Explore the vast range of titles available.

Gun violence against children in the US is a public health crisis which violates the human rights of its victims, resulting in lasting morbidity and death. Firearm-related injury is the leading cause of death for children under eighteen years old in the US. We use the United Nations (UN) 'Universal Declaration of Human Rights', 'UN Convention on the Rights of the Child', and 'UN Sustainable Development Goal's to analyze gun violence against children in the US from a human rights perspective. We recommend to: 1) ratify the 'UN Convention on the Rights of the Child', establishing a framework for comprehensive gun law reform, 2) partner with the UN Special Representative for the Secretary-General on Violence Against Children to draft policy, 3) increase gun violence research funding, and 4) implement evidence-based community violence prevention programs.

The visionary talents of writer Chris Claremont and legendary illustrator Bill Sienkiewicz bring the Demon Bear that has haunted Danielle Moonstar's dreams to horrifying life! It took her parents, and now it has returned for Dani - and only the combined efforts of her fellow New Mutants can stop it from finishing the job! Sink your teeth into a true classic! Then, Dani's nightmare returns years later as San Francisco - and her new team X-Force, come under attack from a similarly unholy ursine!

Data collection and verification should be task-shifted to a non-clinical data team since the excessive workload of LMIC healthcare providers limits daily research involvement. Trauma registries may identify that more road traffic injury hospital admissions are pedestrians or motorcyclists rather than car passengers. Researchers in LMICs must continuously advocate for increased investment in precise and accurate trauma registry data collection to develop the highest-yield interventions.

Background Cameroon is amongst the worst affected countries by road traffic injuries with an estimated 1443 disability-adjusted life years per 100,000 population. There have been very limited reports on the crucial prehospital response to road traffic injuries in Cameroon. This study aimed to identify prehospital factors associated with RTI mortality in Cameroon. Methods We included patients enrolled between June 2022 and March 2023 in the Cameroon Trauma Registry. Information about prehospital factors and demographic data was obtained from patients or their proxies. We examined the association of prehospital care factors like care at the crash scene and type of transportation during crash with final patient outcome. We used Chi-squared test to investigate the association between selected independent variables and mortality. A multivariable logistic regression model was built to identify independent predictors of dying from an RTI. Results RTIs constituted 69.5% ( n  = 3203) of all injuries in the Cameroon Trauma Registry. Only 20.7% ( n  = 102) of 4 + wheel vehicle occupants had seatbelts on and just 2.7% ( n  = 53) of motorcycle riders were wearing helmets during the collision. Only 4.9% ( n  = 156) of patients received any form of scene care. In-hospital mortality was 4.3% ( n  = 139) and was associated with male sex (AOR = 1.7, 95%CI = 1.08–2.80), crashing on a motorcycle (AOR = 2.08, 95%CI = 1.1–3.67) and scene care (AOR = 0.25, 95%CI = 0.04–0.80). Conclusions Receiving any type of care at the scene such as bleeding control or being placed in the recovery position by bystanders is associated with improved survival. Improving on existing informal prehospital care responses should be a priority in Cameroon.

BackgroundInjured patients in Cameroon face high out-of-pocket costs and care discrepancies based on ability to pay. Per government declaration, all Cameroonian hospitals instituted emergency payment deferral (EPD) programmes to mitigate financial barriers to emergency care. Doctors or nurses decide on patients’ eligibility for the EPD programme. However, the impact of EPD on care patterns is unclear.MethodsThe Cameroon Trauma Registry (CTR) is a prospective, multisite trauma registry collecting injured patient data from four hospitals in Cameroon. Using CTR data from March 2020 to February 2022, we analysed associations between patient participation in EPD programmes and healthcare interventions using univariate analysis and multivariate logistic regression.ResultsOf 5287 CTR patients, 58% (n=3081) were emergency payment deferral recipients (EPDR). A greater proportion of EPDR lived in urban residences (89% EPDR vs 87% non-EPDR, p=0.003). EPDR more often presented with a ‘serious’ or more severe estimated injury severity (70% EPDR vs 59% non-EPDR, p<0.001). Compared with non-recipients, a smaller proportion of EPD recipients, a smaller proportion of EPDR underwent recommended X-rays (48% EPDR vs 51% non-EPDR, p<0.001). However, greater percentages of EPDR received a recommended ultrasound (3% vs 1%, p<0.001) or CT scan (14% EDPR vs 10% non-EDPR, p<0.001). EPDR more often did not receive radiological tests due to inability to pay (12% vs 4%, p<0.001). Moreover, 10% of EPDR did not undergo recommended surgery due to cost while 6% of non-EPDR did not undergo recommended surgery due to cost (p<0.001). Multivariate logistic regression controlling for injury severity and other demographics indicates that EPDR were less likely to undergo surgery (adjusted OR=0.63, p=0.001).ConclusionPayment deferral programmes were associated with increased use of some imaging tests, but did not fully address the downstream financial barriers that impede health equity in Cameroon.

