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1
Gumbo, Olivia. "COVID 19 lock-down measures on Zimbabwean populace." Advances in Social Sciences Research Journal 7, no. 7 (August 5, 2020): 797–814. http://dx.doi.org/10.14738/assrj.77.8728.
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This paper examines the impact of COVID-19 lockdown measures on Zimbabwean populace. The objectives of the paper were to understand the influence of lockdown measures on people living in Zimbabwe. The use of virtual qualitative methodology was utilised. The data gathering methods that were used are phone short message services, WhatsApp, telephone conversations with participants, virtual meetings with key informants and informal talks with some participants on shopping queues. The results of the study are that COVID-19 lockdown measures had negative impact on livelihoods of citizens, brought uncertainties on youths’ future, confusion to school students and erosion of social movements. The paper concludes that COVID-19 lock down measures impacted the general public negatively more than the disease itself. It is recommended that the Zimbabwean government considers the impact of lock down restrictions on the most affected groups such as women, youths and children. The government should cushion the vulnerable groups with safety net allowances and consult them when developing strategies that can help them to come out of the shocks they are currently experiencing.
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Malhotra, Naveen, and Marlieta Lassiter. "The Coming Age Of Electronic Medical Records: From Paper To Electronic." International Journal of Management & Information Systems (IJMIS) 18, no. 2 (March 28, 2014): 117. http://dx.doi.org/10.19030/ijmis.v18i2.8493.
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Medical records, first developed in the fifth century, have remained virtually unchanged until the explosion of new technology in the mid-1960s. The National Space and Aeronautics Administrations development of computerized patient record (CPR) brought life to the electronic medical record (EMR) industry. Preventable deaths due to medical errors drew the attention of public and health care professionals to the need for increased patient safety and improved quality measures in medicine. With health care costs compromising 16-17% of the U.S. Gross Domestic Product, Congress passed legislation to financially support providers to adopt electronic medical record (EMR). As a result, future efforts will focus on the sharing of information among all health care stakeholders. Across the world, governments, technology companies, and care providers are collaborating efforts to make the EMR a reality.
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Lee, Hye-Won, Jeong-In Jeon, Hui-Been Lim, Kwi-Bok Lee, So-Yeon Park, and Cheol-Min Lee. "A Preliminary Research Study for Distribution Characteristics and Sources of Indoor Air Pollutants in the Valuable Archive of the National Library of Korea." International Journal of Environmental Research and Public Health 18, no. 4 (February 10, 2021): 1715. http://dx.doi.org/10.3390/ijerph18041715.
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Important records can be damaged directly and indirectly. Their restoration, if possible, is difficult as it is very time-consuming and costly. Although measures have been taken to permanently preserve records, most studies focus on preventing short-term damage from physical or biological factors and not on preventive measures against chemical damage from long-term polluted air exposure. This study investigated the types, concentrations, and distribution characteristics of hazardous chemicals present in the valuable archive of the National Library of Korea (NLK) and identified the sources of these pollutants. Mean SO2, NOX, CO, CO2, and total volatile organic compound (TVOC) concentrations were 1.49 ± 0.44 ppb, 30.52 ± 19.70 ppb, 0.75 ± 0.21 ppm, 368.91 ± 32.23 ppm, and 320.03 ± 44.20 µg/m3, respectively, meeting the Ministry of the Interior and Safety (MOIS) of Korea standards. Toluene (66.43 ± 10.69 µg/m3) and acetaldehyde (157.23 ± 6.43 µg/m3) were present at the highest concentrations, respectively. Two principal components were extracted via a principal component analysis; the primary component (66%) was closely related to outdoor pollution sources and the secondary component (33%) to indoor sources. Results contribute to establishing air quality standards and management measures for preservation of this archive.
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Linja-aho, Vesa. "Fatal electrical accidents in Finland 1980–2019 – trends and reducing measures." International Journal of Occupational and Environmental Safety 4, no. 2 (November 30, 2020): 37–47. http://dx.doi.org/10.24840/2184-0954_004.002_0004.
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This paper analyses the content of fatal electrical accident records (n=157) in Finland during the years 1980–2019 in order to identify and classify accident types and causes. During the 40-year period, the death rate from electrical accidents has decreased from 0.29 per 100,000 people per year to 0.00-0.07 in the last decade. The number of accidents rooting from accidentally touching live parts and by making illegal electrical installations has plummeted. Of all fatalities, 37% could probably have been prevented if the circuit had been protected with a residual current device, which is now mandatory in new installations. The most common electrical accident in 2010–2019 was an electric shock from a railway overhead power line. Of fatal electrical accidents, 76% occur between April and September and 92.5% of victims are male. Child casualties are very rare. The level of electrical safety can be considered acceptable, but educating the public still has room for improvement.
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Hong, Y. Alicia, Shaohai Jiang, and Piper Liping Liu. "Use of Patient Portals of Electronic Health Records Remains Low From 2014 to 2018: Results From a National Survey and Policy Implications." American Journal of Health Promotion 34, no. 6 (February 7, 2020): 677–80. http://dx.doi.org/10.1177/0890117119900591.
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Purpose: To investigate the trend of patient portal use in the general population and the barriers to adoption. Participants: We analyzed 3 iterations of the Health Information National Trends Survey (HINTS) collected in 2014, 2017, and 2018. Measures: Patient portal use, high-speed Internet access, data safety confidence, prior experience of online patient provider communication (OPPC), and demographic variables. Analysis: Logistic regression analyses were conducted separately for the 3 iterations of HINTS. Results: The use of patient portals increased from 25.6% in 2014 to 30.5% in 2017, and 31.4% in 2018. These users were more likely to be white female with higher levels of education or income. Meanwhile, high-speed Internet access, prior experience of OPPC, and data safety confidence were positive predictors of patient portal use in all 3 iterations. Conclusion: The use of patient portals in the general public remains low and a significant digital divide persists, presenting a major challenge on meaningful use of electronic health record. We call for more effective interventions to address these gaps. Such interventions should target people of low socioeconomic status and focus on improving eHealth literacy and patients’ confidence in data safety.
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Walker, Hill M., and Steve Stieber. "Teacher Ratings of Social Skills as Longitudinal Predictors of Long-Term Arrest Status in a Sample of At-Risk Males." Behavioral Disorders 23, no. 4 (August 1998): 222–30. http://dx.doi.org/10.1177/019874299802300407.
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The study described here is one of a number of longitudinal reports involving an at-risk group of 80 males we have been following since 1984 in collaboration with the Oregon Social Learning Center (OSLO. We collected the following measures on the study participants twice annually, fall and spring: (a) direct observations in classroom and playground settings through grade 6; (b) teacher ratings on the Walker-McConnell Scale of Social Competence and School Adjustment; and (c) archival school records (e.g., attendance, discipline referrals, negative narrative comments in cumulative folders, standardized achievement test data, and so forth). OSLC staff accessed public safety and court records annually to record police contacts, arrests, and dispositions of cases. This article examines the relationships over a 6-year period between teacher ratings of social skills recorded in grade 5 and arrest records through grade 11. Results indicated that teacher ratings of social skills were a significant predictor of police contacts and arrest status during middle and high school years for this group of students. Implications for early detection and intervention are discussed in light of these findings.
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Ilić Krstić, Ivana, Danijela Avramović, and Snežana Živković. "Occupational injuries in underground coal mining in Serbia: A case study." Work 69, no. 3 (July 16, 2021): 815–25. http://dx.doi.org/10.3233/wor-213514.
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BACKGROUND: Mining, especially underground coal mining, has always been a hazardous occupation. Injuries, including those that are fatal, are a major occupational risk that all miners have to face. OBJECTIVE: Despite the fact that all workers are aware of the risks, efforts must be made to increase their safety through the implementation of preventive measures. METHODS: This retrospective study includes injury data from all nine Serbian coal mines over a 16-year period, from 2000 to 2016. All injury data were collected from employee safety and health records. RESULTS: In the analyzed period, a total of 9,273 occupational injuries were recorded at Resavica. The highest number of occupational injuries (over 600) were recorded in 2008 (669), 2004 (651), and 2005 (603). The data shows that almost one fifth of the total number of occupational injuries, or 20.74%, occurred during the said three years. On average, 493.06 minor, 51.12 severe, and 1.29 fatal injuries occurred each year. Every day there were 1.29 minor occupational injuries and every seven days there was one severe injury. CONCLUSIONS: Despite indications that there is a connection between some of the variables and the number of injuries, the general conclusion is that injuries are accidental and unpredictable. The high percentages of injuries are due to the organization of work and the age or qualification structure of the staff and, of course, are the consequence of likelihood –the greater the number of workers, the greater the likelihood of injury. However, the present study showed that some measures can be taken to increase occupational safety and reduce the number of injuries.
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Holly, Cheryl, Sallie Porter, Mary Kamienski, and Aubrianne Lim. "School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention." Health Promotion Practice 20, no. 1 (May 10, 2018): 38–47. http://dx.doi.org/10.1177/1524839918774571.
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Background. Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. Objective. To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. Study Design. Systematic review. Method. Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. Results. Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. Conclusions. Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.
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Pavari, Never. "The Role of Apostolic Faith Mission in Zimbabwe in the Fight Against Coronavirus." Journal of Public Administration and Governance 10, no. 3 (September 13, 2020): 306. http://dx.doi.org/10.5296/jpag.v10i3.17690.
