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Healthfacilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care centers. When you ...
This Centers for Disease Control and Prevention (CDC) Health Studies page focuses on cyanobacteria, single-celled organisms thought to be the origin of plants. Cyanobacteria live in fresh, brackish, or marine water and are of concern to the CDC and Environmental Protection Agency (EPA) because some can form harmful blooms that deplete the oxygen and block sunlight that other organisms need to live. They can also produce powerful toxins that affect the brain and liver of animals and humans. This website links to an informational page about cyanobacterial harmful algal blooms (including impact to public health), general information, CDC activities, links to relevant websites, publications, and additional CDC topics.
The recommendations of the South Carolina Task Force on HealthFacilities are presented. Its suggestions stress the need for the following: a study to determine if there is a problem with over-building of healthfacilities in the State; a study of the adv...
Intended to provide current statistics on health manpower and inpatient healthfacilities for the evaluation, planning, and administration of health programs, data were gathered from college and university records, state licensing records, association membership records, and agencies and establishments that provide health services. About 3.7…
National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.
BACKGROUND: Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL) problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of
This student module on industrial sanitation and personal facilities is one of 50 modules concerned with job safety and health. This module deals wth many facets of industrial sanitation and the facilities industries should provide so that proper health procedures may be followed. Following the introduction, 14 objectives (each keyed to a page in…
Center for Occupational Research and Development, Inc., Waco, TX.
This report presents 1979 data on the number and geographic location of providers and suppliers of health services under Medicare, based on records maintained by the Health Care Financing Administration (HCFA). Every provider and supplier of health servic...
The Medical Simulations Working Group conducted a series of medical simulations to evaluate the proposed Health Maintenance Facility (HMF) Preliminary Design Review (PDR) configuration. The goal of these simulations was to test the system effectiveness of...
The health risks facing workers involved in decommissioning nuclear facilities are a critical concern as the nuclear weapons complex and nuclear power plants begin to be dismantled. In addition to risks from exposure to radioactive materials, there are risks from other common industrial materials like crystalline silica dust and asbestos. We discuss these issues in the context of recent research on the risk of low-level ionizing radiation, the classification of crystalline silica as a carcinogen, and early experience with decommissioning nuclear facilities in the United States. Health and safety advocates will need to be vigilant to prevent worker exposure. PMID:17208791
...2013-10-01 false Cooperation with health care facilities. 476.76 Section... Â§ 476.76 Cooperation with health care facilities. Before implementation...review procedures with each involved health care...
The Health Maintenance Facility (HMF) requirements which enable/enhance manned Mars missions (MMMs) are addressed. It does not attempt to resolve any issues that may affect the feasibility of any given element in the HMF. Reference is made to current work...
To improve geographical accessibility to healthfacilities in rural Ghana, it has been recommended that additional healthfacilities be built. Resource constraints make this recommendation infeasible. Using location-allocation models, this paper demonstrates that in the Suhum District of Ghana substantial improvements in accessibility can be achieved with better locational choices and without additional facilities. Also, additional facilities will produce little
A statistical analysis of spatial allocations in university teaching hospitals and medical schools in three countries supports the hypothesis that on the “macro” level of major functional zones there is a considerable degree of invariance in space ratios, despite wide divergence in size, organization, and operating policies. On the basis of these findings a model is developed that makes it possible to predict, from a variety of indicators of space “needs,” the total area of a health sciences facility defined by levels of support servicing. The outputs of the model are seen as the inputs to a design strategy for potentially flexible medical facilities served by a communication lattice capable of indefinite extension. Images Fig. 9
We describe a health care facility to be built and used on an orbiting space station in low Earth orbit. This facility, called the health maintenance facility, is based on and modeled after isolated terrestrial medical facilities. It will provide a phased approach to health care for the crews of Space Station Freedom. This paper presents the capabilities of the health maintenance facility. As Freedom is constructed over the next decade there will be an increase in activities, both construction and scientific. The health maintenance facility will evolve with this process until it is a mature, complete, stand-alone health care facility that establishes a foundation to support interplanetary travel. As our experience in space continues to grow so will the commitment to providing health care. PMID:1743067
The Health Maintenance Facility (HMF) requirements which enable/enhance manned Mars missions (MMMs) are addressed. It does not attempt to resolve any issues that may affect the feasibility of any given element in the HMF. Reference is made to current work being conducted in the design of the space station HMF. The HMF requirements are discussed within the context of two distinctly different scenarios: HMF as part of the Mars surface infrastructure, and HMF as part of the nine months translation from low Earth orbit to Mars orbit. Requirements for an HMF are provided, and a concept of HMF is shown.
