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PubMed2002

Current prevalence and incidence of infectious disease markers and estimated window-period risk in the American Red Cross blood donor population.

BACKGROUND: There has been continuing progress in measures to reduce the risk of transfusion-transmitted infection, including introduction of serologic tests of increased sensitivity and the recent implementation of investigational NAT in small pools of samples. STUDY DESIGN AND METHODS: Data relating to all blood donations to the American Red Cross have been consolidated into a single database. The prevalence of confirmed-positive test results for HBsAg, HCV, HIV, and HTLV were evaluated for each year for first-time donors from 1995 through 2001. Incidence rates for these infections were evaluated among repeat donors having at least two donations in a 2-year period. The frequencies of HIV-1 RNA- and HCV RNA-positive, seronegative donations were assessed for first-time and repeat donations. The relationship risk = (window period) x (incidence) was used to assess residual risk among repeat donations and to evaluate the incidence of HCV and HIV infection among first-time donors. RESULTS: During the study period, prevalence rates for all markers declined significantly over time: in 2001, the rates per 100,000 were 75.6 for HBsAg, 299 for HCV, 9.7 for HIV, and 9.6 for HTLV; the corresponding incidence rates (/100,000 person-years) were 1.267, 1.889, 1.554, and 0.239, respectively. Estimates of residual risk in donations from repeat donors (after NAT) for HCV and HIV were 1 per 1,935,000 and 1 per 2,135,000, respectively. However, incidence rates for these agents are approximately two times greater among first-time donors. For both HCV and HIV, NAT yield was concordant with that predicted by current window-period models. CONCLUSION: These data cover about half of all the whole blood collected in the United States. They suggest increasing improvement in transfusion safety and clearly define the benefit of pooled NAT.

Biomarkers↗
PubMed1994

Outcome of war-injured patients treated at first aid posts of the International Committee of the Red Cross.

This study describes the effects of 'echelons' on the outcome of victims of the Afghan internal armed conflict in terms of mortality and drain of surgical resources. A group of 1127 victims of war treated at ICRC first aid posts (FAPs) and subsequently referred to a surgical hospital of the International Committee of the Red Cross (group A), and a group of 596 victims who were transported directly from the area where the injury occurred to the hospital (group B) were analysed retrospectively. Mortality in patients treated initially at a FAP and admitted within 6-24 h after injury was slightly lower than in patients admitted directly. The number of surgical interventions was higher in patients initially treated at the FAP. Notably, patients belonging to group A with gunshot injuries underwent operation more often than those belonging to group B. No differences were found in relation to the incidence of fever, number of units of blood transfused and average stay in hospital. The study shows that initial treatment at a FAP had no significant influence on the prognosis of the injured. Presumably the best ways to improve the prognosis of the victims of war are to train local people in first aid, to support locally existing medical facilities and to establish an evacuation system in order to support these first aiders and medical facilities.

Adolescent↗
PubMed2005

Prevalence of selected viral infections among temporarily deferred donors who returned to donate blood: American Red Cross blood donor study.

BACKGROUND: Health history questions are introduced into the predonation interview to identify blood donors believed to pose a higher risk of infectious diseases to recipients. This study assesses the current impact of some of those questions. STUDY DESIGN AND METHODS: Donor deferral and donation data were extracted from a research database of the American Red Cross. The prevalence of hepatitis B surface antigen or antibodies to human immunodeficiency virus, hepatitis C virus, or human T-lymphotropic virus was obtained for different groups of donors who were temporarily deferred in 2000 through 2001 and later returned to donate blood in 2000 through 2003. The results were compared with either first-time or repeat donors in 2000 through 2003, while controlling for differences in sex, age, and year of donation. RESULTS: Of donors temporarily deferred in 2000 through 2001 who had had no donation or deferral during the previous 2 years, only 22.08 percent subsequently returned to donate blood in 2000 through 2003. Donations from returning donors who had been deferred for potential infectious disease risk did not show a higher prevalence for any of the viral markers when those with no donation or deferral during the previous two years were compared with first-time donations, and those with prior donation were compared with repeat donations. CONCLUSION: Blood donors temporarily deferred in 2000 through 2001 for potential risk of viral infection who later returned to donate blood did not appear to pose a higher risk compared to first-time or repeat donors. The effectiveness of some of the currently used deferral questions in reducing viral risks warrants further study.

Adult↗
PubMed1997

Primary immunodeficiency diseases at Red Cross War Memorial Children's Hospital.

