COMPARISON OF BODY MASS INDEX LEVEL BY TRIAGE LEVEL IN THE EMERGENCY DEPARTMENT

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED. MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study. RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6-11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98;28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma. CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management. Copyright © 2023 Via Medica.

A longitudinal environmental surveillance study for SARS-CoV-2 from the emergency department of a teaching hospital in Hong Kong.

BACKGROUND: Understanding factors associated with SARS-CoV-2 exposure risk in the hospital setting may help improve infection control measures for prevention. AIM: To monitor SARS-CoV-2 exposure risk among healthcare workers and to identify risk factors associated with SARS-CoV-2 detection. METHODS: Surface and air samples were collected longitudinally over 14 months spanning 2020-2022 at the Emergency Department (ED) of a teaching hospital in Hong Kong. SARS-CoV-2 viral RNA was detected by real-time reverse-transcription polymerase chain reaction. Ecological factors associated with SARS-CoV-2 detection were analysed by logistic regression. A sero-epidemiological study was conducted in January-April 2021 to monitor SARS-CoV-2 seroprevalence. A questionnaire was used to collect information on job nature and use of personal protective equipment (PPE) of the participants. FINDINGS: SARS-CoV-2 RNA was detected at low frequencies from surfaces (0.7%, N = 2562) and air samples (1.6%, N = 128). Crowding was identified as the main risk factor, as weekly ED attendance (OR = 1.002, P=0.04) and sampling after peak-hours of ED attendance (OR = 5.216, P=0.03) were associated with the detection of SARS-CoV-2 viral RNA from surfaces. The low exposure risk was corroborated by the zero seropositive rate among 281 participants by April 2021. CONCLUSION: Crowding may introduce SARS-CoV-2 into the ED through increased attendances. Multiple factors may have contributed to the low contamination of SARS-CoV-2 in the ED, including hospital infection control measures for screening ED attendees, high PPE compliance among healthcare workers, and various public health and social measures implemented to reduce community transmission in Hong Kong where a dynamic zero COVID-19 policy was adopted.

Epidemiology and Outcome of Acute Appendicitis during and before the COVID-19 Pandemic: A Retrospective Single-Center Analysis.

Background and Objectives: We investigated epidemiological factors and outcomes, including the development of complications, for patients with appendicitis according to three sequential coronavirus disease 2019 (COVID-19) pandemic periods, divided by specific time points. Materials and Methods: This observational study included patients with acute appendicitis who arrived at a single-center between March 2019 and April 2022. The study divided the pandemic into three periods: period A as the first phase of the pandemic (from 1 March 2020 to 22 August 2021), period B as the time period the medical system stabilized (from 23 August 2021 to 31 December 2021), and period C as the time period of the exploration of patients with COVID-19 in South Korea (from 1 January 2022 to 30 April 2022). Data collection was based on medical records. The primary outcome was presence or absence of complications and the secondary outcomes were the time taken from ED visit to surgical intervention, the presence and time of the first administration of antibiotics, and the hospital stay time. Results: Of 1,101 patients, 1,039 were included, with 326 and 711 patients before and during the pandemic, respectively. Incidence of complications was not affected during the pandemic (before the pandemic 58.0%; period A 62.7%; period B,55.4%; and period C 58.1%; p = 0.358). Time from symptom onset to emergency department (ED) arrival significantly decreased during the pandemic (before the pandemic 47.8 ± 84.3 h; pandemic 35.0 ± 54 h; p = 0.003). Time from ED visit to the operating room was statistically significantly increased during the pandemic (before the pandemic 14.3 ± 21.67 h; period A 18.8 ± 14.02 h; period B 18.8 ± 8.57 h; period C 18.3 ± 12.95 h; p = 0.001). Age and time from symptom onset to ED arrival were variables affecting the incidence of complications; however, they were not affected during the pandemic (age, OR 2.382; 95% CI 1.545-3.670; time from symptom onset to ED arrival, OR 1.010, 95% CI 1.006-1.010; p < 0.001). Conclusions: This study found no differences in postoperative complications or treatment durations between pandemic periods. The incidence of appendicitis complications was significantly influenced by age and the duration between the onset of symptoms and arrival at the emergency department, but not by the pandemic period itself.

COVID-19 in Patients with a Primary Refugee-Associated Language in a Kentucky Emergency Department During 2020.

