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Student Elective Competition 2016: A call for entries

12 Sep, 16 | by Jenny Thomas

We are now launching thCapture3e 2016 competition for students and interns. Write up your experiences as a global health case report and you could be the winner of a position as a Global Health Associate Editor for BMJ Case Reports. Your case report will also be included in the 2017 special edition print journal.

All authors must be students or interns at the time of submission. Your entry will undergo the same treatment that all our journal submissions do, including the peer review process, so be sure to check out our Instructions for Authors for guidance before you start writing. If you’ve never written a global health case report before, you may find our template useful to help you get started.

Winners will be selected for interview to become a Global Health Associate Editor. We welcome submissions from all over the world. Patients may be anyone seen on the ward or at home, in medical school or on elective. Winners will be announced in September 2017.
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If you’re interested in writing a global health case report, we’re here to help. Seema Biswas, Editor in Chief of BMJ Case Reports, guides you through the writing process in a recent article featured in The Student BMJ. You can also visit the BMJ Case Reports website for examples of previously published global health case reports and look at the annotated example.

Read our guidance, join our global health blog and get writing! We look forward to receiving many interesting global health case reports.

World Immunisation Week 2016

26 Apr, 16 | by Hemali Bedi

By Hemali Bedi

“The two public health interventions that have had the greatest impact on the world’s healtposter-largeh are clean water and vaccines.” – The World Health Organization [1]

World Immunisation week takes place each year during last week of April (24-30). Last year, over 180 countries took part in the campaign, which is coordinated by The World Health Organization (WHO). [2] During this time, WHO encourage the uptake of vaccines and highlight need to improve equitable access to immunisations worldwide. [2]

Immunisation prevents between 2 to 3 million deaths each year. [2] The theme of this year’s World Immunisation Week is “Close the immunisation gap”. [2] This is because, despite promising advances in vaccine coverage so far, WHO estimate that 18.7 million infants worldwide (approximately 1 in 5) still do not receive immunisations for preventable diseases, such as diphtheria and tetanus. [2] Furthermore, over 60% of children who do not receive vaccinations live in just 10 countries, including the India, Iraq, the Philippines and South Africa. [2]

Barriers to vaccine uptake include social, political and economical factors [3]. Inequitable access to health care services, a lack of information about vaccines, insufficient political support, and in some areas, an improper supply of vaccines, all contribute [3]. Cost is also an issue, with new vaccines being more expensive. [2] But what can be done to address these challenges? We want to know just that. Leave a comment below, and let us know what you think.

Our global health case reports highlight important global health issues including the lack of access to health services in all parts of the world. With the resurgence of polio and measles in areas of conflict and disaster, we want to hear from you about vulnerable patients and populations.

For more information about global health, the determinants of health and medical anthropology, see our global health toolkit

References

[1] Public Health England. Information for immunisation practitioners and other health professional https://www.gov.uk/government/collections/immunisation, updated 1 April 2016

[2] World Immunization Week 2016: Immunization game-changers should be the norm worldwide. WHO. http://www.who.int/mediacentre/news/releases/2016/world-immunization-week/en/, published 21 April 2016

[3] World Immunization Week 2016: Close the immunization gap. WHO. http://www.who.int/campaigns/immunization-week/2016/event/en/, accessed 25 April 2016

How to write a global health case report

22 Jan, 16 | by Hemali Bedi

By Hemali Bedi

Have you come across an interesting case in your medical training so far? Whether you have a patient in mind, are browsing through our online collection, or joining our blog, we’re here to help you submit your own global health case reports. Seema Biswas, Editor in Chief of BMJ Case Reports, guides you through the writing process in a new article featured in The Student BMJ.

Seema Biswas comments, “To make a difference in thstudent-849822_1280e lives of patients we must look at the causes of disease, which are often intrinsically related to the environment individual patients and the wider community live in. The field of global health considers the social, cultural, economic, and political determinants of health of patients with the aim of raising awareness of these causes to achieve equity in health for all people worldwide.”

