Competency framework, methods, evaluation, and outcomes of natural disaster preparedness and response training: a scoping review protocol.

OBJECTIVE: This systematic scoping review aims to clarify and map the range of natural disaster preparedness and response training for public health personnel around the world. INTRODUCTION: Various preparedness and response training courses, exercises, and drills for public health professionals have been developed for natural disasters. Most of these focus on developing competency. However, there is no overview of the frameworks, methods, evaluation, and outcomes of these disaster preparedness and response training courses, exercises, and drills. INCLUSION CRITERIA: This review will consider all studies that focus on the framework, evaluation, and outcome of training in natural disaster preparedness for public health personnel. METHODS: The databases and sources to be searched will include MEDLINE (PubMed), CINAHL with Full Text Plus, Academic Search Premier, APA PsycINFO, and Ichushi-Web. Searches for gray literature will be conducted using websites that discuss, introduce, or provide competence-based disaster preparedness and response training. These websites will mainly be for public organizations or universities with a focus on public health. The review will consider studies published in both English and Japanese. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. The findings will be summarized in tabular form and accompanied by narrative text.

[Healthcare and daily needs of expectant Brazilian women residing in Japan. Analysis of fieldwork conducted during prenatal examinations and home visits].

OBJECTIVES: To investigate the everyday lives and public healthcare needs of Brazilian nursing mothers and pregnant women residing in Japan, during the pregnancy and postpartum period, and the difficulties experienced in using or accessing the Japanese public healthcare system. METHODS: The participants included 10 Brazilian expectant mothers who were residing in Prefecture A, but did not understand Japanese well, and those who were delivering for the first time in Japan. From August 2007 to July 2009, the researcher and interpreter conducted fieldwork by accompanying participants to medical examinations and making home visits. Analysis of the findings of this field study was carried out by labeling the relevant field note descriptions of each participant's thoughts and feelings concerning pregnancy and childbirth, the state of their everyday lives, and any additional public health-related difficulties encountered during this time. Additionally, individuals with common occurrences were again grouped and categorized for performing the analysis. RESULTS: Among the 10 participants, 8 were in their twenties and 2 were in their thirties; 8 participants had lived in Japan for less than 3 years and 2 of them for less than 10 years. Eight participants had had no prior experience with childbirth, whereas 2 had experienced childbirth. All 10 had resigned from work before entering into the late pregnancy stage, rendering their economic conditions solely dependent upon their husbands' income. In fact, many participants were in a difficult financial state. 6 women lived with their husbands, 2 others lived with husbands and had children, and 2 others were living with their husbands and parents in the same house. Six participants had families nearby that could provide support. However, none of the 10 participants maintained interactions with friends after having resigned from work. Participants were organized into the following 4 major categories based on the state of their everyday lives and the difficulties experienced in terms of public health: (I) women who had strong support from immediate families, but very little everyday interaction with friends and neighbors; (II) women who were forced to lead irregular lifestyles due to demanding workload, which consequently exerted more burden on their bodies; (III) women who did not have sufficient information regarding childbirth in Japan and who were anxious due to lack of information and comprehension; and (IV) women who were confused due to the system and customs that were different from their country of origin. CONCLUSION: The everyday lives of Brazilian pregnant women living in Japan tend to be isolated, and these women have a tendency to maintain irregular living conditions. With respect to the available facilities in the Japanese public healthcare system, these Brazilian women lacked sufficient information concerning pregnancy and childbirth in Japan, and were often perplexed by the different maternity health standards between Japan and Brazil, such as those regarding weight gain. It is important to understand the living conditions of such women residing in Japan, to form stable relationships with them from the beginning of their pregnancies, to formulate a plan to prevent them from being isolated after childbirth, and to create responses that consider information found in their native country Brazil. Furthermore, municipalities, public health centers, obstetric and pediatric medical facilities, international associations, private support organizations, and employers should cooperate with each other to establish a support system that includes the dissemination of side-by-side translation charts and manuals for intercultural understanding of public health regarding pregnancy; in addition, seminars and consultation sessions should be conducted.

Subacute encephalopathy: clinical features, laboratory data, neuroimaging, and outcomes.

We sought to clarify the clinical, laboratory, neuroradiologic, and neurophysiologic features of the "subacute" subtype of encephalopathy. We retrospectively identified nine patients with subacute encephalopathy out of 97 patients diagnosed as manifesting acute encephalopathy. Neurologic symptoms, clinical course, laboratory data, neuroradiologic and electroencephalographic findings, and outcomes were reviewed through medical records. The median age of patients was 44 months (range, 28-156 months). The initial neurologic sign was a brief seizure in 4, a prolonged seizure in 3, delirious behavior in 1, and a loss of consciousness in 1. Loss of consciousness the next day was subtle in 4, and mild in 5. However, a worsening of consciousness was observed 3-7 days after onset. Laboratory data were unremarkable, and electroencephalography during the early phase found abnormalities in 4 of 7 patients. Magnetic resonance imaging revealed no abnormalities during the early phase, and mild cortical atrophy during the late phase. All but one patient had various degrees of neurologic sequelae. Subacute encephalopathy was characterized by a delayed worsening of neurologic symptoms, mild cortical atrophy on late magnetic resonance imaging, and poor neurologic outcomes. Recognition of this type of acute encephalopathy is important, and a method to promote early diagnosis is desirable.