The objectives were to test the effectiveness of the Health Maintenance Facility (HMF) dental suction/particle containment system, which controls fluids and debris generated during simulated dental treatment, in microgravity; to test the effectiveness of fiber optic intraoral lighting systems in microgravity, while simulating dental treatment; and to evaluate the operation and function of off-the-shelf dental handheld instruments, namely a portable dental hand drill and temporary filling material, in microgravity. A description of test procedures, including test set-up, flight equipment, and the data acquisition system, is given.
...Debt restructuring-hospitals and health care facilities. 1956.143 Section 1956...Debt restructuring—hospitals and health care facilities. This section pertains exclusively...delinquent Community Facility hospital and health care facility loans. Those facilities...
Data concerning the number of mental health specialists in each of four groups (psychiatrists, psychologists, social workers, and correctional counselors) employed in state and Federal correctional facilities are reviewed. Social workers are seen to represent 76% and 57% of all mental health specialists employed in Federal and state facilities, respectively. In addition, a ratio of one mental health specialist to
...2014-01-01 2014-01-01 false Health care facilities. 15b.38 Section 15b...Benefits, or Services § 15b.38 Health care facilities. (a) Communications...the purpose of providing emergency health care. (c) Drug and alcohol addicts....
This document is an addendum to the Final Health and Safety Plan for the Woodbridge Research Facility, Virginia, September 1993. Delivery Order Number DA0014 entitled Woodbridge Research Facility Biota Sampling, provides details and rationale for the envi...
A study aims to examine the existing health care policies in U.S. juvenile detention centres. The results conclude that juvenile detention facilities have many shortfalls in providing care for adolescents, particularly mental health care.
... CDC Features TB in Correctional Facilities is a Public Health Concern Share Compartir Diagnosing and treating TB in ... the community with untreated TB present a serious public health concern. Figure 1 (larger view). TB Control in ...
This report is one of 10 regional documents intended to provide health planners with descriptive information about health care facility licensing practices. It includes information by State in Region IV about the organization of licensing agencies, certif...
...restructuring-hospitals and health care facilities. 1956...UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT...restructuringâhospitals and health care facilities. This...Facility hospital and health care facility loans....
...restructuring-hospitals and health care facilities. 1956...UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT...restructuringâhospitals and health care facilities. This...Facility hospital and health care facility loans....
The Medical Simulations Working Group conducted a series of medical simulations to evaluate the proposed Health Maintenance Facility (HMF) Preliminary Design Review (PDR) configuration. The goal of these simulations was to test the system effectiveness of the HMF PDR configurations. The objectives of the medical simulations are to (1) ensure fulfillment of requirements with this HMF design, (2) demonstrate the conformance of the system to human engineering design criteria, and (3) determine whether undesirable design or procedural features were introduced into the design. The simulations consisted of performing 6 different medical scenarios with the HMF mockup in the KRUG laboratory. The scenarios included representative medical procedures and used a broad spectrum of HMF equipment and supplies. Scripts were written and simulations performed by medical simulations working group members under observation from others. Data were collected by means of questionnaires, debriefings, and videotapes. Results were extracted and listed in the individual reports. Specific issues and recommendations from each simulation were compiled into the individual reports. General issues regarding the PDR design of the HMF are outlined in the summary report.
Lloyd, Charles W.; Gosbee, John; Bueker, Richard; Kupra, Debra; Ruta, Mary
Assisted living facilities (ALFs) are the most rapidly growing type of residential care for the elderly in the United States. However, little is known about facilities' responses to residents' mental health needs. Obtaining a clear understanding of the industry's response to residents' mental health needs is complicated by the fact that many different types of assisted living residences exist. A
...Practices for Unused Pharmaceuticals at Health Care Facilities AGENCY: Environmental...Practices for Unused Pharmaceuticals at Health Care Facilities. The guidance is targeted...pharmaceutical disposal practices at health care facilities, prompted by the...
...Prohibition against contracting with health care facilities. 475.105 Section...Prohibition against contracting with health care facilities. (a) Basic rule...eligible for QIO contracts: (1) A health care facility in the QIO area....
