Dr. Google's Advice on First Aid: Evaluation of the Search Engine's Question-Answering System Responses to Queries Seeking Help in Health Emergencies.

INTRODUCTION: The ever-growing penetration of internet and mobile technologies into society suggests that people will increasingly use web searches to seek health-related information, including advice on first aid in medical emergencies. When a bystander is incompetent in first aid and has no immediate support from Emergency Medical Services (EMS), as it happens in low-resource settings or in disasters, instructions found online could be the sole driver for administering first aid before arrival of professional help. STUDY OBJECTIVE: The aim of this study was to evaluate quality of advice on first aid generated by a web search engine's question-answering system (QAS) in response to search queries concerning provision of help in common health emergencies. METHODS: In December 2022-January 2023, an English-language search was carried out in Google with ten queries based on the keyword combinations (what to do OR how to help) AND (bleeding OR chest pain OR choking OR not breathing OR seizure). The search engine's QAS responses (up to 11 per search query) were evaluated for compliance with the International Federation of Red Cross First Aid Guidelines 2020 using the pre-developed checklists. RESULTS: Out of 98 QAS items generated by Google, 67.3% (n = 66) were excluded, mainly because the QAS answers did not address original queries. Eligible unique QAS responses (n = 27) showed poor coverage of the guideline-compliant instructions on first aid. Mean percentage of QAS responses providing a first aid instruction with complete adherence to the guidelines varied from 0.0 for choking to 19.5 for seizure. Only three (11.1%) QAS responses contained an explicit instruction to access EMS, while 66.7% (n = 18) included directions either contradictory to the guidelines and potentially harmful (eg, use of home remedies in chest pain) or inapplicable for an untrained person (eg, use of tourniquet in bleeding). CONCLUSION: Although the search engine's QAS responds to user's inquiries concerning assistance in health emergencies, the QAS-generated answers, as a rule, omit potentially life-saving evidence-based instructions on first aid and oftentimes give advices noncompliant with current guidelines or inadequate for untrained people, and thus create risks for causing harm to a victim.

EMS at 3600 Meters: Exploring Barriers to Emergency Care and Transport in Rural Andean Perú.

BACKGROUND: Given the demonstrated success of programs that bolster informal Emergency Medical Service (EMS) systems in other low- and middle-income counties (LMICs), this study aimed to explore formal and informal systems, practices, customs, and structures for emergency response and medical transport in Colca Valley, Perú while identifying possible opportunities for future intervention. METHODS: Twenty-two interviews with first responders and community members were conducted in three mountain villages throughout rural Andean Colca Valley of Perú. Subjects were recruited based on profession and experience with medical emergencies in the area. Transcripts were entered into Dedoose, coded, and analyzed to identify themes. RESULTS: Providers and community members shared similar perceptions on the most common barriers to emergency care and transport. Challenges experienced equally by both groups were identified as "structural problems," such as lack of infrastructure, lack of structured care delivery, and unclear protocols.Incongruities of responses between groups emerged with regard to certain barriers to care. Providers perceived baseline health education and use of home remedies as significant barriers to seeking care, which was not proportionally corroborated by community members. In contrast, 86% of community members cited lack of trust in health providers as a major barrier.Community members often noted witnessing a high frequency of emergency events, their personal experiences of helping, and the formal utilization of lay providers. When specifically questioned on their willingness to engage in first aid training, all participants were in agreement. CONCLUSION: While structural changes such as increased infrastructure would likely be the most durable improvement, future interventions focused on both empowering community members and improving the relationship between the health center and the community would be beneficial in this community. Additionally, these interview data suggest that a layperson first aid training program would be feasible and well-received.

Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India.