COVID-19 has heavily impacted the refugee population in the United States due to exposure risks, living and working conditions, and healthcare access, but little is known about outcomes. We reviewed emergency department visits to a Kentucky hospital among 2163 patients from March-December 2020, studying incidence of COVID-19 diagnosis for patients with a primary refugee-associated language compared to English speakers, and outcomes after diagnosis including hospitalization, length of stay, and in-hospital mortality. Patients in the population of interest had higher odds of COVID-19 diagnosis in the hospital (OR = 12.31, 95% CI 7.80-19.40), but, among those with COVID-19, lower odds of hospital admission (OR = 0.58, 95% CI 0.37-0.90) and shorter median length of stay (4.1 vs. 10.5 days) compared to English speakers. The study corroborates reports of comparatively higher COVID-19 incidence in patients speaking a primary refugee-associated language, but implies milder illness severity, possibly reflecting this population's baseline health.

Locked in and locked out: sequelae of a pandemic for distressed and vulnerable teenagers in Ireland : Post-COVID rise in psychiatry assessments of teenagers presenting to the emergency department out-of-hours at an adult Irish tertiary hospital.

OBJECTIVE: The aim of this study is to investigate the impact of the coronavirus pandemic on teenage psychiatry referrals following crisis presentation to the adult emergency department (ED) of an Irish tertiary hospital. In doing so, this study will specifically examine the effect of COVID-19 on self-injurious behaviour, suicidality and substance use among older adolescents (age 16/17 years). METHODS: This is a retrospective descriptive analysis of acute adolescent psychiatry referrals assessed out-of-hours via the adult ED psychiatry service across three consecutive time points (during the months of March, April and May) from pre-pandemic, 2019 (T1); initial pandemic, 2020 (T2); and peak pandemic, 2021 (T3). Data were obtained via the hospital's ED-specific electronic database, review of original assessment notes and cross-referenced by manually extracting data logged in the on-call register. RESULTS: Crisis psychiatry assessments of teenagers during on-call hours trebled during the period of this study (p < 0.001). Although ED/crisis referrals initially decreased overall at the start of the pandemic, the rate of teenage referrals remained constant, before increasing as restrictions tightened in lockdown. The negative impact of COVID-19 on teenagers' ability to cope was found to be statistically significant (p = 0.001). Changes in rates of self-harming and/or suicidal behaviours were not statistically significant between 2019, 2020 and 2021 (p = 0.082). Alcohol misuse occurred in up to one-third of cases across each timeframe and remained virtually constant throughout the pandemic. Drug misuse decreased from onset of COVID-19 (p = 0.01). CONCLUSIONS: To our knowledge, this is the first study to specifically examine the impact of COVID-19 on suicidality, self-harming behaviours, substance misuse and on-call ED presentations of teenagers in Ireland. This study demonstrates that coronavirus-related stress is associated with negative mental health sequelae for vulnerable at-risk older adolescents, as evidenced by a rise in ED presentations and on-call referrals since the onset of the pandemic. Presentation of increased numbers of under-18's for psychiatry assessment at the adult ED/general hospital indicates a deepening chasm between available and aspirational emergency (adolescent-specific) psychiatric care in the community. Mobilising resilience factors and maximising coping skills for at-risk youth will inform tailored intervention and support strategies along with adequate resourcing of services for vulnerable adolescents in the community.

Transition-of-care program from emergency department to gastroenterology clinics improves follow-up.

OBJECTIVES: Patients discharged from the emergency department (ED) with gastrointestinal (GI) symptoms need to appropriately transition their care to a GI outpatient clinic in a timely manner to have their health needs met and avoid significant morbidity. When this transition isn't optimal, patients are lost to follow-up, potentially placing them at risk for adverse events. We sought to study the effectiveness of implementing an electronic medical record (EMR) based transition-of-care (TOC) program from the ED to outpatient GI clinics. METHODS: We performed a retrospective single center cohort study of patients discharged from the ED of a tertiary care academic medical center referred to outpatient GI clinic before (Pre-TOC patients) and after implementation of an EMR based TOC program (TOC patients). We further stratified patients based on the Distressed Communities Index (DCI), which is a composite measure of economic well-being. We compared rates of appointment scheduling and appointment attendance between the two groups, as well as 30-day readmission rates to the ED. We also performed a subgroup analysis to determine if socioeconomic status would affect patient follow-up rates. RESULTS: We included 380 Pre-TOC and 399 TOC patients in our analysis. TOC patients were found to both schedule appointments (50% vs 27% p-value <0.01) as well as show up to appointments (34% vs 24% p-value <0.01) at significantly higher rates compared to Pre-TOC patients. There was no significant difference between 30-day readmission rates between the two groups. In addition, TOC patients from At-Risk and Distressed Communities were over 22 times more likely to schedule an appointment compared to Pre-TOC patients from similar neighborhoods (OR 22.18, 95% CI 4.23-116.32). CONCLUSION: Our study shows that patients who are discharged from the ED with outpatient GI follow-up are more likely to both schedule and show up to appointments with implementation of an EMR-based direct referral program compared to no patient navigation, particularly among patients of lower socioeconomic status.

