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Khatib N, Desouza K, Pritchard J, Erak M, Landes M, Chun S, Bartels S, Battison AW, Sithamparapillai A, Hunchak C, Oyedokun T, Romann V, Heymann E, Stempien J, Johnson K, Eggink K, Collier A. Global emergency medicine partnerships and practice: best practices on forming partnerships. CAN J EMERG MED 2024; 26:224-227. [PMID: 38592663 DOI: 10.1007/s43678-023-00629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/26/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Nour Khatib
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family Medicine, Queen's University, Kingston, Canada.
| | - Kimberly Desouza
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Emergency Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark
| | - Jodie Pritchard
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Marko Erak
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - Megan Landes
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Shannon Chun
- Division of Emergency Medicine, TemertyFacultyofMedicine, University of Toronto, Toronto, Canada
| | - Susan Bartels
- Department of Emergency Medicine, Queen's University, Kingston, Canada
- Departments of Public Health Sciences, Queen's University, Kingston, Canada
| | - Andrew W Battison
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Arjun Sithamparapillai
- Division of Emergency Medicine, TemertyFacultyofMedicine, University of Toronto, Toronto, Canada
| | - Cheryl Hunchak
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Taofiq Oyedokun
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Valerie Romann
- Department of Emergency Medicine, Tiefenau Hospital, Bern, Switzerland
| | - Eric Heymann
- Department of Emergency Medicine, Cantonal Hospital of Neuchâtel, Neuchâtel, Switzerland
| | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Kirsten Johnson
- Division of Emergency Medicine, TemertyFacultyofMedicine, University of Toronto, Toronto, Canada
| | - Kelly Eggink
- Department of Emergency Medicine, North Island Hospital - Comox Valley, Island Health Authority, Courtenay, Canada
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Bartels S, van Olmen J, Bekers E, Drukker C, van Duijnhoven F. Borderline and malignant phyllodes tumors of the breast: a population-based study of all cases in the Netherlands 1989–2020. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Weichert W, Bartels S, Baretton G, Braicu E, Demes M, Endris V, Herold S, Heukamp L, Hummel M, Lehmann U, Merkelbach-Bruse S, Pfarr N, Rad R, Sehouli J, Siemanowski J, Stenzinger A, von Schwarzenberg K, Vollbrecht C, Wild P, Zocholl D. 758P Concordance between multiple HRD assays is substantial in high-grade ovarian cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bartels S, Faisal M, Büsche G, Schlue J, Hasemeier B, Schipper E, Vogtmann J, Westphal L, Lehmann U, Kreipe H. [Bone marrow fibrosis in primary myelofibrosis in relation to myelodysplasia- and age-related mutations of hematopoietic cells]. Pathologe 2020; 41:124-128. [PMID: 33113046 DOI: 10.1007/s00292-020-00828-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Besides histopathological findings, there are no indicators of increased risk for fibrotic progression in myeloproliferative neoplasms (MPNs). Age-related clonal hematopoiesis (ARCH) or clonal hematopoiesis of indetermined potential (CHIP) are frequent findings in the elderly and combinations with MPN driver mutations (JAK2, MPL, and CALR) have been described. To determine the impact of ARCH/CHIP-related mutations for the development of fibrosis in primary myelofibrosis (PMF), the mutational status of cases with fibrotic progression from grade 0 to grade 2/3 (n = 77) as evidenced by follow-up bone marrow biopsies (median 6.2 years) was compared to prefibrotic PMF samples without the development of fibrosis (n = 27; median follow-up 7.3 years). Frequent ARCH/CHIP-associated mutations (TET2, ASXL1, DNMT3A) demonstrable at presentation were not connected with fibrotic progression. However, mutations that are rarely found in ARCH/CHIP (SRSF2, U2AF1, SF3B1, IDH1/2, and EZH2) were present in 24.7% of cases with later development of fibrosis and not detectable in cases staying free from fibrosis (P = 0.0028). Determination of tumor mutational burden (TMB) in a subgroup of cases (n = 32) did not show significant differences (7.68 mutations/MB vs. 6.85 mutations/MB). We conclude that mutations rarely found in ARCH/CHIP provide an independent risk factor for rapid fibrotic progression (median 2.0 years) when already manifest at first presentation.
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Affiliation(s)
- S Bartels
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Faisal
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - G Büsche
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - J Schlue
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Hasemeier
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - E Schipper
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - J Vogtmann
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - L Westphal
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - U Lehmann
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Subedi S, Davison C, Bartels S. Analysis of the relationship between earthquake-related losses and the frequency of child-directed emotional, physical, and severe physical abuse in Haiti. Child Abuse Negl 2020; 106:104509. [PMID: 32413776 DOI: 10.1016/j.chiabu.2020.104509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Child abuse is a public health and human rights issue that is prevalent worldwide. All forms of abuse against children can have negative physical and mental health consequences. Under post-disaster situations, where there is a potential for increased stress and decreased social support among caregivers, the risk of child abuse may be higher. OBJECTIVE To explore the association between earthquake-related losses (family-related and property-related) and the experience of emotional, physical, and severe physical child abuse in the household for children aged 2-14 in Haiti. METHODS A nationally representative sample of Haitian households from the 2012 Demographic and Health Survey (DHS) was used. Descriptive analyses were summarized using frequencies and measures of central tendency. Associations between earthquake-related loss and child abuse was assessed using log-binomial regression modelling. RESULTS Two years following the earthquake, and after considering potentially confounding variables, death of a household member was associated with a higher likelihood of a child being victim to emotional (RR = 1.11, 95 % CI: 1.05-1.17) and severe physical abuse (RR = 1.50, 95 % CI: 1.15-1.96). Conversely, injury of a household member was associated with a lower likelihood of a child experiencing emotional abuse (RR = 0.93, 95 % CI: 0.87-0.99). CONCLUSIONS There were associations between earthquake-related losses and some forms of child abuse; the results were not consistent across all exposures and outcomes. The high prevalence of reported child abuse indicates a need for interventions to reduce child abuse in homes overall. There is also need for further research into the aetiology and influences specific to different types of abuse.
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Affiliation(s)
- Sony Subedi
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada.
| | - Colleen Davison
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
| | - Susan Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queens University, Kingston, Ontario, Canada
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Purkey E, Davison C, MacKenzie M, Beckett T, Korpal D, Soucie K, Bartels S. Experience of emergency department use among persons with a history of adverse childhood experiences. BMC Health Serv Res 2020; 20:455. [PMID: 32448175 PMCID: PMC7245948 DOI: 10.1186/s12913-020-05291-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED utilization among a group of ED users with high ACE scores, as well as their experiences as viewed through the lens of a trauma and violence informed care (TVIC) framework, could be important to their provision of care. METHODS This is the qualitative portion of a larger mixed methods study. Twenty-five ED users with high ACE scores completed in depth interviews. Thematic analysis of the interview transcripts was undertaken and directed content analysis was used to examine the transcripts against a TVIC framework. RESULTS The majority of participants experienced excellent care although challenges to this experience were faced by many in the areas of registration and triage. Some participants did identify negative experiences of care and stigma when presenting with mental health conditions and pain crises, as did participants who perceived that they were considered "different" (dressed differently, living in poverty, young parents, etc.). Participants were thoughtful about their reasons for seeking ED care including lack of timely access to their family doctor, perceived urgency of their condition, or needs that fell outside the scope of primary care. Participants' experiences mapped onto a TVIC framework such that their needs and experiences could be framed using a TVIC lens. CONCLUSIONS While the ED care experience was excellent for most participants, even those with a trauma history, there existed a subset of vulnerable patients for whom the principles of TVIC were not met, and for whom implementation of trauma informed care might have a positive impact on the overall experience of care. Recommendations include training around TVIC for ED leadership, staff and physicians, improved access to semi-urgent primary care, ED patient care plans integrating TVIC principles, and improved support for triage nurses and registration personnel.