INTRODUCTION: India has remarkably the highest number of snakebite cases contributing to nearly 50% of the global snakebite deaths. Despite this fact, there is limited knowledge and awareness regarding the management practices for snakebite in the Indian population. The study aimed to explore the knowledge, awareness, and perception of snakes and snakebites, first aid, and treatment amongst the community and the frontline health workers in a tribal block of Dahanu, Maharashtra, India. METHODS: A cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu Block, Maharashtra. Perceptions, knowledge, awareness, and first-aid practices on the snakebites among the community were studied through focus group discussions (FGDs). Semi-structured questionnaires were used to assess the knowledge, awareness, and experience of the traditional faith healers, snake rescuers, frontline health workers on the snakebites and their management. A facility check survey was conducted using pre-tested questionnaires for different levels of the government health care facilities. RESULTS: Most of the tribal community was aware of the commonly found snakes and their hiding places. However, there was inadequate knowledge on the identification and classification of venomous snakes. Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported by the tribal community. The application of a harmful method (Tourniquet) as the first aid for snakebite was practiced by the tribal community. They preferred herbal medicines and visiting the traditional faith healers before shifting the patient to the government health facility. The knowledge on the ability to identify venomous snakebites and anti-venom was significantly higher amongst nurses and accredited social health activists (ASHAs) than auxiliary nurse midwives (ANMs) and multi-purpose workers (MPWs) (p < 0.05). None of the traditional faith healers; but nearly 60% of snake rescuers were aware of anti-venom. Fifty percent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite. CONCLUSIONS: Inappropriate perception, inadequate awareness, and knowledge about snakes and snakebites may predispose the tribal community to increased risks of venomous snakebites. Unproven and harmful methods for snakebite treatment practiced by the community and traditional faith healers could be dangerous leading to high mortality. Therefore, a multi-sectoral approach of community awareness, mapping of vulnerable populations, capacity building of health care facility, empowerment of health care workers (HCWs) could be useful for reducing the mortality and morbidity due to snakebite envenoming in India.

Differing Effects of Vinegar on Pelagia noctiluca (Cnidaria: Scyphozoa) and Carybdea marsupialis (Cnidaria: Cubozoa) Stings-Implications for First Aid Protocols.

The jellyfish species that inhabit the Mediterranean coastal waters are not lethal, but their stings can cause severe pain and systemic effects that pose a health risk to humans. Despite the frequent occurrence of jellyfish stings, currently no consensus exists among the scientific community regarding the most appropriate first-aid protocol. Over the years, several different rinse solutions have been proposed. Vinegar, or acetic acid, is one of the most established of these solutions, with efficacy data published. We investigated the effect of vinegar and seawater on the nematocyst discharge process in two species representative of the Mediterranean region: Pelagia noctiluca (Scyphozoa) and Carybdea marsupialis (Cubozoa), by means of (1) direct observation of nematocyst discharge on light microscopy (tentacle solution assay) and (2) quantification of hemolytic area (tentacle skin blood agarose assay). In both species, nematocyst discharge was not stimulated by seawater, which was classified as a neutral solution. In P. noctiluca, vinegar produced nematocyst discharge per se, but inhibited nematocyst discharge from C. marsupialis. These results suggest that the use of vinegar cannot be universally recommended. Whereas in case of a cubozoan C. marsupialis sting, the inhibitory effect of vinegar makes it the ideal rinse solution, in case of a scyphozoan P. noctiluca sting, vinegar application may be counterproductive, worsening the pain and discomfort of the stung area.

Spiritual Health First Aid for Self-Care: Nursing During COVID-19.

ABSTRACT: Nurses who provided care to patients with coronavirus (COVID-19) and supported patients in their transition from life to death in the absence of patients' families have been especially needful of spiritual self-care. A spiritual first aid kit can help nurses cope with these difficult times. Spiritual self-care is vital for all nurses to renew and preserve the psychological, spiritual, and physical self.

[What is the Best Therapeutic Strategy for Decompression Illness? First Aid Oxygen Inhalation and Hyperbaric Oxygen Therapy].

Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.

Intervenções educativas na prevenção ou tratamento da obesidade em adolescentes: revisão integrativa / First aid health education interventions in the school environment: an integrative review