Epidemiology and clinical characteristics of drowning patients presenting to a pediatric emergency department from 2017 to 2020.

BACKGROUND: Drowning is a common mechanism of injury in the pediatric population that often requires hospitalization. The primary objective of this study was to describe the epidemiology and clinical characteristics of pediatric drowning patients evaluated in a pediatric emergency department (PED), including the clinical interventions and outcomes of this patient population. METHODS: A retrospective cohort study was conducted of pediatric patients evaluated in a mid-Atlantic urban pediatric emergency department from January 2017 to December 2020 after a drowning event. RESULTS: Eighty patients ages 0-18 were identified, representing 57 79 unintentional events and 1 intentional self-injury event. The majority of patients (50%) were 1-4 years of age. The majority (65%) of patients 4 years of age or younger were White, whereas racial/ethnic minority patients accounted for the majority (73%) of patients 5 years of age or older. Most drowning events (74%) occurred in a pool, on Friday through Saturday (66%) and during the summer (73%). Oxygen was used in 54% of admitted patients and only in 9% of discharged patients. Cardiopulmonary resuscitation (CPR) was performed in 74% of admitted patients and 33% of discharged patients. CONCLUSIONS: Drowning can be an intentional or unintentional source of injury in pediatric patients. Among the patients who presented to the emergency department for drowning, more than half received CPR and/or were admitted, suggesting high acuity and severity of these events. In this study population, outdoor pools, summer season and weekends are potential high yield targets for drowning prevention efforts.

Occupational stress of physicians and nurses in emergency departments after contracting COVID-19 and its influencing factors: a cross-sectional study.

Background: Occupational stress is one of the major occupational health hazards globally. This study investigated the current situation of and factors influencing the occupational stress of physicians and nurses in emergency departments (EDs) after contracting coronavirus disease (COVID-19). Methods: An online questionnaire survey was conducted among physicians and nurses in EDs in China between January 5 and 8, 2023. A general descriptive analysis of variables was conducted, the differences in the occupational stress of physicians and nurses in EDs with different characteristics were analyzed using the chi-square test, and factors influencing occupational stress were investigated using generalized ordinal logistic regression. Results: Of the 1924 physicians and nurses in EDs who contracted COVID-19, 64.71% considered their occupational stress high or very high, with overly intense work as the primary stressor. Those with ≥ 10 years of work tenure, working in tertiary hospitals and with higher professional titles were more stressed, while females, nurses, those with a master's degree or higher, and those who continued to work after contracting COVID-19 were less stressed. There were differences in the predictors of occupational stress between physicians and nurses. Conclusion: China's physicians and nurses in EDs had high occupational stress after contracting COVID-19. Attention should be given to the occupational mental health of physicians and nurses in EDs, and training on the prevention and treatment of COVID-19 infection should be strengthened.

Predictive performance of qSOFA in confirmed COVID-19 patients presenting to the emergency department.

Objectives: It is critical to quickly and easily identify coronavirus disease 2019 (COVID-19) patients who become severely or even critically ill. Thus, this study was conducted to determine the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score in predicting the severity and mortality of COVID-19 patients. Materials and Methods: This was a prospective observational study of COVID-19 patients admitted to the emergency department (ED) between June 22, 2021, and November 21, 2021. The clinical characteristics of the participants were collected by the emergency physicians. The correlation of the qSOFA, Systemic Inflammatory Response Syndrome criteria (SIRS), Pneumonia Severity Index (PSI), and confusion, urea, respiratory rate, blood pressure, 65 years of age and older (CURB-65) scores for 14-day mortality were evaluated. The area under a receiver operating characteristic (AUROC) curve analysis was calculated to compare the effectiveness of qSOFA, SIRS, PSI, and CURB-65 to predict severe disease. Results: Eight hundred and ninety-four subjects were included. Of them, 721 patients (80.6%) survived after 14 days of admission. The mean age was 58.92 ± 17.80 years, and 551 subjects (61.6%) were male. Nonsurvived patients were significantly older (51.09 ± 23.60 vs. 38.10 ± 18.24, P = 0.004) and had more comorbidities (diabetes mellitus, respiratory, cardiovascular, and cerebrovascular disease) in comparison with survived patients. For COVID-19 mortality prediction, the AUROCs of qSOFA, CURB-65, PSI, and SIRS score were 0.799 (95% confidence interval [CI 0.771-0.825]), 0.829 (95% CI [0.803-0.853]), 0.830 (95% CI [0.804-0.854]), and 0.759 (95% CI [0.730-0.787]), respectively. All scores were good predictors of COVID-19 mortality. Conclusion: The qSOFA was more successful than SIRS in predicting mortality for COVID-19 patients and was similar to CURB-65 and PSI. Therefore, the qSOFA score can be considered a simple and rapid screening tool for identifying high-risk patients.

Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England.

BACKGROUND: Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. AIMS: To assess changes to service use following a service user's first visit to a unit, characterise the population accessing these units and examine equality of access to the units. METHODS: A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. RESULTS: The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5-13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%-82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. CONCLUSIONS: Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.

Lung ultrasound in the COVID-19 era: a lesson to be learned for the future.

Lung Ultrasound (LUS) is a reliable, radiation free and bedside imaging technique to assess several pulmonary diseases. Although the diagnosis of COVID-19 is made with the nasopharyngeal swab, detection of pulmonary involvement is key for a safe patient management. LUS is a valid alternative to explore, in paucisymptomatic self-presenting patients, the presence and extension of pneumonia compared to High Resolution Computed Tomography (HRCT) that represent the gold standard. This is a single-centre prospective study with 131 patients enrolled. Twelve lung areas were explored reporting a semiquantitative assessment to obtain the LUS score. Each patient performed reverse-transcription polymerase chain reaction test (rRT-PCR), hemogasanalysis and HRCT. We observed an inverse correlation between LUSs and pO2, P/F, SpO2, AaDO2 (p value < 0.01), a direct correlation with LUSs and AaDO2 (p value < 0.01). Compared with HRCT, LUS showed sensitivity and specificity of 81.8% and 55.4%, respectively, and VPN 75%, VPP 65%. Therefore, LUS can represent an effective alternative tool to detect pulmonary involvement in COVID-19 compared to HRCT.

Impact of the COVID-19 pandemic on medical-seeking behavior in older adults by comparing the presenting complaints of the emergency department visits.

BACKGROUND: The outbreak of the coronavirus disease 2019 (COVID-19) has caused a catastrophic event worldwide. Since then, people's way of living has changed in terms of personal behavior, social interaction, and medical-seeking behavior, including change of the emergency department (ED) visiting patterns. The objective of this study was to analyze the impact of the COVID-19 pandemic on the ED visiting patterns of the older people to explore its variable expression with the intention of ameliorating an effective and suitable response to public health emergencies. METHODS: This was a retrospective study conducted in three hospitals of the Cathay Health System in Taiwan. Patients aged ≥ 65 years who presented to the ED between January 21, 2020, and April 30, 2020 (pandemic stage), and between January 21, 2019, and April 30, 2019 (pre-pandemic stage) were enrolled in the study. Basic demographics, including visit characteristics, disposition, and chief complaints of the patients visiting the ED between these two periods of time, were compared and analyzed. RESULTS: A total of 16,655 older people were included in this study. A 20.91% reduction in ED older adult patient visits was noted during the pandemic period. During the pandemic, there was a decrease in ambulance use among elderly patients visiting the ED, with the proportion decreasing from 16.90 to 16.58%. Chief complaints of fever, upper respiratory infections, psychological and social problems increased, with incidence risk ratios (IRRs) of 1.12, 1.23, 1.25, and 5.2, respectively. Meanwhile, the incidence of both non-life-threatening and life-threatening complaints decreased, with IRRs of 0.72 and 0.83, respectively. CONCLUSION: Health education regarding life-threatening symptom signs among older adult patients and avocation of the proper timing to seek medical attention via ambulance were crucial issues during the pandemic.

Identifying the Challenges of Child Abuse Detection Among Emergency, Pediatrics, and Family Medicine Practitioners in Saudi Arabia.