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Affiliation(s)
- Eva Purkey
- Queen's University Department of Family Medicine, 220, Bagot street, Kingston, Ontario, K7L 5E9, Canada.
| | - Colleen Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Tracey Beckett
- Family Violence and Crisis Team, Department of National Defense, Kingston, Ontario, Canada
| | - Daniel Korpal
- Department of Emergency Medicine, Western University, London, Ontario, Canada
| | - Katherine Soucie
- Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Bartels
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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Lehmann U, Bartels S. [Liquid biopsy in tumor diagnostics : Applications, perspectives, and limitations of the "cancer liquidome"]. Pathologe 2019; 40:250-255. [PMID: 31049676 DOI: 10.1007/s00292-019-0604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The detection of tumor-specific genetic alterations in body fluids as an addition to or even replacement for established tissue-based tumor diagnostics is currently a hot topic in academic research and industry. Progress in methods for nucleic acid analyses together with promising results from clinical studies have raised great expectations for cancer screening, diagnosis, prognosis, and therapy monitoring by means of a minimally invasive blood draw. Individual focused assays have already been introduced into routine diagnostics and represent a valuable option in cases where no tissue samples are available. However, before the use of liquid biopsy outside of clinical studies is enforced and more complex markers (like tumor mutational burden) are analyzed, several practical challenges and principal problems have to be addressed. This review focusses on the detection of free-circulating nucleic acids in blood plasma and critically discusses established and future applications as well as challenges and limitations of this new method.
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Affiliation(s)
- U Lehmann
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - S Bartels
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Hesselton T, Johnson D, Moran D, Seifert B, Pepin R, Oliver B, Flaherty E, Bartels S. IMPLEMENTING CHANGE IN PRIMARY CARE THROUGH THE ANNUAL WELLNESS VISIT: ON-SITE SUPPORT VS. LEARNING COLLABORATIVE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - D Moran
- Dartmouth-Hithcock Medical Center
| | - B Seifert
- National Alliance for Mental Illness
| | - R Pepin
- Geisel School of Medicine, Dartmouth College
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Becker TK, Trehan I, Hayward AS, Hexom BJ, Kivlehan SM, Lunney KM, Modi P, Osei‐Ampofo M, Pousson A, Cho DK, Levine AC, Anderson Reid E, Balhara KS, Bartels S, Becker TK, Beyene T, Bills CB, Bonney J, Bustamante ND, Chan J, Chang J, Cho DK, Coker A, Collier AT, Cook J, Chow Garbern S, Gutierrez CE, Hansoti B, Hauswald M, Hayward AS, Hexom B, Kearney A, Koval K, Keefe DM, Kivlehan SM, Lee S, Levine AC, Lowsby R, Lunney KM, McVane B, Mediratta RP, Modi P, Nicholson B, Osei‐Ampofo M, Osterhoudt KC, Pousson A, Quao NSA, Ragins K, Rees CA, Rybarczyk M, Schultz M, Selvam A, Silvestri D, Stanford K, Trehan I, Vogel L, Winders WT, Zewdie A. Global Emergency Medicine: A Review of the Literature From 2017. Acad Emerg Med 2018; 25:1287-1298. [PMID: 29791967 DOI: 10.1111/acem.13456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 848 articles met our inclusion criteria and underwent full review. Sixty-three percent were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as EM development. Twenty-one articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's kappa of 0.344. CONCLUSIONS In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles.
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Affiliation(s)
- Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville FL
| | - Indi Trehan
- Lao Friends Hospital for Children Luang Prabang Lao PDR
- Department of Pediatrics and Institute for Public Health Washington University in St. Louis St. Louis MO
- Department of Paediatrics and Child Health University of Malawi BlantyreMalawi
| | | | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago IL
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Harvard Humanitarian Initiative Cambridge MA
| | - Kevin M. Lunney
- Navy Trauma Training Center Los Angeles County and University of Southern California Los Angeles CA
| | - Payal Modi
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Maxwell Osei‐Ampofo
- Emergency Medicine Directorate Komfo Anokye Teaching Hospital and the Kwame Nkrumah University of Science and Technology KumasiGhana
| | - Amelia Pousson
- Department of Emergency Medicine The Johns Hopkins University School of Medicine Baltimore MD
| | | | - Adam C. Levine
- Department of Emergency Medicine The Warren Alpert Medical School of Brown University Providence RI
- Humanitarian Innovation Initiative (HI²) Watson Institute for International and Public Affairs Providence RI
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Batsis J, Al-Nimr R, Pidgeon D, Cook S, Jensen M, Clark M, Mackenzie T, Bartels S. A PILOT STUDY OF A MULTICOMPONENT OBESITY INTERVENTION IN OLDER, RURAL ADULTS WITH OBESITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - S Cook
- University of New Hampshire
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Bakhache N, Michael S, Roupetz S, Garbern S, Bergquist H, Davison C, Bartels S. Implementation of a SenseMaker® research project among Syrian refugees in Lebanon. Glob Health Action 2018; 10:1362792. [PMID: 28857014 PMCID: PMC5645689 DOI: 10.1080/16549716.2017.1362792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Syrian conflict has displaced over 1.2 million Syrians into Lebanon. As a result of displacement, some Syrian families are turning to child marriage as a coping mechanism. The prevalence of early marriage has reportedly increased and the average age of marriage decreased during the crisis. The aim of the project was to understand the underlying factors contributing to child marriage among Syrian refugees in Lebanon using Cognitive Edge’s SenseMaker®. This manuscript explores the process of implementing this novel research tool in a humanitarian setting. Twelve interviewers conducted SenseMaker® interviews with married and unmarried Syrian girls, Syrian parents, as well as married and unmarried men. Participants were asked to share a story about the lives of Syrian girls in Lebanon and to self-interpret the narratives by answering follow-up questions in relation to the story provided. Data collection occurred across three locations: Beirut, Beqaa, and Tripoli. In total 1422 narratives from 1346 unique participants were collected over 7 weeks. Data collection using SenseMaker® was efficient, capable of electronically capturing a large volume of quantitative and qualitative data. SenseMaker® limitations from a research perspective include lack of skip logic and inability to adjust font size on the iOS app. SenseMaker® was an efficient mixed methods data collection tool that was well received by participants in a refugee setting in Lebanon. The utility of SenseMaker® for research could be improved by adding skip logic and by being able to adjust font size on the iOS app.