OBJECTIVE: To describe the spectrum of primary immunodeficiency diseases (PIDs) diagnosed at Red Cross War Memorial Children's Hospital. DESIGN: Retrospective, descriptive study. SETTING: Tertiary, referral hospital. PATIENTS: All patients investigated by the immunology service because of suspected PIDs, between January 1983 and December 1996. METHODS: Review of immunology service database and hospital case records. RESULTS: During the 14-year review period, 515 patients were investigated, a mean of 36.8 new patients per annum. Ninety-three patients with PIDs were diagnosed, a mean of 6.6 new patients per annum. The spectrum of PIDs was similar to that reported in developed countries. As in other series, antibody deficiencies predominated, accounting for 56% (52/93) of diagnoses. The male/female ratio was 1.5:1; 73% (62/85) came from the Western Cape, the remaining 27% (23/85) resided in five other provinces. Eighty per cent (70/87) presented with recurrent or atypical infection, with or without failure to thrive. Sinopulmonary infections (80%), diarrhoeal disease (19%) and candidiasis (18%) were the most common preceding infections. By the age of 5 years, only 60% had been diagnosed, compared with about 80% in developed countries. During the study period, 20% (19/93) were known to have died. CONCLUSIONS: The results show a pattern of PIDs incidence similar to that in developed countries. Diagnosis was delayed in many patients, which probably contributed to morbidity. To facilitate earlier diagnosis and to improve outcome, children should be considered for an immunological assessment if they exhibit increased susceptibility to infection.

Adolescent↗
PubMed1996

Injuries of the lower limbs caused by antipersonnel mines: the experience of the International Committee of the Red Cross.

Antipersonnel mines are used frequently in armed conflicts. Victims do not sustain their injuries only during the conflict, but sometimes years after it has ended. The object of this paper is to describe the treatment of patients with mine injuries in terms of mortality and the drain on hospital resources. A group of patients with fresh mine injuries who were treated at hospitals of the International Committee of the Red Cross was analysed retrospectively. About 25 per cent of patients need an amputation. The most common surgical amputation is below the knee. The study shows that the level of the amputation is closely connected with the number of operations, the number of units of blood transfused and the number of days of hospitalization.

Amputation, Surgical↗
PubMed1995

Multiple stressor debriefing and the American Red Cross: the East Bay Hills fire experience.

Workers who are mobilized to help with disaster relief are exposed to a multitude of stressors. Debriefing may prevent or minimize the negative consequences of stress reactions in relief personnel. The multiple stressor debriefing (MSD) intervention promotes the discussion of troubling aspects of the disaster work in a group format. This article discusses two models of debriefing and describes how the MSD model was used with American Red Cross personnel during the East Bay Hills firestorm in California. Specific recommendations are made for debriefing in large-scale, long-term disaster relief efforts.

California↗
PubMed2002

A note on the prevalence of anti-HIV seropositivity in the Preadmission Clinic of the largest Thai Red Cross Society clinic.

Clinical decision-making regarding operative procedures will be influenced when the patient is known to be anti-HIV, so his or her status should be discussed with the patient and clinician responsible for other aspects of his or her care. Here, we reviewed serology screening for anti-HIV in a 1-year period at the PreAdmission Clinic of King Chulalongkorn Memorial Hospital, the largest Thai Red Cross Society hospital. A total of 463 patients, 215 males and 248 females, were investigated, and four cases (all males) were determined to have anti-HIV seropositivity. The infection rate was 0.86%, similar to that of previous surveys of the general population. According to our study, 75% of the HIV-seropositive patients did not know their HIV status before our screening, and most of the infected cases (50%) underwent sex change surgery. The patients who underwent elective surgery in our clinic were usually anti-HIV seronegative. The risk group of our patients seems to be the sexual dysphorian patients who underwent sex change surgery. Additional screening tests for other infectious agents such as hepatitis B and hepatitis C virus is recommended. However, in a setting where HIV infection is common, such as in Thailand, the physician should practice universal precautions since any serological test poses dangers during diagnosis.

Ambulatory Care↗
PubMed2003

Perfluorooctanesulfonate and other fluorochemicals in the serum of American Red Cross adult blood donors.

Perfluorooctanesulfonyl fluoride-based products have included surfactants, paper and packaging treatments, and surface protectants (e.g., for carpet, upholstery, textile). Depending on the specific functional derivatization or degree of polymerization, such products may degrade or metabolize, to an undetermined degree, to perfluorooctanesulfonate (PFOS), a stable and persistent end product that has the potential to bioaccumulate. In this investigation, a total of 645 adult donor serum samples from six American Red Cross blood collection centers were analyzed for PFOS and six other fluorochemicals using HPLC-electrospray tandem mass spectrometry. PFOS concentrations ranged from the lower limit of quantitation of 4.1 ppb to 1656.0 ppb with a geometric mean of 34.9 ppb [95% confidence interval (CI), 33.3-36.5]. The geometric mean was higher among males (37.8 ppb; 95% CI, 35.5-40.3) than among females (31.3 ppb; 95% CI, 30.0-34.3). No substantial difference was observed with age. The estimate of the 95% tolerance limit of PFOS was 88.5 ppb (upper limit of 95% CI, 100.0 ppb). The measures of central tendency for the other fluorochemicals (N-ethyl perfluorooctanesulfonamidoacetate, N-methyl perfluorooctanesulfonamidoacetate, perfluorooctanesulfonamidoacetate, perfluorooctanesulfonamide, perfluorooctanoate, and perfluorohexanesulfonate) were approximately an order of magnitude lower than PFOS. Because serum PFOS concentrations correlate with cumulative human exposure, this information can be useful for risk characterization.

