania/WellSpan Health Nurse Anesthetist Program, York, USA, and Department of Anesthesia, WellSpan Health, York Hospital, York, USA.
Background: Postoperative nausea and vomiting (PONV) remains a significant problem in the surgical population. Many researchers have demonstrated significant reductions in institutional PONV when risk screening and antiemetic prophylaxis protocols are implemented. These protocols have not been universally adopted. Our adoption and implementation led to significant reductions in PONV. The challenge is to sustain these reductions over time.
Methods: A retrospective cohort chart review of consecutive surgical patients (n = 1002) during the period encompassing October through November of 2016, the sustainability group (G16). Descriptive statistics were used to compare G16 with the implementation group (G14) in regard to demographic data, and Z-score and Chi-square (x2) statistics were utilized to determine levels of significance. Correlations were calculated to determine levels of compliance to the protocol and the incidence of PONV.
Results: A significant (P = 0.0007) reduction in PONV incidence was identified as 8.5% (85/1002) in G16 compared to 13.4% (134/997) achieved in G14. Overall compliance with the targeted prophylaxis protocol was 87.2% (G16, 874/1002), a significant (P = 0.0001) improvement compared to 79% (G14, 788/997). A 61.1% (11/18) incidence of PONV in laparoscopic gastric bypass patients was identified in the G16 group.
Conclusions: Initial reductions in PONV were not only sustained but significantly improved. Preoperative risk assessment for PONV, risk stratification, and fidelity to anti-emetic prophylaxis protocols reduce the incidence of PONV in the post-anesthesia care unit. High-risk patients require three or more interventions to obtain acceptable reductions in PONV. Laparoscopic gastric bypass patients remain a high risk group requiring aggressive multimodal prophylaxis beyond their Apfel simplified risk score.
Keywords: Antiemetics; evidence based practice; patient satisfaction; postoperative nausea and vomiting.
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Original Article in Occupational Health
The health of healthcare: Emergency department physician well-being
Authors: Martin Gagne1, Adam Schwartz2, Steven Zimmerman3
1 D.O., M.A., Good Samaritan Hospital Medical Center, West Islip, New York, USA.
2 D.O., Good Samaritan Hospital Medical Center, West Islip, New York, USA.
3 M.D., F.A.A.E.M., F.A.C.E.P., Physician at City, New York, USA.
Introduction: Physician health and well-being is an important issue that ultimately affects job performance. We compared the self-reported incidence of known medical issues, physical and mental health symptoms, and health behaviors of Emergency Physicians (EPs) with the general public in the United States.
Methods: Questions selected from a national survey conducted by the Center for Disease Control (CDC) about public health trends were distributed to via Facebook to a private group of 12,917 EPs. Responses were compared between EPs and the general population using Chi-square tests of independence.
Results: Our results demonstrated that EPs suffer less from chronic diseases, especially those related to the cardiopulmonary system; however, they suffer from a higher incidence of musculoskeletal pain and infectious disease complaints. EPs also exhibit higher rates of mental health symptoms, sleep-related complications, and alcohol consumption.
Conclusions: Awareness, education, and advocacy may help improve physician health and ultimately job performance.
Keywords: Centers for Disease Control and Prevention (U.S.); emergency service, hospital; health promotion; physicians; preventive medicine; occupational medicine; social media.
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Original Article in Moral Psychology
Promoting cross-culture research on moral decision-making with standardized, culturally-equivalent dilemmas: The 4CONFiDe set
Authors: Cinzia Cecchetto1, Raffaella Ida Rumiati2, Valentina Parma1
1 Ph.D., SISSA – International School for Advanced Studies, Neuroscience Area, Trieste, Italy.
2 Ph.D., Professor, SISSA – International School for Advanced Studies, Neuroscience Area, Trieste, Italy and ANVUR – Agenzia Nazionale della Valutazione del sistema Universitario e della Ricerca, Roma, Italy
Introduction: Moral dilemmas are a common tool in moral decision-making research. However, they are often hardly comparable across languages and cultures. Here, we propose a methodology to adapt, convert and test moral dilemmas in languages different from English, by outlining the process followed for the creation of the comprehensive 4CONFiDe set.
Methods: To evaluate cultural effects, English and Italian versions of the 4CONFiDe were evaluated by English-native speakers proficient in Italian, and Italian-native speakers proficient in English (Study 1). To assess the contribution of the four conceptual factors used by Christensen et al. to the levels of arousal, valence and familiarity experienced with each dilemma, an independent group of Italian native speakers (n = 112) completed the 4CONFiDe set (Study 2).
Results: Both linear mixed models and Bayesian statistics confirmed that moral choices were made irrespective of participants’ native language and dilemmas’ version, suggesting that the translation was culturally-representative. Moreover, they showed that the proposed dilemmas were perceived by participants with different degrees of arousal, pleasantness and familiarity based on some of the conceptual factors and that three of the four conceptual factors (Personal force, Intentionality and Evitability) determined participants’ moral choices.
Conclusions:Standardized, culturally-equivalent moral dilemmas provide researchers with a tool that allows further developments of the field.
Keywords: Cross-culture; descriptive ratings; inter-individual differences; moral dilemmas; moral decision-making.