Key messages in this guidance

  • Always get written consent from your patient before you put pen
    to paper. Not only is this good medical practice, it’s also mandatory if you want to submit to a journal such as BMJ Case Reports.
  • Structure your article logically. BMJ Case Reports has a global health template which you can follow.
  • Don’t forget to ask for the patient’s perspective – they may, or may not want to contribute to your article, but they should have the chance to do so.
  • Remember, global health case reports don’t have to come from abroad. Cases from your part of the world are just as worthy. We should be thinking about the social determinants of health of all our patients, wherever we happen to be working.
  • Visit the BMJ Case Reports website for examples of previously published global health case reports and look at the annotated example.

Read the full article here, join our global health blog and get writing! We look forward to receiving many interesting global health case reports!

The Student Elective Competition – have you entered yet?

31 Dec, 15 | by Hemali Bedi

By Hemali Bedi

Travelling far afield for your elective? If so, we want to hear all about it. Write up your experiences into a Global Health case report and not only could you be the lucky winner of a £500 travel bursary, your article could also be included in the 2016 special edition print journal.

We’ve put together a quick guide to tell you everything you need to person with suitcaseknow.

What is a Global Health case report?

Global Health case reports should focus on:

  • the causes of disease
  • the social determinants of health
  • access to healthcare services
  • how Global Health issues affect individual lives

Global Health case reports require a comprehensive review of the relevant literature. This includes related publications published by governments and global organisations, not simply the medical literature. For more information, see our website.

What could I win?

  • A £500 travel bursary to help you attend a medical conference or event related to Global Health.
  • Your article will be published in our 2016 special edition print journal along with three runners-up.

How do I get started?

Before you begin, why not have a browse of our existing Global Health case reports collection? Be sure to check out our Instructions for Authors for guidance on patient consent, the submission process, and formatting issues such as the use of images. If you’ve never written a Global Health case report before, you may find our template useful to help get you writing.

The deadline for entries is 30th April 2016. For more information, visit our competition website or get in touch!

Can technology help reduce childhood blindness in developing countries?

22 Jul, 15 | by Kristy Ebanks

By Midhun Mohan

This case report outlines an extremely important treatable global health issue: childhood blindness.

Access to essential paediatric eye surgery in the developing world: a case of congenital cataracts left untreated
Untreated childhood cataracts remain prevalent especially in developing countries. They are a major health burden, not only affecting the individual’s quality of life but also predisposing the individual to becoming a financial burden for the country. This report is of a case of congenital cataracts in a young boy from the Philippines who was left blind since birth.
The mother observed the boy’s vision problems when she noted him bumping into things at the age of 1. When the boy was 2, the health care worker noted opacities on both lenses. The boy was seen at the rural health clinic at the age of 5 and diagnosed with bilateral congenital cataracts and referred to an opthamologist.
Note above the three year delay in getting the boy seen at the rural health clinic. This delay is likely due to:
The poor education of the parents affecting their health seeking behaviours and thus not fully appreciating the seriousness of their child’s condition
Inadequate competency levels of the health care workers. This is could be due to a lack of proper training, which is likely to stem from a lack of funding

Despite being diagnosed, the patient remained untreated for the next 7 years!
What was the reasoning behind such a long gap between diagnosis and treatment? There were two reasons:
The family were not able to afford the treatment
There was a lack of funding from the national health provider

The patient was not able to attend follow up, and three months after surgery, the patient’s visual acuity started to decrease.
There are 3 main factors that that can result in good visual outcomes after cataract surgery:

  • Early recognition
  • Surgical intervention
  • Good follow up after surgery

The report states that:
“Early diagnosis is essential for appropriate and timely intervention and good visual function. Visual outcome is largely dependent on the timing of surgery when dense cataracts are present. Good results have been reported in children undergoing surgery before 6 weeks of age for unilateral cataract and before 10 weeks of age in bilateral cases”

What are the ways in which early diagnosis and intervention can be increased?
It is important to note that any proposed method of increasing early diagnosis has to be economically viable for this developing country. A novel tool that has been recently introduced is the “Portable Eye Examination Kit (PEEK).”

