Frontiers in public health
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Front Public Health · Jan 2020
Rocketship and the Rural Health Workforce Revolution in the Pacific: Growing Skilled Medical Generalists Across the "Blue Continent".
Dramatic shifts are occurring in the size, shape and skill of rural health workforces in Pacific island countries (PICs) due to an unprecedented convergence of political agreement, policy commitment, donor support and technical assistance. In particular, the impact of "medical internationalism" is being felt across the Pacific region, with new doctors returning home in far greater numbers than ever before, the majority having graduated from medical schools in Cuba, China and other countries outside the region, in addition to the more typical numbers graduating and returning home from the region's main medical schools in Fiji and Papua New Guinea. With an agreed regional vision of "Healthy Islands" across the Pacific, the main objective of expanding overseas training opportunities for Pacific island medical students has been to correct the widespread centralization and maldistribution of the medical workforce in PICs and improve health access and quality of care in rural areas by deploying the new graduates to outer-island facilities. ⋯ Since 2015, Rocketship has been working in partnership with the Ministries of Health and other key partners in Solomon Islands, Timor-Leste, Tonga and Vanuatu to design and deliver postgraduate training programmes in the core generalist disciplines family, community and rural hospital medicine. To date, this has resulted in new postgraduate Family Medicine courses being established in Timor-Leste and Tonga; a rural medical workforce support programme being delivered in Vanuatu; and a new Postgraduate Diploma in Rural Generalist Medicine being designed in Solomon Islands. These new programmes, as well as other notable initiatives elsewhere in the Pacific such as the Master of Medicine (Rural) programme in Papua New Guinea, the Diploma and Master of Family Medicine programme in Fiji and the Cook Islands Fellowship in General Practice, are transforming the health workforce in PICs with the potential to benefit island people across the "Blue Continent." This paper describes the establishment of new postgraduate training programmes in family, community and rural hospital medicine in Timor-Leste, Tonga, Solomon Islands and Vanuatu from the perspective of Rocketship, the non-profit organization engaged by each country's Ministry of Health (or equivalent) to provide expert technical assistance with their initiative.
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Front Public Health · Jan 2020
Integrating Air Quality and Public Health Benefits in U.S. Decarbonization Strategies.
Research on air quality and human health "co-benefits" from climate mitigation strategies represents a growing area of policy-relevant scholarship. Compared to other aspects of climate and energy policy evaluation, however, there are still relatively few of these co-benefits analyses. This sparsity reflects a historical disconnect between research quantifying energy and climate, and research dealing with air quality and health. ⋯ Studies in the peer-reviewed literature (n = 26) have evaluated carbon pricing, renewable portfolio standards, energy efficiency, renewable energy deployment, and clean transportation. A number of major findings have emerged from these studies: [1] decarbonization strategies can reduce air pollution disproportionally on the most polluted days; [2] renewable energy deployment and climate policies offer the highest health and economic benefits in regions with greater reliance on coal generation; [3] monetized air quality health co-benefits can offset costs of climate policy implementation; [4] monetized co-benefits typically exceed the levelized cost of electricity (LCOE) of renewable energies; [5] Electric vehicle (EV) adoption generally improves air quality on peak pollution days, but can result in ozone dis-benefits in urban centers due to the titration of ozone with nitrogen oxides. Drawing from these published studies, we review the state of knowledge on climate co-benefits to air quality and health, identifying opportunities for policy action and further research.
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Front Public Health · Jan 2019
ReviewGeospatial Science and Point-of-Care Testing: Creating Solutions for Population Access, Emergencies, Outbreaks, and Disasters.
Objectives: (a) To understand how to integrate geospatial concepts when implementing point-of-care testing (POCT); (b) to facilitate emergency, outbreak, and disaster preparedness and emergency management in healthcare small-world networks; (c) to enhance community resilience by using POCT in tandem with geographic information systems (GISs) and other geospatial tools; and (d) to advance crisis standards of care at points of need, adaptable and scalable for public health practice in limited-resource countries and other global settings. Content: Visual logistics help integrate and synthesize POCT and geospatial concepts. The resulting geospatial solutions presented here comprise: (1) small-world networks and regional topography; (2) space-time transformation, hubs, and asset mapping; (3) spatial and geospatial care paths™; (4) GIS-POCT; (5) isolation laboratories, diagnostics isolators, and mobile laboratories for highly infectious diseases; (6) alternate care facilities; (7) roaming POCT-airborne, ambulances, space, and wearables; (8) connected and wireless POCT outside hospitals; (9) unmanned aerial vehicles; (10) geospatial practice-demographic care unit resource scoring, geographic risk assessment, and national POCT policy and guidelines; (11) the hybrid laboratory; and (12) point-of-careology. ⋯ POCT-enabled spatial grids can map sentinel cases and establish geographic limits of epidemics for ring vaccination. Impact: Geospatial solutions generate inherently optimal and logical placement of POCT conceptually, physically, and temporally as a means to improve crisis response and spatial resilience. If public health professionals, geospatial scientists, and POCT specialists join forces, new collaborative teamwork can create faster response and higher impact during disasters, complex crises, outbreaks, and epidemics, as well as more efficient primary, urgent, and emergency community care.
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Front Public Health · Jan 2019
ReviewYou're It-You've Got to Save Someone: Immediate Responders, Not Bystanders.
Recurring disasters and life-threatening emergencies mandate that communities across the world be adequately prepared to prevent, respond, and recover from these events. Experiences throughout the world with mass casualty incidents and other disasters have increasingly highlighted the vital role that "active bystanders"-persons at the scene of an event who step forward to help-can play in preventing, containing, reporting, saving lives, decreasing morbidity, and increasing resilience. This paper seeks to emphasize the importance of the public in response to emergencies. ⋯ Immediate responders can and do play a valuable and unique role in reducing mortality, morbidity, and suffering from emergency events. While some cultures and countries have a long history of engaging the public as critical in an emergency response, others do not. The challenge is how best to increase the number of individuals who are motivated, prepared and ready to respond appropriately when they find themselves at the scene of an active shooter, bombing, hurricane, earthquake, tornado, fire, vehicle crash, or other life-threatening emergency.
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Background: Telemedicine, or healthcare delivery from a distance, has evolved over the past 50 years and helped alter health care delivery to patients around the globe. Its integration into numerous domains has permitted high quality care that transcends obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine ("tele-ultrasound") has advanced substantially in recent years, particularly in high-income settings. ⋯ The most common outcome measures were image quality, telemedicine system requirements, diagnostic accuracy, and changes in clinical management. Limitations: The studies included were of poor quality with a dearth of randomized control trials and with significant between study heterogeneity which resulted in incomplete data and made cross study comparison difficult. Conclusions and Implications of Key Findings: Low-quality evidence suggests that ultrasound images acquired in resource-limited settings and transmitted using a telemedical platform to an expert interpreter are of satisfactory quality and value for clinical diagnosis and management.