BACKGROUND: Child abuse is a significant issue across many countries. Despite the situation's innate understanding, many children are not reported to authorities and continue to experience abuse, sometimes even death. Healthcare professionals must be alert for abuse in any child who appears with injuries that are out of the ordinary because it is easy for indicators of child abuse to go unnoticed in a busy emergency department. The current study aims to evaluate and detect the challenges in diagnosing and reporting cases of child abuse among healthcare practitioners in emergency, pediatrics, and family medicine. METHODS: A self-administered online disseminated questionnaire was used for data collection during the period from October 1 to December 30, 2022. A cross-sectional study was conducted on emergency, pediatrics, and family medicine healthcare practitioners working in hospitals in healthcare centers in Riyadh, Saudi Arabia. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for (IBM Corp., Armonk, NY) Windows. RESULTS: The study sample constituted 200 physicians working in the front lines of healthcare like emergency, pediatrics, and family medicine primary care services, 50.5% were males and 49.5% were females. 36.5% of participants were 31-39 years old. 42% were family medicine physicians, 36.5% were pediatricians, and 21.5% were emergency medicine. About 43% of participants attended an educational workshop on child abuse. Nineteen percent of participants are very familiar with the diagnosis of child abuse and 36% of participants reported one to three cases of child abuse in the emergency department in the last year, 5% reported four to six cases and 56.5% reported none. Forty-seven percent of participants reported diagnosing one to five cases of child abuse throughout their whole career, 13% reported 11-15 cases, 6.5% reported six to 10 cases and 28.5% reported none. Causes of underdiagnosis of child abuse by healthcare providers were reported as 63% inexperience, 59% inadequate time for physical examination, 59% lack of diagnosis protocol, 51% lack of confidence in communicating with parents, 36% physicians' cultural background, and 38% lack of confidence in the diagnosis. 93.5% of participants think that healthcare practices need further education for child abuse. CONCLUSION: In conclusion, physicians in Saudi Arabia who participated in the study had good knowledge to diagnose a case of child abuse. Inexperience, inadequate time for physical examination, lack of diagnosis protocol, lack of confidence in communicating with parents, and physicians' cultural background were the main identified challenges for diagnosing child abuse. Familiarity with cases of child abuse was significantly associated with physicians' age, specialty, and level of training.

Investigating the factors affecting adolescents' test anxiety in Greece during the COVID-19 pandemic

The most prevalent mental health challenges in teenagers are generalized anxiety disorder and depression. The (COVID-19) pandemic has added an extra negative effect on children's mental health.(1) This study focuses on the investigation of a specific form of adolescent anxiety, i.e. test anxiety (TA). TA in adolescents is associated with mental and behavioral comorbidities and may have adverse effects on students' academic performance as well as their physiological and psychological well-being. Therefore, this study examines the impact of family communication and body image dissatisfaction on adolescents' test anxiety in Greece. According to the results of the Structural Equation Model that was examined, family communication presented a minimal negative effect on students' TA. However, the main finding of this study was that body image dissatisfaction had an important direct and minimal indirect effect on students' TA. The indirect effect was via the physical activity hours that acted as a mediator between body image dissatisfaction and TA. As a result, examining body image concerns and enhancing family communication may be crucial in assisting adolescents at risk for severe TA symptoms. Implications of the findings are discussed.(1)

An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease.

COVID-19 patients are oftentimes over- or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.

Helmet Continuous Positive Airway Pressure in the Emergency Department: A Practical Guide.

Helmet continuous positive airway pressure is a simple, noninvasive respiratory support strategy to treat several forms of acute respiratory failure, such as cardiogenic pulmonary edema and pneumonia. Recently, it has been largely used worldwide during the COVID-19 pandemic. Given the increased use of helmet continuous positive airway pressure in the emergency department, we aimed to provide an updated practical guide for nurses and clinicians based on the latest available evidence. We focus our attention on how to set the respiratory circuit. Moreover, we discuss the interactions between flow generators, filters, and positive end-expiratory pressure valves and the consequences regarding the delivered gas flow, fraction of inspired oxygen, positive end-expiratory pressure, and noise level.

Predictors of self-harm and emergency department attendance for self-harm in deprived communities.