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Practical theology, according to Stone (2002) posits that churches should care and sacrifice for the community. Consequently, Christianity has been handling epidemics for more than 2000 years. This paper seeks to assess the role that is being played by the leadership in Apostolic Faith Mission in Zimbabwe (AFMZ) in response to the COVID-19 pandemic. The term leadership in this paper refers to those in charge of the congregants and this includes church pastors, reverends, bishops and elders. Church leaders are people who play influential roles within their faith communities and the broader local community. They benefit from trust and exercise moral authority over members of their local faith community, and shape public opinion in the broader community and even at the national or international level. The paper argues that the church and its leadership play an important role in providing moral guidance to tackle COVID-19 and also to dispel fear that stalks communities alongside the disease. In order to evaluate the role that AFMZ leadership is playing in the fight against COVID-19, the paper employs a qualitative research approach in its exploration and analysis of data gathered through an online survey method. The paper found out that the church is playing a vital role in communities by communicating messages of hope in the midst of severe fears of COVID-19. It also found out that the church leadership is playing a vital role in changing people’s attitudes toward COVID-19 by providing in depth discussions of safety measures in times of the pandemic. Lastly, the paper found out that the church leadership is not doing enough on the practical matters like providing food to the most vulnerable groups in their respective communities and for quarantined patients, maintaining clear communication with families and ensuring that basic primary care is not undermined due to limited finances. The paper therefore recommends that more finance should be availed to church leadership especially from the main church coffers to enable them to meet the above-mentioned demands.
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O’donovan, Róisín, and Eilish Mcauliffe. "A systematic review of factors that enable psychological safety in healthcare teams." International Journal for Quality in Health Care 32, no. 4 (March 31, 2020): 240–50. http://dx.doi.org/10.1093/intqhc/mzaa025.
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Abstract Purpose The current systematic review will identify enablers of psychological safety within the literature in order to produce a comprehensive list of factors that enable psychological safety specific to healthcare teams. Data sources A keyword search strategy was developed and used to search the following electronic databases PsycINFO, ABI/INFORM, Academic search complete and PubMed and grey literature databases OpenGrey, OCLC WorldCAT and Espace. Study selection Peer-reviewed studies relevant to enablers of psychological safety in healthcare setting that were published between 1999 and 2019 were eligible for inclusion. Covidence, an online specialized systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers. Data extraction Thirty-six relevant studies were identified for full review and data extraction. A data extraction template was developed and included sections for the study methodology and the specific enablers identified within each study. Results of data synthesis Identified studies were reviewed using a narrative synthesis. Within the 36 articles reviewed, 13 enablers from across organizational, team and individual levels were identified. These enablers were grouped according to five broader themes: priority for patient safety, improvement or learning orientation, support, familiarity with colleagues, status, hierarchy and inclusiveness and individual differences. Conclusion This systematic review of psychological safety literature identifies a list of enablers of psychological safety within healthcare teams. This list can be used as a first step in developing observational measures and interventions to improve psychological safety in healthcare teams.
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Liberman, Ava L., and David E. Newman-Toker. "Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data." BMJ Quality & Safety 27, no. 7 (January 22, 2018): 557–66. http://dx.doi.org/10.1136/bmjqs-2017-007032.
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BackgroundThe public health burden associated with diagnostic errors is likely enormous, with some estimates suggesting millions of individuals are harmed each year in the USA, and presumably many more worldwide. According to the US National Academy of Medicine, improving diagnosis in healthcare is now considered ‘a moral, professional, and public health imperative.’ Unfortunately, well-established, valid and readily available operational measures of diagnostic performance and misdiagnosis-related harms are lacking, hampering progress. Existing methods often rely on judging errors through labour-intensive human reviews of medical records that are constrained by poor clinical documentation, low reliability and hindsight bias.MethodsKey gaps in operational measurement might be filled via thoughtful statistical analysis of existing large clinical, billing, administrative claims or similar data sets. In this manuscript, we describe a method to quantify and monitor diagnostic errors using an approach we call ‘Symptom-Disease Pair Analysis of Diagnostic Error’ (SPADE).ResultsWe first offer a conceptual framework for establishing valid symptom-disease pairs illustrated using the well-known diagnostic error dyad of dizziness-stroke. We then describe analytical methods for both look-back (case–control) and look-forward (cohort) measures of diagnostic error and misdiagnosis-related harms using ‘big data’. After discussing the strengths and limitations of the SPADE approach by comparing it to other strategies for detecting diagnostic errors, we identify the sources of validity and reliability that undergird our approach.ConclusionSPADE-derived metrics could eventually be used for operational diagnostic performance dashboards and national benchmarking. This approach has the potential to transform diagnostic quality and safety across a broad range of clinical problems and settings.
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Hviid, Anders, Nicklas M. Thorsen, Louise N. Thomsen, Frederik T. Møller, Andreas Wiwe, Morten Frisch, Palle Valentiner-Branth, Dorte Rytter, and Kåre Mølbak. "Human papillomavirus vaccination and all-cause morbidity in adolescent girls: a cohort study of absence from school due to illness." International Journal of Epidemiology 50, no. 2 (February 6, 2021): 518–26. http://dx.doi.org/10.1093/ije/dyab003.
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Abstract Background A growing body of evidence supports the safety of the human papillomavirus (HPV) vaccines. However, concerns about autonomic dysfunction syndromes and non-specific symptoms continue to linger. These conditions are not easily captured by traditional diagnostic classification schemes and call for innovative approaches to the study of vaccine safety which take more general measures of all-cause morbidity into account. Methods Taking advantage of the unique Danish registers, including regional registration of absence from school, we conducted a cohort study of 14 068 adolescent Danish girls attending 5th through 9th grade in public schools in the municipality of Copenhagen during 1 August 2013–23 January 2018. We obtained time-varying HPV vaccination status and demographic information from nationwide registers. Using Poisson regression with random effects, we estimated rate ratios (RRs) of absence due to illness, comparing HPV-vaccinated girls with unvaccinated girls with adjustment for grade, season, calendar period, demographic factors and random effects at the individual, class and school levels. Results Our study included 6 206 188 school days with 213 221 days of absence from school due to illness (absence rate, 3.4%). Comparing absence rates due to illness in HPV-vaccinated and unvaccinated girls yielded an adjusted RR of 1.00 (95% confidence interval [CI], 0.98–1.03). Conclusions Our study provides an important and novel contribution to HPV vaccine safety. Using absence from school records, we were able to address important safety concerns without relying on medical diagnoses. We conclude that HPV vaccination does not increase the risk of morbidity in any manner that manifests as absence from school due to illness.
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Okonkwo, Ozioma C., Michael Crowe, Virginia G. Wadley, and Karlene Ball. "Visual attention and self-regulation of driving among older adults." International Psychogeriatrics 20, no. 1 (February 2008): 162–73. http://dx.doi.org/10.1017/s104161020700539x.
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ABSTRACTBackground: With the number of older drivers increasing, self-regulation of driving has been proposed as a viable means of balancing the autonomy of older adults against the sometimes competing demand of public safety. In this study, we investigate self-regulation of driving among a group of older adults with varying functional abilities.Method: Participants in the study comprised 1,543 drivers aged 75 years or older. They completed an objective measure of visual attention from which crash risk was estimated, and self-report measures of driving avoidance, driving exposure, physical functioning, general health status, and vision. Crash records were obtained from the State Department of Public Safety.Results: Overall, participants were most likely to avoid driving in bad weather followed by driving at night, driving on high traffic roads, driving in unfamiliar areas, and making left-hand turns across oncoming traffic. With the exception of driving at night, drivers at higher risk of crashes generally reported greater avoidance of these driving situations than lower risk drivers. However, across all driving situations a significant proportion of higher risk drivers did not restrict their driving. In general, self-regulation of driving did not result in reduced social engagement.Conclusion: Some older drivers with visual attention impairments do not restrict their driving in difficult situations. There is a need for physicians and family members to discuss driving behaviors with older adults routinely to ensure their safety. The association between visual attention and driving restriction also has implications for interventions aimed at preserving mobility in the elderly.
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Conti, Maria Giulia, Fabio Natale, Ilaria Stolfi, Roberto Pedicino, Giovanni Boscarino, Camilla Ajassa, Viviana Cardilli, et al. "Consequences of Early Separation of Maternal-Newborn Dyad in Neonates Born to SARS-CoV-2 Positive Mothers: An Observational Study." International Journal of Environmental Research and Public Health 18, no. 11 (May 31, 2021): 5899. http://dx.doi.org/10.3390/ijerph18115899.
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As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues its spread all over the world, data on perinatal management of the maternal-infant dyad are urgent. We performed an observational study to describe the effects of the early separation of the maternal-infant dyad, in case of maternal SARS-CoV-2 infection. We reported the medical records for 37 neonates born to 37 SARS-CoV-2 positive mothers in a setting of separation of the dyad after birth. Data on neonatal infection, clinical condition, and breastfeeding rate were recorded until the first month of life. No maternal deaths were recorded; 37.8% of women had at least one pregnancy-related complication. We reported a high adherence to recommended safety measures after discharged with 84.8% of the mothers using at least one personal protective device and 51.5% using all the protective devices. We reported one case of vertical transmission and no cases of horizontal transmission. However, the separation of the dyad had a negative impact on breastfeeding because only 23.5% of the newborns received exclusively human milk during the first month of life. Despite early separation of the dyad protecting the newborns from possible horizontal transmission of SARS-CoV-2, it negatively affects breastfeeding during the first months of life.
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Sanjurjo-de-No, Almudena, Blanca Arenas-Ramírez, José Mira, and Francisco Aparicio-Izquierdo. "Driver Liability Assessment in Vehicle Collisions in Spain." International Journal of Environmental Research and Public Health 18, no. 4 (February 4, 2021): 1475. http://dx.doi.org/10.3390/ijerph18041475.
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An accurate estimation of exposure is essential for road collision rate estimation, which is key when evaluating the impact of road safety measures. The quasi-induced exposure method was developed to estimate relative exposure for different driver groups based on its main hypothesis: the not-at-fault drivers involved in two-vehicle collisions are taken as a random sample of driver populations. Liability assignment is thus crucial in this method to identify not-at-fault drivers, but often no liability labels are given in collision records, so unsupervised analysis tools are required. To date, most researchers consider only driver and speed offences in liability assignment, but an open question is if more information could be added. To this end, in this paper, the visual clustering technique of self-organizing maps (SOM) has been applied to better understand the multivariate structure in the data, to find out the most important variables for driver liability, analyzing their influence, and to identify relevant liability patterns. The results show that alcohol/drug use could be influential on liability and further analysis is required for disability and sudden illness. More information has been used, given that a larger proportion of the data was considered. SOM thus appears as a promising tool for liability assessment.
