National vaccination policies for health workers - A cross-sectional global overview.

BACKGROUND: Immunization is essential for safeguarding health workers from vaccine-preventable diseases (VPDs) that they may encounter at work; however, information about the prevalence and scope of national policies that protect health workers through vaccination is limited. Understanding the global landscape of health worker immunization programmes can help direct resources, assist decision-making and foster partnerships as nations consider strategies for increasing vaccination uptake among health workers. METHODS: A one-time supplementary survey was distributed to World Health Organization (WHO) Member States using the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization (JRF). Respondents described their 2020 national vaccination policies for health workers - detailing VPD policies and characterising technical and funding support, monitoring and evaluation activities and provisions for vaccinating health workers in emergencies. RESULTS: A total of 53 % (103/194) Member States responded and described health worker policies: 51 had a national policy for vaccinating health workers; 10 reported plans to introduce a national policy within 5 years; 20 had subnational/institutional policies; 22 had no policy for vaccinating health workers. Most national policies were integrated with occupational health and safety policies (67 %) and included public and private providers (82 %). Hepatitis B, seasonal influenza and measles were most frequently included in policies. Countries both with and without national vaccination policies reported monitoring and reporting vaccine uptake (43 countries), promoting vaccination (53 countries) and assessing vaccine demand, uptake or reasons for undervaccination (25 countries) among health workers. Mechanisms for introducing a vaccine for health workers in an emergency existed in 62 countries. CONCLUSION: National policies for vaccinating health workers were complex and context specific with regional and income-level variations. Opportunities exist for developing and strengthening national health worker immunization programmes. Existing health worker immunization programmes might provide a foothold on which broader health worker vaccination policies can be built and strengthened.

Hysteroscopic resection for management of early pregnancy loss: a case report and literature review.

Objective: To report a case of early pregnancy loss successfully managed by hysteroscopic resection, review the literature comparing hysteroscopic resection to dilation and curettage for retained products of conception, and review potential advantages of hysteroscopic resection over dilation and curettage for management of early pregnancy loss. Design: Case report. Setting: Private practice. Patients: One woman with early pregnancy loss. Interventions: Hysteroscopic resection using a mechanical morcellation device. Main Outcome Measures: Complete uterine evacuation after hysteroscopic resection as demonstrated by a normal transvaginal ultrasound and cessation of bleeding 2 weeks after surgery. Results: The hysteroscopic fluid deficit was 365 ml, with minimal blood loss. Products of conception were confirmed on pathologic examination. There were no intraoperative or postoperative complications. A saline infusion sonogram obtained 4 months after surgery demonstrated a normal endometrial cavity with no intrauterine adhesions. Conclusions: Surgical management of early pregnancy loss may be complicated by retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Hysteroscopic resection of RPOC has been associated with fewer cases of intrauterine adhesions, more cases of complete tissue removal, and earlier time to conception compared with dilation and curettage. Early pregnancy loss can also be characterized as RPOC with potentially similar benefits from hysteroscopic resection. Thus, hysteroscopic resection can be considered as an alternative surgical technique for management of early pregnancy loss. This case report demonstrates the successful application of hysteroscopic resection in a case of early pregnancy loss.

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy.

BACKGROUND: To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAPd) and non-donor kidneys (MAPnd) with post-donation renal function. METHODS: Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAPd and MAPnd were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively. RESULTS: Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m2 (range 17.1-39.6) and median age 45 years (range 19-78). MAPd score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAPnd score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/1.73m2 (range 48.8-138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAPnd = 0, donors with a MAPnd > 0, mean eGFR was - 2.33 ml/min/1.73m2 lower at postoperative day 1 (95% CI - 4.24 to - 0.41, p = 0.018), - 3.02 ml/min/1.73m2 lower at 1 month (95% CI - 5.11 to - 0.93, p = 0.005), and - 2.63 ml/min/1.73m2 lower at 6 months postoperatively (95% CI - 5.01 to - 0.26, p = 0.030). CONCLUSIONS: MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.

The Association of the Mayo Adhesive Probability (MAP) Score With Total Operative Time in Patients Undergoing Hand-assisted Laparoscopic Donor Nephrectomy.

OBJECTIVE: To assess whether donor kidney Mayo Adhesive probability (MAP) score is associated with (total operative time) ORT in patients undergoing hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS: Three hundred and thirty-one patients undergoing HALDN were reviewed. Donor kidney MAP scores were recorded based on preoperative computed tomography or magnetic resonance imaging. Single variable and multiple variable regression analysis were used to evaluate the correlation between MAP score and ORT. RESULTS: Three hundred and thirty-one patients underwent HALDN between January 2007 and April 2017. Median body mass index was 26.4 kg/m2 (interquartile range 23.4, 29.5) and median age at time of surgery was 45 years (interquartile range 37, 53). Two hundred and thirty-one patients had donor kidney MAP = 0. Hundred patients had donor kidney MAP >0. Mean ORT was 163 minutes for females with MAP = 0 and 166 minutes for females with MAP >0. Median ORT was 180 minutes for males with MAP =0 and 191 minutes for males with MAP >0. Donor kidney MAP score > 0 was significantly correlated with longer ORT (increase of 24.4 minutes, P = .001) in single variable analysis. In multivariable analysis, this correlation was only significant for males (increase of 28.9 minutes, P = .013). CONCLUSION: MAP score > 0 is associated with longer ORT for males undergoing HALDN.

Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis.

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.

Results from a survey of national immunization programmes on home-based vaccination record practices in 2013.

BACKGROUND: Data on home-based records (HBRs) practices within national immunization programmes are non-existent, making it difficult to determine whether current efforts of immunization programmes related to basic recording of immunization services are appropriately focused. METHODS: During January 2014, WHO and the United Nations Children's Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013. RESULTS: A total of 140 countries returned a completed HBR questionnaire. Two countries were excluded from analysis because they did not use a HBR during 2013. HBR types varied across countries (vaccination only cards, 32/138 [23.1%]; vaccination plus growth monitoring records, 31/138 [22.4%]; child health books, 48/138 [34.7%]; combination of these, 27/138 [19.5%] countries). HBRs were provided free-of-charge in 124/138 (89.8%) respondent countries. HBRs were required for school entry in 62/138 (44.9%) countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was

Home-based child vaccination records--a reflection on form.

Home-based child vaccination records play an important role in documenting immunization services received by children. We report some of the results of a review of home-based vaccination records from 55 countries. In doing so, we categorize records into three groups (vaccination only cards, vaccination plus cards, child health books) and describe differences in characteristics related to the quality of data recorded on immunization. Moreover, we highlight areas of potential concern and areas in need of further research and investigation to improve our understanding of the home-based vaccination record form related to improved data quality from immunization service delivery.

Risk factors for mortality during the 2002 landslides in Chuuk, Federated States of Micronesia.

This study examines health effects resulting from landslides in Chuuk during Tropical Storm Chata'an in July 2002, and suggests strategies to prevent future mortality. In August 2002, we conducted a cross-sectional survey to identify risk factors for mortality during landslides, which included 52 survivors and 40 surrogates for 43 decedents to identify risk factors for death. Findings suggest that 1) females had a higher mortality rate from this event than males, and 2) children aged 5-14 years had a 10-fold increase in mortality when compared with annual mortality rates from all causes. Awareness of landslides occurring elsewhere and knowledge of natural warning signs were significantly associated with lower risks of death; being outside during landslides was not associated with reduced mortality. In Chuuk, improving communication systems during tropical storms and increasing knowledge of natural warnings can reduce the risk for mortality during landslides.

Chronic disease and related conditions at emergency treatment facilities in the New Orleans area after Hurricane Katrina.

BACKGROUND: Disaster preparations usually focus on preventing injury and infectious disease. However, people with chronic disease and related conditions (CDRCs), including obstetric/gynecological conditions, may be vulnerable to disruptions caused by disasters. METHODS: We used surveillance data collected after Hurricane Katrina to characterize the burden of visits for CDRCs at emergency treatment facilities (eg, hospitals, disaster medical assistance teams, military aid stations). In 6 parishes in and around New Orleans, health care providers at 29 emergency treatment facilities completed a standardized questionnaire for injury and illness surveillance from September 8 through October 22, 2005. RESULTS: Of 21,673 health care visits, 58.0% were for illness (24.3% CDRCs, 75.7% non-CDRCs), 29.1% for injury, 7.2% for medication refills, and 5.7% for routine or follow-up care. The proportion of visits for CDRCs increased with age. Among men presenting with CDRCs, the most common illnesses were cardiovascular disease (36.8%), chronic lower-respiratory disease (12.3%), and diabetes/glucose abnormalities (7.7%). Among women presenting with CDRCs, the most common were cardiovascular disease (29.2%), obstetric/gynecological conditions (18.2%), and chronic lower-respiratory disease (12.0%). Subsequent hospitalization occurred among 28.7% of people presenting with CDRCs versus 10.9% of those with non-CDRCs and 3.8% of those with injury. CONCLUSIONS: Our data illustrate the importance of including CDRCs as a part of emergency response planning.

Evidence-based approach for disaster preparedness authorities to inform the contents of repositories for prescription medications for chronic disease management and control.

INTRODUCTION: Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death. PROBLEM: A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications. METHODS: Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented. RESULTS: The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions. CONCLUSIONS: Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.

Rapid assessment of the needs and health status in Santa Rosa and Escambia counties, Florida, after Hurricane Ivan, September 2004.