Portable Eye Examination Kit (PEEK)
PEEK is a multifunctional, smartphone based tool which aims to empower eye health workers to diagnose eye diseases and provide a low-cost device for managing and monitoring the treatment of patients.
The modified smartphone contains a series of eye tests in the form of apps that can be used by individuals with little training. Furthermore, because the eyes tests are on a smartphone, it is extremely portable being able to reach the most remotest areas.
One of the app’s it contains is the “Acuity App” which uses a shrinking letter that appears on screen and is used as a basic vision test. It uses the camera’s flash to illuminate the back of the eye to check for disease.
The smartphone is relatively cheap, costing around £300 rather than using bulky eye examination equipment costing in excess of £100,000. The low cost of this device makes it very appealing for developing countries.

Below are useful links to learn more about the Portable Eye Examination Kit (PEEK)
http://www.peekvision.org
http://www.bbc.co.uk/news/health-32914227
http://cehc.lshtm.ac.uk/peek/

Technology has the potential to greatly enhance patient care especially in developing countries. If PEEK was available in this boy’s village, could his blindness have been prevented?

 

The Devastating Effects of a Fire Burn in a Child

6 Jul, 15 | by Kristy Ebanks

By Manasi Jiwrajka 

Background

I recently completed a surgical placement with a Burns Unit, and was drawn to a recent case report on Global Health describing the appalling effects of severe paediatric burns. The Devastating Effects of a Fire Burn in a Child (1) is about a 2-year old boy with 40% burns to his head and arms. He was not seen immediately after the burn, instead, he presented 1 month later to an eye clinic in Hakkari, Turkey. By then he was blind.

This case raises two main issues:

  1. “Accidental house fires cause nearly half (49%) of the injuries resulting in death” (1). How could these be prevented?
  2. Delayed presentation without adequate first aid led to a poor outcome for the child. Would the outcome have been different if the patient had better access to healthcare?

Epidemiology

“Burn injuries represent a significant public health concern in both developing and developed countries” (1). Specifically, the WHO estimates that 265 000 deaths occur each year from fires alone, with more than 96% of deaths occurring in low and middle-income countries. Mortality due to burns is over 10 times higher in low and middle income than in high income countries (2). Many studies have found a correlation between socioeconomic deprivation and the incidence and severity of burn injury (3-5). The socioeconomic factors including crowding, poverty and poor maternal education pose as significant risk factors for paediatric burns (6).

Causes of burns

The relevance of this case in Hakkari, in Turkey is that “the incidence of childhood fire burns in Turkey is unknown because of inadequate records.” (1). “In Turkey, tea is made using two narrowly based containers that are stacked on top of each other”; these may easily topple (7). Globally, most burns occur at home, especially in the kitchen. Paediatric burns often occur when parents leave their children alone (even for a moment). His mother “left [her] baby at home sleeping near the electric heater” (1, 8, 9).

Worldwide, open flame burns are the most common, followed closely by scalds. Ignition of clothing is a common cause of burns in low and middle income countries including Ethiopia, India and Papua New Guinea. In Ethiopia, it was found that 93% of burn injuries in rural areas were due to open fires inside homes causing the ignition of clothing. In India, saris catching fire whilst cooking on kerosene stoves are a cause of deaths due to burns amongst adults. Similarly, 50% of hospitalizations due to burn injuries in Papua New Guinea are due to ignition of grass skirts (10-13). In Mexico, Ghana and Taiwan, boiling liquids and hot baths were found to cause scalds among children (2, 14-16).

Global Health Issues

There are several socio-economic factors that play a role. The authors write:

“Socio-demographic factors linked to an increase incidence of burns include low household income, living in a deprived are, living in rented accommodation, young mothers, single-parent families and children from ethnic minorities. The parental educational level, parent occupation and the type and size of accommodation are also important.”

The issue of access to healthcare is two-fold: (i) access to treatment and (ii) access to prevention. This patient’s mother quotes, “because we are poor and have no health insurance, I could not take the child to the hospital right away. It was only one month later that I was able to take the child to an ophthalmologist” (1). Access to a reliable electrical supply precludes the use of open fires.