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Affiliation(s)
- Nour Bakhache
- a Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Saja Michael
- b Sexualities and Sexual and Reproductive Health and Rights , ABAAD Resource Center for Gender Equality , Beirut , Lebanon
| | - Sophie Roupetz
- c University of Leipzig , Department of Psychology , Leipzig , Germany
| | - Stephanie Garbern
- d Department of Emergency Medicine , Beth Israel Deaconess Milton , Milton , MA , USA
| | - Harveen Bergquist
- e Brigham and Women's Hospital , Department of Emergency Medicine , Boston , MA , USA.,f Department of Emergency Medicine , Harvard Medical School , Boston , MA , USA
| | - Colleen Davison
- a Department of Public Health Sciences , Queen's University , Kingston , ON , Canada.,g Department of Emergency Medicine , Queen's University , Kingston , ON , Canada.,h Kingston General Hospital Research Institute , Kingston , ON , Canada
| | - Susan Bartels
- a Department of Public Health Sciences , Queen's University , Kingston , ON , Canada.,g Department of Emergency Medicine , Queen's University , Kingston , ON , Canada.,h Kingston General Hospital Research Institute , Kingston , ON , Canada
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Scott J, Onyango MA, Burkhardt G, Mullen C, Rouhani S, Haider S, Albutt K, Greiner A, VanRooyen M, Bartels S. A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo. BMC Pregnancy Childbirth 2018; 18:322. [PMID: 30089448 PMCID: PMC6083512 DOI: 10.1186/s12884-018-1942-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in conflict-affected settings and may result in sexual violence-related pregnancies (SVRPs). There are limited data on how women with SVRPs make decisions about pregnancy continuation or termination, especially in contexts with limited or restricted access to comprehensive reproductive health services. METHODS A qualitative study was conducted in Bukavu, Democratic Republic of the Congo (DRC) as part of a larger mixed methods study in 2012. Utilizing respondent-driven sampling (RDS), adult women who self-reported sexual violence and a resultant SVRP were enrolled into two study subgroups: 1) women currently raising a child from an SVRP (parenting group) and 2) women who terminated an SVRP (termination group). Trained female research assistants conducted semi-structured interviews with a subset of women in a private setting and responses were manually recorded. Interview notes were translated and uploaded to a qualitative software program, coded, and thematic content analysis was conducted. RESULTS A total of 55 women were interviewed: 38 in the parenting group and 17 in the termination group. There were a myriad of expressed attitudes, beliefs, and emotional responses toward SVRPs and the termination of SVRPs with three predominant influences on decision-making, including: 1) the biologic, ethnic, and social identities of the fetus and/or future child; 2) social reactions, including fear of social stigmatization and/or rejection; and 3) the power of religious beliefs and moral considerations on women's autonomy in the decision-making process. CONCLUSION Findings from women who continued and women who terminated SVRPs reveal the complexities of decision-making related to SVRPs, including the emotional reasoning and responses, and the social, moral, and religious dimensions of the decision-making processes. It is important to consider these multi-faceted influences on decision-making for women with SVRPs in conflict-affected settings in order to improve provision of health services and to offer useful insights for subsequent programmatic and policy decisions.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA 02215 USA
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
| | - Monica A. Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM 87131 USA
| | - Colleen Mullen
- Department of Psychiatry, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118 USA
| | - Shada Rouhani
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Sadia Haider
- Department of Obstetrics & Gynecology, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL 60615 USA
| | - Katherine Albutt
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Ashley Greiner
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215 USA
| | - Michael VanRooyen
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Susan Bartels
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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Scott J, Mullen C, Rouhani S, Kuwert P, Greiner A, Albutt K, Burkhardt G, Onyango M, VanRooyen M, Bartels S. A qualitative analysis of psychosocial outcomes among women with sexual violence-related pregnancies in eastern Democratic Republic of Congo. Int J Ment Health Syst 2017; 11:64. [PMID: 29075319 PMCID: PMC5648419 DOI: 10.1186/s13033-017-0171-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC) and has potentially devastating psychosocial consequences. Previous studies have reported on sexual violence and its impact on the mental health of survivors, but there are few studies conducted among women with sexual violence-related pregnancies (SVRPs). Women with SVRPs may be at greater risk of complex psychosocial outcomes, including social stigmatization. This study aimed to describe psychosocial outcomes among this subgroup of sexual violence survivors in order to inform future interventions. METHODS A mixed methods study was conducted in Bukavu, DRC in 2012 among adult women who self-reported an SVRP and either (1) were currently raising a child from an SVRP (parenting group) or (2) had terminated an SVRP (termination group). This manuscript presents qualitative findings from the mixed methods study. Participants were recruited using respondent-driven sampling and a proportion engaged in semi-structured qualitative interviews conducted by trained female interviewers. Thematic content analysis was conducted and key themes were identified. RESULTS In total, 55 women were interviewed, of whom 38 were in the parenting group and 17 in the termination group. Women with SVRPs experienced a myriad of emotional responses as they navigated their social environments following the SVRPs. Negative reactions, including social stigmatization and/or social rejection, toward women with SVRPs and toward children born from SVRPs were important influences on psychological well-being. Women expressed both internalized emotionality intertwined with externalized experiences in the social environment. Many women demonstrated resilience, or what could be termed post-traumatic growth, identifying avenues of agency to advance the social conditions for women. CONCLUSIONS The findings from the qualitative study, and in particular, the respondents' needs and suggested strategies, may be useful to inform future research, programs, and policies for women with SVRPs in eastern DRC. Future research could move beyond cross-sectional assessments to utilize innovative research methodologies to assess processes of psychological adaptation among women with SVRPs. Multi-dimensional psychosocial programs for women with SVRPs should consider basic needs such as shelter, food, and health care within the broader framework of trauma-informed care. Participatory programming, guided by beneficiaries, could provide further avenues for agency to advance social conditions for women with SVRPs in eastern DRC.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA 02215 USA
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Colleen Mullen
- Department of Psychiatry, One Boston Medical Center Place, Boston Medical Center, Boston, MA 02118 USA
- Department of Psychiatric Emergency Services for Cambridge/Somerville, Boston Medical Center, Boston, MA USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, and HELIOS-Hansehospital Stralsund, University of Greifswald, Greifswald, Germany
| | - Ashley Greiner
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM 87131 USA
| | - Monica Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118 USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 190 Pilgrim Road, Boston, MA 02215 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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Becker TK, Hansoti B, Bartels S, Hayward AS, Hexom BJ, Lunney KM, Marsh RH, Osei-Ampofo M, Trehan I, Chang J, Levine AC. Global Emergency Medicine: A Review of the Literature From 2016. Acad Emerg Med 2017; 24:1150-1160. [PMID: 28474823 DOI: 10.1111/acem.13216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. CONCLUSIONS In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review.
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Affiliation(s)
- Torben K. Becker
- Department of Critical Care Medicine; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Susan Bartels
- Department of Emergency Medicine; Queen's University; Kingston Ontario Canada
- Harvard Humanitarian Initiative; Cambridge MA
| | | | - Braden J. Hexom
- Department of Emergency Medicine; Rush University Medical Center; Chicago IL
| | - Kevin M. Lunney
- TheMedical Corps, US Navy, and the Navy Trauma Training Center; Los Angeles County and University of Southern California; Los Angeles CA
| | - Regan H. Marsh
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- Partners In Health; Boston MA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate; Komfo Anokye Teaching Hospital, and Kwame Nkrumah University of Science and Technology; Kumasi Ghana
| | - Indi Trehan
- Partners In Health; Harper Liberia
- Department of Pediatrics and Institute for Public Health; Washington University in St. Louis; St. Louis MO
- Department of Paediatrics and Child Health; University of Malawi; Blantyre Malawi
| | | | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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15
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Batsis J, Mackenzie T, Bartels S. ASSOCIATION OF SARCOPENIC OBESITY WITH MORTALITY: DATA FROM NHANES 1999–2004. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J.A. Batsis
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - T.A. Mackenzie
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - S. Bartels
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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16
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Batsis J, Mackenzie T, Vasquez E, Germain C, Emeny R, Rippberger P, Lopez-Jimenez F, Bartels S. ASSOCIATION OF ADIPOSITY, TELOMERE LENGTH AND AGE: NHANES 1999–2002. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J.A. Batsis
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - T.A. Mackenzie
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | | | | | - R.T. Emeny
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - P. Rippberger
- University of New England College of Osteopathic Medicine, Biddeford, Maine,
| | | | - S. Bartels
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
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17
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Batsis J, Emeny R, Mackenzie T, Vasquez E, Germain C, Rippberger P, Bartels S. ASSOCIATION OF TELOMERE LENGTH WITH FUNCTIONAL IMPAIRMENTS: DATA FROM NHANES 1999–2002. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J.A. Batsis
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - R.T. Emeny
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - T.A. Mackenzie
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | | | | | - P. Rippberger
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - S. Bartels
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
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18
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Crow R, Lohman M, Bruce M, Titus A, Mackenzie T, Bartels S, Batsis J. ASSOCIATION OF OBESITY AND FRAILTY IN OLDER ADULTS: NHANES 1999–2004. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R.S. Crow
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - M. Lohman
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - M.L. Bruce
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - A.J. Titus
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - T.A. Mackenzie
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - S. Bartels
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - J.A. Batsis
- Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
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Jimenez D, Bartels S, Alegria M, Reynolds C. THE HAPPY OLDER LATINOS ARE ACTIVE (HOLA) HEALTH PROMOTION AND PREVENTION STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D. Jimenez
- Psychiatry, University of Miami Miller School of Medicine, Miami, Florida,
| | - S. Bartels
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - M. Alegria
- Massachsuettes General Hospital, Boston, Massachusetts,
| | - C. Reynolds
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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20
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Affiliation(s)
- J.A. Batsis
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - T.A. Mackenzie
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - R.T. Emeny
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
| | - P. Rippberger
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | | | - S. Bartels
- Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,
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21
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Burkhardt G, Scott J, Onyango MA, Rouhani S, Haider S, Greiner A, Albutt K, VanRooyen M, Bartels S. Sexual violence-related pregnancies in eastern Democratic Republic of Congo: a qualitative analysis of access to pregnancy termination services. Confl Health 2016; 10:30. [PMID: 28031743 PMCID: PMC5175384 DOI: 10.1186/s13031-016-0097-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 09/07/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Sexual violence has been prevalent throughout the armed conflict in eastern Democratic Republic of Congo (DRC). Research on sexual violence-related pregnancies (SVRPs) and pregnancy termination in eastern DRC, a context with high prevalence of sexual violence, high maternal mortality, and restrictive abortion laws, is scant but crucial to improving the overall health of women in the DRC. Understanding women's perceptions and experiences related to an SVRP, and in particular to pregnancy termination in this context, is critical for developing effective, targeted programming. METHODS Respondent-driven sampling (RDS) was used to recruit two subgroups of women reporting SVRPs, 1) women raising a child from an SVRP (parenting group) and 2) women who had terminated an SVRP (termination group), in Bukavu, DRC in 2012. Semi-structured qualitative interviews on pregnancy history and outcomes were conducted with a systematically selected sub-group of women recruited through RDS methodology. Interview responses were translated, transcribed and uploaded to the qualitative data analysis software Dedoose. Thematic content analysis, complemented by the constant comparative technique from grounded theory, was subsequently used as the analytic approach for data analysis. RESULTS Fifty-five qualitative interviews (38 parenting group and 17 termination group) were completed. The majority of women in the termination group reported using traditional herbs to terminate the SVRP, which they often obtained on their own or through family, friends and traditional healers; whereas women in the parenting group reported ongoing pregnancies after attempting pregnancy termination with herbal medications. Three women in the termination group reported accessing services in a health center. Almost half of the women in the parenting group cited fear of death from termination as a reason for continuing the pregnancy. Other women in the parenting group contemplated pregnancy termination, but did not know where to access services. Potential legal ramifications and religious beliefs also influenced access to services. CONCLUSIONS Women in this study had limited access to evidence-based safe abortion care and faced potential consequences from unsafe abortion, including increased morbidity and mortality. Increased access to reproductive health services, particularly safe, evidence-based abortion services, is paramount for women with SVRPs in eastern DRC and other conflict-affected regions.