Intended as a companion piece to volume 5 in the Method Series, HealthFacilities Planning (CE 024 233), this sixth of six volumes in the International Health Planning Reference Series is a combined literature review and annotated bibliography dealing with healthfacilities planning for developing countries. The review identifies literature…
Goals: The authors examined assault frequency and risk factors in health care. Methods: The authors conducted a cross-sectional question naire survey in 142 hospitals. Analyses are presented at the level of the individual and aggregated by facility. Results: Thirteen percent of employees described at least 1 assault in the last year; the proportion assaulted per facility ranged from 1% to
Michael J. Hodgson; Richard Reed; Thomas Craig; Frances Murphy; Larry Lehmann; Linda Belton; Nick Warren
A survey of healthfacilities and services in LaPorte County, Indiana is presented by the Northwest Indiana Comprehensive Health Planning Council. LaPorte County contains a mixture of rural and urban populations, a large portion of which relies on industr...
The American College of Sports Medicine (ACSM) sets the industry standard for certifying professionals involved in health and fitness and their clinical applications. This 5-part publication provides a revised edition of six standards representing the industry's consensus on design and operation of a safe and high-quality health/fitness facility.…
Background Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour. Methods A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of healthfacilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison. Results Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a healthfacility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a healthfacility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a healthfacility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of healthfacility did not demonstrate impact. Conclusion Perceived severity of the disease is the most important determinant of seeking health care or visiting a healthfacility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks promising, but the number not visiting a healthfacility is large and calls for supplementary control options.
Danso-Appiah, Anthony; Stolk, Wilma A.; Bosompem, Kwabena M.; Otchere, Joseph; Looman, Caspar W. N.; Habbema, J. Dik F.; de Vlas, Sake J.
As mandated in Public Law 110-387, the VA Office of Inspector General (OIG) conducted a review of residential mental health care facilities, including domiciliary facilities, of the Veterans Health Administration (VHA). As part of the review, the OIG was ...
...false Services of residents in skilled nursing facilities and home health agencies...204 Services of residents in skilled nursing facilities and home health agencies...specified requirements: (1) Skilled nursing facility. Payment to a...
The National Institute for Occupational Safety and Health (NIOSH) conducted several evaluations of occupational health problems at or near hazardous waste disposal facilities. Several examples illustrate the variety of public health concerns, including contamination of water supplies, airborne exposure to toxic substances for nearby residential areas, fires affecting nearby residents and local firefighters, and occupational health hazards for workers at these sites. Most of the potential health problems can be prevented with appropriate planning, orientation, and monitoring of the facility. The most difficult part is assuring the community that the design and operation will minimize risks.
In recent years, dozens of countries have introduced accreditation and other quality improvement initiatives. A great deal of information is available regarding best practices in high- and middle-income countries; however, little is available to guide developing nations seeking to introduce an accreditation programme. This paper describes the outputs and lessons learned in the first year of establishing an accreditation programme in Liberia, a developing nation in West Africa that in 2003 emerged from a brutal 14-year civil war. The Liberian experience of developing and implementing a government-sponsored, widespread accreditation programme may provide insight to other low-income and post-conflict countries seeking a way to drive rapid, system-wide reform in the health system, even with limited infrastructure and extremely challenging conditions.
Cleveland, Emily C.; Dahn, Bernice T.; Lincoln, Teta M.; Safer, Meredith; Podesta, Mae; Bradley, Elizabeth
The integration of electronic health records (EHRs) across care settings including residential care facilities (RCFs) promises to reduce medical errors and improve coordination of services. Using data from the 2010 National Survey of Residential Care Facilities (n=2302), this study examines the association between facility structural characteristics and the use of EHRs in RCFs. Findings indicate that in 2010, only 3% of RCFs nationwide were using an EHR. However, 55% of RCFs reported using a computerized system for one or more (but not all) of the functionalities defined by a basic EHR. Ownership, chain membership, staffing levels, and facility size were significantly associated with the use of one or more core EHR functionalities. These findings suggest that facility characteristics may play an important role in the adoption of EHRs in RCFs.