Emergency departments (EDs) are often the first point of contact for individuals following self-harm. The majority of previous research relies on hospital-based data, yet only a minority of individuals who self-harm in the community present to healthcare services. The study design is cross-sectional survey design. Data from the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC) Household Health Survey, a community-based public health survey in North West England, was collected using stratified random sampling. Three thousand four hundred twelve people were recruited in 2018 from relatively disadvantaged areas. The sample included 1490 men and 1922 women aged 18 to 100 years (M = 49.37, SD = 18.91). Logistic regression analysis was employed to examine demographic, health and socioeconomic predictors of self-harm and ED attendance for self-harm. Age (18-24 years), lower financial status, depression, anxiety and physical and mental health co-morbidity was associated with significantly higher levels of self-harm. People aged 18-24 years, with physical and mental health co-morbidity and lower levels of social support had significantly higher levels of attending EDs for self-harm. Improving people's financial situations, social connectivity, mental and physical health may help to reduce individual risk for self-harm and strain on health services.

A Comprehensive Examination of Pediatric Behavioral Health Service Demand and Utilization in a Large, Academic Health System from 2019 to 2021.

Studies of the effects of COVID-19 on youth suggest a worsening in mental health globally. We performed a retrospective analysis of data from January 2019-November 2021 for all outpatient referrals, as well as outpatient, inpatient, and emergency department (ED) encounters for behavioral health (BH) reasons in children aged < 18 in a large academic health system in the United States. Mean weekly rates of outpatient psychiatry referrals, outpatient psychiatry visits, ED visits, and inpatient admissions for BH reasons were compared between pre-pandemic and pandemic periods. The average weekly rate of ambulatory referrals (8.0 ± 0.33 to 9.4 ± 0.31) and completed appointments (194.2 ± 0.72 to 213.1 ± 0.71) significantly increased during the pandemic, driven largely by teenagers. The weekly average of ED pediatric encounters for BH did not increase during the pandemic, although the percentage of all pediatric ED encounters that were for BH did increase from 2.6 to 4.1% (p < 0.001). Length of stay for pediatric BH ED patients increased from 1.59 ± 0.09 days pre-pandemic to 1.91 ± 0.11 days post-pandemic (p < 0.0001). Inpatient admissions for BH reasons overall decreased during the pandemic, due to a decrease in inpatient psychiatric bed capacity. However, the weekly percentage of inpatient hospitalizations for BH reasons that occurred on medical units increased during the pandemic (15.2% ± 2.8-24.6% ± 4.1% (p = 0.0006)). Taken together, our data suggest the COVID-19 pandemic had varying degrees of impact, depending on the setting of care.

COVID-19 pandemic: ethical issues and recommendations for emergency triage.

The current epidemic of Coronavirus Disease 2019 (COVID-19) has become a public health event worldwide. Through ethical analysis of a series of epidemic prevention phenomena and epidemic prevention measures taken by the Chinese (and other countries) government and medical institutions during the COVID-19 pandemic, this paper discusses a series of ethical difficulties in hospital emergency triage caused by the COVID-19, including the autonomy limitation of patients and waste of epidemic prevention resources due to over-triage, the safety problem of patients because of inaccurate feedback information from intelligent epidemic prevention technology, and conflicts between individual interests of patients and public interests due to the "strict" implementation of the pandemic prevention and control system. In addition, we also discuss the solution path and strategy of these ethical issues from the perspective of system design and implementation based on the Care Ethics theory.

Identifying and Managing Vector-Borne Diseases in Migrants and Recent Travelers in the Emergency Department.

Purpose of Review: Recognition and treatment of neglected tropical and vector-borne diseases is paramount as travel and immigration resume after a brief lull during the COVID-19 pandemic. These patients often present initially to the emergency department, and increasing physician knowledge of symptoms and treatment can reduce morbidity and mortality. This paper aims to summarize typical presentations of common tropical diseases, both neglected and vector borne, and provide the emergency physician with a diagnostic pathway based on current recommendations. Recent Findings: Co-circulation of ZIKV, CHIKV, and DENV is increasingly common in many countries throughout Caribbean and the Americas, requiring that patients be tested for each virus upon presentation. Dengvaxia is now approved as a vaccine against dengue in pediatric and young adult patients. A malaria vaccine, RTS,S/AS01, is currently in phase 3 trials and has been approved as a short-term vaccine by WHO for children in regions with high transmission risk after showing a 30% reduction in severe malaria. Mayaro is currently a neglected arbovirus that presents similarly to Chikungunya and is continuing to spread throughout the Americas at a rapid rate, gaining more attention after the 2016 Zika outbreak. Summary: Emergency physicians should consider internationally acquired illnesses to appropriately identify which patients require admission among well-appearing febrile immigrants or recent travelers presenting to the emergency department. Identifying symptomatology and understanding the appropriate workup and treatment for tropically acquired diseases will assist in recognizing severe complications with prompt treatment.