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Affiliation(s)
- Gillian Burkhardt
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Jennifer Scott
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
- Brigham and Women’s Hospital, Division of Women’s Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | | | - Shada Rouhani
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, IL USA
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard School of Public Health, Boston, MA USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Department of Emergency Medicine, Queen’s University, Kingston, ON Canada
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22
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Onyango MA, Burkhardt G, Scott J, Rouhani S, Haider S, Greiner A, Albutt K, Mullen C, VanRooyen M, Bartels S. A Qualitative Analysis of Disclosure Patterns among Women with Sexual Violence-Related Pregnancies in Eastern Democratic Republic of Congo. PLoS One 2016; 11:e0164631. [PMID: 27741262 PMCID: PMC5065222 DOI: 10.1371/journal.pone.0164631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
The Democratic Republic of the Congo (DRC) has experienced nearly two decades of civil conflict in the Eastern regions of North and South Kivu. This conflict has been notorious for the use of sexual violence as a weapon of war, leading in many cases to pregnancy after rape. The objectives of this analysis were: 1) to describe patterns of sexual violence-related pregnancy (SVRP) disclosure; 2) to consider why survivors chose to disclose to particular individuals; and 3) to examine the dialogue around SVRPs between women with SVRPs and their confidants. In South Kivu Province, Democratic Republic of Congo, two sub-groups of sexual violence survivors completed qualitative interviews, those currently raising a child from an SVRP (parenting group, N = 38) and those who had terminated an SVRP (termination group, N = 17). The findings show that a majority of SVRPs were conceived when participants were held in sexual captivity for prolonged periods of time. The SVRPs were disclosed to friends, family members, other sexual violence survivors, community members, spouses, health care providers, or perpetrators. The confidants were most often chosen because they were perceived by the participants as being discreet, trusted, and supportive. The confidants often provided advice about continuing or terminating the SVRP. Trust and discretion are the most important factors determining to whom women with SVRPs disclose their pregnancies. The vital role of confidants in giving support after disclosure cannot be overlooked. Providing opportunities for survivors to safely disclose their SVRPs, including to health care providers, is a necessary first step in allowing them to access safe and comprehensive post-assault care and services.
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Affiliation(s)
- Monica Adhiambo Onyango
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, Massachusetts, United States of America
| | - Jennifer Scott
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Department of Obstetrics and Gynecology, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Division of Women’s Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shada Rouhani
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, United States of America
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts, United States of America
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts, United States of America
| | - Colleen Mullen
- Boston Medical Center, Department of Psychiatry, Boston, Massachusetts, United States of America
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts, United States of America
- Queen’s University, Department of Emergency Medicine, Kingston, Canada
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23
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Becker TK, Hansoti B, Bartels S, Bisanzo M, Jacquet GA, Lunney K, Marsh R, Osei‐Ampofo M, Trehan I, Lam C, Levine AC, Anderson RE, Armstrong P, Aschkenasy M, Balhara KS, Boyd M, Chan J, Dickason RM, Grover E, Hauswald M, Hayward AS, Hexom B, House E, Jenson A, Kearney A, Keefe DM, Kivlehan S, Machen HE, Mahal J, Marsh RH, Millikan DJ, Modi P, Nicholson B, Rahman N, Rybarczyk M, Schroeder ED, Selvam A, Silvestri D, Trehan I, Tyler Winders W. Global Emergency Medicine: A Review of the Literature From 2015. Acad Emerg Med 2016; 23:1183-1191. [PMID: 27146277 DOI: 10.1111/acem.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year 12,435 articles written in six languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. A total of 723 articles were deemed appropriate by at least one reviewer and approved by their editor for formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 723 articles met our predetermined inclusion criteria and underwent full review. Sixty percent were categorized as emergency care in resource-limited settings (ECRLS), 17% as EM development (EMD), and 23% as disaster and humanitarian response (DHR). Twenty-four articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability between reviewers gave an intraclass correlation coefficient of 0.71 (95% confidence interval = 0.66 to 0.75). Studies and reviews with a focus on infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. CONCLUSIONS In 2015, there were almost twice as many articles found by our search compared to the 2014 review. The number of EMD articles increased, while the number ECRLS articles decreased. The number of DHR articles remained stable. As in prior years, the majority of articles focused on infectious diseases.
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Affiliation(s)
- Torben K. Becker
- Department of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | - Bhakti Hansoti
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Susan Bartels
- Department of Emergency Medicine Queen's University Kingston Ontario Canada
- Harvard Humanitarian Initiative Cambridge MA
| | - Mark Bisanzo
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine Boston University School of Medicine, and Boston University Center for Global Health and Development Boston MA
| | - Kevin Lunney
- Medical Corps US Navy Department of Emergency Medicine Navy Hospital Camp Lejeune Camp Lejeune NC
| | - Regan Marsh
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Partners In Health Boston MA
| | - Maxwell Osei‐Ampofo
- Accident & Emergency Department Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Indi Trehan
- Department of Pediatrics and Institute for Public Health Washington University in St. Louis St. Louis MO
- Department of Pediatrics and Child Health University of Malawi Blantyre Malawi
| | - Christopher Lam
- Warren Alpert Medical School of Brown University Providence RI
| | - Adam C. Levine
- Department of Emergency Medicine Warren Alpert Medical School of Brown University Providence RI
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24
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Rouhani SA, Scott J, Greiner A, Albutt K, Hacker MR, Kuwert P, VanRooyen M, Bartels S. Stigma and Parenting Children Conceived From Sexual Violence. Pediatrics 2015; 136:e1195-203. [PMID: 26438704 PMCID: PMC4890150 DOI: 10.1542/peds.2014-3373] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Since armed conflict began in 1996, widespread sexual violence in eastern Democratic Republic of Congo has resulted in many sexual violence-related pregnancies (SVRPs). However, there are limited data on the relationships between mothers and their children from sexual violence. This study aimed to evaluate the nature and determinants of these maternal-child relationships. METHODS Using respondent-driven sampling, 757 women raising children from SVRPs in South Kivu Province, Democratic Republic of Congo were interviewed. A parenting index was created from questions assessing the maternal-child relationship. The influences of social stigma, family and community acceptance, and maternal mental health on the parenting index were assessed in univariate and multivariable analyses. RESULTS The majority of mothers reported positive attitudes toward their children from SVRPs. Prevalence of perceived family or community stigma toward the women or their children ranged from 31.8% to 42.9%, and prevalence of perceived family or community acceptance ranged from 45.2% to 73.5%. In multivariable analyses, stigma toward the child, as well as maternal anxiety and depression, were associated with lower parenting indexes, whereas acceptance of the mother or child and presence of a spouse were associated with higher parenting indexes (all P ≤ .01). CONCLUSIONS In this study with a large sample size, stigma and mental health disorders negatively influenced parenting attitudes, whereas family and community acceptance were associated with adaptive parenting attitudes. Interventions to reduce stigmatization, augment acceptance, and improve maternal mental health may improve the long-term well-being of mothers and children from SVRPs.