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Ugelvig Petersen, Kajsa, Henrik Lyngbeck Hansen, Linda Kaerlev, and Johnni Hansen. "Turning the tide: reducing mortality among Danish merchant seafarers." Occupational and Environmental Medicine 77, no. 11 (July 8, 2020): 761–68. http://dx.doi.org/10.1136/oemed-2020-106427.
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ObjectivesWhile life at sea traditionally has presented a variety of potential hazards, rigorous measures have been taken in the past decades to ensure the safety and health of all aboard merchant ships. The aim of this study was to examine overall and cause-specific mortality among Danish seafarers in light of these changes.MethodsA cohort of 44 555 male (75%) and female (25%) seafarers employed on Danish ships during 1986–1999 was established through records from the Danish Seafarer Registry. Subsequently, information on vital status and causes of death was linked to members of the cohort from the Danish Civil Registration System and the Danish Register of Causes of Death using unique personal identification numbers. Standardized mortality ratios (SMRs) were calculated for the seafarers using rates from a sample of the Danish employed population.ResultsAmong seafarers with first employment prior to 1992, the overall mortality was high, with increases observed for many individual causes of death (overall SMR 1.78, 95% CI 1.72 to 1.83 for male seafarers; SMR 1.61, 95% CI 1.48 to 1.75 for female seafarers). Mortality among seafarers employed in the following period was reduced, with only a slight remaining excess of deaths. This excess in mortality was evident primarily among non-officers on board tankers and smaller ships.ConclusionsDuring recent decades, mortality among seafarers has changed, replacing the traditional image of a high-risk profession with almost normalised figures compared with the general working population. Marked imbalances in mortality according to job and ship categories have persisted though.
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Olsen, Catherine M., Kyoko Miura, Jean Claude Dusingize, Ian Hosegood, Russell Brown, Michael Drane, Peter Clem, et al. "Melanoma incidence in Australian commercial pilots, 2011–2016." Occupational and Environmental Medicine 76, no. 7 (May 21, 2019): 462–66. http://dx.doi.org/10.1136/oemed-2018-105676.
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ObjectivesOccupational exposure to cosmic and ultraviolet radiation may increase airline pilots’ risk of cutaneous melanoma. Meta-analyses of available data show a higher than average incidence of melanoma in airline pilots, but the most recent systematic review revealed that few contemporary data are available. Moreover, all relevant studies have been conducted in Northern Hemisphere populations. We therefore aimed to examine if Australian commercial pilots have a raised incidence of melanoma compared with the general population.MethodsWe examined all melanoma histologically diagnosed among Australian-licensed commercial pilots in the period 2011–2016 by manually reviewing de-identified data in the medical records system of the Australian Civil Aviation Safety Authority. We estimated age-specific incidence rates and compared these with corresponding population rates using standardised incidence ratios (SIRs) as measures of relative risk. Expected numbers were calculated by multiplying age- and calendar period-specific person-years (PYs) with corresponding rates from the entire Australian population; 95% CI were calculated assuming a Poisson distribution of the observed cases.ResultsIn this cohort of Australian-licensed commercial pilots observed for 91 370 PYs, 114 developed a melanoma (51 invasive, 63 in situ). More than 50% of melanomas occurred on the trunk, and the predominant subtype was superficial spreading melanoma. The SIR for invasive melanoma was 1.20 (95% CI 0.89 to 1.55) and for melanoma in situ, 1.39 (95% CI 1.08 to 1.78).ConclusionAustralian-licensed commercial pilots have a modestly raised risk of in situ melanoma but no elevation of invasive melanoma compared with the general population.
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Afshari, Maryam, Akram Karimi-Shahanjarini, Sahar Khoshravesh, and Fereshteh Besharati. "Effectiveness of interventions to promote pesticide safety and reduce pesticide exposure in agricultural health studies: A systematic review." PLOS ONE 16, no. 1 (January 26, 2021): e0245766. http://dx.doi.org/10.1371/journal.pone.0245766.
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Objective There is a relationship between pesticide exposure and farmworkers’ health. Well-conducted evaluations can provide an insight into how to develop and implement more effective interventions to prevent farmers and farmworkers’ exposure to pesticides. This review aimed to summarize the literature on the effectiveness of interventions to promote pesticide safety and reduce pesticide exposure among farmers and farmworkers. Methods A comprehensive search on PubMed, Embase, ISI Web of Science, Scopus, Science Direct, Agricola, NIOSHTIC, and Agris databases was performed to identify relevant studies published from 2000 to 2019. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effectiveness of interventions on a variety of outcomes related to pesticide exposure were considered. The searches were restricted to articles written in English. The methodological quality of included reviews was appraised using the Effective Public Health Practice Project quality assessment tool (EPHPP). Results The initial search led to 47912 records, 31 studies of which including nine RCTs and twenty-two quasi-experimental studies met the criteria. The majority of the included studies focused on the educational/ behavioral approach. The studies that applied this approach were effective in improving the participants’ knowledge and attitude; however, these interventions were less effective in terms of making changes in participants’ behaviors and their risk of exposure to toxic pesticides. Multifaceted interventions were moderately effective in terms of improving farmers’ and farmworkers’ behaviors and reduction in exposure to toxic pesticides. We did not find any studies that had evaluated the effectiveness of engineering/technological, and legislation/enforcement interventions. Conclusions Although the majority of studies were based on an educational/behavioral approach and did not assess the effect of interventions on objective measures, the results of this review highlight the significant effectiveness of educational programs and some potential key elements of these interventions. These findings may inform policymakers to develop interventions to reduce pesticide exposure among farmers and farmworkers.
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Burlakov, Vladimir, Vladislav Shchepelkov, and Nelli Diveeva. "Criminological Security in the Sphere of Preventive Medicine: Risks and Their Prevention." Russian Journal of Criminology 14, no. 5 (November 20, 2020): 647–59. http://dx.doi.org/10.17150/2500-4255.2020.14(5).647-659.
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Currently there is a high public interest in solving the problems of preventive medicine (vaccinations, medical check-ups, clinical examinations). This can be largely explained by legislative initiatives that draw mixed reactions from the public, by real problems that people face during vaccinations and medical check-ups, and, certainly, by the pandemic of COVID-19. A separate group of problems connected with various preventive medical programs is composed of criminological risks and prevention of crimes associated with preventive healthcare. The authors give a definition of criminological security in the sphere of preventive medicine, single out criminological risks and present their classification. They describe the essence of key criminological risks of preventive medicine (iatrogenic and corruption ones), establish their causes and outline the ways of their prevention. To reduce the iatrogenic risks of vaccination, it is suggested that a systemic national monitoring of the safety of vaccines should be organized, including the analysis of official data, public surveys, comparison of data from various sources, and other measures. To reduce the iatrogenic risks of medical check-ups, it is necessary to reject medical examinations that pose high risks to life and health; it is also necessary for the Russian Ministry of Healthcare to issue orders with a list of medical manipulations included in check-ups which would also act as criteria of their completeness. The authors believe that corruption risks in the sphere of preventive medicine can be reduced through the following measures: 1) vaccinations and check-ups should be conducted after citizens request them in their accounts (this should reduce the number of distorted records); 2) the list of compulsory check-up procedures should not include the procedures that cause pain, are dangerous to health and life, as well as those connected with accessing closed parts of the human body, or they should be substituted with alternative procedures that provide diagnostic results; 3) a time limit for check-ups should be introduced; 4) preventive medicine should be included in the monitoring of the effectiveness of corruption counteraction. A legal and criminological expertise of draft legal acts that regulate the procedure of medical check-ups, conducted by leading legal centers (universities), should become a general measure of preventing criminological risks of medical check-ups.
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McLeod, M., S. Farah, K. Macaulay, T. Sheth, M. Patel, A. Ghafour, M. Denning, et al. "Designing a continuous data-driven feedback and learning initiative to improve electronic prescribing: an interdisciplinary quality improvement study." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i18—i19. http://dx.doi.org/10.1093/ijpp/riab016.023.
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Abstract Introduction The WHO Global Patient Safety Challenge aims to reduce severe avoidable medication-related harm by 50% by 2023[1]. Research suggests that providing timely, trusted feedback that incorporates relevant action can improve practice. However, a key barrier is lack of prescribing error data. Hospital electronic prescribing (EP) data may help address this gap. Aims To explore approaches for continuously monitoring medication safety signals using existing or new EP data, and to deliver personalised prescribing feedback and learning to improve patient safety. Methods We conducted a feasibility study (November 2019 - February 2020) on a 28-bed adult gastroenterology. This ward was chosen because of a high prescribing error rate. All foundation year 1 and 2 doctors, and pharmacists on the ward, participated in the study. The study team comprised pharmacists, doctors, quality improvement experts and clinical analysts, and used a quality improvement approach to design and test (i) methods for extracting electronic data to calculate prescribing accuracy rates, (ii) ways to refine a paper-prototype of an electronic pharmacists’ interventions form, (iii) potential digital medication safety indicators, and (iv) approaches for feedback for doctors to augment existing verbal feedback from pharmacists. Data were documented in accordance with local information governance and analysed using Excel. Acceptability and usability was assessed through verbal feedback from participants during weekly huddles. Outcome measures: feasibility of using EP to determine prescribing accuracy, user acceptability and usability of data collection, feedback and learning by pharmacists and doctors. We also measured changes in prescribing accuracy rate, pharmacists’ interventions, and quality of prescribing for targeted problematic medications. Results Extracting EP data required multiple data linkages to be configured and validated, and not all required data were available. Potential digital medication safety indicators: utility of the reason code ‘prescribed in error’ and actions by pharmacists to modify medications were limited by underuse and lack of data granularity. After testing different ways to extract relevant EP data, we eventually used a combination of EP and manual retrospective review of electronic patient records to determine prescribing accuracy rates. An intervention form was redesigned to tally interventions and capture details for contextual learning for email feedback to doctors and weekly prescribing improvement huddles. Doctors reported emails as timely and helpful for gaining new prescribing- and system-related knowledge. Pharmacists reported intervention data as providing invaluable evidence to drive improvement. Statistical process control charts showed no special cause variation around a mean prescription accuracy rate of 98% for inpatient orders, and 87% for discharge orders. By contrast, pharmacists recorded a mean of 10 interventions/day with 7 special cause variation (above upper control limit of 19) in the first two months. Omission of venous thromboembolism prophylaxis was identified as a priority medication issue. Specific prescriber- and system-based improvements were suggested (Jan 2020), some implemented (Feb 2020) and others fed back to the thrombosis committee (Feb 2020). Conclusion Harnessing the potential of EP data to improve medication safety requires the workforce to have a deeper understanding of the EP data structure and processes. Using a quality improvement approach, we developed a feedback and learning model that is acceptable and useful to pharmacists and doctors. Further research should explore adapting the approach to other clinical areas. Reference 1. Sheikh, A., Dhingra-Kumar, N., Kelley, E., Kieny, M. and Donaldson, L. The Third Global Patient Safety Challenge: Tackling Medication-Related Harm. Bulletin of the World Health Organization. World Health Organisation. 2017;95:546-546A.