Resumo Objetivo: Identificar a eficácia de intervenções educativas para prevenir ou tratar a obesidade em adolescentes. Método: Foi uma revisão integrativa da literatura, a partir da questão norteadora: "Qual a efetividade das intervenções de prevenção / tratamento da obesidade em adolescentes?" A busca foi realizada em seis bases de dados eletrônicas nos idiomas português, inglês e espanhol, em julho de 2020, o que permitiu a identificação de 5.401 artigos. Resultados: Foram identificados 31 artigos que abrangem intervenções educativas baseadas no suporte nutricional e psicológico, atividade física e estilo de vida saudável. Predominaram atividades físicas, intervenções interdisciplinares comportamentais, nutricionais e de estilo de vida. As ações tiveram um efeito benéfico na qualidade de vida dos participantes, índice de massa corporal, hábitos de exercícios diários e comportamento alimentar positivo entre adolescentes. As intervenções para controle e prevenção da obesidade analisadas nesta revisão tiveram efeitos positivos na redução do peso corporal. Conclusão: Os achados apontaram para a necessidade de mais estudos para maior controle dos benefícios e adesão às intervenções voltadas para a prevenção e tratamento da obesidade.

Abstract Objective: To identify the effectiveness of educational interventions to prevent or treat obesity in adolescents. Method: It was an integrative review of the literature, based on the guiding question: "What is the effectiveness of obesity prevention / treatment interventions in adolescents?" The search was carried out in six electronic databases in Portuguese, English and Spanish in July 2020, which allowed the identification of 5,401 articles. Results: 31 articles were identified that cover educational interventions based on nutritional and psychological support, physical activity and a healthy lifestyle. Physical activity, interdisciplinary behavioral, nutritional and lifestyle interventions predominated. The actions had a beneficial effect on the participants' quality of life, body mass index, daily exercise habits, and positive eating behavior among adolescents. The interventions for the control and prevention of obesity analyzed in this review had positive effects on reducing body weight. Conclusion: The findings pointed to the need for more studies to have greater control over the benefits and adherence to interventions aimed at preventing and treating obesity.

Resumen Objetivo: Identificar la efectividad de las intervenciones educativas para prevenir o tratar la obesidad en adolescentes. Método: Se trató de una revisión integradora de la literatura, basada en la pregunta orientadora: "¿Cuál es la efectividad de las intervenciones de prevención / tratamiento de la obesidad en adolescentes?". La búsqueda se realizó en seis bases de datos electrónicas en portugués, inglés y español en julio de 2020, lo que permitió identificar 5401 artículos. Resultados: Se identificaron 31 artículos que cubren intervenciones educativas basadas en el apoyo nutricional y psicológico, la actividad física y un estilo de vida saludable. Predominó la actividad física, las intervenciones interdisciplinarias conductuales, nutricionales y de estilo de vida. Las acciones tuvieron un efecto beneficioso sobre la calidad de vida de los participantes, el índice de masa corporal, los hábitos de ejercicio diario y la conducta alimentaria positiva entre los adolescentes. Las intervenciones para el control y la prevención de la obesidad analizadas en esta revisión tuvieron efectos positivos en la reducción del peso corporal. Conclusión: Los hallazgos señalaron la necesidad de realizar más estudios para tener un mayor control sobre los beneficios y la adherencia a las intervenciones destinadas a prevenir y tratar la obesidad

Hyperbaric oxygen for decompression sickness.

Decompression sickness (DCS, "bends") is caused by formation of bubbles in tissues and/or blood when the sum of dissolved gas pressures exceeds ambient pressure (supersaturation). This may occur when ambient pressure is reduced during any of the following: ascent from a dive; depressurization of a hyperbaric chamber; rapid ascent to altitude in an unpressurized aircraft or hypobaric chamber; loss of cabin pressure in an aircraft; and during space walks.

First-hand knowledge about snakes and snake-bite management: an urgent need.

Snake-bite is a well-known but fairly ignored medical problem in India. Lack of precise first aid knowledge for snake-bite is a substantial reason for its severe fatality in human beings. The present study is comprised of a pilot survey that assesses and evaluates the knowledge of people of different occupations (teachers, students, farmers, medical residents, and miscellaneous) about snakes and snake-bite management. The pilot survey was conducted through a well-structured open-ended questionnaire about experiences with snakes and snake-bites and first aid measures for accidental snake-bites. Proper knowledge of snakes and snake-bite management was either diminutive or absent in the majority of the subjects, especially amongst teachers. Even the medical professionals were not well acquainted with knowledge about snakes and snake-bite management. Only 13% knew about 'big four', 18% knew 'dry bite', and 21% of subjects knew about anti-snake venom (ASV) used in India. 39% of subjects knew about the whereabouts of traditional healer. Only 12% of subjects, mostly medical residents, knew of any bedside test for diagnosis of snake-bite, and 11% of respondents also knew of LD50 of Indian cobra. A well-timed first aid treatment is always decisive in the management of life-threatening snake-bite cases but the present survey has found that most of the study groups had inadequate and little misleading fundamental knowledge comprising regional snakes, first aid measures for accidental snake-bite, and welfare schemes for snake-bite victims. Therefore, the present study proposes to conduct more such appraisals and strengthening of education curricula on snake-bite that would surely inculcate an adequate level of primary skill in ignorant societies.

Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan.

BACKGROUND: Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries. AIMS AND METHODOLOGY: Structured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites. RESULT: Heath workers scored 27-91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim's visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers. CONCLUSION: Health workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan.

Snakebite in children in Nigeria: A comparison of the first aid treatment measures with the world health organization's guidelines for management of snakebite in Africa.

Background: Snakebite and envenomation remains a public health problem with significant morbidity and mortality in children in developing countries. The World Health Organization (WHO) in 2010 developed guidelines for the prevention and management of snakebite in Africa. Aim: The aim of this study was to compare the pattern of first aid treatment among children presenting with snakebite/envenomation with the 2010 WHO guideline for the prevention and clinical management of snakebite in Africa. Patients and Methods: All children who presented with snakebite over a 7-year period in a teaching hospital in Enugu, Nigeria. The first aid treatment given to these children was obtained and was compared with the provisions of the WHO guideline for the prevention and clinical management of snakebite in Africa (2010). Data collected were analyzed using SPSS version 22. Results: Five (71.4%) of the snakebites occurred in the rainy season and in the dark involving the lower limbs in 85.7% of cases. Six (87.5%) of the patients received one form of first aid before presentation to a health facility. None received first aid interventions in line with the WHO recommendation. Topical application of herbal concoctions to the site of the bite (37.5%) was the most common intervention. One (14.3%) of the children was promptly brought to the health facility following snakebite. The interval from bite to presentation to the health facility ranged from 1 to 12 h (median 5 h: 43 min). Conclusion: Huge gaps still exist in the first aid treatment given to snakebite victims compared to the WHO guidelines.

RésuméContexte: La morsure de serpent et l'envenomation demeurent un problème de santé publique avec une morbidité et une mortalité importantes chez les enfants des pays en développement. L'Organisation mondiale de la Santé (OMS) a élaboré en 2010 des lignes directrices pour la prévention et la gestion des morsures de serpent en Afrique. Objectif: L'objectif de cette étude était de comparer le modèle de traitement des premiers soins chez les enfants présentant des morsures de serpent/envenomation avec la directive 2010 de l'OMS pour la prévention et la prise en charge clinique des morsures de serpent en Afrique. Patients et méthodes: Tous les enfants qui se sont présentés avec des morsures de serpent sur une période de 7 ans dans un hôpital d'enseignement à Enugu, Nigeria. Le traitement de premiers soins accordé à ces enfants a été obtenu et a été comparé aux dispositions de la ligne directrice de l'OMS pour la prévention et la prise en charge clinique des morsures de serpent en Afrique (2010). Les données recueillies ont été analysées à l'aide de la version 22 du SPSS. Résultats: Cinq (71.4%) des morsures de serpent se sont produites pendant la saison des pluies et dans l'obscurité impliquant les membres inférieurs dans 85,7% des cas. Six (87,5 %) des patients ont reçu une forme de premiers soins avant d'être présentés à un établissement de santé. Aucun d'entre eux n'a reçu d'interventions de premiers soins conformément à la recommandation de l'OMS. Application topique des concoctions à base de plantes sur le site de la morsure (37,5%) était l'intervention la plus courante. Un (14,3%) des enfants a été rapidement amené à l'établissement de santé à la suite d'une morsure de serpent. L'intervalle allant de la morsure à la présentation à l'établissement de santé variait de 1 à 12 h (médiane 5 h : 43 min). Conclusion: Il existe encore d'énormes lacunes dans le traitement des premiers soins accordé aux victimes de morsures de serpent par rapport aux lignes directrices de l'OMS.

Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study.