Burn care costs comprise preventative measures, emergency response, and treatment and follow-up. In Turkey, Sahin et al. showed that the mean cost associated with per percent of burn area was $368 (compared to $927 per percent burn in New Zealand), and each percent burn corresponded to 2 days in the hospital. In the case of the 2 year old patient with 40% burns, the total cost would be about $15000 with 80 days in the hospital. This overall cost of burn management is higher than other medical problems such as stroke and HIV/AIDS (17, 18). In comparison, cost analysis of burns management in Australia showed that management of burns patient was not significantly higher than other patients in ICU receiving a similar level of care. The only difference, however, was in physiotherapy, dressing and medication costs (19). This lack of discrepancy in Australia could be attributed to overall increased healthcare costs rather than specifically for burns, similar to the high cost in New Zealand. In low and middle-income countries, including Turkey, the costs associated with HIV/AIDS and cardiovascular issues is lower than burns due to the availability of knowledge, resources and medical specialists compared to burns management that requires highly specialised care. A lack of specialist burn services is, therefore, an important factor not only in burn care, but also in healthcare funding.

Interventions to prevent burn injuries can be divided into education programs, engineering programs and enforcement, and include “improvement in socioeconomic status, improved housing, provision of basic amenities (eg, water), proper regulation and design of industrial products (eg, kerosene stove), proper storage of flammable substances, and supervision of children” (20).

Education is also fundamental to long-term awareness of burn injuries. The authors suggest “the establishment of a national programme would help ensure sufficient funds are available and allow coordination of the efforts of district, regional and tertiary care centres.” Others suggest the need for public education, broadcasting programmes, and the implementation of stringent government regulation (7).

References

  1. Istek Ş. The devastating effects a fire burn in a child. BMJ Case Reports. 2015;2015.
  2. Agbenorku P, Agbenorku M, Fiifi-Yankson PK. Pediatric burns mortality risk factors in a developing country’s tertiary burns intensive care unit. International Journal of Burns and Trauma. 2013;3(3):151-8.
  3. Edelman LS. Social and economic factors associated with the risk of burn injury. Burns : journal of the International Society for Burn Injuries.33(8):958-65.
  4. Cubbin C, Smith GS. Socioeconomic Inequalities in Injury: Critical Issues in Design and Analysis. Annual Review of Public Health. 2002;23(1):349-75.
  5. Park JO, Shin SD, Kim J, Song KJ, Peck MD. Association between socioeconomic status and burn injury severity. Burns : journal of the International Society for Burn Injuries. 2009;35(4):482-90.
  6. Delgado J, Ramírez-Cardich ME, Gilman RH, Lavarello R, Dahodwala N, Bazán A, et al. Risk factors for burns in children: crowding, poverty, and poor maternal education. Injury Prevention. 2002;8(1):38-41.
  7. Nursal TZ, Nursal TZ, Yildirim S, Tarim A, Caliskan K. Burns in Southern Turkey: Electrical Burns Remain a Major Problem. Journal of burn care & rehabilitation. 2003;24(5):309-14.
  8. Forjuoh SN. Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns : journal of the International Society for Burn Injuries. 2006;32(5):529-37.
  9. Rossi LA, Braga ECF, Barruffini RdCdP, Carvalho EC. Childhood burn injuries: circumstances of occurrences and their prevention in Ribeirão Preto, Brazil. Burns : journal of the International Society for Burn Injuries. 1998;24(5):416-9.
  10. Sawhney CP. Flame burns involving kerosene pressure stoves in India. Burns : journal of the International Society for Burn Injuries. 1989;15(6):362-4.
  11. Kalayi GD. Burns in children under 3 years of age: the Zaria experience. Annals of tropical paediatrics. 1996;16(3):243-8.
  12. Barss P, Wallace K. Grass-skirt burns in Papua New Guinea. Lancet. 1983;1(8327):733-4.
  13. Peck MD. Epidemiology of burn injuries globally. 2015. In: UpToDate [Internet]. Waltham, MA: UpToDate.
  14. Hijar-Medina MC, Tapia-Yanez JR, Lozano-Ascencio R, Lopez-Lopez MV. [Home accidents in children less than 10 years of age: causes and consequences]. Salud publica de Mexico. 1992;34(6):615-25.
  15. Tung KY. A seven-year epidemiology study of 12,381 admitted burn patients in Taiwan–using the Internet registration system of the Childhood Burn Foundation. Burns : journal of the International Society for Burn Injuries. 2005;31 Suppl 1(1):S12-7.
  16. Forjuoh SN. Childhood burns in Ghana: epidemiological characteristics and home-based treatment. Burns : journal of the International Society for Burn Injuries. 1995;21(1):24-8.
  17. Sahin I, Ozturk S, Alhan D, Açikel C, Isik S. Cost analysis of acute burn patients treated in a burn centre: the Gulhane experience. Annals of Burns and Fire Disasters. 2011;24(1):9-13.
  18. Lofts JA. Cost analysis of a major burn. The New Zealand medical journal. 1991;104(924):488-90.
  19. Patil V, Dulhunty JM, Udy A, Thomas P, Kucharski G, Lipman J. Do burn patients cost more? The intensive care unit costs of burn patients compared with controls matched for length of stay and acuity. Journal of burn care & research : official publication of the American Burn Association. 2010;31(4):598-602.
  20. Peck MD. Prevention of fire and burn injuries. 2015. In: UpToDate [Internet]. Waltham, MA: UpToDate.

