Risk factors for postpartum posttraumatic stress disorder after emergency admission

BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.

Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.

Risk assessment of the emergency processes： Healthcare failure mode and effect analysis

BACKGROUND: Ensuring about the patient's safety is the f irst vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care.METHODS: In this study, in combination(qualitative action research and quantitative crosssectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis(HFMEA). To classify the failure modes from the "nursing errors in clinical management model(NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics(total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used.RESULTS: In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identifi ed by HFMEA. 25(11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors(54.7%) and knowledge and skill(9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy.CONCLUSION: "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.

Research on the risk-based model for regional emergency resource allocation for ship-source oil spill

The key point for rational allocation of emergency resources is to match the oil spill response capacity with the risk of oil spill. This paper proposes an innovative risk-based model for quantitative regional emergency resource allocation, which comprehensively analyzes the factors such as oil spill probability, hazard consequences, oil properties, weathering process and operation efficiency, etc. The model calculates three major resources, i.e., mechanical recovery, dispersion and absorption, according to the results of risk assessment. In a field application in Xiaohu Port, Guangzhou, China, and the model achieved scientific and rational allocation of emergency resources by matching the assessed risk with the regional capacity, and allocating emergency resources according to capability target. The model is considered to be beneficial to enhancing the resource efficiency and may contribute to the planning of capacity-building programs in high-risk areas.

Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.

Smoking and the risk of acute coronary syndrome in young women treated in an emergency department

The aim of this study is to compare the clinical characteristics of young women (.

Development and psychometric assessment of the public health emergency risk perception scale:Under the outbreak of COVID-19

Objective:Correctly understanding and evaluating the level of public risk perception toward public health emergencies not only helps experts and decision-makers understand the public’s preventative health behaviors to these emergencies but also enhances their risk information communication with the public.The aim of this study was to develop a risk perception scale for public health emergencies and test its validity and reliability during the coronavirus disease 2019(COVID-19)pandemic.Methods:Guided by the theoretical model of risk perception,an initial scale was generated through literature review,group meetings,resident interviews,and expert consultation.A pretest and item screening were then conducted to develop a formal risk perception scale for public health emergencies.Finally,the reliability and validity of the scale were validated through a questionnaire survey of 504 Chinese adults.Results:The final scale had 9 items.The content validity index of the scale was 0.968,and the content validity index of individual items ranged from 0.83 to 1.00.Three common factors,dread risk perception,severe risk perception,and unknown risk perception,were extracted for exploratory factor analysis,and together they explained 66.26%of the variance in the score.Confirmatory factor analysis showed that the model had a satisfactory fit,whereχ^(2)/df=1.384,the goodness-of-fit index(GFI)=0.989,root mean square error of approximation(RMSEA)=0.028,root mean square residual(RMR)=0.018,comparative fit index(CFI)=0.995,normed fit index(NFI)=0.982,and non-normed fit index(NNFI)=0.990.The correlations between dimensions ranged from 0.306 to 0.483(P<0.01).Cronbach’s a was 0.793 for the total scale and ranged between 0.687 and 0.801 for the individual dimensions.The split-half coefficient was 0.861 for the total scale and ranged from 0.727 to 0.856 for induvial dimensions.The test-retest coefficient was 0.846 for the total scale and ranged from 0.843 to 0.868 for induvial dimensions.Conclusion:The developed scale for the risk perception of public health emergencies showed acceptable levels of reliability and validity,suggesting that it is suitable for evaluating residents’risk perception of public health emergencies.

Drug dependence and its risk factors in emergency department patients:A retrospective cross-sectional study