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Affiliation(s)
- Shada A Rouhani
- Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts;
| | - Jennifer Scott
- Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Women's Health and Departments of Obstetrics and Gynecology and
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michele R Hacker
- Harvard Medical School, Boston, Massachusetts; Departments of Obstetrics and Gynecology and Harvard School of Public Health, Boston, Massachusetts
| | - Philipp Kuwert
- Department of Psychiatry, HELIOS Hansehospital, University Medicine Greifswald, Stralsund, Germany; and
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Emergency Medicine, Queen's University, Ontario, Canada
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Bartels S, Bothe M, Honndorf S, Harleman J, Brito-de la Fuente E, Stover J, Westphal M. SUN-LB024: Omegaven® 10% Ameliorates Stroke Severity by Early Neuroprotection in a Transient Stroke Model in Mice. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Becker TK, Bartels S, Hansoti B, Jacquet GA, Lunney K, Marsh R, Osei-Ampofo M, Lam C, Levine AC. Global emergency medicine: a review of the literature from 2014. Acad Emerg Med 2015. [PMID: 26223901 DOI: 10.1111/acem.12733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a worldwide audience of academics and clinical practitioners. METHODS This year 6,376 articles written in six languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. A total of 477 articles were deemed appropriate by at least one reviewer and approved by the editor for formal scoring of overall quality and importance. RESULTS Of the 477 articles that met our predetermined inclusion criteria, 63% were categorized as emergency care in resource-limited settings, 13% as EM development, and 23% as disaster and humanitarian response. Twenty-five articles received scores of 17.5 or higher and were selected for formal summary and critique. Inter-rater reliability for two reviewers using our scoring system was good, with an intraclass correlation coefficient of 0.657 (95% confidence interval = 0.589 to 0.713). Studies and reviews focusing on infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. CONCLUSIONS In 2014, there were fewer total articles, but a slightly higher absolute number of articles screening in for formal scoring, when compared to the 2013 review. The number of EM development articles decreased, while the number of disaster and humanitarian response articles increased. As in prior years, the majority of articles focused on infectious diseases and trauma.
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Affiliation(s)
- Torben K. Becker
- Department of Emergency Medicine; University of Michigan; Ann Arbor MI
| | - Susan Bartels
- Department of Emergency Medicine; Queen's University; Kingston Ontario Canada
- Harvard Humanitarian Initiative; Cambridge MA
| | - Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine; Boston University School of Medicine; Boston MA
- Boston University Center for Global Health and Development; Boston MA
| | - Kevin Lunney
- Medical Corps; US Navy, Department of Emergency Medicine; Navy Hospital Camp Lejeune; Camp Lejeune NC
| | - Regan Marsh
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- Partners In Health; Boston MA
| | - Maxwell Osei-Ampofo
- Accident & Emergency Department; Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology; Kumasi Ghana
| | - Christopher Lam
- Warren Alpert Medical School of Brown University; Providence RI
| | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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Scott J, Rouhani S, Greiner A, Albutt K, Kuwert P, Hacker MR, VanRooyen M, Bartels S. Respondent-driven sampling to assess mental health outcomes, stigma and acceptance among women raising children born from sexual violence-related pregnancies in eastern Democratic Republic of Congo. BMJ Open 2015; 5:e007057. [PMID: 25854968 PMCID: PMC4390729 DOI: 10.1136/bmjopen-2014-007057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Assess mental health outcomes among women raising children from sexual violence-related pregnancies (SVRPs) in eastern Democratic Republic of Congo and stigma toward and acceptance of women and their children. DESIGN Participants were recruited using respondent-driven sampling. SETTING Bukavu, Democratic Republic of Congo in 2012. PARTICIPANTS 757 adult women raising children from SVRPs were interviewed. A woman aged 18 and older was eligible for the study if she self-identified as a sexual violence survivor since the start of the conflict (∼1996), conceived an SVRP, delivered a liveborn child and was currently raising the child. A woman was ineligible for the study if the SVRP ended with a spontaneous abortion or fetal demise or the child was not currently living or in the care of the biological mother. INTERVENTION Trained female Congolese interviewers verbally administered a quantitative survey after obtaining verbal informed consent. OUTCOME MEASURES Symptom criteria for major depressive disorder, post-traumatic stress disorder, anxiety and suicidality were assessed, as well as stigma toward the woman and her child. Acceptance of the woman and child from the spouse, family and community were analysed. RESULTS 48.6% met symptom criteria for major depressive disorder, 57.9% for post-traumatic stress disorder, 43.3% for anxiety and 34.2% reported suicidality. Women who reported stigma from the community (38.4%) or who reported stigma toward the child from the spouse (42.9%), family (31.8%) or community (38.1%) were significantly more likely to meet symptom criteria for most mental health disorders. Although not statistically significant, participants who reported acceptance and acceptance of their children from the spouse, family and community were less likely to meet symptom criteria. CONCLUSIONS Women raising children from SVRPs experience symptoms of mental health disorders. Programming addressing stigma and acceptance following sexual violence may improve mental health outcomes in this population.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hansehospital Stralsund, Stralsund, Germany
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
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Bartels S, Lehmann U, Büsche G, Schlue J, Mozer M, Stadler J, Triviai I, Alchalby H, Kröger N, Kreipe H. SRSF2 and U2AF1 mutations in primary myelofibrosis are associated with JAK2 and MPL but not calreticulin mutation and may independently reoccur after allogeneic stem cell transplantation. Leukemia 2014; 29:253-5. [PMID: 25231745 PMCID: PMC4287655 DOI: 10.1038/leu.2014.277] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Bartels
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - U Lehmann
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - G Büsche
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - J Schlue
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - M Mozer
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - J Stadler
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - I Triviai
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - H Alchalby
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - H Kreipe
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
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Becker TK, Jacquet GA, Marsh R, Schroeder ED, Foran M, Bartels S, Duber HC, Cockrell H, Levine AC. Global emergency medicine: a review of the literature from 2013. Acad Emerg Med 2014; 21:810-7. [PMID: 25040254 DOI: 10.1111/acem.12414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and grey literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a worldwide audience of academics and clinical practitioners. METHODS This year 8,768 articles written in six languages were identified by our search. These articles were distributed among 22 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the grey literature. A total of 434 articles were deemed appropriate by at least one reviewer and approved by an editor for formal scoring of overall quality and importance. RESULTS Of the 434 articles that met our predetermined inclusion criteria, 65% were categorized as emergency care in resource-limited settings, 18% as EM development, and 17% as disaster and humanitarian response. A total of 24 articles received scores of 18 or higher and were selected for formal summary and critique. Interrater reliability for two reviewers using our scoring system was good, with an intraclass correlation coefficient of 0.63 (95% confidence interval = 0.55 to 0.69). Infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. CONCLUSIONS In 2013, there were more emergency care in resource-limited settings articles, while the number of disaster and humanitarian response articles decreased, when compared to the 2012 review. However, the distribution of articles selected for full review did not change significantly. As in prior years, the majority of articles focused on infectious diseases, as well as trauma and injury prevention.