BACKGROUND: Hurricane Ivan, a Category 3 storm, devastated the Florida panhandle on September 16, 2004, causing extensive property damage and 24 deaths. The Florida Department of Health requested assistance from the Centers for Disease Control and Prevention to conduct a rapid assessment in Santa Rosa and Escambia counties to determine the health impact of the hurricane and needs of the affected population. METHODS: A questionnaire was administered 6 days after the hurricane made landfall. The survey instrument elicited information about house damage, illness/injury, and access to utilities. A modified cluster sampling method was used to select 30 clusters in each county. Seven households were interviewed in each cluster and reported weighted frequencies. RESULTS: Three quarters of houses in each county were damaged. Households in Santa Rosa and Escambia lacked basic utilities, including regular garbage pick-up, telephone service, and electricity. Fifty-four percent of households in Santa Rosa and 27% in Escambia reported using a generator. The most commonly self-reported health conditions were sleep disturbances in Santa Rosa (54%) and upper respiratory problems in Escambia (46%). Injuries were reported in fewer than 15% of households in each county. CONCLUSION: Rapid restoration of power, telephone services, and debris pick-up remained a priority 1 week after the event. Findings demonstrated the need for (1) mental health and primary care services, (2) information about safe generator use, and (3) ways to access medical care and medications.

Impact of Hurricane Ivan on pharmacies in Baldwin County, Alabama.

OBJECTIVE: To evaluate the impact of Hurricane Ivan, which made landfall east of Mobile, Alabama, on September 16, 2004, on pharmacies in the affected areas. DESIGN: Retrospective cross-sectional analysis. SETTING: Baldwin County, Alabama. INTERVENTIONS: Pharmacy community rapid-needs-assessment survey. PARTICIPANTS: 41 hospital and community (chain and independent) pharmacies. MAIN OUTCOME MEASURES: Posthurricane pharmacy hours of operations, prescription volumes, infrastructure damage, and prehurricane disaster planning. RESULTS: During the week of the hurricane, both chain and independent community pharmacies within the evacuation zone worked significantly fewer hours (46% and 49%, respectively) and dispensed significantly fewer prescriptions (37% and 52%) compared with the same week of the prior year. Overall, 40% of pharmacies depleted their supplies of certain medications (e.g., anxiolytics, antihypertensives). A total of 60% of the chain and independent pharmacies outside the evacuation zone closed because of loss of electricity, but pharmacies with a generator were significantly less likely to report having turned away patients. The proportion of pharmacies that had a disaster plan but turned away patients or rationed or ran out of medications was similar to that of pharmacies without a disaster plan. CONCLUSION: Although Hurricane Ivan primarily affected the operation of pharmacies within the evacuation zone, pharmacies in the surrounding area were also affected because of loss of power. Emergency management officials should evaluate the efficacy of specific guidelines outlined in disaster plans and identify ways to deliver essential medications to people in disaster-affected areas.

Uninsured adults aged 65 years and older: is their health at risk?

Some U.S. adults aged 65 years and older lack health care coverage. As a result, they may have unmet health needs and be vulnerable to excess morbidity and mortality. Due to their small numbers, little data on them exist. We used data from the 1996-2000 Behavioral Risk Factor Surveillance System, an ongoing telephone survey operated by the state health departments with assistance from the Centers for Disease Control and Prevention, to examine a representative sample of adults 65 years old and older. We found that blacks and Hispanics were disproportionately represented among uninsured older adults. Compared with their insured counterparts, the uninsured elderly experienced cost barriers to needed care, lacked receipt of an annual checkup, and did not receive preventive health screenings. Given the projected growth of the elderly population, particularly among blacks and Hispanics, it is crucial to ensure all older adults have access to preventive health services.

Access to health care among older adults and receipt of preventive services. Results from the Behavioral Risk Factor Surveillance System, 2002.

BACKGROUND: Although most of the 34 million U.S. adults aged 65 years and older have health care coverage, many do not receive preventive care. To investigate why, we examined various barriers to access of health care and their effect on obtaining preventive care. METHODS: A cross-sectional study was conducted of noninstitutionalized adults, aged 65 years or older, in states that participated in the Behavioral Risk Factor Surveillance System in 2002. RESULTS: Of the 46,659 respondents aged 65 years and older, 93% had a regular care provider, 98% had a regular place of care, and 98% were able to obtain needed medical care. Those with a regular care provider or a regular place of care were more likely to receive clinical preventive services than those without either of these. Reasons for not obtaining needed medical care were cost (27%), too long a wait for an appointment (20%), no transportation or distance (9%), office not open when the individual could get there (8%), and other reasons (32%). CONCLUSIONS: Having a regular care provider or a regular place of care is associated with a significant likelihood of receipt of clinical preventive services among older adults. Efforts to eliminate barriers to health care access may increase older adults' receipt of such services.

Natural and technologic hazardous material releases during and after natural disasters: a review.

Natural disasters may be powerful and prominent mechanisms of direct and indirect hazardous material (hazmat) releases. Hazardous materials that are released as the result of a technologic malfunction precipitated by a natural event are referred to as natural-technologic or na-tech events. Na-tech events pose unique environmental and human hazards. Disaster-associated hazardous material releases are of concern, given increases in population density and accelerating industrial development in areas subject to natural disasters. These trends increase the probability of catastrophic future disasters and the potential for mass human exposure to hazardous materials released during disasters. This systematic review summarizes direct and indirect disaster-associated releases, as well as environmental contamination and adverse human health effects that have resulted from natural disaster-related hazmat incidents. Thorough examination of historic disaster-related hazmat releases can be used to identify future threats and improve mitigation and prevention efforts.