Characteristics of Emergency Room and Hospital Encounters Resulting From Consumer Home Monitors.

BACKGROUND AND OBJECTIVES: Consumer home monitors (CHM), which measure vital signs, are popular products marketed to detect airway obstruction and arrhythmia. Yet, they lack evidence of infant death prevention, demonstrate suboptimal accuracy, and may result in false alarms that prompt unnecessary acute care visits. To better understand the hospital utilization and costs of CHM, we characterized emergency department (ED) and hospital encounters associated with CHM use at a children's hospital. METHODS: We used structured query language to search the free text of all ED and admission notes between January 2013 and December 2019 to identify clinical documentation discussing CHM use. Two physicians independently reviewed the presence of CHM use and categorized encounter characteristics. RESULTS: Evidence of CHM use contributed to the presentation of 36 encounters in a sample of over 300 000 encounters, with nearly half occurring in 2019. The leading discharge diagnoses were viral infection (13, 36%), gastroesophageal reflux (8, 22%) and false positive alarm (6, 17%). Median encounter duration was 20 hours (interquartile range: 3 hours to 2 days; max 10.5 days) and median cost of encounters was $2188 (interquartile range: $255 to $7632; max $84 928). CONCLUSIONS: Although the annual rate of CHM-related encounters was low and did not indicate a major public health burden, for individual families who present to the ED or hospital for concerns related to CHMs, there may be important adverse financial and emotional consequences.

Electronic health records, mobile health, and the challenge of improving global health.

Technology continues to impact healthcare around the world. This provides great opportunities, but also risks. These risks are compounded in low-resource settings where errors in planning and implementation may be more difficult to overcome. Global Health Informatics provides lessons in both opportunities and risks by building off of general Global Health. Global Health Informatics also requires a thorough understanding of the local environment and the needs of low-resource settings. Forming effective partnerships and following the lead of local experts are necessary for sustainability; it also ensures that the priorities of the local community come first. There is an opportunity for partnerships between low-resource settings and high income areas that can provide learning opportunities to avoid the pitfalls that plague many digital health systems and learn how to properly implement technology that truly improves healthcare.

Characterization of the Demographics and Psychiatric Co-Morbidites Among Clients of a Human Rights Clinic in Miami-Dade County, Florida, United States.

Miami-Dade County (MDC) represents a major port of entry for people seeking asylum in the United States, and few studies have systematically evaluated the demographic characteristics of this vulnerable population. Moreover, while the burden of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are thought to be higher in this population, the prevalence of these psychiatric conditions in our community is unknown. An analysis of demographics and psychiatric co-morbidities of the Human Rights Clinic (HRC) of Miami's 93 clients between 2010 and 2015 was conducted. The HRC cohort had the following characteristics: median age of 30 years, 52% female, 46% male, 2% transgender or intersex, and 88% originating from Latin America and the Caribbean. The prevalence of PTSD was 67% and MDD was 53% in the HRC population. We conclude that the mental health burden in asylum-seekers in MDC is alarmingly high and that healthcare providers should remain keenly attentive to the unique needs of this population.

Reporting on pediatric unintentional firearm injury--who's responsible.

BACKGROUND: Gun injury is a leading cause of death among US children and adolescents. Unintentional firearm death disproportionately affects youth. Reports have shown that at least a third of US homes with children have firearms. When children are fatally injured by guns, the location is most often a home, the shooter is family, the gun owner is a relative, and the gun most often originates from the home, where it was left unlocked. METHODS: We conducted an Internet search of pediatric (0-18 years old) fatal and nonfatal firearm injuries from January 1 to August 31, 2014, in the United States, querying the terms shot, gun, accident, and year-old for media reports. Cases were screened for intent and coded for demographics, location, gun specifics, circumstances, relationship between the victim, shooter, gun owner, and any resultant charges. RESULTS: A total of 277 unintentional pediatric gun injury events were reviewed, two-thirds were nonfatal. Half of the victims were younger than 13 years; 25.3% were younger than 7 years, 80% of the victims and 85.6% of the shooters were male. Of shooters, 84.3% were the child victim themselves, a family member, or a friend/acquaintance. Seventy-seven percent of the events took place in a residence. When gun ownership was reported, 68% were owned by a family member. When charges were reported, a third were against minors. CONCLUSION: This study reinforced previous studies that unintentional child firearm injuries predominantly involve the home, family guns, young children, and males, and most could be prevented through adult responsibility for minimizing child access and securing storage of firearms. We further learned that media accounts frequently did not report on gun ownership or charges, details which might increase community awareness or inform policies useful to prevention. Shooters, not owners, were more often charged in unintentional child injuries, and minors were charged even when Child Access Prevention laws could be applied. LEVEL OF EVIDENCE: Epidemiologic study, level 4.