Burial workers' perceptions of community resistance and support systems during an Ebola outbreak in the Eastern Democratic Republic of the Congo: a qualitative study

BACKGROUND

Community Health Workers (CHWs) provide vital services during disease outbreaks. Appropriate burials of those who died from an infectious disease outbreak is a critical CHW function to prevent infection and disease spread. During the 2018 Ebola Virus Disease (EVD) outbreak in Beni Town, North Kivu, Democratic Republic of the Congo, we sought to understand the levels of understanding, trust, and cooperation of the community in response to the outbreak, the barriers burial workers faced in their health work and its impact on local burial workers and other CHWs.

METHODS

12 EVD burial CHWs in Beni Town completed an hour-long qualitative in-depth interview on their experiences. They were recruited from a local counseling center. Interviews were recorded, transcribed and translated into English. A team of 3 researchers identified structural and emergent themes using applied thematic analysis.

RESULTS

Workers reported major misconceptions in the community surrounding the initiation of the outbreak. Community misconceptions were based on widespread governmental mistrust as well as a belief system that intertwines traditional and scientific understandings of the world. EVD burial workers identified violence directed at them and community misinformation as the two largest barriers to effectively carrying out their work. They named several important support systems including family and friends, personal relaxation techniques, and a local counseling center.

CONCLUSIONS

As with other disease outbreaks globally, we found that government mistrust and religious beliefs strongly impacted community perceptions of the EVD outbreak. Previous studies have demonstrated clinic-based medical personnel are often the targets of violence. Our research shows that burial workers were also targeted and exposed to extreme levels of violence in their work. Along with their ability to effectively respond to the outbreak, violence has a negative impact on their own mental wellbeing. Burial workers found group counseling sessions to be an effective tool for managing the stress associated with their work. Further developing and testing of group-based interventions for this group is a priority for future research.

Support systems for cyclists in automated traffic: A review and future outlook

Interaction with vulnerable road users in complex urban traffic environments poses a significant challenge for automated vehicles. Solutions to facilitate safe and acceptable interactions in future automated traffic include equipping automated vehicles and vulnerable road users, such as cyclists, with awareness or notification systems, as well as connecting road users to a network of motorised vehicles and infrastructure. This paper provides a synthesis of the current literature on communication technologies, systems, and devices available to cyclists, including technologies present in the environment and on motorised interaction partners such as vehicles, and discusses the outlook for technology-driven solutions in future automated traffic. The objective is to identify, classify, and count the technologies, systems, and devices that have the potential to aid cyclists in traffic with automated vehicles. Additionally, this study aims to extrapolate the potential benefits of these systems and stimulate discourse on the implications of connected vulnerable road users. We analysed and coded 92 support systems using a taxonomy of 13 variables based on the physical, communicational, and functional attributes of the systems. The discussion frames these systems into four categories: cyclist wearables, on-bike devices, vehicle systems, and infrastructural systems, and highlights the implications of the visual, auditory, motion-based, and wireless modes of communication of the devices. The most common system was cyclist wearables (39%), closely followed by on-bike devices (38%) and vehicle systems (33%). Most systems communicated visually (77%). We suggest that interfaces on motorised vehicles accommodate cyclists with visibility all around the car and incorporate two-way communication. The type of system and the effect of communication modality on performance and safety needs further research, preferably in complex and representative test scenarios with automated vehicles. Finally, our study highlights the ethical implications of connected road users and suggests that the future outlook of transport systems may benefit from a more inclusive and less car-centred approach, shifting the burden of safety away from vulnerable road users and promoting more cyclist-friendly solutions.

Fracture pattern projection on 3D bone models as support for bone fracture simulations

BACKGROUND AND OBJECTIVE

Obtaining bone models that represent certain types of fractures is limited by the need for such fractures to occur in real life and to be processed from medical images. This work aims to propose a method that starts from the design of specific fracture patterns in order to be projected on 3D geometric bone models, being prepared for their subsequent geometric fracturing.

METHODS

The process of projecting expert-generated fracture patterns has been approached in such a way that they contain geometrical and topological information for the subsequent fracture of the triangle mesh representing the bone model, giving information about the validity of the fracture pattern due to the design process, the validation performed, and the relationships between the fracture lines.

RESULTS

Different 3D models of long bones have been used (femur, humerus, ulna and fibula). Also, different types of fracture patterns have been created. These patterns have been used to obtain their projection on three-dimensional bones. In this study, an expert validation of the fracture patterns projected on the bone models is performed. A forensic validation of the fracture patterns used as starting point for the projection is also performed for cases in which this fracture is produced by impact, for which there is scientific evidence based on forensic analysis. This validation also supports the experts, giving them the necessary feedback to complete or modify their fracture patterns according to criteria analyzed from a forensic point of view.

CONCLUSIONS

The patterns fit the bone models correctly, despite the irregularities of the bone models, and correspond to the expected projection. In addition, it provides us with a clear line of work, by using the topological information of the fracture pattern and the bone model, which allows us to establish a consistent basis for future guided fractures.