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Odes, Rachel, OiSaeng Hong, and Susan Chapman. "3076 Findings from the first year of California’s Workplace Violence Prevention in Healthcare standard (Title 8, Section 3342)." Journal of Clinical and Translational Science 3, s1 (March 2019): 117–18. http://dx.doi.org/10.1017/cts.2019.268.
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OBJECTIVES/SPECIFIC AIMS: This research project aims to: 1) describe the incidents of workplace violence that have been reported to CalOSHA through the Workplace Violent Incident Reporting System for Hospitals; 2) determine if there are any relationships between the types of violent incidents reported and the unit or hospital where the event occurred; 3) describe what mitigation strategies facility representatives report having utilized immediately following a violent incident, such as changes to practice or involvement of law enforcement. METHODS/STUDY POPULATION: Reports submitted to CalOSHA pursuant to the Workplace Violent Incident Reporting System for Hospitals are considered public record and are available through the state’s Public Records Act (PRA) mandate. Records from 7/1/17 – 9/30/18 were obtained through the CalOSHA PRA request process. Descriptive statistics and correlations were calculated using Stata. RESULTS/ANTICIPATED RESULTS: Records reporting 11,116 individual events of violence were analyzed. These results do not include reports submitted by the five California State Hospitals, a group of facilities which treated nearly 13,000 patients in 2017, many of whom have a psychiatric diagnosis and are undergoing treatment mandated by judicial decision. For each record, 111 variables were reported, including description of the event itself, characteristics of the workers involved, factors which may have triggered the event, and what measures were taken to mitigate the situation during and after the incident. All events identified an aggressor; 10,357 (93%) described this individual as a patient. 11,048 reports had a unit or hospital location listed to describe where the incident occurred. Of these, 9393 (84.5%) were inpatient, behavioral health, or surgical units. A physical injury was reported in 3672 events (33%) and stress/psychological impairment was reported in 536 (5%) of the incidents. Police officers were deployed to the scene following the incident in 1122 (10%) of reported events, resulting in arrest of the perpetrator in 402 (3.6%) of the reported incidents. DISCUSSION/SIGNIFICANCE OF IMPACT: While the impulse to address the high prevalence of workplace violence towards healthcare providers has led to deserved attention from policy makers, safety regulators, and healthcare unions, plans for ensuring that new initiatives are achieving their desired effect for workers have yet to fully materialize. An ongoing concern is that incidents are known to be under-reported through official mechanisms, leading to challenges in determining the scope of the problem itself and evaluating the efficacy of interventions to address it. CalOSHA’s new reporting requirement and online interface provides a new channel for improving validity of prevalence data, as early findings indicate that less serious events are being reported through the system. In addition, information describing how hospital leaders report responding to incidents in their immediate aftermath will provide needed insight into what additional efforts are needed to support victims of violence given the unique challenges present in the healthcare industry.
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Kosola, S., P. Salminen, and T. Laine. "Heading for a Fall — Moped and Scooter Accidents from 2002 to 2007." Scandinavian Journal of Surgery 98, no. 3 (September 2009): 175–79. http://dx.doi.org/10.1177/145749690909800309.
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Background and Aims: Mopeds and scooters have become increasingly popular among Finnish teenagers. The aim of this retrospective study was to assess incidence of and injury patterns associated with moped and scooter accidents in adolescents. Materials and Methods: All 222 patients treated for moped and scooter-related injuries at Helsinki Children's Hospital and Töölö Trauma Centre from January 2002 to December 2007 were included. Information was drawn from patient records and compared with nation-wide Finnish data gathered from public data-bases. Results: The annual number of patients at our centres increased from 14 to 76 and the proportion of girls increased from 7% to 25%. A similar trend was found on a national level. In our material, collisions between mopeds and other motorized vehicles accounted for 52% of accidents, and 33% of patients were injured from falling. Seventy-five percent of patients were hospitalized, and 50% needed at least one procedure requiring general anaesthesia. Five percent of the patients were under the influence of alcohol. Trauma of the head occurred in 22%; helmets did not protect against severe trauma. On a national level the proportion of 15- to 17-year-old road traffic victims has doubled in five years. Among this age group, more than half of all road-traffic accidents involve mopeds and scooters. Conclusions: Over a time span of six years, moped accidents among adolescents have become very common. Our results suggest that measures should be taken to diminish the number of moped and scooter accidents and to improve driver safety.
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Sydes, Matthew R., Yolanda Barbachano, Louise Bowman, Tom Denwood, Andrew Farmer, Steph Garfield-Birkbeck, Martin Gibson, et al. "Realising the full potential of data-enabled trials in the UK: a call for action." BMJ Open 11, no. 6 (June 2021): e043906. http://dx.doi.org/10.1136/bmjopen-2020-043906.
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RationaleClinical trials are the gold standard for testing interventions. COVID-19 has further raised their public profile and emphasised the need to deliver better, faster, more efficient trials for patient benefit. Considerable overlap exists between data required for trials and data already collected routinely in electronic healthcare records (EHRs). Opportunities exist to use these in innovative ways to decrease duplication of effort and speed trial recruitment, conduct and follow-up.ApproachThe National Institute of Health Research (NIHR), Health Data Research UK and Clinical Practice Research Datalink co-organised a national workshop to accelerate the agenda for ‘data-enabled clinical trials’. Showcasing successful examples and imagining future possibilities, the plenary talks, panel discussions, group discussions and case studies covered: design/feasibility; recruitment; conduct/follow-up; collecting benefits/harms; and analysis/interpretation.ReflectionSome notable studies have successfully accessed and used EHR to identify potential recruits, support randomised trials, deliver interventions and supplement/replace trial-specific follow-up. Some outcome measures are already reliably collected; others, like safety, need detailed work to meet regulatory reporting requirements. There is a clear need for system interoperability and a ‘route map’ to identify and access the necessary datasets. Researchers running regulatory-facing trials must carefully consider how data quality and integrity would be assessed. An experience-sharing forum could stimulate wider adoption of EHR-based methods in trial design and execution.DiscussionEHR offer opportunities to better plan clinical trials, assess patients and capture data more efficiently, reducing research waste and increasing focus on each trial’s specific challenges. The short-term emphasis should be on facilitating patient recruitment and for postmarketing authorisation trials where research-relevant outcome measures are readily collectable. Sharing of case studies is encouraged. The workshop directly informed NIHR’s funding call for ambitious data-enabled trials at scale. There is the opportunity for the UK to build upon existing data science capabilities to identify, recruit and monitor patients in trials at scale.
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Garcia-Diez, J., and AC Coelho. "Causes and factors related to pig carcass condemnation." Veterinární Medicína 59, No. 4 (June 17, 2014): 194–201. http://dx.doi.org/10.17221/7480-vetmed.
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Ante mortem and post mortem carcass condemnation records could be of use as a potential database for the study of swine diseases, epidemiology or animal welfare. Thus, the aim of this study was to investigate the causes of ante mortem rejections and post mortem carcass condemnation of pigs intended for human consumption during a 78-month period. The records considered for study were, date of slaughter, total pigs slaughtered and total number of ante mortem rejections (deaths during transportation and deaths in the pens) and post mortem carcass condemnations (osteomyelitis, caseous lymphadenitis, erysipelas, cachexia, pale, soft and exudative meat (PSE), bloody meat, muscular necrosis, purulent nephritis, purulent metritis, jaundice, meats from febrile pigs and peritonitis). The influence of several factors such as year, season, mandatory fulfilment of a food chain information form (FCIf) and compulsory certification of swine drivers/transporters on ante mortem rejections and post mortem carcass condemnation was also studied. A total of 161 001 pigs slaughtered resulted in 238 (0.15%) ante mortem deaths, 160 763 pigs processed for meat consumption (99.7%) and 392 (0.24%) carcass condemnations. The ante mortem rejections revealed that 146 pigs (61.3%) died during transportation whereas 92 (38.7%) were rejected due to death in pens. The main causes of carcass condemnations were osteomyelitis (38.5%), granulomatous lymphadenitis (22.7%) and pleurisy/pneumonia (21.2%). A relationship was found between the month and ante mortem condemnations (P < 0.01), death losses during transport (P < 0.01) and between compulsory certification of animal transporters and deaths by transportation (P < 0.05). During the cold season, the probability of ante mortem rejections (OR = 1.84; CI 95%: 1.32–2.59) and death in pens (OR = 1.62; CI 95%: 1.02–2.57) was higher. The compulsory fulfilment of a food chain information form was not revealed to be significantly linked with the total number of carcass condemnations although the odds of ante mortem rejections were higher (OR = 2.10; CI 95%: 1.44–3.08) when it was not mandatory. Higher post mortem condemnations compared to ante mortem condemnations can be explained by the fact that several post mortem findings are asymptomatic in live animals. A progressive decrease in losses during transport was associated with on-farm improvements in animal welfare measures in addition with compulsory training of animal transporters. However, the consistent values of deaths in pens throughout the study period, with an increase during the winter, indicate a need for an improvement in the thermal conditions of the holding area in slaughterhouse. Regarding the post mortem condemnations, the improvement in animal welfare conditions may explain the decrease in osteomyelitis condemnations while the environmental origin of granulomatous lymphadenitis may be associated with region, climate or with the presence of hosts that may explain the influence of the time of year on its variations. The FCIf was implemented as a measure to improve the transparency of food safety and animal health in the food chain from farm to fork. Although osteomyelitis and granulomatous lymphadenitis condemnations were influenced by the FCIf, this relationship cannot be fully explained due to the scarce information related to disease prevalence and/or diagnostics at the farm level. Consequently, the improvement in food safety elicited by this measure is not entirely clear. Data on carcass condemnation could be used to verify the emergence, evolution and control of swine diseases as well as to improve animal health, food safety and veterinary public health programs and/or strategies according to the epidemiological context, with the ultimate aim of guaranteeing public health.
