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He L, Lv C, Song X, Hao W, Wang J, Hu Y, Chen Y, Gan Y, Han X, Yan S. Knowledge and practices related to snakebite prevention, China: a cross-sectional study. Bull World Health Organ 2024; 102:234-243. [PMID: 38562205 PMCID: PMC10976863 DOI: 10.2471/blt.23.290169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 04/04/2024] Open
Abstract
Objective To assess knowledge and practices related to snakebite prevention among Chinese residents. Methods By using a multistage random sampling approach augmented by snowball sampling, we surveyed residents from 10 provinces, one municipality and one autonomous region south of the Yangtze River Basin between May 2022 and February 2023. We supplemented the data with a national online survey. We used a χ2-test to identify differences in knowledge and behaviour across various demographic characteristics. We conducted multifactor logistic regression analyses to evaluate factors potentially influencing snakebite knowledge and practices. Findings We obtained 55 775 valid survey responses, 16 200 respondents from the face-to-face survey and 39 575 respondents from the online survey. Only 25.7% (14 325) respondents demonstrated adequate knowledge about snakebites whereas 25.6% (14 295) respondents knew basic first-aid practices or preventive behaviours. Age, marital status, educational attainment, occupation, type of residence and frequency of exposure to nature are significant independent variables affecting snakebite knowledge (P-values: < 0.05). On the other hand, gender, age, marital status, educational attainment, occupation and type of residence were significant independent variables affecting the behaviour of snakebite prevention and first aid (P-values: < 0.05). Conclusion There is a notable shortfall in knowledge, first aid and preventive behaviours among Chinese residents regarding snakebites. Misguided first aid practices can severely compromise the effectiveness of evidence-based therapeutic interventions. Consequently, improving health education concerning snakes and snakebites in this population is needed.
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Affiliation(s)
- Lanfen He
- International School of Public Health and One Health, Hainan Medical University, No 3 Xueyuan Road, Longhua Zone, Haikou, Hainan Province, 571199, China
| | - Chuanzhu Lv
- Emergency Medicine Center of the Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xingyue Song
- Department of Emergency Medicine, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Wenjie Hao
- International School of Public Health and One Health, Hainan Medical University, No 3 Xueyuan Road, Longhua Zone, Haikou, Hainan Province, 571199, China
| | - Juntao Wang
- International School of Public Health and One Health, Hainan Medical University, No 3 Xueyuan Road, Longhua Zone, Haikou, Hainan Province, 571199, China
| | - Yanlan Hu
- International School of Public Health and One Health, Hainan Medical University, No 3 Xueyuan Road, Longhua Zone, Haikou, Hainan Province, 571199, China
| | - Yu Chen
- International School of Public Health and One Health, Hainan Medical University, No 3 Xueyuan Road, Longhua Zone, Haikou, Hainan Province, 571199, China
| | - Yong Gan
- Department of Social Medicine and Health Management at the School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial People's Hospital of Hunan Normal University, Changsha, China
| | - Shijiao Yan
- International School of Public Health and One Health, Hainan Medical University, No 3 Xueyuan Road, Longhua Zone, Haikou, Hainan Province, 571199, China
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Knisely BM, Gaudaen JC, Smith AV, Perta JM, Pamplin JC, Quinn MT, Schmidt PM. Evaluating Medic Performance in Combat Casualty Care Simulation and Training: A Scoping Review of Prospective Research. Mil Med 2023; 188:e1664-e1672. [PMID: 35986604 DOI: 10.1093/milmed/usac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Combat medics are required to perform highly technical medical procedures in austere environments with minimal error. Effective means to quantify medic performance in field and simulated environments are critical to optimize medic training procedures as well as to evaluate the influence of medical equipment and other supportive technologies on medic performance. Human performance evaluation in combat casualty care presents many unique challenges due to the unique environment (battlefields) and population (medics) that must be represented. Recent advances in simulation and measurement technology have presented opportunities to improve simulation fidelity and measurement quality; however, it is currently unclear to what extent these advances have been adopted in this domain. METHODOLOGY In this work, a scoping review of recent (2011-2021) prospective research on Army medic (68 W and Special Operations) performance is presented. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines served as the framework for the review. The goal of this work was to summarize recent trends and practices and to illuminate opportunities for future work. Two human factors experts performed an exhaustive review of relevant, peer-reviewed literature and systematically identified articles for inclusion in the final analysis. The articles were examined in detail, and data elements of interest were extracted. RESULTS Forty-eight articles were identified based on the defined inclusion criteria. Thirty three of the articles focused on technological evaluation, 25 focused on medic training procedures, and 5 focused on evaluating medical techniques. Study contributions were predominantly related to medic training materials/procedures and simulator technology. Supportive medical technologies, including telemedical systems, hemorrhage control devices, and ultrasound devices, also received significant attention. Timing was the most common metric used to quantify medic performance, followed by skill pass/fail ratings. There was a notable lack of neurophysiological data used to examine medic physical/cognitive workload during procedures, a growing practice in many other related domains. The most commonly simulated procedures were hemorrhage control, airway management, and thoracostomy. Notable limitations cited across articles were insufficient simulation fidelity, inadequate sample size or sample representativeness, and poor study design. CONCLUSIONS This work provided a summary of recent peer-reviewed research related to medic simulation and training, and performance evaluation. This article should be used to contextualize existing research and inspire new research questions. Expanding and advancing research on medic simulation and training will help to ensure optimal casualty care at the front lines.