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Affiliation(s)
- Torben K. Becker
- The Department of Emergency Medicine; University of Michigan; Ann Arbor MI
| | - Gabrielle A. Jacquet
- The Department of Emergency Medicine; Boston University School of Medicine; Boston MA
- The Boston University Center for Global Health and Development; Boston MA
| | - Regan Marsh
- The Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- The Department of Emergency Medicine; Partners In Health; Boston MA
| | - Erika D. Schroeder
- The Department of Emergency Medicine; Providence Regional Medical Center; Everett WA
| | - Mark Foran
- The Department of Emergency Medicine; New York University; New York NY
- The Harvard Humanitarian Initiative; Cambridge MA
| | - Susan Bartels
- The Harvard Humanitarian Initiative; Cambridge MA
- The Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston MA
- The FXB Center for Health and Human Rights; Boston MA
| | - Herbert C. Duber
- The Division of Emergency Medicine; University of Washington; Seattle WA
| | - Hannah Cockrell
- The Department of Emergency Medicine; Rhode Island Hospital; Providence RI
| | - Adam C. Levine
- The Harvard Humanitarian Initiative; Cambridge MA
- The Department of Emergency Medicine; Rhode Island Hospital; Providence RI
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Johnson K, Scott J, Sasyniuk T, Ndetei D, Kisielewski M, Rouhani S, Bartels S, Mutiso V, Mbwayo A, Rae D, Lawry L. A national population-based assessment of 2007-2008 election-related violence in Kenya. Confl Health 2014; 8:2. [PMID: 24438430 PMCID: PMC3932993 DOI: 10.1186/1752-1505-8-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/07/2014] [Indexed: 11/28/2022] Open
Abstract
Background Following the contested national elections in 2007, violence occurred throughout Kenya. The objective of this study was to assess the prevalence, characteristics, and health consequences of the 2007–2008 election-related violence. Methods A cross-sectional, national, population-based cluster survey of 956 Kenyan adults aged ≥ 18 years was conducted in Kenya in September 2011 utilizing a two-stage 90 x 10 cluster sample design and structured interviews and questionnaires. Prevalence of all forms of violence surrounding the 2007 election period, symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), and morbidity related to sexual and physical violence were assessed. Results Of 956 households surveyed, 916 households participated (response rate 95.8%). Compared to pre-election, election-related sexual violence incidents/1000 persons/year increased over 60-fold (39.1-2370.1; p < .001) with a concurrent 37-fold increase in opportunistic sexual violence (5.2-183.1; p < .001). Physical and other human rights violations increased 80-fold (25.0-1987.1; p < .001) compared to pre-election. Overall, 50% of households reported at least one physical or sexual violation. Households reporting violence were more likely to report violence among female household members (66.6% vs. 58.1%; p = .04) or among the Luhya ethnic group (17.0% vs. 13.8%; p = 0.03). The most common perpetrators of election-related sexual violence were reported to be affiliated with government or political groups (1670.5 incidents/1000 persons per year); the Kalenjin ethnic group for physical violations (54.6%). Over thirty percent of respondents met MDD and PTSD symptom criteria; however, symptoms of MDD (females, 63.3%; males, 36.7%; p = .01) and suicidal ideation (females, 68.5%; males, 31.5%; p = .04) were more common among females. Substance abuse was more common among males (males, 71.2%; females, 28.8%; p < .001). Conclusion On a national level in Kenya, politically-motivated and opportunistic sexual and physical violations were commonly reported among sampled adults with associated health and mental health outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Lynn Lawry
- Division of Women's Health, Brigham and Women's Hospital, Boston MA, USA.
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Lommatzsch AP, Bartels S, Heimes B, Spital G, Dietzel M, Freistühler M, Bornfeld N, Pauleikhoff D. [Endophthalmitis as a serious complication of intravitreal drug delivery]. Klin Monbl Augenheilkd 2013; 230:1130-4. [PMID: 24065511 DOI: 10.1055/s-0033-1350686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endophthalmitis, regarded as a severe complication, can occur after intraocular injection of drugs (IVI). At present only few reports exist on the development of this disease, although recently the number of intraocular injections to treat especially age-related macular degenerations is increasing considerably. METHODS In this paper we present our results of a retrospective study of 27 patients suffering from endophthalmitis after IVI. Treatment had been performed between January 2008 and March 2012. The indications for IVI were as follows: age-related macular degeneration 19, venous branch occlusion 1, diabethic retinopathies 6, uveitis 1. The following drugs were injected: bevacizumab in 8, Rranibizumab in 19 patients. The following data were assessed: incubation time, best corrected visual acuity that had been determined before treatment and later 3, 6 and 9 months after therapeutic vitrectomy. Additionally we describe the ophthalmoscopic changes and the results of bacteriological studies. RESULTS Endophthalmitis was diagnosed 5.8 days after IVI on average. The vision of all patients had only been hand movements during the first examination. During the observation time the postoperative visual acuity could be improved only to 1/35 on average. During vitrectomy in 24 out of 27 patients a whitish retinal infiltration could be observed. 18 of 27 patients showed a hypopyon during slit lamp examination. 11 patients developed a retinal detachment and one eye had to be enucleated. CONCLUSIONS Endophthalmitis must be regarded as a severe complication causing a high risk of retinal detachment with permanent loss of visual acuity. Retinal infiltrations and haemorrhages occur already in the early stages and cause finally a very poor prognosis. The incubation time as a rule amounts to 6 days. The increasing number of IVI and the high risk of damaged retinal structures due to intraocular infections should make postoperative retinal follow-up examinations mandatory, especially during the first 6 days.
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Affiliation(s)
- A P Lommatzsch
- Retinologie, Augenabteilung am St. Franziskus Hospital Münster
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Jacquet GA, Foran M, Bartels S, Becker TK, Schroeder ED, Duber HC, Goldberg E, Cockrell H, Levine AC. Global Emergency Medicine: a review of the literature from 2012. Acad Emerg Med 2013; 20:835-43. [PMID: 24033627 DOI: 10.1111/acem.12173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 04/15/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and grey literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a worldwide audience of academics and clinical practitioners. METHODS This year, our search identified 4,818 articles written in six languages. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Two additional reviewers searched and screened the grey literature. A total of 224 articles were deemed appropriate by at least one reviewer and were approved by their editor for formal scoring of overall quality and importance. RESULTS Of the 224 articles that met our predetermined inclusion criteria, 56% were categorized as Emergency Care in Resource-limited Settings, 18% as EM development, and 26% as Disaster and Humanitarian Response. A total of 28 articles received scores of 16 or higher and were selected for formal summary and critique. Inter-rater reliability for two reviewers using our scoring system was good, with an intraclass correlation coefficient of 0.625 (95% confidence interval = 0.512 to 0.711). CONCLUSIONS In 2012 there were more disaster and humanitarian response articles than in previous years. As in prior years, the majority of articles addressed the acute management of infectious diseases or the care of vulnerable populations such as children and pregnant women.
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Affiliation(s)
| | | | | | - Torben Kim Becker
- Department of Emergency Medicine; University of Michigan; Ann Arbor; MI
| | | | | | | | - Hannah Cockrell
- Watson Institute for International Studies; Brown University; Providence; RI
| | - Adam C. Levine
- Department of Emergency Medicine; Brown University Alpert Medical School; Providence; RI
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Lehmann U, Bartels S, Hasemeier B, Geffers R, Schlue J, Büsche G, Hussein K, Kreipe H. O-002 Comprehensive mutational profiling identifies molecular overlap between MDS and myeloproliferative neoplasms with fibrosis. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bartels S, Kelly J, Scott J, Leaning J, Mukwege D, Joyce N, VanRooyen M. Militarized sexual violence in South Kivu, Democratic Republic of Congo. J Interpers Violence 2013; 28:340-358. [PMID: 22929338 DOI: 10.1177/0886260512454742] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Eastern DRC has been the site of a protracted conflict in which sexual violence has been a defining feature. The method used was a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital between 2004 and 2008. This analysis aimed to describe the patterns of sexual violence described by survivors and to analyze perpetrator profiles. As regards results, a total of 4,311 records were analyzed. Perpetrators in this data set were identified as follows: (a) 6% were civilians; (b) 52% were armed combatants; and (c) 42% were simply identified as "assailant(s)" with no further identifying information. Those identified simply as "assailants" perpetrated patterns of sexual violence that were similar to those of armed combatants, suggesting that this group included a large number of armed combatants. Civilian assailants perpetrated a pattern of sexual violence that was distinct from armed combatants. Conclusions are as follows: These data suggest that a high proportion of sexual assaults in South Kivu are perpetrated by armed combatants. Protection of women in South Kivu will require new strategies that take into account the unique nature of sexual violence in DRC. Engaging with local communities, the UN and other aid organizations is necessary to create new context-appropriate protection programs.