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Munk, Marc-David, Dora M. Carboneau, Muhammed Hardan, and Faleh Mohamed Ali. "Seatbelt Use in Qatar in Association with Severe Injuries and Death in the Prehospital Setting." Prehospital and Disaster Medicine 23, no. 6 (December 2008): 547–52. http://dx.doi.org/10.1017/s1049023x00006397.
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AbstractIntroduction:Road traffic crashes (RTCs) are common in Qatar, and are now considered the third leading cause of mortality. In this study, the safety devices used by the Qatari public at the time of RTCs were assessed and the association between seatbelt use by vehicle occupants involved in RTCs and severe injury/death in the prehospital setting was determined.Methods:This study was a retrospective case-control investigation. A Hamad Medical Corporation Emergency Medical Services (EMS) database of RTCs occurring from January 2006 to April 2007 was utilized for this study, providing a total of 5,267 patient records (83.5 % male, 16.5% female, median age = 28 years). Patient demographics, crash characteristics, prehospital assessments, and interventions were identified, and use of safety devices was determined. Univariate analysis including chi-square, Student's t-test, and analysis of variance (ANOVA) was performed as appropriate. “Case” patients are defined as those who had specific, critical prehospital assessments, or who received advanced cardio-respiratory life support measures in the field. Logistic regression modeling was used to predict the probability of a case being unbelted, controlling for confounders.Results:Seatbelt use in Qatar was low: 33.9% of males and 32.6% of females wore seatbelts at the time of the RTC. Victims involved in a vehicle rollover crash were less likely to be belted than were those involved in a non-rollover incident (26.2% belted vs. 37.8%; OR = 0.59; 95%CI = 0.50–0.68). Case patients—those with defined critical assessment findings or resuscitation in the field—and control patients were similar in age (30 years vs. 28 years median). Case patients were disproportionately male (89.1% vs. 83.2%; OR = 1.65; 95%CI = 1.01–2.83) and were more likely to be victims of a vehicle rollover crash (44.7% vs. 23.8%; OR = 2.57; 95%CI = 1.84–3.59). Seatbelt use was significantly lower among cases than controls: 19.7% of cases were reported to have worn seatbelts compared to 34.2% of controls (OR = 0.47; 95%CI = 0.31–0.69). This relationship also persisted (OR = 0.51; 95%CI = 0.33–0.76) after controlling for confounders.Conclusions:Seatbelt use in Qatar is low. Seatbelts are protective: in the pre-hospital setting unbelted vehicle occupants involved in RTCs were nearly twice as likely to suffer severe injury or death compared to belted patients. Prehospital morbidity and mortality appears to be reduced significantly by the consistent use of seatbelts by the motoring population in Qatar.
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McDonald, Douglas C., Sharmini Radakrishnan, Alicia C. Sparks, Nida H. Corry, Carlos E. Carballo, Kenneth Carlson, and Valerie A. Stander. "High-risk and Long-term Opioid Prescribing to Military Spouses in the Millennium Cohort Family Study." Military Medicine 185, no. 9-10 (July 22, 2020): e1759-e1769. http://dx.doi.org/10.1093/milmed/usaa146.
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Abstract Introduction The use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses’ opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness. Materials and Methods This study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military’s Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members’ spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses’ physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center’s Institutional Review Board and the Office of Management and Budget approved the study. Results Spouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions. Conclusions Approximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.
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Osifo, Osarumwense David, Theophilus Osasumwen Osagie, and Pius Ehiawaguan Iribhogbe. "Pediatric Road Traffic Accident Deaths Presenting to a Nigerian Referral Center." Prehospital and Disaster Medicine 27, no. 2 (April 2012): 136–41. http://dx.doi.org/10.1017/s1049023x12000465.
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AbstractIntroductionRoad traffic accident (RTA) is a common cause of pediatric trauma death and disability, constituting a worldwide loss of financial resources and potential manpower. This study was designed to determine the causes, prehospital care, presentation, and injuries that resulted in deaths among pediatric victims of RTA in Nigeria, and to make suggestions, based on the study data, to reduce RTA deaths.MethodsThis is a retrospective analysis of pediatric RTA presenting to a Nigerian referral center. The records of all pediatric RTA between January 2006 and December 2010 at the University of Benin Teaching Hospital were analyzed for age, gender, causes of death, injury, rescue team prehospital treatment, injury to hospital arrival time, clinical condition on arrival, treatment, duration of hospitalization before death, challenges, and postmortem findings.ResultsTwenty-six (18%) of 143 pediatric RTA, comprising 18 males and 8 females, between less than one and 18 (mean 9.3 ± 5.2) years of age died. There was no significant statistical demographic difference observed when 15 (58%) deaths recorded among 67 (46.9%) children involved in motor vehicle accidents were compared with 11 (42%) involved in 76 (53.1%) motorcycle accidents (P = .31). More severe injuries resulting in the majority of deaths were associated with alcohol intoxication (P < .0001). Fourteen (54%) of the deaths were pedestrians, eight of whom were selling wares on the roadside; six were crossing roads that had no traffic signs or traffic control. Of the eight vehicle passengers who died, only two wore seat belts or used pediatric car seats, with no statistical significance compared to those who did not use seat belts or car seats (P = .37). Four of 14 front seat passengers and four of 32 rear seat passengers died (P = .222). Of motorcycle passengers, none of those who wore protective crash helmets died, while four died who were not wearing helmets. Passers-by and sympathizers served as rescuers provided emergency treatment, and presented the victims between one hour and four days after the accidents. Head injury in 14 (54%) cases was the most common cause of death.ConclusionPediatric RTA deaths in this study were due mainly to preventable causes. There is a need to stress road safety education to children, drivers, the general public and government policy formulators, and to adopt RTA preventive measures in this region of Nigeria.Osifo OD, Osagie TO, Iribhogbe PE. Pediatric road traffic accident deaths presenting to a Nigerian referral center. Prehosp Disaster Med. 2012;27(2):1-6.
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Rodgers, Sarah E., Rowena Bailey, Rhodri Johnson, Wouter Poortinga, Robert Smith, Damon Berridge, Pippa Anderson, et al. "Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study." Public Health Research 6, no. 8 (June 2018): 1–104. http://dx.doi.org/10.3310/phr06080.
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BackgroundPoor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this.ObjectiveThis research investigated the health impact of bringing housing to a national quality standard.DesignA natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level.SettingCarmarthenshire, UK.ParticipantsA total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015.InterventionsMultiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms).Main outcome measuresEmergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs.Data sourcesCarmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register.MethodsThe study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation.ResultsResidents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72;p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81;p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84;p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83;p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01;p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11;p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17;p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06;p = 0.287).LimitationsThere was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme.ConclusionsThis complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards.Future workAt their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model.FundingThe National Institute for Health Research Public Health Research programme.
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Subbe, Christian P., Hawys Tomos, Gwenlli Mai Jones, and Paul Barach. "Express check-in: developing a personal health record for patients admitted to hospital with medical emergencies: a mixed-method feasibility study." International Journal for Quality in Health Care 33, no. 3 (August 19, 2021). http://dx.doi.org/10.1093/intqhc/mzab121.
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Abstract Background Patient participation is increasingly recognized as a key component in the redesign of healthcare processes and is advocated as a means to improve patient safety. Objective To explore the usage of participatory engagement in patient-created and co-designed medical records for emergency admission to the hospital. Methods design: prospective iterative development and feasibility testing of personal health records; setting: an acute medical unit in a university-affiliated hospital; participants: patients admitted to hospital for medical emergencies; interventions: we used a design-led development of personal health record prototypes and feasibility testing of records completed by patients during the process of emergency admission. ‘Express-check-in’ records contained items of social history, screening questions for sepsis and acute kidney injury in addition to the patients’ ideas, concerns and expectations; main outcome measures: the outcome metrics focused on feasibility and a selection of quality domains, namely effectiveness of recording relevant history, time efficiency of the documentation process, patient-centredness of resulting records and staff and patient feedback. The incidence of sepsis and acute kidney injury were used as surrogate measures for assessing the safety impact. Results The medical record prototypes were developed in an iterative fashion and tested with 100 patients, in which 39 patients were 70 or older and 25 patients were classified as clinically frail. Ninety-six per cent of the data items were completed by patients with no or minimal help from healthcare professionals. The completeness of these patient records was superior to that of the corresponding medical records in that they contained deeply held beliefs and fears, whereas concerns and expectations recorded by patients were only mirrored in a small proportion of the formal clinical records. The sepsis self-screening tool identified 68% of patients requiring treatment with antibiotics. The intervention was feasible, independent of the level of formal education and effective in frail and elderly patients with support from family and staff. The prototyped records were well received and felt to be practical by patients and staff. The staff indicated that reading the patients’ documentation led to significant changes in their clinical management. Conclusions Medical record accessibility to patients during hospital care contributes to the co-management of personal healthcare and might add critical information over and above the records compiled by healthcare professionals.
