Epidemiology of sexually transmitted infections in rural Haitian men.

The study attempts to determine the prevalence of organisms associated with urethritis in men in rural southwestern Haiti and to determine the association with demographic, clinical and laboratory variables. A standardised verbal interview was conducted; genital examinations were done; urethral swabs were collected for nucleic acid amplification testing, and first void urine was obtained for urinalysis. The mean participant age was 54; 88.8% lived in a rural area. Swabs were positive for Trichomonas vaginalis in 13.7% (28/205), Mycoplasma genitalium in 6.3% (13/205), Chlamydia trachomatis in 4.4% (9/205) and Neisseria gonorrhoeae in 0% (0/205). Subjects who never reported using condoms were nearly 3.5 times more likely to have any positive swab result (OR: 3.46, 95% CI 1.31-9.14). Subjects who reported their partners had other sexual partners or were unsure were more than three times likely to have any positive swab result (OR: 3.44, 95% CI 1.33-8.92). Infections with Trichomonas vaginalis and Mycoplasma genitalium were the most common.

Epidemiology of sexually transmitted infections in rural southwestern Haiti: the Grand'Anse Women's Health Study.

The study attempts to define socioeconomic, clinical, and laboratory correlates in vaginitis and other sexually transmitted infections in rural southwestern Haiti. A convenience sample of subjects recruited from a rural women's health clinic and attending an established clinic at the Haitian Health Foundation (HHF) clinic was studied. A standardized history and physical examination, including speculum examination, and collection of blood, urine, and vaginal swabs were obtained from the women at the rural clinic. Additional vaginal swab samples only for Nucleic Acid Amplification Test (NAAT) testing were obtained from women at the HHF clinic in Jérémie. Laboratory results from Leon subjects were positive for Gardnerella vaginalis in 41% (41 of 100), Trichomonas vaginalis in 13.5% (14 of 104), Candida sp. in 9% (9 of 100), Mycoplasma genitalium in 6.7% (7 of 104), Chlamydia trachomatis in 1.9% (2 of 104), and Neisseria gonorrhea in 1% (1 of 104) of patients. Human immunodeficiency virus (HIV) antibody tests were negative in 100% (103 of 103) of patients, and syphilis antibody testing was positive for treponemal antibodies in 7.7% (8 of 104) patients. For subjects from the HHF, 19.9% were positive for T. vaginalis, 11.9% were positive for C. trachomatis, 10.1% were positive for M. genitalium, and 4.1% were positive for N. gonorrhea. Infections with G. vaginalis, T. vaginalis, and Candida were the most common. N. gonorrhea, C. trachomatis, Candida sp., T. vaginalis, and M. genitalium infections were associated with younger age (less than 31 years old).

Economic outcome of cardiac CT-based evaluation and standard of care for suspected acute coronary syndrome in the emergency department: a decision analytic model.

RATIONALE AND OBJECTIVES: Cardiac computed tomography (CCT) in the emergency department may be cost saving for suspected acute coronary syndrome (ACS), but economic outcome data are limited. The objective of this study was to compare the cost of CCT-based evaluation versus standard of care (SOC) using the results of a clinical trial. MATERIALS AND METHODS: We developed a decision analytic cost-minimization model to compare CCT-based and SOC evaluation costs to obtain a correct diagnosis. Model inputs, including Medicare-adjusted patient costs, were primarily obtained from a cohort study of 102 patients at low to intermediate risk for ACS who underwent an emergency department SOC clinical evaluation and a 64-channel CCT. SOC costs included stress testing in 77% of patients. Data from published literature completed the model inputs and expanded data ranges for sensitivity analyses. RESULTS: Modeled mean patient costs for CCT-based evaluation were $750 (24%) lower than the SOC ($2384 and $3134, respectively). Sensitivity analyses indicated that CCT was less expensive over a wide range of estimates and was only more expensive with a CCT specificity below 67% or if more than 44% of very low risk patients had CCT. Probabilistic sensitivity analysis suggested that CCT-based evaluation had a 98.9% probability of being less expensive compared to SOC. CONCLUSION: Using a decision analytic model, CCT-based evaluation resulted in overall lower cost than the SOC for possible ACS patients over a wide range of cost and outcome assumptions, including computed tomography-related complications and downstream costs.

Disaster relief in post-earthquake Haiti: unintended consequences of humanitarian volunteerism.

This article provides an overview of US humanitarian relief efforts in Haiti following the earthquake on January 12, 2010. Humanitarian aid arrived rapidly from many sources and was largely provided by organized and skilled humanitarian volunteers. There are however multiple impacts on the existing health care systems, as well as the pharmaceutical and medical supply chain created by massive relief efforts involving personnel, medicines, supplies and equipment that should be considered even in the immediate post-disaster period. Additionally the consequences of short-term medical missions by secular and non-secular NGOs should be considered carefully both in the post-disaster period and as ongoing support to underserved populations.

Off-service resident education in the emergency department: outline of a national standardized curriculum.

Although many residency programs mandate at least one rotation in emergency medicine (EM), to the best of our knowledge, a standardized curriculum for emergency department (ED) rotations for "off-service" residents has not been developed. As a result, the experiences of these residents in the ED tend to vary during their rotations. To design an off-service EM curriculum, we adopted Kern's six-step approach to curriculum development as a conceptual framework. The resulting program encompasses clinical experience and didactic sessions through which residents are trained in core topics and skills. This knowledge will be applicable in the clinical settings in which residents will continue to train and ultimately practice their specialty. It is flexible enough to be applicable and implementable without being limited by resource availability or faculty strengths.

Medical treatment at Louis Armstrong New Orleans International Airport after hurricane Katrina: the experience of disaster medical assistance teams WA-1 and OR-2.

In the week following Hurricane Katrina, over 3000 patients were evacuated by air from a triage and medical treatment station at the Louis Armstrong New Orleans International Airport. This represents the largest air evacuation in history. Over 24,000 additional evacuees were transported from the airport to shelters. Disaster Medical Assistance Teams (DMATs) from several US states were deployed to the Louis Armstrong New Orleans International Airport to provide medical care to those evacuated from New Orleans. Despite warning from the US National Weather Service of catastrophic damage to New Orleans, adequate medical staffing was not attained at the airport triage station until 6 days after the hurricane struck. Organizational lapses, including inadequate medical and operational planning, understaffing of medical personnel, and failure to utilize Incident Command System, diminished the effectiveness of the Hurricane Katrina New Orleans Medical Operation.