 

A new coronavirus identified in the Middle East

24 Sep, 12 | by Dr Dean Jenkins

There are early reports of a new coronavirus not previously seen in humans. One case of severe respiratory infection is in a 49-year-old man being treated in Intensive Care in London. He was from Qatar and was flown to the UK after being admitted to hospital in Doha. A similar case of a 60-year-old man who died in Saudi Arabia is being investigated.

The UK’s Health Protection Agency has notified the World Health Organisation.

“Coronaviruses are causes of the common cold but can also include more severe illness, such as the virus responsible for SARS (Severe Acute Respiratory Syndrome).”

http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120923acuterespiratoryillnessidentified/

“The WHO said it was not recommending any travel restrictions but would be seeking further information on the virus.”

http://www.reuters.com/article/2012/09/23/us-virus-who-idUSBRE88M0FV20120923

“Sars is a serious respiratory infection that caused a global outbreak in 2002, spreading from Hong Kong to more than 30 different countries around the world and killing around 800 people. Although it has not been eradicated its spread was fully contained in 2003. Like other coronaviruses, it is spread through droplets of body fluids – produced by sneezing and coughing.”

http://www.bbc.co.uk/news/health-19698335

Case reports are recognised as a powerful tool in identifying the infective agent in new outbreaks. Subsequent contact tracing can help confirm the modes of transmission, infectivity and range of severity.

Air travel is clearly the principle route for international travel of a new virus. There is likely to be debate on the value of screening (especially with new ‘non-contact’ technologies [1-3] ) at airports and controversy over permission to travel whilst ‘unwell’.

1. Bitar D, Goubar A, Desenclos JC. International travels and fever screening during epidemics: a literature review on the effectiveness and potential use of non-contact infrared thermometers. Euro Surveill. 2009 Feb;14(6). Available from: http://www.ncbi.nlm.nih.gov/pubmed/19215720

2. Tan C-C. SARS in Singapore–key lessons from an epidemic. Ann. Acad. Med. Singap. 2006 May;35(5):345–349. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16830002

3. St John RK, King A, de Jong D, Bodie-Collins M, Squires SG, Tam TWS. Border screening for SARS. Emerging Infect. Dis. 2005 Jan;11(1):6–10. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/15705315/

Surfers ankle: a bony spur of the talar neck

29 Sep, 09 | by Emilia Demetriou

“”As a sport surfing is generally safe. It is different for competitive surfers where this rapid sport calls for great agility and balance. This case report of an ankle injury demonstrates the type of damage that can be done. The authors describe the clinical investigation of this case and outline the circumstances that led to the injury.”

Surfers ankle: a bony spur of the talar neck

BMJ Case Reports: publishing, sharing and learning through experience

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