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Background: Capnography is universally accepted as an essential patient safety monitor in high-income countries (HICs) yet is often unavailable in low and middle-income countries (LMICs). Increasing capnography availability has been proposed as one of many potential approaches to improving perioperative outcomes in LMICs. This scoping review summarises the existing literature on the effect of capnography on patient outcomes to help prioritise interventions and guide expansion of capnography in LMICs.Methods: We searched MEDLINE and EMBASE databases for articles published between 1980 and March 2019. Studies that assessed the impact of capnography on morbidity, mortality, or the use of airway interventions both inside and outside the operating room were included.Results: The search resulted in 7445 unique papers, and 31 were included for analysis. Retrospective and non-randomised data suggest capnography use may improve outcomes in the operating room, ICU, and emergency department, and during resuscitation. Prospective data on capnography use for procedural sedation suggest earlier detection of hypoventilation and a reduction in haemoglobin desaturation events. No randomised studies exist that assess the impact of capnography on patient outcomes.Conclusion: Despite widespread endorsement of capnography as a mandatory perioperative monitor, rigorous data demonstrating its impact on patient outcomes are limited, especially in LMICs. The association between capnography use and a reduction in serious airway complications suggests that closing the capnography gap in LMICs may represent a significant opportunity to improve patient safety. Additional data are needed to quantify the global capnography gap and better understand the barriers to capnography scale-up in LMICs. [ABSTRACT FROM AUTHOR]

Alpha Gal Syndrome (AGS) is an emerging immune response to mammalian products (MP) containing the oligosaccharide galactose-α-1,3 galactose (α-Gal) which includes meats and inactive ingredients in certain medications. This becomes clinically important in the perioperative realm as MPs are commonly found in the operating room, and pre- and post-operative settings, and can trigger responses as severe as anaphylaxis. In this review, authors discuss the epidemiology, diagnosis and treatment of AGS reactions. Additionally, strategies are explored in order to screen and prevent exposure to MP with a multidisciplinary approach. While this emerging allergy is still not fully understood, it is of paramount importance that all anesthesia providers recognize the implications of MP exposure in AGS patients and ultimately prevent harm in this highly vulnerable population. • Alpha gal syndrome is IgE mediated response to mammalian products. • Alpha gal syndrome has been identified worldwide. • Symptoms of alpha gal syndrome can be as severe as anaphylaxis. • Many surgical products and drugs contain mammalian products. • Prevention of exposure in the perioperative space can mitigate risk. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is a significant public health threat that contributes to a wide range of mental and physical health problems for victims. Aims: The purpose of this study was to examine IPV-related experiences and mental health outcomes among college students in Japan, Singapore, South Korea and Taiwan. Methods: The data were obtained from the Inter-University Consortium for Political and Social Research (ICPSR), the International Dating Violence Study (IDVS) 2001–2006 (ICPSR 29583; N = 981; Japan n = 207; Singapore n = 260; South Korea n = 256; Taiwan n = 258). Results: Co-experience of physical IPV victimization and perpetration was associated with borderline personality traits and posttraumatic stress disorder (PTSD), but not with depression. Childhood sexual abuse, gender hostility and violence socialization were significant predictors of borderline personality traits, depression and PTSD. While country and gender variations in mental health are noted, there are two specific populations that may need special attention for mental health interventions: Taiwanese women especially for borderline personality traits and PTSD, and Japanese men especially for depression. Conclusion: IPV victimization and perpetration, childhood sexual abuse, gender hostility and violence socialization have a significant impact on the mental health of college students in Japan, Singapore, South Korea and Taiwan. Since IPV and mental health are significant public health issues, research on IPV and mental health consequences of IPV victimization and perpetration in these countries should be further expanded in order to better understand the interventions that will be effective in treating victims, perpetrators and victim/perpetrators of IPV. [ABSTRACT FROM AUTHOR]