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Affiliation(s)
- Susan Bartels
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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35
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Bartels S, Kyavar L, Blumstein N, Görg T, Glöckner S, Zimmermann R, Heckmann J. FDG PET findings leading to diagnosis of neurosarcoidosis. Clin Neurol Neurosurg 2013; 115:85-8. [DOI: 10.1016/j.clineuro.2012.03.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/16/2012] [Accepted: 03/24/2012] [Indexed: 11/29/2022]
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Günther G, Bartels S, Tessen H, Sterchele⁎ J. Real-world efficacy and safety of bendamustine with or without rituximab in treatment-naïve older patients with chronic lymphocytic leukemia: Retrospective analysis by age group from a German registry. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nelson BD, Collins L, VanRooyen MJ, Joyce N, Mukwege D, Bartels S. Impact of sexual violence on children in the Eastern Democratic Republic of Congo. Med Confl Surviv 2011; 27:211-225. [PMID: 22416569 DOI: 10.1080/13623699.2011.645148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The conflict in the Eastern Democratic Republic of Congo (DRC) has been particularly devastating for children and has been typified by high levels of sexual and gender-based violence (SGBV). In this study, we seek to characterize the patterns and impact of sexual violence on children in the Eastern DRC. Semi-structured questionnaires were administered among a convenience sample of women <18 years of age presenting for post-sexual-violence care at Panzi Hospital in South Kivu, DRC. Analysis included quantitative and qualitative methods to describe the characteristics of the violence, perpetrators, and survivors and to illuminate common themes within the narratives. A total of 389 survivors of SGBV under the age of 18 were interviewed between 2004 and 2008. These paediatric survivors were more likely than adult survivors to have experienced gang rape, been attacked by a civilian perpetrator, and been assaulted during the day. Survivor and perpetrator characteristics were further stratified by type of attack. Reports of violence perpetrated by civilians increased 39-fold while reports of violence perpetrated by armed combatants decreased by 70% between 2004 and 2008. Qualitative analysis of the narratives revealed common themes, such as physical signs and symptoms among SGBV survivors (23.9%), pregnancy resulting from rape (19.3%), perpetrators being brought to justice (18.3%), and neighbourhood men as perpetrators (17.7%). Children in the Eastern DRC continue to face significant threats of sexual violence. By understanding the patterns of this violence, local and international approaches could be more effectively implemented to protect these vulnerable children.
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Affiliation(s)
- Brett D Nelson
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
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Wilhelm S, Mueller L, Tessen HW, Schlichting A, Bartels S. The palliative therapy of NSCLC in the medical practice. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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39
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Lima A, Van Genderen M, Klijn E, Bartels S, Van Bommel J, Bakker J. Perfusion index as a predictor for central hypovolemia in humans. Crit Care 2011. [PMCID: PMC3061699 DOI: 10.1186/cc9489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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40
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Bayram J, Rosborough S, Bartels S, Lis J, VanRooyen MJ, Kapur GB, Anderson PD. Core curricular elements for fellowship training in international emergency medicine. Acad Emerg Med 2010; 17:748-57. [PMID: 20653590 DOI: 10.1111/j.1553-2712.2010.00795.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to describe the common educational goals, curricular elements, and methods of evaluation used in international emergency medicine (IEM) fellowship training programs currently. IEM fellowship programs have been developed to provide formal training for emergency physicians (EPs) interested in pursuing careers in IEM. Those fellowships are variable in scope, objectives, and duration. Previously published articles have suggested a general curriculum structure for IEM fellowships. METHODS A search of MEDLINE, EMBASE, and CINAHL databases from 1950 to June 2008 was performed, combining the terms international, emergency medicine, and fellowship. Online curricula and descriptive materials from IEM fellowships listed by the Society for Academic Emergency Medicine (SAEM) were reviewed. Knowledge and skill areas common to multiple programs were organized in discrete categories. IEM fellowship directors were contacted for input and feedback. RESULTS Eight articles on IEM fellowships were identified. Two articles described a general structure for fellowship curriculum. Sixteen of 20 IEM fellowship programs had descriptive materials posted online. These information sources, plus input from seven fellowship program directors, yielded the following seven discrete knowledge and skill areas: 1) emergency medicine systems development, 2) humanitarian relief, 3) disaster management, 4) public health, 5) travel and field medicine, 6) program administration, and 7) academic skills. CONCLUSIONS While IEM fellowships vary with regard to objectives and structure, this article presents an overview of the current focus of IEM fellowship training curricula that could serve as a resource for IEM curriculum development at individual institutions.
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Affiliation(s)
- Jamil Bayram
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Bartels S, Sivilotti M, Crosby D, Richard J. Are recommended doses of acetaminophen hepatotoxic for recently abstinent alcoholics? A randomized trial. Clin Toxicol (Phila) 2009; 46:243-9. [DOI: 10.1080/15563650701447020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rubin B, Rizzo K, Bartels S. [Report on the patient forum on medical ethics. "Curse and blessing of knowledge of disease"]. Zentralbl Gynakol 2004; 126:3-6. [PMID: 14981562 DOI: 10.1055/s-2004-820532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
From July 15th to July 16th the Protestant Academy of Tutzing opened its doors for the fourth time to the public for a discussion between medical doctors, patients, relatives, nurses and pastors on the new developments of medical diagnosis. The central idea of this type of forum, first initiated in 1993 by Prof. Reiter-Theil, bioethicist at the university of Basel, is to let patients and their relatives actively participate in the bioethical discussion. The dialogue between medical doctor and patient is part of a complex set of interactions between medical progress, ethical aspects and legal regulations. It should be governed by the respect for the autonomy of the patient and by his or her will and capacity to deal with a difficult diagnosis. The communication should be non directive in its nature, but nevertheless take place in an ethically sensitised and responsible manner. As a result counts not what type of message was intended, but what type of message the patient received. The diverse results of the conference can be summarized under the phrase "the patient should determine the rhythm", i. e. the timing and the type of diagnostic knowledge she or he wants to receive.
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Affiliation(s)
- B Rubin
- Institut für Angewandte Ethik und Medizinethik, Medizinische Fakultät der Universität Basel.
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Abstract
Conflicting investigations regarding the potential protective effect of melanin against noise-induced sensorineural hearing loss have suggested that eumelanin and pheomelanin may have differing effects within the stria vascularis. Three strains of C57BL/6J mice, (+/+, a/a) wild-types (dark coats/black eyes), (c2j/c2j, a/a), albinos (white coats/pink eyes), and (+/+, Ay/Ay) yellow mice (yellow coats/black eyes), were subjected to five consecutive days of broad band noise exposure at 112 dB(A) SPL for 3 h/day. Cochlear function was evaluated with auditory brainstem response audiometry to pure tones immediately pre-exposure, 5-6 h postexposure, and 14 days post-exposure. No significant difference in the degree of sensorineural hearing loss induced in the three strains of mice was identified. The eumelanin and pheomelanin content of each stria vascularis and amount of protein per stria for both mouse and guinea pig (2/NCR) were determined via high performance liquid chromatography. No pheomelanin was found in the stria of yellow mice, suggesting that coat color is not an accurate predictor of strial melanin content. The melanin content per mg of strial protein was higher in mice than in guinea pigs. A species-specific difference in melanin content does not explain the absence of a protective effect in mice.
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Affiliation(s)
- S Bartels
- Department of Otolaryngology/Head and Neck Surgery, Oregon Hearing Research Center, Oregon Health Sciences University, Portland 97201-3098, USA
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Bartels S, Talbot JM, DiTomasso J, Everts EC, Andersen PE, Wax MK, Cohen JI. The relative value of fine-needle aspiration and imaging in the preoperative evaluation of parotid masses. Head Neck 2000; 22:781-6. [PMID: 11084638 DOI: 10.1002/1097-0347(200012)22:8<781::aid-hed6>3.0.co;2-b] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To establish the sensitivity, specificity, and accuracy of imaging and fine-needle aspiration (FNA), alone or in combination, in distinguishing benign from malignant histologic findings for parotid lesions. METHODS Retrospective blinded review of preoperative imaging and FNA studies of parotid masses and comparison with histologic findings after excision. RESULTS Forty-eight patients were identified (13 with CT, 35 with MRI); 23 (48%) of the lesions were malignant, 25 (52%) were benign. MRI, CT, and FNA misclassified 17%, 46%, and 21% of the lesions, respectively. The sensitivity/specificity/accuracy of these tests for detecting malignant lesions were as follows: MRI (88%,77%,83%), CT (100%,42%, 69%), and FNA (83%,86%,85%) and were not significantly different. Combinations of imaging and FNA were not significantly better in detecting malignancy. CONCLUSIONS Imaging and FNA are comparable in their ability to correctly identify malignant parotid lesions preoperatively. Combining these two modalities yields no advantage in terms of specificity, sensitivity, or accuracy of a malignant diagnosis.