Evolution of seizures and electroencephalographical findings in 23 cases of deletion type Angelman syndrome.

Angelman syndrome (AS) is a genetic disorder with characteristic clinical and EEG findings. We report here the results of long-term follow-up studies on the epileptic seizures and EEG findings of 23 cases of deletion type AS confirmed by FISH analysis, including seven cases previously reported by Matsumoto et al. in 1992. The age at last follow-up in 23 patients was from 1 to 37 years of age (average: 18.0 years), with 10 patients (43.5%) in their 20s, and five over 30. Epileptic seizures were seen in all patients, and the age at seizure onset ranged from 3 to 50 months (average: 21.7 months). Status epilepticus was seen in 11 patients (47.8%). The percentages of cases seizure-free for more than 3 years were 25% (4/16) at 10 years of age, 70% (7/10) at 20, and 80% (4/5) at 30. The EEG findings were classified into six patterns according to the previous report: N (no spike, including focal slow waves), HVS (diffuse high-voltage slow bursts with or without spikes), F (focal spikes or multifocal spikes), S (diffuse spike and waves), C (continuous diffuse spike and waves), Hy (hypsarrythmia or hypsarrhythmia like waves). Hy was noted at ages 0-2 years in two cases. C was observed from the ages 2 to 15 years, being most frequently noted at 3-6 years of age, and it was never seen after 16 years of age. S was observed from ages 1 to 21 years. F was seen from 2 to 21 years of age, and most frequently during the ages of 2-7 years. HVS was seen from 0 years, and still remained after the age of 20. After 22 years of age, all patients showed N pattern including focal slow waves. One of the two patients who had bilateral frontal dominant delta slow waves in their 30s, had a recent seizure. Even if the spikes disappear with age, when bi-frontal focal slow waves remain, seizures may occur even in patients over 30.

Unconsciousness and delirious behavior in children with febrile seizures.

The aim of this study is to clarify the incidence and clinical features of prolonged unconsciousness and delirious behavior in children with febrile seizures. We studied 213 consecutive febrile seizures during 208 febrile episodes in 203 patients. The seizure manifestations, the duration of seizures, the duration of unconsciousness, and the presence or absence of delirious behavior were determined on the basis of interviews with the parents with the assistance of medical records. The duration of seizures was less than 5 minutes in 90.2% of the seizures. The duration of unconsciousness was less than 30 minutes in 93% of the seizures. Delirious behavior was observed in 2.0% of the patients. Delirious behavior appeared before febrile seizures, and its duration was not long. On multiple regression analysis, nongeneralized seizures, seizures of >/=5 minutes, and intravenous diazepam were demonstrated to be independently associated with prolonged unconsciousness. In conclusion, prolonged unconsciousness and delirious behavior are rare in children with febrile seizures. Careful diagnostic evaluation is necessary when a child with febrile seizures has associated prolonged unconsciousness or delirious behavior.

Efficacy of antiepileptic drugs in patients with benign convulsions with mild gastroenteritis.

The aim of this study was to clarify the efficacy of antiepileptic drugs during a cluster of seizures in patients with convulsions with mild gastroenteritis (CwG). We retrospectively investigated the details of antiepileptic treatment in 110 consecutive episodes in 103 patients with CwG. The temporal course of the seizures and the use of antiepileptic drugs were investigated in each episode. Drugs were judged as effective when seizure cessation was achieved after administration of the drug. As the first drug, diazepam (DZP)/bromazepam (BZP) was effective in 38%, phenobarbital (PB) in 40%, and lidocaine (LD) in 100%. As the second drug, DZP/BZP was effective in 42%, PB in 69%, and LD in 100%. As the third drug, PB was effective in 70%. When the efficacy of the first doses of PB and LD were compared, the efficacy rate was significantly higher for LD than for PB (P = 0.047). In conclusion, LD was effective for the cessation of seizures in patients with CwG.

Clinical features of benign convulsions with mild gastroenteritis.

The aim of this study is to reveal the detailed clinical features of benign convulsions with mild gastroenteritis (CwG). We studied 114 consecutive episodes in 105 patients with CwG between January 1995 and March 2000. CwG was defined as when a patient met the following two conditions: (a) seizures accompanied the symptoms of gastroenteritis without clinical signs of dehydration or electrolyte derangement and (b) the body temperature remained less than 38.0 degrees C before and after the seizures. Patients with meningitis, encephalitis/encephalopathy or apparent history of epilepsy were excluded. The age of onset ranged from 8 to 52 months (mean, 21.1 +/- 8.4 months). Six patients (6%) had a family history of afebrile convulsions and seven (7%) had one of febrile convulsions. The average interval between the onset of gastroenteritis and that of seizures was 2.3 +/- 1.1 days (range, 1-6 days). The average number of seizures during a single episode was 2.6 +/- 1.5 (range, 1-7). Two or more seizures occurred in 86 (75%) of the 114 episodes. Seizures induced by pain and/or crying were seen in 35 (43%) of 82 episodes. Antiepileptic drugs were administered for 96 episodes. Seizures did not cease after the administration of one kind of antiepileptic drug in 56 episodes (58%). Epilepsy developed in none of the patients. All patients exhibited normal psychomotor development. CwG is characterized by a cluster of seizures that are sometimes induced by pain and/or crying. The seizures are rather refractory to antiepileptic treatment, although the seizure and development outcomes are good.