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Affiliation(s)
- Benjamin M Knisely
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - James C Gaudaen
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Andrew V Smith
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Julie M Perta
- MedStar Montgomery Medical Center, Olney, MD 20832, USA
| | - Jeremy C Pamplin
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
- Uniformed Services University, Bethesda, MD 20814, USA
| | - Matthew T Quinn
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Patricia M Schmidt
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
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Hamza M, Knudsen C, Gnanathasan CA, Monteiro W, Lewin MR, Laustsen AH, Habib AG. Clinical management of snakebite envenoming: Future perspectives. Toxicon X 2021; 11:100079. [PMID: 34430847 PMCID: PMC8374517 DOI: 10.1016/j.toxcx.2021.100079] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/29/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Snakebite envenoming is a major cause of morbidity and mortality in rural communities throughout the tropics. Generally, the main clinical features of snakebites are local swelling, tissue necrosis, shock, spontaneous systemic hemorrhage, incoagulable blood, paralysis, rhabdomyolysis, and acute kidney injury. These clinical manifestations result from complex biochemical venom constituents comprising of cytotoxins, hemotoxins, neurotoxins, myotoxins, and other substances. Timely diagnosis of envenoming and identification of the responsible snake species is clinically challenging in many parts of the world and necessitates prompt and thorough clinical assessment, which could be supported by the development of reliable, affordable, widely-accessible, point-of-care tests. Conventional antivenoms based on polyclonal antibodies derived from animals remain the mainstay of therapy along with supportive medical and surgical care. However, while antivenoms save countless lives, they are associated with adverse reactions, limited potency, and are relatively inefficacious against presynaptic neurotoxicity and in preventing necrosis. Nevertheless, major scientific and technological advances are facilitating the development of new molecular and immunologic diagnostic tests, as well as a new generation of antivenoms comprising human monoclonal antibodies with broader and more potent neutralization capacity and less immunogenicity. Repurposed pharmaceuticals based on small molecule inhibitors (e.g., marimastat and varespladib) used alone and in combination against enzymatic toxins, such as metalloproteases and phospholipase A2s, have shown promise in animal studies. These orally bioavailable molecules could serve as early interventions in the out-of-hospital setting if confirmed to be safe and efficacious in clinical studies. Antivenom access can be improved by the usage of drones and ensuring constant antivenom supply in remote endemic rural areas. Overall, the improvement of clinical management of snakebite envenoming requires sustained, coordinated, and multifaceted efforts involving basic and applied sciences, new technology, product development, effective clinical training, implementation of existing guidelines and therapeutic approaches, supported by improved supply of existing antivenoms.
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Affiliation(s)
- Muhammad Hamza
- Infectious and Tropical Diseases Unit, Bayero University Kano, Nigeria
| | - Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Wuelton Monteiro
- Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Matthew R. Lewin
- Center for Exploration and Travel Health, California Academy of Sciences, San Francisco, USA
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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Samuel SP, Chinnaraju S, Williams HF, Pichamuthu E, Subharao M, Vaiyapuri M, Arumugam S, Vaiyapuri R, Baksh MF, Patel K, Trim SA, Duncombe TE, Vaiyapuri S. Venomous snakebites: Rapid action saves lives-A multifaceted community education programme increases awareness about snakes and snakebites among the rural population of Tamil Nadu, India. PLoS Negl Trop Dis 2020; 14:e0008911. [PMID: 33382715 PMCID: PMC7774832 DOI: 10.1371/journal.pntd.0008911] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022] Open
Abstract
The lack of public awareness surrounding the dangers of snakebite envenomation (SBE) is one of the most critical factors contributing to SBE-induced complications, and subsequently exacerbating the number of deaths and disabilities resulting from SBE. In this study, we deployed a multifaceted community education programme to educate students, healthcare professionals and members of the public in rural areas of Tamil Nadu, India about the dangers of SBE, appropriate first aid measures and the 'do's and don'ts' following a snakebite. An assessment of prior knowledge within these communities identified several misconceptions concerning snakes and SBE. Using a combination of direct engagement (estimated to reach over 200,000 people), information leaflets (200,000 distributed), posters, video documentaries, media and social media (>2.8 million engagements), over the course of one year (January to December 2019) we reached over 3 million people in rural Tamil Nadu (around 8% of population). Evaluation of community-based assemblies indicated that at least 90% of attendees were able to recall the key messages at the end of the events, and at least 85% were able to recall the key messages even after 12 months. Due to high demand, a one-day symposium was organised to provide clinical knowledge and training on SBE to 250 healthcare professionals in rural Tamil Nadu. Notably, an assessment of patient data (291 victims) collected from a snakebite referral hospital over the same 12-month period (2019) indicated that arrival time at hospital following a snakebite was significantly faster and the effective first aid measures were administered to patients who were aware of our activities compared to those that were not. Overall, our approach provides a framework on how to educate rural communities about the dangers of SBE and thereby, mitigate delayed SBE treatment leading to an overall reduction in SBE-induced mortality, morbidity, treatment costs and other socio-economic ramifications.
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Affiliation(s)
- Stephen Paul Samuel
- Queen Elizabeth Hospital, Kings Lynn, United Kingdom
- TCR Multispeciality Hospital, Krishnagiri, Tamil Nadu, India
| | | | | | | | | | | | | | | | - M. Fazil Baksh
- Department of Mathematics and Statistics, University of Reading, Reading, United Kingdom
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | | | - Tracey E. Duncombe
- Research and Enterprise Services, University of Reading, Reading, United Kingdom
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