Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools.

BACKGROUND: Dengue is a common viral illness and severe disease results in life-threatening complications. Healthcare services in low- and middle-income countries treat the majority of dengue cases worldwide. However, the clinical decision-making processes which result in effective treatment are poorly characterised within this setting. In order to improve clinical care through interventions relating to digital clinical decision-support systems (CDSS), we set out to establish a framework for clinical decision-making in dengue management to inform implementation. METHODS: We utilised process mapping and task analysis methods to characterise existing dengue management at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. This is a tertiary referral hospital which manages approximately 30,000 patients with dengue each year, accepting referrals from Ho Chi Minh city and the surrounding catchment area. Initial findings were expanded through semi-structured interviews with clinicians in order to understand clinical reasoning and cognitive factors in detail. A grounded theory was used for coding and emergent themes were developed through iterative discussions with clinician-researchers. RESULTS: Key clinical decision-making points were identified: (i) at the initial patient evaluation for dengue diagnosis to decide on hospital admission and the provision of fluid/blood product therapy, (ii) in those patients who develop severe disease or other complications, (iii) at the point of recurrent shock in balancing the need for fluid therapy with complications of volume overload. From interviews the following themes were identified: prioritising clinical diagnosis and evaluation over existing diagnostics, the role of dengue guidelines published by the Ministry of Health, the impact of seasonality and caseload on decision-making strategies, and the potential role of digital decision-support and disease scoring tools. CONCLUSIONS: The study highlights the contemporary priorities in delivering clinical care to patients with dengue in an endemic setting. Key decision-making processes and the sources of information that were of the greatest utility were identified. These findings serve as a foundation for future clinical interventions and improvements in healthcare. Understanding the decision-making process in greater detail also allows for development and implementation of CDSS which are suited to the local context.

Health and safety risks faced by delivery riders during the Covid-19 pandemic.

OBJECTIVES: Delivery riders have been front-line workers throughout the pandemic but little is known about their own health and safety during this time. This study explores the health and safety issues facing delivery riders in Ho Chi Minh City, Vietnam, during the Covid-19 pandemic, in particular during the second lockdown (May-October 2021). METHOD: A web-based survey of more than 800 riders was conducted in August-September 2021. Following descriptive statistics, four logit models were fitted to examine the factors associated with (a) sanitizing one's hands, (b) using a face shield, (c) contracting a new health issue, and (d) engaging in riskier traffic behaviors during the lockdown. RESULTS: The riders who were less consistent in adopting health and safety measures tended to be male, older, less-educated, and vaccinated. Also, they were under greater financial pressure and had suffered a larger loss of income during the pandemic. To recover the loss, they worked longer hours and felt under more intense pressure at work. The job pressure, long working hours, and financial burdens led many drivers to adopt risky traffic behaviors, such as speeding. Conversely, where the companies and co-workers were more supportive, riders tended to adopt health prevention measures more often. Fear of Covid-19 also acted as a facilitator. Job and financial pressure combined with the fear of contracting the virus contributed to the occurrence of new heath issues during the pandemic. Again, support from the company and co-workers helped to reduce the risk of new health problems emerging. CONCLUSION: In Ho Chi Minh City and other Global South megacities that employ tens of thousands of riders, ensuring their health and safety is important to support both private businesses and public health. Overall, companies should assume a much larger responsibility here.

Dynamic Variations in Infrared Skin Temperature of Weaned Pigs Experimentally Inoculated with the African Swine Fever Virus: A Pilot Study.

African swine fever (ASF) is a devastating viral disease in pigs and is therefore economically important for the swine industry. ASF is characterized by a short incubation period and immediate death, making the early identification of ASF-infected pigs essential. This pilot-scale study evaluates whether the infrared thermography (IRT) technique can be used as a diagnostic tool to detect changes in skin temperature (Tsk) during the early stages of disease development in experimentally ASF-infected pigs. Clinical symptoms and rectal temperatures (Tcore) were recorded daily, and IRT readings during the experimental ASF infection were analyzed. All infected pigs died at 5-8 days post inoculation (dpi), and the incubation period was approximately 4 dpi. The average Tcore increased from 0 dpi (38.9 ± 0.3 °C) to 7 dpi (41.0 ± 0.5 °C) and decreased by 8 dpi (39.8 ± 0 °C). The maximum Tsk of ASF-infected pigs increased from 2 (35.0 °C) to 3 dpi (38.5 °C). The mean maximum Tsk observed from three regions on the skin (ear, inguinal, and neck) significantly increased from 2 to 3 dpi. This study presents a non-contact method for the early detection of ASF in infected pigs using thermal imaging at 3 days after ASF infection.