BACKGROUND: Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This healthfacility is one of the seven upgraded BRAC facilities providing
This paper stresses the importance of the strategic integration of the organisational facilities management function as being an essential prerequisite towards facilities and organisational effectiveness. The impact of both the strategic and operational facilities management function on community health-care facility users is also documented. The value of the facilities management function in terms of other health-care related organisational core deliverables
Clinicians and clinical administrators should have a basic understanding of physical and financial risk to mental healthfacilities related to external physical threat, including actions usually viewed as "terrorism" and much more common sources of violence. This article refers to threats from mentally ill persons and those acting out of bizarre or misguided "revenge," extortionists and other outright criminals, and perpetrators usually identified as domestic or international terrorists. The principles apply both to relatively small and contained acts (such as a patient or ex-patient attacking a staff member) and to much larger events (such as bombings and armed attack), and are relevant to facilities both within and outside the U.S. Patient care and accessibility to mental health services rest not only on clinical skills, but also on a place to practice them and an organized system supported by staff, physical facilities, and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or to serve at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state and national standards for hospital safety, or insurance providers' individual facility requirements. PMID:24733720
The objective of this document is to determine the extent to which American Indians and Alaska Natives (AI/AN) have access to mental health services at Indian Health Service (IHS) and tribal facilities. A member of Congress expressed concern about AI/ANs'...
This kid's page offers information on mine safety and the dangers of abandoned mines, an interactive map illustrating which minerals are mined in each state, a presentation on the Mine Safety and Health Administration (MSHA) and their role in mining, a pictorial history of children working in mines, the amount of minerals, metals and fuels each American will use in a lifetime, and a story based on the practice of taking a canary bird into the mines to warn of low oxygen supply.
Background: There is dearth of information about psychiatric morbidity at secondary level healthfacility in India. Aim: To study psychiatric morbidity amongst patients attending psychiatry clinic in secondary level healthfacility. Settings and Design: Present study is based on hospital record review of psychiatry clinic at secondary care hospital in Ballabgarh, Haryana. Materials and Methods: Service record of psychiatry clinic at civil hospital Ballabgarh was reviewed. Diagnosis of psychiatric morbidity was done according to DSM IV and ICD 10 classification. Statistical Analysis: Descriptive analysis of data was carried out. Results: A total of 724 (0.7%) new OPD patients consulted psychiatry clinic. Common Mental Disorders comprising of mood disorders, neurotic stress –related and somatoform disorders were the most commonly diagnosed disorders (60.5%) amongst reported psychiatric morbidity in the hospital. Conclusion: Substantial burden of psychiatry morbidity highlights necessity of psychiatry clinic at secondary care hospital in India.
Independent healthfacilities ("IHFs") are an important part of Canada's health care system existing at the interface of public and private care. They offer benefits to individual patients and the public at large, such as improved access to care, reduced wait times, improved choice in the delivery of care, and more efficient use of health care resources. They can also provide physicians greater autonomy, control of resources, and opportunity for profit compared to other practice settings, particularly because IHFs can deliver services outside of publicly-funded health care plans. IHFs also present challenges, particularly around quality of care and patient safety, and the potential to breach the principles of "Medicare" under the Canada Health Act. Various measures are in place to address these challenges, while still enabling the benefits IHFs can offer. IHFs are primarily regulated and overseen at the provincial level through legislation, regulations and provincial medical regulatory College by-laws. Health Canada is responsible for administering the overarching framework for "Medicare". Oversight and regulatory provisions vary across Canada, and are notably absent in the Maritime provinces and the territories. This article provides an overview of specific provisions related to IHFs across the country and how they can co-exist with the Canada Health Act. PMID:24696939
Pries, Charlene R; Vanin, Sharon; Cartagena, Rosario G
Environmental pollution, primarily from industrialization, has caused significant adverse effects to humans, animals, and the ecosystem. Attempts have been made to reduce and prevent these pollutants through better waste management practices. Incineration is one such practice, which seeks to prevent adverse health impacts to future generations by destroying waste today, without increasing risk to those living near incineration facilities in the process. As with any industrial process, however, proper design and operation are important requirements to ensure the facility can be operated safely. Any technology that cannot be managed safely should not be considered acceptable. This paper reviews the scientific basis of past allegations associated with the process of hazardous waste incineration. These five case studies, which have attracted considerable public attention, have not been shown to be scientifically accurate of factually based. This paper attempts to separate fact from fiction and to show some of the consistent inaccuracies that were repeated throughout all five studies. In reviewing the above cases and others in the literature, several common elements become apparent. 1. Most of the reports are based on single newspaper articles, activist newsletters, interviews with admittedly biased respondents, and other secondary or inappropriate sources of information that do not withstand scientific scrutiny. 2. Research studies are quoted incompletely or out of context. Often the original point made by the researcher is the exact opposite of the impression left by Costner and Thornton. 3. In four of five cases, no data were supplied to substantiate the claims. As an observation, where substantive research data do not exist to support allegations of adverse health effects, a tendency seems to be increasing over time to make allegations and then not provide supporting data. Because public damage is often done simply by making the allegation, this tactic appears to be effective. Thus, unsubstantiated allegations should not go unchallenged. 4. A relatively small group of people appears to be consistently generating most of the allegations. 5. The format of the allegations tends to be similar; often just the name of the facility changes. 6. Furthermore, these same few individuals tend to repeat the same allegations about the same facilities, even after the allegations have been long since proven incorrect. Despite the widespread prevalence of incineration facilities around the world and the millions of tons of waste destroyed in them each year, surprisingly few reports of adverse health effects exist in the scientific literature relative to other types of waste management practices. 7. The existing reports do not indicate that hazardous waste incineration has widespread potential for adverse health effects. However, as with all industrial processes, care must be taken to ensure that facilities are well designed and well operated to minimize or prevent adverse health effects. As with all environmental exposures, potential impacts on public health need to be addressed scientifically. Making a scientifically valid connection between operation of an incinerator and resulting disease within a population is a difficult undertaking, requiring the combined efforts of toxicologists, epidemiologists, chemists, physicians, and persons in other disciplines. Nevertheless, concerns regarding potential impacts of incineration must be addressed and communicated, both accurately and effectively, if the actual risks of incineration are to become widely understood. PMID:8794540
...Indian Health Service facilities. 431.110 Section 431.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND...
