Evidence for Use of Validated Sepsis Screening Tools in the Prehospital Population: A Scoping Review.

INTRODUCTION: Early detection and treatment of sepsis improves chances of survival; however, sepsis is often difficult to diagnose initially. This is especially true in the prehospital setting, where resources are scarce, yet time is of great significance. Early warning scores (EWS) based on vital signs were originally developed to guide medical practitioners in determining the degree of illness of a patient in the in-patient setting. These EWS were adapted for use in the prehospital setting to predict critical illness and sepsis. We performed a scoping review to evaluate the existing evidence for use of validated EWS to identify prehospital sepsis. METHODS: We performed a systematic search using the CINAHL, Embase, Ovid-MEDLINE, and PubMed databases on September 1, 2022. Articles that examined the use of EWS to identify prehospital sepsis were included and assessed. RESULTS: Twenty-three studies were included in this review: one validation study, two prospective studies, two systematic reviews, and 18 retrospective studies. Study characteristics, classification statistics, and primary conclusions of each article were extracted and tabulated. Classification statistics varied markedly for prehospital sepsis identification across all included EWS: sensitivities ranged from 0.02-1.00, specificities from 0.07-1.00, and PPV and NPV from 0.19-0.98 and 0.32-1.00, respectively. CONCLUSIONS: All studies demonstrated inconsistency for the identification of prehospital sepsis. The variety of available EWS and study design heterogeneity suggest it is unlikely that new research can identify a single gold standard score. Based on our findings in this scoping review, we recommend future efforts focus on combining standardized prehospital care with clinical judgment to provide timely interventions for unstable patients where infection is considered a likely etiology, in addition to improving sepsis education for prehospital clinicians. At most, EWS can be used as an adjunct to these efforts, but they should not be relied on alone for prehospital sepsis identification.

The mediation effects of sexual self-efficacy in the relationship between psychosocial wellbeing and depressive symptoms among female migrant workers in Vietnam.

BACKGROUND: Depression is a common mental disorder that significantly contributes to the global burden of disease. Studies have consistently reported that migrant workers experience higher levels of depressive symptoms, especially women. AIMS: This study aimed to examine the mediation role of sexual self-efficacy on the relationship between psychological wellbeing, and depressive symptoms among young female migrant workers in Vietnam's industrial zones. METHODS: A cross-sectional study was conducted among 1061 female migrant workers aged 18 to 29 from January to November 2020 in Hanoi, Vietnam. Anonymous interview questionnaires were used to collect data on demographic characteristics, psychosocial wellbeing (PWB), sexual self-efficacy, and depressive symptoms. Mediation analysis was conducted to explore the mediation effect of sexual self-efficacy on the relationship between PWB and depressive symptoms. RESULTS: Nearly 8% of the female migrant workers reported experiencing depressive symptoms. The final mediation model showed that the effect of overall psychological wellbeing on depressive symptoms was partially mediated by sexual self-efficacy. Specifically, 4.1% of the effect of overall PWB on depressive symptoms was mediated through sexual self-efficacy. In the PWB subdimension analyses, sexual self-efficacy mediated 14.3% of the effect of personal growth, 8.8% of the effect of purpose in life, 8.0% of the effect of autonomy, and 7.8% of the effect of environmental mastery on depressive symptoms, respectively. CONCLUSION: The study findings demonstrate that sexual self-efficacy plays an important role in the relationship between psychosocial wellbeing and depressive symptoms among female migrant workers in industrial zones in Vietnam. Improving psychosocial wellbeing and promoting sexual health including sexual self-efficacy should be prioritized when addressing depressive symptoms and mental health concerns among industrial zone female migrant workers in Vietnam, which may also be applicable in other low- and middle-income countries with similar socio-cultural settings.