Emergency care with lay responders in underserved populations: a systematic review.

OBJECTIVE: To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. METHODS: We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. FINDINGS: Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). CONCLUSION: First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.

Patterns of marine bacterioplankton biodiversity in the surface waters of the Scotia Arc, Southern Ocean.

Spatial patchiness in marine surface bacterioplankton populations was investigated in the Southern Ocean, where the Antarctic Circumpolar Current meets the islands of the Scotia Arc and is subjected to terrestrial input, upwelling of nutrients and seasonal phytoplankton blooms. Total bacterioplankton population density, group-specific taxonomic distribution and six of eight dominant members of the bacterioplankton community were found to be consistent across 18 nearshore sites at eight locations around the Scotia Arc. Results from seven independent 16S rRNA gene clone libraries (1223 sequences in total) and fluorescent in situ hybridization suggested that microbial assemblages were predominantly homogeneous between Scotia Arc sites, where the Alphaproteobacteria, Gammaproteobacteria and the Cytophaga-Flavobacterium-Bacteroidetes cluster were the dominant bacterial groups. Of the 1223 useable sequences generated, 1087 (89%) shared ≥ 97% similarity with marine microorganisms and 331 (27%) matched published sequences previously detected in permanently cold Arctic and Antarctic marine environments. Taken together, results suggest that the dominant bacterioplankton groups are consistent between locations, but significant differences may be detected across the rare biodiversity.