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Shields, Morgan C. "Effects of the CMS’ Public Reporting Program for Inpatient Psychiatric Facilities on Targeted and Nontargeted Safety: Differences Between For-Profits and Nonprofits." Medical Care Research and Review, March 12, 2021, 107755872199892. http://dx.doi.org/10.1177/1077558721998924.
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The Centers for Medicare and Medicaid Services implemented the Inpatient Psychiatric Facility Quality Reporting Program in 2012, which publicly reports facilities’ performance on restraint and seclusion (R-S) measures. Using data from Massachusetts, we examined whether nonprofits and for-profits responded differently to the program on targeted indicators, and if the program had a differential spillover effect on nontargeted indicators of quality by ownership. Episodes of R-S (targeted), complaints (nontargeted), and discharges were obtained for 2008-2017 through public records requests to the Commonwealth of Massachusetts. Using difference-in-differences estimators, we found no differential changes in R-S between for-profits and nonprofits. However, for-profits had larger increases in overall complaints, safety-related complaints, abuse-related complaints, and R-S-related complaints compared with nonprofits. This is the first study to examine the effects of a national public reporting program among psychiatric facilities on nontargeted measures. Researchers and policymakers should further scrutinize intended and unintended consequences of performance-reporting programs.
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Don-solomon, Amakiri, and Michael Joshua Ayawei. "Cloud Computing and Student’s Record Management Efficiency in Niger Delta University." European Journal of Business and Management Research 5, no. 5 (September 10, 2020). http://dx.doi.org/10.24018/ejbmr.2020.5.5.490.
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Information is relatively the life conduit of any organization. An inappropriate management of records and the information contained therein could cost organization both operational and financial fortune. The focus of this paper was to establish the empirical link between cloud computing and student’s record management efficiency in Niger Delta University. Software as a service (Saas) and Platform as a service (Paas) were used to operationalize the predictor variable, while records accessibility and safety were used as measures of record management efficiency. 301 staffers were sampled randomly with questionnaire. Data collected was inferential analyzed using spearman rank order correlation coefficient with the aid of SPSS. Result shows high correlation amongst all variables which means that increase cloud computing practices in the institution would enhance record’s management efficiency. The study recommends therefore that management of Niger Delta University should leverage on available software service provides to store all students’ records on cloud to avoid losses of records due to flood and undue physical environmental conditions. Also, cloud computing model should be utilized for efficiency in record management to create good public image for vantage competitive edge.
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Masanganise, Kaurai E., Gift Matope, and Davies M. Pfukenyi. "A survey on auditing, quality assurance systems and legal frameworks in five selected slaughterhouses in Bulawayo, south-western Zimbabwe." Onderstepoort J Vet Res 80, no. 1 (March 4, 2013). http://dx.doi.org/10.4102/ojvr.v80i1.575.
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The purpose of this study was to explore the audits, quality assurance (QA) programmes and legal frameworks used in selected abattoirs in Zimbabwe and slaughterhouse workers’ perceptions on their effectiveness. Data on slaughterhouse workers was gathered through a self-completed questionnaire and additional information was obtained from slaughterhouse and government records. External auditing was conducted mainly by the Department of Veterinary Public Health with little contribution from third parties. Internal auditing was restricted to export abattoirs. The checklist used on auditing lacked objective assessment criteria and respondents cited several faults in the current audit system. Most respondents (>50.0%) knew the purposes and benefits of audit and QA inspections. All export abattoirs had QA programmes such as hazard analysis critical control point and ISO 9001 (a standard used to certify businesses’ quality management systems) but their implementation varied from minimal to nil. The main regulatory defect observed was lack of requirements for a QA programme. Audit and quality assurance communications to the selected abattoirs revealed a variety of non-compliances with most respondents revealing that corrective actions to audit (84.3%) and quality assurance (92.3%) shortfalls were not done. A high percentage of respondents indicated that training on quality (76.8%) and regulations (69.8%) was critical. Thus, it is imperative that these abattoirs develop a food safety management system comprising of QA programmes, a microbial assessment scheme, regulatory compliance, standard operating procedures, internal and external auditing and training of workers.
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Repeta, Lawrence. "Japan’s News Media, The Information Disclosure Law, and The Fukushima Nuclear Disaster." Issues in Legal Scholarship 11, no. 1 (January 1, 2013). http://dx.doi.org/10.1515/ils-2015-0003.
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AbstractOfficial investigations that followed the Fukushima Nuclear Disaster revealed that it could have been prevented by reasonable safety measures. Investigators concluded that close relationships between government officials and industry executives led to very weak regulatory oversight and the failure to address the risk of violent earthquakes and tsunami such as those that struck the Fukushima Nuclear Power Station on March 11, 2011. News reporters conducted their own investigations in the months following the disaster. Japan’s information disclosure law provided an invaluable tool that enabled them to obtain government records related to regulation of Japan’s nuclear power plants. This article describes some of the stories they produced. Appearing on the front pages of newspapers with daily circulations in the millions, this work provided an authoritative inside view of the failed regulatory process to the Japanese people. The work of the investigative bodies and the news media drove the demand for change that led to disbanding of the regulatory agencies that failed and their replacement by an entirely new regulatory body. This article highlights the importance of “right to know” laws such as Japan’s information disclosure law in creating the opportunity for news reporters and others to demand the release of otherwise confidential government records that can enlighten everyone on matters of great public interest.
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Aslanyan, L. A., and N. T. Truzyan. "Challenges in meeting patient assessment international standards in ambulatory tuberculosis services." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.820.
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Abstract Background Limitations of tuberculosis (TB) diagnostic tools and measures restrict proper TB control in places with high drug-resistant TB prevalence. This study aimed to explore gaps in the primary health care (PHC) TB services in Armenia compared to international standards on Assessment of Patients (AOP). Methods We applied mixed methods to assess the AOP standards in 30 outpatient TB centers using observational and documents/medical records review's standardized checklists, in-depth interviews, and focus group discussions. Evaluation was conducted in all 10 regions of Armenia and the capital city Yerevan. Joint Commission International Standards for Ambulatory Care, International Standards for TB Care, and WHO framework, served as a guideline for this assessment. Results PHC physicians are qualified for a set of examinations to diagnose TB. Planned reassessments are conducted continuously, though defined writings for the scope and content of reassessments administered by each clinical discipline is absent. Laboratory departments provide high quality services to the TB patients with the defined timeframes for reporting the results. Laboratory and radiology services staff is qualified and experienced. The biosafety rules are compliant with local and international standards. However, the location and conditions of the laboratory departments are mostly non-compliant with the standards. Lack of modern equipment restricts maintaining proper environmental controls, including ventilation systems. Laboratory technicians have little knowledge of the organization's safety management program and its relation to the laboratory safety program. The facilities have neither formal quality control programs regulated by documents and policies nor an identified radiation safety program protocol. Conclusions On the level of AOP standards, the PHC TB services in Armenia have satisfactory performance. However, assessed standards for this function required certain improvements. Key messages In Armenia, the tuberculosis care in PHC facilities presents high level of compliance for patient assessment international standards. To fully meet the standards, facilities need to reconstructed/renovated laboratories and establish the radiology and diagnostic equipment management, quality control and radiation safety programs.
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"Research on the Security Policies for Cloud Computing." International Journal of Innovative Technology and Exploring Engineering 8, no. 12S2 (December 31, 2019): 393–96. http://dx.doi.org/10.35940/ijitee.l1076.10812s219.
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The sizable progressive patterns in customary exchange and the need for non-public statistics to skip global outskirts featured the need to diagram protection pointers and inspire particular guidelines to improve the nicely-being of residents' close to home statistics. An modern jump beforehand, which makes stressful situations to the well being of individual records, is Cloud Computing. the rule of thumb highlight of Cloud Computing is that it allows on-name for arrange get admission to figuring property with least control assignment or company association collaboration. This new innovation gives new measurements to traditional exchanges of private records and due to this it has become easy to installed order a safety affiliation for Cloud Computing administrations. For the easy out of the plastic new age of Cloud Computing, the idea device of a fitness inclusion is to shield humans and data, set proposals for foreseen conduct with the valuable asset of customers, problem threats and help to tune consistence with guideline This investigations paper centered at the development of a Cloud safety inclusion, in admire to facts insurance. basically focused on the model of programming as-an management (SaaS), this paper is meant to focus on a Framework for gatherings, clients, Cloud bearers and supply a gauge to the security inclusion of Cloud Computing. Pointed honestly on the protection requirements which is probably specific to Cloud circumstance, feature how those conditions connect to our Cloud well-being inclusion and endorse, the measures and the relating health regulations. except, it proposes a manner that might be observed with the manual of Cloud corporations for comparing the well being in their structures as, insurance is one of the internal abilties of the Cloud provide
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Kats, Daniel J., Yosra Adie, Abdulhakim Tlimat, Peter J. Greco, David C. Kaelber, and Yasir Tarabichi. "Assessing Different Approaches to Leveraging Historical Smoking Exposure Data to Better Select Lung Cancer Screening Candidates: A Retrospective Validation Study." Nicotine & Tobacco Research, September 25, 2020. http://dx.doi.org/10.1093/ntr/ntaa192.