BACKGROUND: Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon. METHODS: We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated. FINDINGS: Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519-841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5-156), p = 0.005) and complications (aOR: 17.3, 2.4-123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%). CONCLUSIONS: We observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals.

Management of epistaxis in patients on novel oral anticoagulation therapy.

BACKGROUND: Individuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy. OBJECTIVE: This paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management. METHOD: A comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019. RESULTS: Patients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined. CONCLUSION: Clinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.

Traditional and modern practices in wounds and burn injuries in a population of North Western Turkey.

BACKGROUND AND AIM: Recommended first aid approaches on burn injuries and wounds are highly effective to reduce complications and improve positive patient outcomes. However, traditional practices can be harmful for wound healing and increase infection risks. Therefore, the present study is aimed at determining Turkish people's traditional and modern first aid practices in burn injuries and wound. METHODS: This population-based descriptive study included 544 participants. Data was collected via questionnaire form. RESULTS: In this study, the most frequent cases that received first aid were cut wounds (56%) and burn injuries (22%). Most of participants (71.7% for burn injuries, 93.9% for open wound, 53% for closed wound) used modern first aid practices. However, some participants believed in the efficiency of traditional remedies in burn injuries and wounds and learned from family elders. In addition, it was found that educational status influenced belief in the effectiveness of traditional practices and that the conditions receiving first aid varied according to age and gender (p < 0.05). CONCLUSIONS: We believe that more individuals (especially, older and female participants) should be contacted in order to provide first aid training and disseminate recommended practices on first aid. Further comprehensive studies are indicated to improve the quality of healthcare and to determine the needs and reasons to Turkish peoples choose of traditional practices.

First-aid knowledge regarding small area burns in children among 5814 caregivers: A questionnaire analysis.

BACKGROUND: To assess caregivers'knowledge of first aid for small-area thermal burns in children, and reduce burns-induced morbidity and damage in children. METHODS: The multi-stage cluster random sampling method was used to recruit school-age children from different kinds of schools. For each child, we selected only one caregiver as our study participant. First-aid knowledge regarding small area burns in children and choices of medical treatment were investigated in the manner of questionnaires. RESULTS: The effective response rate of questionnaire was 99.4% (5814/5850). Folk remedies and daily necessities were chosen by 17.8% (1,036/5814) and 48.9% (2841/5814), respectively. 39.8% (2,312/5814) of caregivers knew all standard burn first aid measures. Moreover, the proportion of knowing all five measures among caregivers with undergraduate education was significantly higher than the figures among those with other educational levels. CONCLUSIONS: Child caregivers had poor knowledge of first aid for small area burns in children. Only a few caregivers knew all five standard first aid measures for managing small area burns. Many non-scientific and inappropriate home remedies are still widely applied among Shanghai citizens. Our study results suggest relevant scientific evidence-informed measures should be more widely disseminated to the citizens.

Creative expression workshops as Psychological First Aid (PFA) for asylum-seeking children: An exploratory study in temporary shelters in Montreal.

BACKGROUND: Considering the growing number of asylum-seeking children worldwide, research on interventions which may buffer the effects of early resettlement conditions on asylum-seeking children's adjustment is warranted. In Canada, creative expressive workshops for asylum-seeking children and adolescents were implemented as a Psychological First Aid (PFA) intervention in temporary shelters. The present exploratory study aims to describe the implementation of these workshops to assess whether the intervention met core elements of PFA and explore its potential in supporting the diverse needs of asylum-seeking youth in temporary shelters, adopting a process-evaluation research approach. METHOD: The intervention was evaluated via a qualitative thematic analysis of extensive field and supervision notes and focus groups with facilitators. RESULTS: Preliminary results suggest that the intervention contributed to fostering emotional safety and a sense of normalcy in children and supported the creation of connections among both children and parents. Children's expression of past and present experiences during the workshops was seen as a way to promote self-efficacy in children and was reported as a potential way to provide some comfort and hope in a time of high instability. However, the high needs of children and the lack of resources in the temporary shelters represented significant challenges and barriers. CONCLUSIONS: PFA using creative expression may be a promising youth mental health prevention intervention in temporary shelters.

Saudi women's complementary alternative medicine practice and attitudes in superficial injuries first aids.