The Epidaurus Project, an advanced initiative in holistic (or whole-person) medicine, has operated in the Military Health System (MHS) since 2001. Its purpose has been to engage prominent civilian authorities on evidence-based building design, family-centered approaches, interdisciplinary care integration, and wellness, to optimize outcomes in the MHS. Over the past decade, many of the Epidaurus idea sets have been incorporated into MHS facility designs and therapeutic programs. The MHS owes a debt of gratitude to the numerous civilian thought leaders who participated in this project. PMID:22338971
Recent cases involving the decisions of Elizabeth Bouvia and G. Ross Henninger to starve themselves to death highlight the ethical obligations of patients, health care facilities, and the courts. When a patient seeks the hospital's cooperation in his or her attempt to commit suicide, society's responsibility is not merely to restrain the patient from suicide but to offer physical care, financial aid, and personal support. The hospital's duty is to intervene, and the court's responsibility is to allow such intervention. The most compassionate way in which the hospital can help is to force-feed the patient. If a patient is mentally competent, the refusal to eat is morally wrong. The patient is morally not permitted to commit suicide, though the avoidance of treatment may be justified in cases when force-feeding would be considered an extraordinary means, because of the patient's age or physical condition, for example. If a patient is incompetent, the refusal to eat is not a fully rational act; for the hospital to refrain from force-feeding would not be considered cooperation in suicide, since the incompetent patient cannot commit suicide. To avoid court rulings that order compliance with a patient's wishes, health care facilities in the future may have to require patients or their families to agree in writing to treatment by ordinary means. PMID:10268324
Background Prompt and effective case management is needed to reduce malaria morbidity and mortality. However, malaria diagnosis and treatment is a multistep process that remains problematic in many settings, resulting in missed opportunities for effective treatment as well as overtreatment of patients without malaria. Methods Prior to the widespread roll-out of malaria rapid diagnostic tests (RDTs) in late 2011, a national, cross-sectional, complex-sample, healthfacility survey was conducted in Malawi to assess patient-, health worker-, and healthfacility-level factors associated with malaria case management quality using multivariate Poisson regression models. Results Among the 2,019 patients surveyed, 34% had confirmed malaria defined as presence of fever and parasitaemia on a reference blood smear. Sixty-seven per cent of patients with confirmed malaria were correctly prescribed the first-line anti-malarial, with most cases of incorrect treatment due to missed diagnosis; 31% of patients without confirmed malaria were overtreated with an anti-malarial. More than one-quarter of patients were not assessed for fever or history of fever by health workers. The most important determinants of correct malaria case management were patient-level clinical symptoms, such as spontaneous complaint of fever to health workers, which increased both correct treatment and overtreatment by 72 and 210%, respectively (p?0.0001). Complaint of cough was associated with a 27% decreased likelihood of correct malaria treatment (p?=?0.001). Lower-level cadres of health workers were more likely to prescribe anti-malarials for patients, increasing the likelihood of both correct treatment and overtreatment, but no other health worker or healthfacility-level factors were significantly associated with case management quality. Conclusions Introduction of RDTs holds potential to improve malaria case management in Malawi, but health workers must systematically assess all patients for fever, and then test and treat accordingly, otherwise, malaria control programmes might miss an opportunity to dramatically improve malaria case management, despite better diagnostic tools.