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Abstract Background There is mounting interest in the use of risk prediction models to guide lung cancer screening. Electronic health records (EHRs) could facilitate such an approach, but smoking exposure documentation is notoriously inaccurate. While the negative impact of inaccurate EHR data on screening practices reliant on dichotomized age and smoking exposure-based criteria has been demonstrated, less is known regarding its impact on the performance of model-based screening. Methods Data was collected from a cohort of 37,422 ever-smokers between the ages of 55 and 74, seen at an academic safety-net healthcare system between 1999 and 2018. The National Lung Cancer Screening Trial (NLST) criteria, PLCOM2012 and LCRAT lung cancer risk prediction models were validated against time to lung cancer diagnosis. Discrimination (area under the receiver operator curve [AUC]) and calibration were assessed. The effect of substituting the last documented smoking variables with differentially retrieved “history conscious” measures was also determined. Results The PLCOM2012 and LCRAT models had AUCs of 0.71 (95% CI, 0.69–0.73) and 0.72 (95% CI, 0.70–0.74) respectively. Compared to the NLST criteria, PLCOM2012 had a significantly greater time-dependent sensitivity (69.9% vs. 64.5%, p<0.01) and specificity (58.3% vs. 56.4%, p<0.001). Unlike the NLST criteria, the performances of the PLCOM2012 and LCRAT models were not prone to historical variability in smoking exposure documentation. Conclusions Despite the inaccuracies of EHR-documented smoking histories, leveraging model-based lung cancer risk estimation may be a reasonable strategy for screening, and is of greater value compared to using NLST criteria in the same setting. Implications Electronic health records (EHRs) are potentially well-suited to aid in the risk-based selection of lung cancer screening candidates, but healthcare providers and systems may elect not to leverage EHR data due to prior work that has shown limitations in structured smoking exposure data quality. Our findings suggest that despite potential inaccuracies in the underlying EHR data, screening approaches that use multivariable models may perform significantly better than approaches that rely on simpler age and exposure-based criteria. These results should encourage providers to consider using pre-existing smoking exposure data with a model-based approach to guide lung cancer screening practices.
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Mumtaz, Shadaab, James Cymerman, and Deepak Komath. "Cycling-Related Injuries During COVID-19 Lockdown: A North London Experience." Craniomaxillofacial Trauma & Reconstruction, March 30, 2021, 194338752110070. http://dx.doi.org/10.1177/19433875211007008.
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Objectives: There has been a notable surge in cycling injuries during the COVID-19(SARS-CoV-2 virus) pandemic. Cycling in general increased during lockdown as a leisure & fitness activity along with reduction in the use of public transport for commuting. We investigated the bicycle-related maxillofacial injuries & associations presenting through our emergency department(ED) which covers more than 1.6 million of London population. Study Design/Methods: A retrospective observational study was undertaken in the Barnet General Hospital (“hub”) which receives all maxillofacial referrals from 6 “spoke” hospitals & other urgent primary/community care practices in North London area between 16 March 2020 & 16 July 2020. All data corresponding to cycling injuries during the lockdown period was analyzed with the aid of trauma database/trust-wide electronic patient records. Results: Twenty-two patients (6.7%) with cycling-related injuries out of a total of 322 patients who attended during the 4 months study period with maxillofacial emergencies were identified. Average age of patient cohort was 35.4 years, mainly consisting of adult males (77%). Seven patients had minor head injury and 1 patient suffered traumatic brain injury. About 59% patients did not wear a protective helmet & 3 patients had heavy alcohol/recreational drug intoxication during the accidents. Four patients needed inpatient admission and treatment under general anesthesia. Conclusions: Based on our humble study, we advocate the need for robust road & personal safety measures with mandatory government legislations, policing of drug intoxication & encouragement of physical & mental health improvement measures during these unprecedented times & beyond.
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DEMIKHOV, Oleksii. "Digital Transformation of the Sphere of Public Health in Ukraine." University Scientific Notes, April 3, 2021, 217–26. http://dx.doi.org/10.37491/unz.79.21.
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Currently, coronavirus infection is spreading around the world. Public health professionals need to develop new tools to ensure the epidemiological safety of citizens. First of all, it concerns the implementation of public health policy and health culture at the intersectoral level. Big data analytics, smart solutions for COVID-19 vaccination and morbidity monitoring, mobile applications to monitor the movement and contact of individuals, personal smart devices, cyberphysical technologies, and smart city infrastructure help in this regard. Scientific works of researchers are devoted to the impact of the digital economy on the development of society, the application digital communications in the activities of public authorities, the peculiarities of the formation of digital culture, cybersecurity and e-democracy. NGO’s experts offer their projects of digital transformation in the country, including in the field of health care. The issue of electronic tools in the field of public health and related public policy has not yet been addressed in recent scientific publications. The purpose of the article is to find out the current state of digital transformation in public administration and politics of Ukraine and the world, to determine further effective areas of application of IT tools in the field of public health policy. The article examines domestic laws and regulations in the field of e-government. Alternative projects of digital transformation of Ukraine proposed by public organizations are analyzed. It is established that at the national level, the foundations of digital transformation in the field of health care and public health in particular have been formed. The author of the article records a private initiative of professional associations of ICT specialists, the desire and efforts of the third sector in the direction of dynamic development of digitalization of health care. Regions and local communities at the united territorial communities’ level are not sufficiently covered by digital development. The directions of digitalization of public administration and public policy are proposed. Thus, the use of digital and mobile jobs in the public sector and in local governments will bring employees closer to society; will enable them to perform quality service functions, including health care. E-government tools are one of the leading positions in public policy-making. Today, Ukraine has laid the foundations for the digital transformation of public administration and public policy. The necessary legislative and regulatory framework for the development of e-government has been developed, including in terms of morbidity prevention, monitoring and assessment of public health, promotion of healthy lifestyles, anti-epidemiological measures, formation of health culture and development of health-preserving regional and local visions. However, the problem of further development at the regional level of public health remains. There are not enough funds in local budgets and experienced staff. Further research should focus on aspects of human-centred, humanistic public health policy, especially in quarantine.
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Gulliford, Martin C., A. Toby Prevost, Judith Charlton, Dorota Juszczyk, Jamie Soames, Lisa McDermott, Kirin Sultana, et al. "Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial." BMJ, February 12, 2019, l236. http://dx.doi.org/10.1136/bmj.l236.
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Abstract Objectives To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections. Design Open label, two arm, cluster randomised controlled trial. Setting UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017. Participants 79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care. Interventions AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial. Main outcome measures Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported. Results The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89 (95% confidence interval 0.68 to 1.16) and 0.88 (0.78 to 0.99, P=0.04), respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years (adjusted rate ratio 0.84, 95% confidence interval 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years (adjusted rate ratio 0.96, 95% confidence interval 0.82 to 1.12) or people aged 85 years and older (0.97, 0.79 to 1.18); there was also no evidence of an increase in serious bacterial complications (0.92, 0.74 to 1.13). Conclusions Electronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation. Trial registration ISRCTN95232781.
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Cox, Robynn S., Cheryl Bradas, Victoria Bowden, Beth Buckholz, Kathleen Kerber, and Molly McNett. "Abstract WP375: Fall Risk in Acute Ischemic Stroke." Stroke 48, suppl_1 (February 2017). http://dx.doi.org/10.1161/str.48.suppl_1.wp375.
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Fall Risk Factors among Hospitalized Acute Post-Ischemic Stroke Patients in an Urban Public Healthcare System Background: Falls remain an important benchmarking indicator for hospitals. The incidence of falls is a nursing-sensitive indicator, amenable to preventable measures. Research indicates factors associated with falls, but few studies specifically identify factors among hospitalized patients with acute ischemic stroke (AIS). Purpose: Identify prevalence and risk factors for falls among acute, hospitalized AIS patients within an urban safety net hospital. Methods: Retrospective cohort study. Data abstracted from stroke and fall registries, and medical records from 2013-2015 among all adult patients admitted for AIS. Variables included traditional risk factors for falls, as well as stroke-specific factors (NIHSS score, functional status, stroke location and vessel, administration of tPA). Results: N=683 AIS stroke patients, with 1.6% fall rate. Falls among AIS patients accounted for 6% of all hospital falls. AIS patients who experienced an inpatient fall had a mean age of 67 (range 46-86), were mostly male (82%), and ambulating independently prior to arrival (91%). Mean NIHSS scores upon admission were higher among those who experienced a fall, when compared to AIS patients who did not fall (mean=8.73, 7.01, respectively). Most patients who experienced a fall demonstrated weakness and/or paresis upon initial exam (90%), with 64% experiencing small vessel ischemic changes, and 36% MCA strokes. Administration of tPA was not associated with increased falls. LOS was significantly increased among AIS patients who experienced a fall (7.7 vs. 4.8, respectively, p <0.01). Conclusions: Fall rates among hospitalized AIS patients may be lower than earlier reports, reflecting increased vigilance among providers and widespread integration of fall prevention strategies. Elevated NIHSS scores and weakness/paresis upon initial exam may be important predictors of falls among newly diagnosed AIS patients who had previously been able to ambulate independently. Consistent with fall literature among other populations, the occurrence of a fall in the inpatient setting can substantially increase length of stay.
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Guo, Taozi. "Analysis on the Development Path of Music Education in Rural Areas under the Influence of COVID-19 Outbreak." CONVERTER, July 29, 2021, 169–75. http://dx.doi.org/10.17762/converter.276.
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In 2020, the sudden COVID-19 outbreak brought huge economic and life losses to the whole world, affecting all walks of life in China, including the education industry which suffered from many problems, such as students' learning needs for medical health knowledge, publicity needs for public health safety, psychological and mental health protection needs, and online learning needs based on internet accelerated speed .In rural China, some rural students have physical and mental health problems due to the problems of rural population structure, infrastructure construction, talent mobility, etc. In this period, schools should pay more attention to the psychological counseling and education of rural students, on which music education has a positive impact. During the epidemic period, rural education construction around cultural revitalization was gradually implemented under the background of China's full implementation of rural revitalization strategy. In the construction of rural education, music education is an important cornerstone to promote the all-round development of students, build a rural cultural atmosphere and inherit the excellent national culture. With the change of social environment, the country music education welcomes new opportunities, but also faces some practical problems to be solved.First of all, the literature on the COVID-19 outbreak and rural music education is studied and analyzed through on-the-spot visits and investigation on the current situation of music education in rural schools. Then, interviews and records are made with rural music teachers and students. Next, discussions are made on the construction of rural music teachers, information technology of music education, cultural life of the rural masses and other aspects. Finally, relevant strategies for the development of rural music education are put forward.The COVID-19 outbreak has narrowed the channels for rural music teachers' professional promotion, and caused some problems in rural students' mental health. In addition, rural schools have some shortcomings in online learning and information education based on internet plus, and the number of rural cultural performances and activities has decreased.Education managers should take corresponding management measures to innovate the music education model with the aid of modern teaching technology. At the same time, rural schools need to maintain long-term cooperation with all sectors of society and cooperate in public health, medical resources, education resources, curriculum innovation, rural cultural activities and other aspects to ensure the real implementation, promotion and development of music education, aesthetic education and art education in the countryside during the COVID-19 epidemic.