Objective:To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential(DAP)in an emergency department(ED).Methods:This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1,2019 and March 1,2020.The demographic and baseline information were recorded.All the prescibed DAP,the reasons to use these drugs,secondary drug dependence,the department where DAP were first prescribed,types of doctors who preferred to prescribed DAP,and the risk factors for the development of drug dependence were determined.Results:A total of 3000 patients were screened from medical records,and among them,80 patients developed drug dependence.Drug dependence only developed for tramadol(n=57,71.3%),diazepam(n=11,13.8%),and biperiden(n=12,15.0%).Tramadol was the most frequently prescribed drug(n=57,71.3%).The most common reason for drug dependence was psychiatric disorders(n=29,36.3%).Drug dependence developed in renal colic patients due to the administration of tramadol(n=7,100%).On the contrary,dependence to biperiden were mainly developed in patients with psychiatric complaints(n=12,41.4%).The rate of secondary drug dependence was 15%(n=12).Of the Biperiden users,41.7%developed secondary drug dependence on diazepam.Most DAP were first prescribed in the ED(n=52,65%),and the specialist preferred to prescribe DAP(n=43,53.8%).For the development of dependence,the presence of renal colic(OR:3.387,95%confidence interval(CI):1.473-7.788,P=0.004)and low back pain(OR:5.778,95%CI:2.779-12.014,P<0.001)were the risk factors.Conclusions:Most DAP were first prescribed in the ED compared to other departments,and specialist are preferred to use DAP.Tramadol is the most commonly used drugs caused drug dependence.Psychiatric disorder patients are easier to develope drug dependence.Furthermore,renal colic and low back pain patients needs more attention to avert drug dependence.

A Fundamental Study on Multi-agent Pedestrian Model Based on Risk Avoidance Behavior during Road Blockage and Evacuation Simulation of Regional Urban Disaster

Regional cities in Japan are at the risk of experiencing big fire accidents or earthquakes every day.However,neither the number nor the capacity of shelters has increased because local governments might not consider them owing to budget shortfall.By contrast,wide-area evacuation simulations can easily provide an antagonizing image of regional urban disasters.After a disaster,the city collapses and the evacuation routes are closed;consequently,evacuees feel anxious and they cannot move as usual.This anxiety behavior has not been considered in previous related studies and simulations.In this study,a wide-area evacuation simulation is developed;this model can not only calculate the possibility of blocking escape routes when the city is broken but also provide safe and more realistic evacuation plans before a disaster occurs by incorporating into the simulation the risk avoidance behaviors of evacuees from road blockage,such as“the route re-seeking behavior”and“the shelter re-selecting behavior”.

Research on Risk Analysis and Avoidance of Private Financing

Private financing is a supplementary of financial services and capital market allocation of resources, and it is also an important financing channel for SMEs and an important factor which has great impact on economic and financial operations. However, with the growing scale of private financing, there are large potential risks which affect the normal operation of private financing, and even affect the long-term development of financial markets. This paper analyzes the current situation of private financing and risks existing in current private financing, and propose some ways to avoid the risk of private financing, to provide a theoretical basis for future research on private financing risks.

Study of the Frequency of Cardiovascular Diseases and Their Risk Factors in the Emergency Units of Two Hospitals in Dakar (Senegal)

Introduction: Cardiovascular diseases constitute the deadliest pathology in the world with 31% of global mortality in 2018. This is how we felt it necessary to conduct a study on cardiovascular diseases in emergency units of Senegal, more precisely in Dakar, in order to know epidemiological profile of these patients. Methods: The study setting was the reception and emergency units of the Hôpital de Pikine and Hôpital Principal de Dakar. This was an observational, descriptive cross-sectional study with an analytical aim to search for factors associated with the occurrence of cardiovascular disease. The study ran from January 25th to February 5th, 2018 at the Hôpital de Pikine and from February 25th to March 5th, 2018 at Hôpital Principal de Dakar. The source population consisted of patients over 18 years of age and not in a state of pregnancy, who were been received there and had given their free and informed consent to participate in the survey. A representative sample had drawn and a consecutive recruitment of eligible patients were been carried out. The data collection tools were been based on the WHO STEPwise survey questionnaire. Data collection was been carried out in accordance with ethical rules. Results: The study involved 615 patients. The proportions of sedentary lifestyle, low daily consumption of fruits/vegetables, overweight and obesity were 72.4%, 96.4%, 22.7% and 17.3% respectively. This was 55.5% of women who had a waist circumference that corresponded to a high risk of a cardiovascular event and 10.2% for men. 38.9% of patients had blood pressure above 140/90mmhg and 32.2% said they had never controlled their blood pressure in their life. The use of a consultation in a health structure to control his blood pressure was by far the most frequent modality with 61.4%. The proportion of people with cardiovascular disease was 50.1%. Hypertensive flare-ups/hypertensive emergencies were the leading complications diagnosed with 33.33%. Factors associated with the occurrence of cardiovascular disease were sex, age, professional status and body mass index. Discussion & Conclusion: The risk factors for cardiovascular disease are highly represented in our emergency units. In addition to the available care offer, the identification of factors associated with the occurrence of cardiovascular diseases in patients who are been seen there will allow targeted preventive actions within this fragile and vulnerable population. All this to help achieve target 3.4 of the Sustainable Development Goals (SDGs) by 2030. Furthermore, according to the associated factors identified, it appears that achieving SDG 8 will greatly contribute to the prevention of cardiovascular disease. This proves the urgency and interest of an integrated multi-ministerial vision in our strategic plans for the prevention against major non-communicable diseases and cardiovascular diseases in particular.