Background. Skin cancer is the most commonly diagnosed form of cancer in the United States (US). However, knowledge, behaviors, and attitudes regarding sun protection vary among the general population. The purpose of this study is to examine sun protection behaviors of low-income primary care patients and assess the association between these health behaviors and the self-efficacy, susceptibility, and skin cancer awareness. Methods. Uninsured primary care patients utilizing a free clinic (N=551) completed a self-administered survey in May and June 2015. Results. Using sunscreen was the least common tactic among the participants of this study. Skin cancer awareness and self-efficacy are important to improve sun protection behaviors. Spanish speakers may have lower levels of skin care awareness compared to US born and non-US born English speakers. Male and female participants use different sun protection methods. Conclusion. It is important to increase skin cancer awareness with self-efficacy interventions as well as education on low-cost sun protection methods. Spanish speaking patients would be a target population for promoting awareness. Male and female patients would need separate gender-specific sun protection education. Future studies should implement educational programs and assess the effectiveness of the programs to further promote skin cancer prevention among underserved populations. [ABSTRACT FROM AUTHOR]

M ycoplasma arthritidis is a natural pathogen of rodents causing arthritis, toxic shock and necrotizing fasciitis. It secretes a potent superantigen ( SAg), MAM, that differentially affects the immune system depending upon presence or absence of TLR4, thus potentially influencing disease outcomes. Here, we establish that antibody to co-stimulatory molecule B7-1( CD80) enhances arthritis in wild-type C3 H/ HeSnJ ( TLR2+4+) mice but suppresses arthritis in TLR4-defect C3 H/ HeJ ( TLR2+4−) mice. Also, blockade of the B7-1/ CD28 co-stimulatory pathway in C3 H/ HeSnJ mice resulted in a marked increase in an alternative co-stimulatory pathway ICOS/ ICOSL that was associated with elevation of the IL-17/ Th17cascade with enhanced IL-23, IL-6, and the RORγt and STAT3 transcriptional factors on CD4+ T cells. Anti- B7-1 also increased inflammatory chemokines and the stress protein HMGB1 that promotes cellular infiltration to joints. Using a MAM-deficient strain of M . arthritidis, a monoclonal antibody to TLR4 and a TLR4-defective mouse strain, we established that both MAM and TLR4 are required for the systemic and local joint triggering of the Th17/ IL-17 cascade in mice treated with anti- B7-1 antibody. Importantly, blocking of IL-17 with anti- IL-17 antibody suppressed the elevated arthritis in M . arthritidis-infected mice treated with anti- B7-1 antibody. Thus, this unique model of arthritis illustrates how microbial agonists can bridgeinnate and adaptive immune responses to redirect signalling pathways, thus promoting chronic inflammatory and autoimmune disease. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience in surgical processing wherein he learned how surgical processing makes surgeons' lives easier and helps them provide the best service to their patients.

This study examined factors associated with physical IPV perpetration in Russia and Lithuania. The data from the International Dating Violence Study 2001–2006 were analyzed (N= 818). Male and female perpetrators as compared to non-perpetrators of physical IPV have a higher prevalence of being perpetrators of other forms of IPV. Perpetrators of physical IPV as compared to non-perpetrators are more likely to have been victims of IPV. Male and female ‘intimate terrorist’ perpetrators exhibit different characteristics. Factors associated with IPV are different between male and female perpetrators. Interventions should focus on victimization and perpetration. [ABSTRACT FROM PUBLISHER]

Food insecurity is a significant public health issue that affects the physical and mental health of people of all ages. Higher levels of self-efficacy may reduce levels of food insecurity. In addition, acculturation is potentially an important factor for food insecurity among immigrant populations. The purpose of this study is to examine food insecurity associated with self-efficacy and acculturation among low-income primary care patients in the United States. A self-administered survey was administered in May and June 2015 to uninsured primary care patients (N = 551) utilizing a free clinic that provides free primary care services to low-income uninsured individuals and families in the United States. On average, participants reported low food security. Higher levels of self-efficacy were associated with lower levels of food insecurity. Higher levels of heritage language proficiency were related to lower levels of food insecurity. US-born English speakers, women, and unmarried individuals potentially have higher risks of food insecurity and may need interventions to meet their specific needs. Self-efficacy should be included in nutrition education programs to reduce the levels of food insecurity. Future studies should further examine why these groups have a high risk to better understand needs for interventions. [ABSTRACT FROM AUTHOR]