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Affiliation(s)
- S Bartels
- Department of Otolaryngology Head and Neck Surgery, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, PV-01, Portland, Oregon 97201-3098, USA
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Affiliation(s)
- C Gutgesell
- Department of Dermatology, Goettingen, Germany
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Abstract
A series of eight focus groups were convened to: (1) identify tasks and activities performed by youth on farms with the potential for causing non-traumatic work-related Musculoskeletal Disorders (MSDs); (2) determine the participants perceptions about risks of MSDs for youths performing those tasks; and (3) determine other factors that might relate to MSDs for youth working on farms, such as possible interventions for prevention. Seventy-two farm family members, 40 adults and 32 farm youth aged 8-18, participated in focus groups. Ten questions were posed to each of the eight groups about what tasks youth perform on the farm, how the work is assigned, and what risk factors are associated with the work. There was general agreement among the adults that maturity rather than age is the dominant factor for determining what tasks are performed by youth workers on the farm. Youth, on the other hand, believed that task urgency dictated what jobs were assigned to youth workers. Most adults indicated that lifting objects, forking, or shoveling was responsible for most of the serious non-traumatic injuries. Bending over while working, sitting in an awkward position looking back at equipment from a tractor, sitting in a cramped position, looking down at a combine header, and long hours of work were also identified as potential problems. Youth described muscle aches and strains of the legs, arms, shoulder, back or neck as everyday occurrences. According to the youth, "If it's not broken, you're fine". Only basic training is provided and most respondents believed that youth learned best through observation. There was general agreement that physician recommended guidelines for assigning youth to tasks would be ignored unless they carried the force of the law.
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Affiliation(s)
- S Bartels
- Ohio State University Extension, Butler County, USA
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Abstract
BACKGROUND Methods to select physicians most likely to benefit from educational interventions to improve the outcome of depression have not been adequately developed. OBJECTIVE The purpose of this study was to identify a combination of primary care provider (PCP) self-report questions to improve the precision of PCP estimates of actual antidepressant prescribing as a potential tool for PCP selection. METHODS The total number of new and refill antidepressant prescriptions written by 124 PCPs and actually filled at pharmacies over a 2-year period were matched with telephone survey results of these PCPs completed before the 2-year period. Multiple regression techniques were used to identify a set of variables that improved upon PCPs' self-report of prescriptions. RESULTS The mean for PCP-reported antidepressant prescriptions written in the last week was 7.8 (+/-11.2). The average weekly prescriptions actually filled was 6.72 (+/-5.65). Most survey variables were significantly correlated with antidepressant prescriptions. The final model included 6 variables that explained 52% of the variance in prescriptions. In addition to PCP-reported number of antidepressants prescribed, average number of primary care patients seen per week and number of patients covered by managed care were directly related to the volume of prescriptions. PCP age, percentage of patients referred immediately without treatment, and mental health services being too far away were inversely related. CONCLUSIONS PCP self-reports on antidepressant prescribing are reasonably accurate proxies of actual prescribing. The precision of estimates of actual prescribing can be improved by considering practice structural and financial characteristics.
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Affiliation(s)
- T E Oxman
- Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
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Abstract
BACKGROUND Many methods are available to the facial plastic surgeon for elevating and separating tissue, from cold steel to monopolar cautery to various laser-cutting technologies. Bipolar cautery has replaced monopolar cautery as the optimal hemostatic technique because of its decreased tissue damage and improved capabilities. Bipolar scissors concurrently offer a dissecting technique with hemostatic capability. Little exists in the otolaryngology literature on the use of bipolar scissors for soft tissue dissection. OBJECTIVE To describe our experience using bipolar scissors in a variety of facial plastic and reconstructive procedures. SETTING Tertiary care referral academic center. DESIGN We retrospectively reviewed 78 procedures performed using bipolar scissors between June 1997 and August 1999. In facial plastic cosmetic surgery, bipolar scissors were used 31 times for deep plane face-lifts and 16 times for endoscopic browlifts. In facial plastic reconstructive surgery, bipolar scissors were used in 15 radial forearm free flaps, 10 fibula osteocutaneous flaps, 3 rectus abdominis free flaps, and 3 latissimus dorsi myocutaneous free flaps. RESULTS In all procedures, bipolar scissors facilitated the dissection. By allowing for a drier field, less time was required to elevate the flap and obtain hemostasis. Complications were not increased compared with historical controls. In the harvesting of fibula osteocutaneous free flaps, use of bipolar scissors allowed harvesting without use of a tourniquet. CONCLUSION Bipolar scissors, a new technology in facial plastic surgery, allow the same control as sharp dissection and provide simultaneous hemostasis.
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Affiliation(s)
- C P Winslow
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd PV-01, Portland, OR 97201, USA
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Solberg LI, Korsen N, Oxman TE, Fischer LR, Bartels S. The need for a system in the care of depression. J Fam Pract 1999; 48:973-979. [PMID: 10628578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Many problems have been identified in the usual care of patients with depression, including lack of identification, overreliance on medications, and inadequate treatment and follow-up. Most of these problems can be attributed to an absence of depression care systems in primary care practice. We collected information from a group of practices to assess the need for and acceptability of such systems. METHODS We conducted 4 focus groups with primary care physicians and their staffs to identify attitudes and perceived behaviors for depression problems and to determine the participants' level of acceptance of alternative systematic approaches. We also surveyed clinicians and a sample of patients who recently visited their practices. RESULTS Systematic screening was viewed unfavorably, and many barriers were identified with collaborative care with mental health clinicians. Participants did support involvement of other office staff and more systematic follow-up for patients with depression. The patient survey suggested that some patients with depressive symptoms were unrecognized and undertreated, but the key finding was considerable variation in care among practices. CONCLUSIONS These findings suggest that a more systematic approach could improve the problems associated with treatment of patients with depression in primary care and would be acceptable to physicians if introduced appropriately. There are at least 2 promising approaches to introducing such changes. One involves external feedback of data about their care to the practices, followed by offering a variety of systems concepts and tools. The other involves an internal change process in which a multiclinic improvement team collects its own data and develops its own systematic solutions using rapid-cycle testing.
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Affiliation(s)
- L I Solberg
- HealthPartners/HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA.
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Kayser K, Bartels S, Yoshida Y, Fernandez-Britto J, Gabius HJ. Atherosclerosis-associated changes in the carbohydrate-binding capacities of smooth muscle cells of various human arteries. Zentralbl Pathol 1993; 139:307-12. [PMID: 8130161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A set of labelled neoglycoproteins and sulfated polysaccharides, recognizing carbohydrate receptors specific for glucose (glu), mannose (man), lactose (lac), fucose (fuc), fucoidan (fud), dextran sulfate (dex), and heparin (hep), as well as polyclonal antibodies specific for an endogenous beta-galactoside-specific lectin of molecular weight 14kD (A14kD) and a heparin-binding lectin (AHL) have been applied to the main arteries of 10 autopsy cases. Slides of the following types of vessels were incubated with solutions of the biotinylated probes or antibodies at room temperature for 60 min: right and left coronary artery, carotid artery, abdominal and thoracic aorta, pulmonal artery, and the left femoral artery. Atherosclerotic lesions and non-atherosclerotic areas were analyzed for each individual type of vessel. The percentage of the determined expression of the presence of specific binding sites for the various probes was the lowest in the carotid and cardiac arteries, and the highest in the pulmonal artery. Pronounced quantitative differences between the normal and atherosclerotic arterial walls were noted for binding of fuc-, man-, and lac-exposing neoglyco-proteins of the right coronary artery and the carotid artery. Pulmonal and femoral arteries differed with respect to fucoidan or dextran sulfate binding. The heparin-specific lectin and the 14kD-lectin were found to be present in nearly all arterial walls, independent from the localization and the presence of an atherosclerotic lesion. The findings suggest that the expression of sugar receptors, as assessed by labelled neoglycoproteins or sulfated polysaccharides, may be of importance in the development of atherosclerotic lesions in the coronary and carotid arteries.
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Affiliation(s)
- K Kayser
- Department of Pathology, Thoraxklinik, Heidelberg, Germany
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