Risk Communication and External Emergency Plan in Angra dos Reis, Brazil

The presence of a potentially hazardous facility in a community demands several safety procedures. Bringing risk communication among those actions may help the population that lives near the facility feel more confident and have the required knowledge on how to behave in an emergency situation. A research performed in Angra dos Reis, RJ, Brazil, where a nuclear power plant is located, shows that there is a lack of information and awareness about the emergency plan.

Does country risk impact the banking sectors’non‑performing loans?Evidence from BRICS emerging economies

This study aims to fill the gap in the literature by specifically investigating the impact of country risk on the credit risk of the banking sectors operating in Brazil,Russia,India,China,and South Africa(BRICS),emerging countries.More specifically,we explore whether the country-specific risks,namely financial,economic,and political risks significantly impact the BRICS banking sectors’non-performing loans and also probe which risk has the most outstanding effect on credit risk.To do so,we perform panel data analysis using the quantile estimation approach covering the period 2004–2020.The empirical results reveal that the country risk significantly leads to increasing the banking sector’s credit risk and this effect is prominent in the banking sector of countries with a higher degree of non-performing loans(Q.25=−0.105,Q.50=−0.131,Q.75=−0.153,Q.95=−0.175).Furthermore,the results underscore that an emerging country’s political,economic,and financial instabilities are strongly associated with increasing the banking sector’s credit risk and a rise in political risk in particular has the most positive prominent impact on the banking sector of countries with a higher degree of non-performing loans(Q.25=−0.122,Q.50=−0.141,Q.75=−0.163,Q.95=−0.172).Moreover,the results suggest that,in addition to the banking sectorspecific determinants,credit risk is significantly impacted by the financial market development,lending interest rate,and global risk.The results are robust and have significant policy suggestions for many policymakers,bank executives,researchers,and analysts.

Development and Validation of a Prediction Model on Adult Emergency Department Patients for Early Identification of Fulminant Myocarditis

Objective It is difficult to predict fulminant myocarditis at an early stage in the emergency department.The objective of this study was to construct and validate a simple prediction model for the early identification of fulminant myocarditis.Methods A total of 61 patients with fulminant myocarditis and 160 patients with acute myocarditis were enrolled in the training and internal validation cohorts.LASSO regression and multivariate logistic regression were selected to develop the prediction model.The selection of the model was based on overall performance and simplicity.A nomogram based on the optimal model was built,and its clinical usefulness was evaluated by decision curve analysis.The predictive model was further validated in an external validation group.Results The resulting prediction model was based on 4 factors:systolic blood pressure,troponin I,left ventricular ejection fraction,and ventricular wall motion abnormality.The Brier scores of the final model were 0.078 in the training data set and 0.061 in the internal testing data set,respectively.The C-indexes of the training data set and the testing data set were 0.952 and 0.968,respectively.Decision curve analysis showed that the nomogram model developed based on the 4 predictors above had a positive net benefit for predicting probability thresholds.In the external validation cohort,the model also showed good performance(Brier score=0.007,and C-index=0.989).Conclusion We developed and validated an early prediction model consisting of 4 clinical factors(systolic blood pressure,troponin I,left ventricular ejection fraction,and ventricular wall motion abnormality)to identify potential fulminant myocarditis patients in the emergency department.

Diagnostic value of ABCD2 and ABCD3-Ⅰ risk scoring systems in determining one-month risk of stroke in patients with transient ischemic attack: An observational study

Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.