"I just keep thinking that I don't want to rely on people." a qualitative study of how people living with dementia achieve and maintain independence at home: stakeholder perspectives

Background

Most people living with dementia want to remain in their own homes, supported by family and paid carers. Care at home often breaks down, necessitating transition to a care home and existing interventions are limited. To inform the development of psychosocial interventions to enable people with dementia to live well for longer at home, we qualitatively explored the views of people living with dementia, family carers and health and social care professionals, on how to achieve and maintain independence at home and what impedes this.

Methods

We conducted an inductive thematic analysis of qualitative interviews with 11 people living with dementia, 19 professionals and 22 family carers in England.

Results

We identified four overarching themes: being in a safe and familiar environment, enabling not disabling care, maintaining relationships and community connectedness, and getting the right support. For people living with dementia, the realities of staying active were complex: there was a tension between accepting support that enabled independence and a feeling that in doing so they were accepting dependency. Their and professionals’ accounts prioritised autonomy and ‘living well with dementia’, while family carers prioritised avoiding harm. Professionals promoted positive risk-taking and facilitating independence, whereas family carers often felt they were left holding this risk.

Discussion

Psychosocial interventions must accommodate tensions between positive risk-taking and avoiding harm, facilitating autonomy and providing support. They should be adaptive and collaborative, combining self-management with flexible support. Compassionate implementation of rights-based dementia care must consider the emotional burden for family carers of supporting someone to live positively with risk.

"It Happens to Girls All the Time": Examining Sexual Assault Survivors' Reasons for Not Using Campus Supports

Sexual assault is a prevalent problem in higher education, and despite the increasing availability of formal supports on college campuses, few sexual assault survivors use them. Experiencing sexual assault can have devastating consequences on survivors' psychological and educational wellbeing, which may intensify if survivors do not receive adequate care. Drawing from existing theoretical frameworks and empirical research, this study used a mixed methodological approach to examine why survivors did not use three key campus supports-the Title IX Office, the sexual assault center, and housing staff-and if these reasons differed across the three supports. Using data from 284 women who experienced sexual assault in college, our qualitative findings identified four overarching themes, including logistical issues (e.g., lacking time and knowledge), feelings, beliefs, and responses that made it seem unacceptable to use campus supports, judgments about the appropriateness of the support, and alternative methods of coping. Quantitative findings revealed that survivors' reasons for not seeking help differed across supports. Collectively, our findings suggest that community norms and institutional policies can make it challenging for survivors to use campus supports. We propose several suggestions for institutional change (e.g., taking a stronger stance against "less serious" forms of sexual assault, reducing a quasi-criminal justice approach to investigation and adjudication, limiting mandated reporting).

Childhood adversity and the risk of substance use and delinquency: The role of protective adult relationships

Youth involved in the child welfare system experience multiple early adversities that can contribute to increased risk of substance use and delinquency. Although adverse childhood experiences (ACEs) have been associated with poorer behavioral outcomes among youth, less is known about the possible protective factors that may influence the relationship between early adversity and risk-taking behavior. This study examined whether protective adult relationships moderated the link between cumulative ACEs and substance use and delinquency after controlling for demographic characteristics in child welfare-involved youth. The sample included 1054 youth, ages 11-17, from the National Survey of Child and Adolescent Well-Being II who were in the first wave of data collection. Results showed that protective adult relationships moderated the relationship between ACEs and substance use, but not for delinquency. Specifically, under lower levels of protective adult relationships, cumulative ACEs related to increased substance use among youth. Implications for child welfare practices to target youths' support systems are discussed.

Behavioral and affective disorders after brain injury: French guidelines for prevention and community supports

OBJECTIVE

The purpose of this study was to elaborate practice guidelines for the prevention of behavioral and affective disorders in adult outpatients after traumatic brain injury (TBI); but also to identify the support systems available for family, caregivers of patients with TBI within the community.

METHODS

The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. This involved a systematic and critical review of the literature looking for studies that investigated the impact of programs in community settings directed to behavioral and affective disorders post-TBI. Recommendations were than elaborated by a group of professionals and family representatives.

RESULTS

Only six articles were found comprising 4 studies with a control group. Two studies showed a beneficial effect of personalized behavior management program delivered within natural community settings for persons with brain injury and their caregivers. Two other studies showed the relevance of scheduled telephone interventions to improve depressive symptoms and one study emphasized the usefulness of physical training. One study investigated the relevance of an outreach program; this study showed an improvement of the patients' independence but did not yield any conclusions regarding anxiety and depression.

DISCUSSION AND RECOMMENDATIONS

In addition to the application of care pathways already established by the SOFMER, prevention of behavioral and affective disorders for brain-injured outpatients should involve pain management, as well as development of therapeutic partnerships. It is recommended to inform patients, their family and caregivers regarding the local organization and facilities involved in the management of traumatic brain injury. The relevance of therapeutic education for implementing coping strategies, educating caregivers on behavioral disorder management, follow-up telephone interventions, and holistic therapy seems established. The level of evidence is low and preliminary studies should be confirmed with larger controlled trials.