OBJECTIVE: To detect Saudi women's complementary and alternative medicine (CAM) practice and attitudes in superficial injuries first aids. METHODS: A cross-sectional descriptive study included 500 women from Princess Nourah bint Abdul Rahman University, Riyadh, Saudi Arabia. Pre-designed questionnaire was used to collect their socio-demographic characteristics, complementary and alternative medicine practice and attitude in superficial injuries first aids. RESULTS: Most of the participants were young unmarried women coming from middle regions. Burn and superficial cuts represented the commonest superficial injuries. Honey and medical herbs; myrrh were the commonly used CAM. Most participants agreed that CAM is available. Half of participants believed that CAM is safe that could be used without medical consultation. CONCLUSIONS: There is increased interest and positive attitudes toward CAM use among Saudi women, yet they are not aware about its interactions and side effects.

Ethno-knowledge and attitudes regarding snakebites in the Alto Juruá region, Western Brazilian Amazonia.

BACKGROUND: The Alto Juruá region, located in the extreme western part of the Brazilian Amazonia, possesses an indigenous and riverine population which is involved in agricultural and forest extraction activities, and is a region that stands out for its high incidence of snakebites. OBJECTIVES: To assess the attitudes of the victims, the characteristics of the snakes and the circumstances of the snakebites which occurred in a region where human populations are highly exposed to snakes. METHODS: The study was conducted at the Regional Hospital of Juruá in the Municipality of Cruzeiro do Sul (Acre), which regularly attends victims of snakebites in the Alto Juruá region. The snakes that caused the envenomations were identified from clinical and epidemiological diagnosis of the symptoms and signs that patients presented during hospital, and by enzyme immunoassay for venom detection using serum samples of the patients, or by identification of the snake responsible for the envenomation when it was taken to the hospital or photographed. People who suffered or witnessed the snakebite were interviewed to assess the circumstances of the bite, the attitude adopted after the accident and whether they recognized the species of snake that caused the envenomation. RESULTS: There were 133 cases of snakebite (76.24/100.000 inhabitants), mainly involving male individuals living in the rural area and who had a low level of education. The most affected groups were farmers (48%) and children and teenagers (39%). It was observed that 8.3% of them presented a history of recurrence for bites. The lower limbs were the most affected anatomical region (84%). The Bothrops atrox snake, mainly small specimens (mostly juveniles), was the main species involved in the envenomations (83.4%). Snakebites occurred mainly in forest areas, backyards of houses in rural areas and near to aquatic environments, during activities (walking, farming, extractivism, hunting). Most of the time, the snake was on the ground and the bite occurred because of the approximation of the individual, either by trampling or by approximation of a hand. Half of the victims performed some kind of inadequate first aid (not drinking water, use of tourniquet, incision at the site of the bite, use of black stone, drinking a compound "Específico Pessoa"). CONCLUSIONS: Snakebite is an important cause of morbidity in the Alto Juruá region. Bothrops bites are mostly caused by small-sized specimens, probably due to the greater abundance of B. atrox juveniles, and also because small snakes are more difficult for people to see. People are more often bitten on the lower limbs probably due to the size of B. atrox (small and medium) and because the snakes are usually on the ground in most situations. Many victims resort to ineffective actions that can cause complications and also delay serotherapy. A low level of education is a factor that may contribute to worse outcomes in snakebites since it is associated with a lack of knowledge of preventive and first aid measures.

Application of Virtual Reality Technology in Disaster Medicine.

The occurrence of major emergencies often leads to environmental damage, property damage, health challenges and life threats. Despite the tremendous progress we have made in responding to the many challenges posed by disasters in recent years, there are still many shortcomings. As an emerging technology widely used in recent years, virtual reality (VR) technology is very suitable for many fields of disaster medicine, such as basic education, professional training, psychotherapy, etc. The purpose of this review article is to introduce the application of VR technology in the disaster medical field and prospect its trend in the future.

First aid is associated with improved outcomes in large body surface area burns.

BACKGROUND: Animal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%). METHODS: Data was prospectively collected for patients with ≥20% TBSA burns from 2004- 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes - mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury. FINDINGS: 390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12-1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI -13.6% to -6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI -19% to -4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI --0.29 to -0.08; P < 0.001). INTERPRETATION: Adequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care.