Objectives. Conventional theory regarding externalities and personal choices implies that in the absence of negative externalities, there is no economic rationale for government to regulate or ban those choices. We evaluate whether legally recognizing (or prohibiting) same-sex marriage has any adverse impact on societal outcomes specifically related to \"traditional family values.\" Methods. Using data from 1990 to 2004 in the U.S. states, with statistical controls appropriate for the particular model, and with fixed effects, we test the claim of the Family Research Council that same-sex marriage will have negative impacts on marriage, divorce, abortion rates, the proportion of children born to single women, and the percent of children in female-headed households. Results. We find no statistically significant adverse effect from allowing gay marriage. Bans on gay marriage, when they are not overturned, appear to be associated with a lower abortion rate and a lower percentage of children in female-headed households. However, allowing gay marriage also shows the same or stronger associations. Conclusions. The argument that same-sex marriage poses a negative externality on society cannot be rationally held. Although many might believe that this conclusion is so obvious that it does not warrant testing, many politicians use this argument as a fact-based rationale to legitimize bans on same-sex marriage.

ObjectivesWe analyzed resuscitation practices in Cameroonian patients with trauma as a first step toward developing a context-appropriate resuscitation protocol. We hypothesized that more patients would receive crystalloid-based (CB) resuscitation with a faster time to administration than blood product (BL) resuscitation.MethodsWe included patients enrolled between 2017 and 2019 in the Cameroon Trauma Registry (CTR). Patients presenting with hemorrhagic shock (systolic blood pressure (SBP) <100 mm Hg and active bleeding) were categorized as receiving CB, BL, or no resuscitation (NR). We evaluated differences between cohorts with the Kruskal-Wallis test for continuous variables and Fisher’s exact test for categorical variables. We compared time to treatment with the Wilcoxon rank sum test.ResultsOf 9635 patients, 403 (4%) presented with hemorrhagic shock. Of these, 278 (69%) patients received CB, 39 (10%) received BL, and 86 (21%) received NR. BL patients presented with greater injury severity (Highest Estimated Abbreviated Injury Scale (HEAIS) 4 BL vs 3 CB vs 1 NR, p<0.001), and lower median hemoglobin (8.0 g/dL BL, 11.4 g/dL CB, 10.6 g/dL NR, p<0.001). CB showed greater initial improvement in SBP (12 mm Hg CB vs 9 mm Hg BL vs 0 NR mm Hg, p=0.04) compared with BL or no resuscitation, respectively. Median time to treatment was lower for CB than BL (12 vs 131 min, p<0.01). Multivariate logistic regression adjusted for injury severity found no association between resuscitation type and mortality (CB adjusted OR (aOR) 1.28, p=0.82; BL aOR 1.05, p=0.97).ConclusionsCB was associated with faster treatment, greater SBP elevation, and similar survival compared with BL in Cameroonian patients with trauma with hemorrhagic shock. In blood-constrained settings, treatment delays associated with blood product transfusion may offset the physiologic benefits of an early BL strategy. CB prior to definitive hemorrhage control in this resource-limited setting may be a necessary strategy to optimize perfusion pressure.Level of evidence and study typeIII, retrospective study.

We are pleased that Professors Allen and Price (2015) have continued to investigate the empirical connection between state laws that permit (or do not ban) same-sex unions/marriages and the possibility of adverse consequences for families. Using updated information about state laws, and using their preferred coding of that information, Professors Allen and Price have largely replicated our findings (Langbein and Yost 2009). In both investigations, same-sex marriage laws appear to have no adverse effects on families in the state where the laws operate. Both studies suffer from low power. More data and better research designs were not available when we wrote our study; we look forward to these improvements in the future.

Purpose: A non-governmental organization (NGO) conducts short-term medical missions in the Dominican Republic. Diabetes (DM) diagnosis and treatment, including a recent pilot of insulin, is an important practice of the NGO clinic. Here we report on 1) initial outcomes of the insulin treatment program (clinical component) and 2) longer-term blood glucose control among patients diagnosed with DM (research component).Methods: In the clinical component, patients identified with uncontrolled DM had baseline HbA1c measurements drawn before starting insulin and were trained by community health workers (CHWs) to use insulin. The patients reported daily fasting blood glucose measurements to the CHWs for insulin dose titration. Follow-up was scheduled for three and six months after starting insulin.In the research component, charts were reviewed at the NGO clinic for patients diagnosed with diabetes between 2004 and 2018. Researchers recorded baseline characteristics and outcome measurements of diabetic patients. We examined HbA1c over time, defining a “target” HbA1c measurement of 1% decrease compared to baseline or a measurement less than 8%. We estimated the proportion of measurements at which the target was met.Results: In the clinical component, four patients began insulin treatment in late June 2018. There were no episodes of hypoglycemia. Patients reported 93% of expected daily fasting blood glucose measurements. The median net change in HbA1c compared to baseline after three months of insulin was -0.7 (IQR: -1.9, 0.8) %. The median net change in HbA1c from baseline after six months was -1.1 (IQR: -2.9, 1.1) %. One patient discontinued insulin after five months. In the research component, we found 170 patients with DM. 53.5% were female. The median age at DM diagnosis was 56 (IQR: 49, 67) years. DM patients had their disease followed at the NGO clinic for a median duration of 4.8 (IQR: 1.5, 7.4) years. 71% of diabetic patients had hypertension. 51% of the patients had two or more comorbidities at the time of diagnosis. A median of 2 (IQR: 1, 5) follow-up HbA1c measurements were available per patient, 1 (IQR: 0, 3) measurement of which was at target. 56% of patients had at least one HbA1c measurement at target.Conclusions: The NGO was able to successfully and safely introduce insulin therapy in a rural setting. Increased frequency of HbA1c monitoring in diabetic patients and expanded insulin use are recommended. Follow up among the diabetes patients is limited and may be more frequent among diabetes patients with better glycemic control.