Analysis on Earthquake Emergency Material Preparation Demand Based on Earthquake Risk Evaluation Taking Datong City of Shanxi Province as an Example

The earthqnake emergency material preparation demand analysis can provide the scientific basis for all levels of governments to conduct reasonable and unified configuration of the emergency preparation resources, in order to further optimize the earthquake emergency ability construction to provide reference. This paper takes Datong City of Shanxi Province as an example, using the earthquake risk evaluation method, adopting the deterministic method and probabilistic method to conduct earthquake danger analysis, combined with the earthquake emergency rescue case and the previous scholars＇ research achievements, in order to study and analyze the earthquake emergency material preparation demand in different earthquake dangers.

Obstetric Emergencies: Frequency, Socio-Demographic Aspects and Risk Factors at the Labe Regional Hospital Maternity Unit (Guinea)

Introduction: Obstetric emergencies are clinical situations of a serious nature, often dangerous, which develop unexpectedly, threatening the vital prognosis of the mother and/or foetus in the short term. The aim of this study was to contribute to a review of obstetric emergencies at the Labé Regional Hospital maternity unit. Methods: This was a prospective descriptive and analytical study conducted over a period of 6 months in the maternity unit of the Labé Regional Hospital. It concerned all patients admitted to the department for obstetric emergencies. Results: Obstetric emergencies accounted for 20% of obstetric admissions. The mean age of the patients was 25.12 ± 7.15 years, with extremes of 14 and 45 years. The patients were housewives (42.52%), 42.86% did not attend school and 77.41% were from urban areas. The poor were the most numerous (43.52%). The ambulance was the means of transport in only 9% of cases. Acute foetal distress, pre-eclampsia, bony dystocia and post-partum haemorrhage were the most common types of emergency in our series, with frequencies of 27.57%, 22.59%, 17.94% and 10.63% respectively. The risk factors identified were age, origin, gestational age and the state of the maternal pelvis. Conclusion: Obstetric emergencies are frequent in our study site and represent a major concern for patients, providers and the community alike. In order to reduce the frequency of obstetric emergencies, young girls should be enrolled in school, the legal age for marriage should be respected, quality antenatal care should be provided in basic health facilities, and proper planning and spacing of pregnancies should be implemented.

环境规制影响企业税收规避吗?--基于新《环保法》实施的准自然实验

作为重要的命令控制型环境规制工具,新《环保法》实施对企业经营产生了广泛的影响。以2010-2020年我国A股上市公司为样本,利用新《环保法》这一外生冲击事件,采用双重差分模型检验环境规制对企业税收规避的影响。结果表明,环境规制趋严促使企业提高税收规避程度。机制检验表明,环境规制导致企业融资约束程度和经营风险增加。进一步分析发现,环境规制与税收规避的正相关关系主要存在于融资难度较高和经营压力较大的企业,新《环保法》实施情境下的企业避税行为提升了财务业绩和企业价值。研究结论提供了微观企业如何应对宏观环境规制的经验证据,为政府部门结合税收政策优化环境政策提供了参考。

碳中和目标下全球清洁能源消纳的风险识别与规避路径研究

加快向清洁能源转型是二十一世纪的全球目标,在碳中和目标约束下,清洁能源消纳的机遇与挑战并存。本文聚焦不同类别的清洁能源消纳风险,对此进行识别并讨论其风险规避路径。通过深入分析极端天气风险、资源分布的均衡性、消纳技术的特点与应用、政策不确定性、市场及投资环境等情况,发现清洁能源消纳面临多维度、强交叉性风险。鉴于此,提出一套针对性的综合策略,从而促进清洁能源的稳健发展并加速其全球化消纳,包括强化国际合作、选择消纳技术演进路径、加强跨区域政策及监管,构建灵活高效的能源市场等。通过这些策略,旨在为实现清洁能源的广泛应用与可持续消纳提供实用路径,进而支持全球碳中和目标的达成。

交互视角下重大突发公共卫生事件风险影响因素识别

为了有效识别重大突发公共卫生事件风险的影响因素,基于交互视角,从事件特征、预防能力、控制能力、恢复能力等4个方面,构建了包含4个一级指标、18个二级指标的重大突发公共卫生事件风险影响因素的指标体系。在此基础上,运用模糊DEMATEL方法识别影响重大突发公共卫生事件风险的关键因素。最后,通过实际案例,对重大突发公共卫生事件风险影响因素的影响度、原因度和中心度进行了分析,识别出关键影响因素,验证了方法的可行性。