Adult↗
PubMed1993

Amputees in a hospital of the International Committee of the Red Cross.

The object of this study is to describe the treatment of patients with an amputation in terms of causes and distribution of injuries, mortality and drain on surgical resources. A group of patients with war injuries, who did not undergo an amputation (1796) and a group of war-injured patients with an amputation (245) were analysed retrospectively. All these patients were treated in the hospital for Afghan war wounded of the International Committee of the Red Cross. The most common amputation was below-knee amputation (BKA). In more than 90 per cent of the patients a BKA was the result of a mine explosion. About 80 per cent of amputations of the lower limb were caused by antipersonnel mines. The upper limb amputations were mainly caused by mines or by fragments. War-injured patients with an amputation face more serious problems than non-amputated patients. Their mortality is higher, they stay longer in the hospital, the risk of infection is higher, they need more blood and they undergo more surgical interventions. The high percentage of non-combatants stresses the need to give civilians better protection against the indiscriminate use of mines.

Adolescent↗
PubMed1987

Abdominal tuberculosis in children. A survey of cases at the Red Cross War Memorial Children's Hospital, 1976-1985.

Fifty-nine cases of abdominal tuberculosis were seen at the Red Cross War Memorial Children's Hospital, Cape Town, during the period 1976-1985. More than half these patients were under 4 years of age and all were malnourished. Mesenteric adenitis and/or peritoneal involvement accounted for the majority of cases and only 8 patients with proven gastro-intestinal lesions were seen. The diagnosis of suspected abdominal tuberculosis is relatively easily made since abdominal distension occurs in almost all patients. More than half have an abdominal mass, a chest radiograph suggestive of tuberculosis, a positive Mantoux skin test or a combination of these as supportive evidence for the diagnosis. Over a quarter of the patients presented with signs suggestive of intestinal obstruction. Response to antituberculosis therapy is excellent. Stricture formation on healing may occur in a minority of patients with the enteric form of the disease. Providing it is not part of disseminated tuberculosis in a grossly malnourished young child, the prognosis with treatment for abdominal tuberculosis is satisfactory.

Age Factors↗
PubMed2001

[Henri Dunant, Genève-Convention and Red Cross: a historical view].

Several appalling reports throughout the ages are at hand concerning the inhuman treatment of the wounded persons at the battlefields where they were left without any help, killed and maybe taken away as slaves. Not until Napoleon's time there was from military as well as civil side raised claim on the human treatment and a real sanitary service. The demands were advanced with weight of persons like Larrey, Dufour adn Dunant, who was the prime mover in all the efforts, at last leading to his "Un Souvenir de Solferino", which helped making the way for the Genève-Convention 22. August 1864, and afterwards the foundation of the Red Cross, thus as we today know it as the biggest international relief-organization in the world.

History, 19th Century↗
PubMed1997

Effects of the civil war in central Mozambique and evaluation of the intervention of the International Committee of the Red Cross.

In October 1994, a retrospective study of mortality of children was conducted in Maringué, a district of central Mozambique. Estimates based on maternity histories of 1503 women aged 15-60 years revealed complex changes in the under-5 death rate. During the colonial period (1955-1974), mortality declined from 373 to 270 per 1000. During the civil war period (1975-1991), mortality increased rapidly to reach a peak of 473 per 1000 in 1986. It declined again thereafter and reached a plateau of 380 in 1991. A health intervention conducted by the International Red Cross Committee since 1992 further reduced mortality to 269 per 1000 in 1994. Most of the 1992-1994 decline was attributable to vaccinations, in particular measles and tetanus immunizations, and to Vitamin A supplementation.

Adolescent↗
PubMed2005

Quality improvement programme on the frontline: an International Committee of the Red Cross experience in the Democratic Republic of Congo.

BACKGROUND: Majority of research in Quality Improvement, focuses on developed countries or development programs. Humanitarian organisations frequently work in developing countries, often in emergency situations with rapid staff turnover. Objectives of this study are twofold: first to develop a methodology of motivation and restoration of collapsed health structures through the creation of community based QI indicators; second, to implement these indicators to improve quality of care. METHODOLOGY: Using a community-based approach, the International Committee of the Red Cross (ICRC) team together with local health committee and nurses developed quality indicators divided into six different categories. Of 16 community primary health centers and four hospitals supported by ICRC, six health centers and one hospital were chosen to follow quality indicators for three of six indicator categories. Initial data were collected in January 2003 and compared with data serially gathered throughout the year. RESULTS: In the category rational prescription, all health facilities except for one showed improvement in every category. In the hygiene category, four of seven health structures showed 100% improvement in their score. Three of seven facilities showed impressive improvement in the category pharmacy management. CONCLUSION: Involving the community to design population based indicators helped communities take ownership of the indicators. Our findings that poor performance on indicators prompted communities to seek training and assistance to improve quality of care emphasized this. Continued adherence and improvement in each category confirmed the long term effects of teaching sessions in the areas of rational prescription, hygiene and pharmacy maintenance.

Community Participation↗