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Original Article in Social Psychology
A qualitative study examining psychosocial distress and coping mechanisms among orphan and vulnerable children living in institutional care in New Delhi, India
Authors: Abhishek Saraswat1, Sayeed Unisa2
1 M. Phil, Doctoral fellow, International Institute for Population Sciences, Mumbai, India.
2 Ph.D., Professor, International Institute for Population Sciences, Mumbai, India.
Introduction: India is home to the largest population of orphaned children in the South Asia, who are at increased risk of poor psychosocial well-being. In the Indian context, literature on the psychosocial well-being of orphans and vulnerable children (OVC) is scarce. Our research was aimed at fulfilling this gap by understanding self-reported psychosocial distress among OVC and subsequent coping strategies adopted during their stay at orphanages.
Methods: The present study was conducted in three randomly selected orphanages of Delhi, India, during August-December 2016. Fifteen children (M = 9, F = 6) aged 10-17, were selected for in-depth interviews through a non-probability purposive sampling. Descriptive analysis was used to describe the characteristics of the study participants. Data analysis required the examination and comparison of interview transcripts for content analysis and themes identification.
Results and Discussion: Our findings revealed psychological turmoil and poor social cognition among OVC. Even though children were happy to enjoy their basic necessities of life, the majority of them faced parental bereavement yearning for love, and desiring advocacy and guidance in life. OVC showed low self-concept and lack of purpose in life. Isolation from outside world resulted in feelings of mistrust among OVC. They also felt stigmatized, socially excluded and remained distressed. Coping strategies adopted by OVC included praying to God, forgetting parents, shifting focus, avoiding crowded places, and treating inmates as their family. They also reported indulgence in self-discrimination, substance abuse, and delinquency to avoid psychosocial distress.
Conclusions: Ongoing programs aimed exclusively at fulfilling materialistic needs of OVC could lose focus on their psychosocial issues. New robust interventions are required not only for sufficing the quality services, but also for identifying psychological issues, enhancing social skills, and improving coping strategies and building resilience among OVC.
Keywords: Child, orphaned; coping strategies; health; psychosocial well-being; social psychology; vulnerable children.
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Case Report in Internal Medicine
Acute pancreatitis mimicking myocardial ischemia: A case report and a review of the literature
Authors: Antonio Villa1, Francesca Campagna1, Giulia Gallotta1, Riccardo Bennicelli2, Paola Sartori3
1 M.D., Department of Emergency, ASST Monza, PO Desio, Monza, Italy.
2 M.D., Department of Cardiology, ASST Monza, PO Desio, Monza, Italy.
3 M.D., Department of Surgery, ASST Monza, PO Desio, Monza, Italy.
In literature, acute pancreatitis has been shown to be associated with a wide range of electrocardiographic changes. In the present report, we describe a case of a young woman who presented to our emergency room with chest pain and electrocardiographic alterations suggestive of myocardial ischemia; laboratory data showed elevated amylase and lipase levels. A computed tomography (CT) scan of the abdomen confirmed the diagnosis of acute pancreatitis. In the next day, she repeated the electrocardiogram, which showed a regression of the ST-segment depression. T-waves changes and ST-segment depression are common in acute pancreatitis and, therefore, emergency physicians should consider acute pancreatitis in the differential diagnosis of patients presenting with chest pain and electrocardiographic changes.
Keywords: Acute pancreatitis; electrocardiographic changes; myocardial ischemia.
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Case Report in Internal Medicine
Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report
Authors: Gabriella Nucera1, Valentina Raffaelli1, Lisa Caliari1, Giulia Cantoni1, Pietro Marino1
1 M.D., Department of Emergency, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy.
The patient was an 80-year-old man who arrived at the emergency room with breathing problems. He presented a history of chronic obstructive pulmonary disease (COPD), hypertension, diabetes mellitus and early (stage 1) chronic renal failure with normal levels of creatinine and no sign and symptoms of renal disease. A chest X-ray showed pneumonia. Therefore, he was first treated with 1 g daily of ceftriaxone IV. We did not observe any clinical improvement, and for this reason, a sputum culture was performed to guide the right antibiotic treatment. Subsequently, we started a new antibiotic therapy with trimethoprim/sulfamethoxazole (TMP/SMX) adjusted to renal functioning. Appropriate medical treatment was administered, as well as urine alkalinisation. After the first day of treatment, the patient’s clinical and laboratory status worsened very quickly, with an increased level of serum creatinine from 1.5 to 3.5 mg/dL. We stopped administering the antibiotic therapy immediately. However, we observed acute renal failure with a serum creatinine level of 9.0 mg/dL and four days after his admission, the patient died. Literature showed that patients can develop acute kidney injury (AKI) during or immediately following TMP/SMX therapy. Intrinsic renal impairment –rather, interstitial nephritis– appeared responsible for the great majority of cases, and impairment was transient if therapy was discontinued. In our study, despite the therapy with TMP/SMX was immediately discontinued, and our patient underwent appropriate medical treatment, urine alkalinisation and, then, haemodialysis, the AKI was rapidly fatal. In conclusion, particular attention should be paid to prescribing TMP/SMX to patients affected by chronic renal failure.
Keywords: Acute kidney injury; anti-Bacterial agents; renal insufficiency, acute; trimethoprim/sulfamethoxazole.
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