The abuse of substances is a significant public health issue. Perceived stress and depression have been found to be related to the abuse of substances. The purpose of this study is to examine the prevalence of substance use (i.e., alcohol problems, smoking, and drug use) and the association between substance use, perceived stress, and depression among free clinic patients. Patients completed a self-administered survey in 2015 (N = 504). The overall prevalence of substance use among free clinic patients was not high compared to the U.S. general population. U.S.-born English speakers reported a higher prevalence rate of tobacco smoking and drug use than did non-U.S.-born English speakers and Spanish speakers. Alcohol problems and smoking were significantly related to higher levels of perceived stress and depression. Substance use prevention and education should be included in general health education programs. U.S.-born English speakers would need additional attention. Mental health intervention would be essential to prevention and intervention. [ABSTRACT FROM PUBLISHER]

Background The increasing incidence of healthcare-associated infections (HAIs) and multidrug-resistant organisms demonstrate the need for innovative technological solutions. Staphylococcus aureus , Streptococcus pneumonia , Escherichia coli, and Pseudomonas aeruginosa in particular are common pathogens responsible for a large percentage of indwelling medical device-associated clinical infections. The bactericidal effects of visible light sterilization (VLS) using 405-nm is one potential therapeutic under investigation. Materials and methods Light-emitting diodes of 405-nm were used to treat varying concentrations of S aureus , S pneumonia, E coli , and P aeruginosa . Irradiance levels between 2.71 ± 0.20 to 9.27 ± 0.36 mW/cm 2 and radiant exposure levels up to 132.98 ± 6.68 J/cm 2 were assessed. Results Dose-dependent effects were observed in all species. Statistically significant reductions were seen in both Gram-positive and Gram-negative bacteria. At the highest radiant exposure levels, bacterial log 10 reductions were E coli —6.27 ± 0.54, S aureus —6.10 ± 0.60, P aeruginosa —5.20 ± 0.84, and S pneumoniae —6.01 ± 0.59. Statistically significant results (<0.001*) were found at each time point. Conclusions We have successfully demonstrated high-efficacy bacterial reduction using 405-nm light sterilization. The VLS showed statistical significance against both Gram-positive and Gram-negative species with the given treatment times. The β-lactam antibiotic-resistant E coli was the most sensitive to VLS, suggesting light therapy could a suitable option for sterilization in drug-resistant bacterial species. This research illustrates the potential of using VLS in treating clinically relevant bacterial infections. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the impact of neighborhood environments on health consciousness, information seeking, and attitudes among uninsured free clinic patients to better understand the specific needs of the population for health promotion and prevention efforts.Methods: US-born English-speaking, non-US-born English-speaking, and Spanish-speaking free clinic patients completed a self-administered survey using reliable measures in autumn 2014 (N = 769).Results: The results of this study suggest that social cohesion is positively associated with health consciousness, information seeking, and attitudes. Lower levels of available healthy food in the community were associated with higher levels of health consciousness. Although Spanish speakers reported lower levels of the availability of healthy food, social cohesion, and access to the Internet or text messaging compared with US-born or non-US-born English speakers, they were more likely to be health conscious and have higher levels of health information seeking. Spanish speakers as well as non-US-born English speakers, were more likely to attend health education classes compared with US-born English speakers.Conclusions: Health education programs for free clinic patients should include strategies to increase social cohesion. Health education programs should consider the diverse needs of these individual populations to maximize the effectiveness of the programs for free clinic patients. [ABSTRACT FROM AUTHOR]

The article discusses a survey on depression, stress and coping strategies among uninsured adults who belong to the low-economic strata in the U.S. It focuses on English speakers born in the U.S., English speakers not born in the U.S. and Spanish speakers. The survey found higher levels of depression and stress among U.S.-born English speakers than non U.S.-born English and Spanish Speakers. Different coping strategies are mentioned including negative psychological coping strategies.