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Dubowitz, Howard, Lisa Saldana, Laurence A. Magder, Lawrence A. Palinkas, John A. Landsverk, Rose L. Belanger, and Ugonna S. Nwosu. "Protocol for comparing two training approaches for primary care professionals implementing the Safe Environment for Every Kid (SEEK) model." Implementation Science Communications 1, no. 1 (September 22, 2020). http://dx.doi.org/10.1186/s43058-020-00059-9.
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Abstract Background Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents; promote children’s health, development, and safety; help prevent CM; and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK’s adoption, implementation, and sustainment, and its effectiveness in preventing CM. Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology-driven implementation strategies to scale-up SEEK—in pediatric and family medicine primary care settings. The aims are to (1) evaluate the effectiveness of training strategies on SEEK’s implementation in primary care practices, (2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK, and (3) examine the model’s effectiveness in preventing CM and the economic costs of implementing SEEK. Methods This randomized type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK’s adoption and implementation in pediatric and family medicine practices in different regions of the USA. These are independent online training and in-depth structured training via a quality improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a “Traditional” paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews, and data abstracted from electronic health records. Discussion The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science and guide future interventions in primary care. Trial registration NCT03642327, Clinical Trials, registered August 21, 2018.
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Walsh, Andrew. "Enhancing Syndromic Surveillance with Procedure Data: A 2017-8 Influenza Case Study." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9748.
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ObjectiveTo identify additional data elements in existing syndromic surveillance message feeds that can provide additional insight into public health concerns such as the influenza season.IntroductionSyndromic surveillance achieves timeliness by collecting prediagnostic data, such as emergency department chief complaints, from the start of healthcare interactions. The tradeoff is less precision than from diagnosis data, which takes longer to generate. As the use and sophistication of electronic health information systems increases, additional data that provide an intermediate balance of timeliness and precision are becoming available.Information about the procedures and treatments ordered for a patient can indicate what diagnoses are being considered. Procedure records can also be used to track the use of preventive measures such as vaccines that are also relevant to public health surveillance but not readily captured by typical syndromic data elements. Some procedures such as laboratory tests also provide results which can provide additional specificity about which diagnoses will be considered. If procedure and treatment orders and test results are included in existing syndromic surveillance feeds, additional specificity can be achieved with timeliness comparable to prediagnostic assessments.MethodsHL7 messages were collected for syndromic surveillance using EpiCenter software. They were retroactively scanned for PR1 procedure segments; procedure codes and descriptions were extracted when available. Influenza-related procedures were identified and classified as either a test for the virus or an administration of a vaccine. Classification was based on the procedure code when a standard code set was used and could be identified, otherwise it was based on the text description of the procedure.Messages were also scanned for the presence of ‘influenza’ in text fields. Influenza test results were identified first by selecting messages with ‘influenza’ in an OBX segment and then further refining based on the test code and description.ResultsA total of 443,074,748 messages from 2,577 healthcare facilities received between July 1, 2017 and August 31, 2018 were scanned for procedure information. Procedure codes were present in 39,142,670 messages from 287 facilities. The most common procedures included blood glucose measurements and other diabetes maintenance activities, incentive spirometry, blood count and metabolic panels, safety observation, and vital signs.Of those, 995,754 messages from 142 facilities contained influenza-related procedure codes for 106,610 visits. 14,672 visits from 62 facilities had one of 48 vaccine procedure codes, and 91, 948 visits from 127 facilities had one of 66 test codes. Time series of both types of procedures showed a seasonal trend consistent with the influenza season. Figure 1 shows the daily counts of influenza test orders and vaccine administrations. Figure 2 breaks out the test orders by test type (antibody assay, antigen assay, PCR, or unspecified).Seven facilities sent a total of 58,182 messages containing influenza test results. These included both positive and negative results. These results distinguished between influenza A and influenza B. Figure 3 shows the daily counts of both positive and negative results by virus type; this also follows the expected seasonal pattern.ConclusionsSince procedure information was not specifically requested from healthcare facilities, the overall representation of procedure data elements was low. These initial results indicate that such data would be useful both as a supplement to syndromic surveillance activities and as a new data source for other surveillance activities such as vaccine uptake tracking. Given the frequency of procedures and treatments for chronic diseases such as diabetes and heart disease, these data may be relevant for understanding the prevalence of those conditions as well. Tests and treatments relevant to other public health concerns like opioid use disorder were also present, suggesting a wide range of potential applications.It is also possible to obtain and extract influenza test results from these syndromic surveillance messages. Both positive and negative results were present, providing information not just on the number of positive cases but also the rate of testing and rate of positive results. The pattern of testing and results also indicates that at least some facilities test for influenza throughout the season, contrary to some conventional wisdom about testing patterns.
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Oliveira, Juliana Da Silva, Tatiane Oliveira de Souza Constâncio, Isleide Santana Cardoso Santos, and Adriana Alves Nery. "Óbitos por causas externas relacionadas ao trabalho." Revista de Enfermagem UFPE on line 13 (June 14, 2019). http://dx.doi.org/10.5205/1981-8963.2019.237870.
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RESUMOObjetivo: descrever os óbitos por causas externas relacionadas ao trabalho. Método: trata-se de um estudo quantitativo, retrospectivo, do tipo ecológico, baseado em registros de óbitos por acidentes de trabalho no Brasil disponíveis no Sistema de Informação sobre Mortalidade do Departamento de Informática do Sistema Único de Saúde do Ministério da Saúde, no período de 1996 a 2015. Processaram-se a analisaram-se os dados no software Microsoft Office Excel 2010. Apresentaram-se os resultados em forma de tabela. Resultados: registraram-se, no período investigado, 58.940 óbitos relacionados ao trabalho, onde 21.067 (35,74%) ocorreram na região Sudeste, sendo que o sexo masculino foi o mais acometido em todas as regiões e, nas regiões Norte, Nordeste e Centro-Oeste prevaleceram a faixa etária de 25 a 64 anos e indivíduos de cor parda. Revela-se que os principais locais de ocorrência dos óbitos relacionados ao acidente de trabalho foram o hospital e a via pública, e o maior número de óbitos ocorreu entre os acidentes de transporte e outras causas externas de lesões de acidente. Conclusão: entende-se que há um elevado índice de mortalidade por causas externas em ambientes de trabalho no Brasil, e isso demonstra a necessidade do desenvolvimento de ações de proteção e segurança ao trabalhador visando à redução do número de óbitos por acidentes de trabalho no país. Descritores: Saúde do Trabalhador; Causas Externas; Epidemiologia; Acidentes de Trabalho; Sistema de Informação; Mortalidade. ABSTRACT Objective: to describe the deaths due to external causes related to work. Method: this is a retrospective quantitative study of the ecological type, based on records of work-related injuries in Brazil, available in the Mortality Information System of the Department of Information Technology of the National Health System of the Ministry of Health, in the period from 1996 to 2015. The data was processed in Microsoft Office Excel 2010 software. The results were presented in tabular form. Results: 58,940 work-related deaths were registered in the investigation period, where 21,067 (35.74%) occurred in the Southeast region, with the male gender being the most affected in all regions, and in the North, Northeast and Center-West prevailed between 25 and 64 years of age and individuals of brown color. It is revealed that the main places of occurrence of deaths related to the work accident were the hospital and the public highway, and the highest number of deaths occurred between transportation accidents and other external causes of accident injuries. Conclusion: it is understood that there is a high mortality rate due to external causes in work environments in Brazil, and this demonstrates the need to develop worker protection and safety measures aimed at reducing the number of deaths due to work-related accidents in Brazil. Descriptors: Worker's Health; External causes; Epidemiology; Work Accidents; Information system; Mortality. RESUMEN Objetivo: describir las muertes por causas externas relacionadas con el trabajo. Método: se trata de un estudio cuantitativo, retrospectivo, del tipo ecológico, basado en registros de muertes por accidentes de trabajo en Brasil disponibles en el Sistema de Información sobre Mortalidad del Departamento de Informática del Sistema Único de Salud del Ministerio de Salud, en el período de 1996 a 2015. Se procesaron y se analizaron los datos en el software Microsoft Office Excel 2010. Se presentaron los resultados en forma de tabla. Resultados: en el período investigado, 58.940 muertes relacionadas al trabajo, donde 21.067 (35,74%) ocurrieron en la región Sudeste, siendo que el sexo masculino fue el más acometido en todas las regiones y, en las regiones Norte, Nordeste y Centro Oeste prevalecieron el grupo de edad de 25 a 64 años y los individuos de color parda. Se reveló que los principales lugares de ocurrencia de muertes relacionadas con el accidente de trabajo fueron el hospital y la vía pública, y el mayor número de muertes ocurrió entre los accidentes de transporte y otras causas externas de lesiones de accidente. Conclusión: se entiende que hay un elevado índice de mortalidad por causas externas en ambientes de trabajo en Brasil, y eso demuestra la necesidad del desarrollo de acciones de protección y seguridad al trabajador objetivando la reducción del número de muertes por accidentes de trabajo en el país. Descritores: La Salud del Trabajador; Causas Externas; Epidemiología; Accidentes en el Trabajo; Sistema de Informacion; Mortalidad.