The "health literacy environment" of a healthcare facility represents the expectations, preferences, and skills of those providing health information and services. Some of these demands are in the form of physical aspects of the hospital or health center, such as signs and postings. At the same time, access to and navigation of health services…
In order to assess the prevalence of mental health and substance abuse among youth in one state's juvenile justice facilities, a survey was conducted of 40 Tennessee facilities. A total of 1215 youth were being held on the \\
Louise Barnes; Deborah Bennett; Charlotte Bryson; Sita Diehl; Trish Hayes; Craig Anne; Liz Ledbetter; Pam McCain; Linda O'Neal; Patti Orten; Nancy Reed; Adriane Sheffield; Debrah Stafford; Pat Wade
The VA Office of Inspector General Office of Healthcare Inspections evaluated construction safety at Veterans Health Administration (VHA) facilities. The purpose of the evaluation was to determine whether VHA facilities had developed effective constructio...
The VA Office of Inspector General Office of Healthcare Inspections evaluated selected infection prevention (IP) practices in Veterans Health Administration facilities. The purposes of the evaluation were to determine whether facilities complied with requ...
Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions. PMID:10122747
The ES&H Management Plan describes all of the environmental, safety, and health evaluations and reviews that must be carried out in support of the implementation of the National Ignition Facility (NIF) Project. It describes the policy, organizational responsibilities and interfaces, activities, and ES&H documents that will be prepared by the Laboratory Project Office for the DOE. The only activity not described is the preparation of the NIF Project Specific Assessment (PSA), which is to be incorporated into the Programmatic Environmental Impact Statement for Stockpile Stewardship and Management (PEIS). This PSA is being prepared by Argonne National Laboratory (ANL) with input from the Laboratory participants. As the independent NEPA document preparers ANL is directly contracted by the DOE, and its deliverables and schedule are agreed to separately with DOE/OAK.
...of the operations and records of health care facilities and practitioners...of the operations and records of health care facilities and practitioners...charges) that are pertinent to health care services furnished to Medicare...
The report provides information on: Changes in the veteran population, veterans' demand for health care from Veterans Administration (VA), VA medical facility workload, and obligation of VA health care dollars from fiscal years 1981 to 1985. The authors c...
The Michigan Department of Environmental Quality (DEQ) asked for the assistance of the Michigan Department of Community Health (DCH) to identify the public health hazards present at the Michigan Industrial Finishes Corporation (MIF) facility in Hamtramck,...
This preintervention/postintervention pilot study examined impact of onsite support by a dental hygiene champion (DHC) on oral health and quality of life (QOL) of elderly residents in three long-term care facilities (LTCFs) in Arkansas. Oral health and oral health-related QOL were operationalized using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI), respectively. CNAs in Facility A received standardized oral health education/materials with onsite DHC support. Facility B received education/materials only. Facility C served as control. Data analyses included Wilcoxon-signed rank tests (OHAT) and repeated measures ANOVA (GOHAI) (p ? .05). OHAT postintervention data in Facility A showed significant improvements in three measured areas (tongue health, denture status, and oral cleanliness); in Facility B, one area (tongue health); and none in Facility C. No significant differences were found in GOHAI scores across facilities. Findings suggest that the presence of DHCs in LTCFs may positively impact the oral health of CNA-assisted residents. PMID:25039379
Amerine, Carol; Boyd, Linda; Bowen, Denise M; Neill, Karen; Johnson, Tara; Peterson, Teri
Background Tuberculosis infection control (TBIC) is rarely implemented in the healthfacilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. Methods We conducted a cross-sectional study in 51 healthfacilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Results Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. Conclusion TBIC measures were not implemented in healthfacilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.
To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services…
This paper explores factors that are influencing the utilization of occupational therapists in mental healthfacilities in Western Pennsylvania from the perspective of administrators of mental health agencies. Administrators completed a 32 item survey. Descriptive statistics were compiled and inferential statistical analysis compared group means by type of facility, employment of occupational therapy personnel, awareness of occupational therapy education, and
Jaime Phillip Muñoz; John Sciulli Jr; Dara L. Thomas; Ryan S. Wissner
Hypochlorite has been used as a disinfectant for more than 100 years. It has many of the properties of an ideal disinfectant, including a broad antimicrobial activity, rapid bactericidal action, reasonable persistence in treated potable water, ease of use, solubility in water, relative stability, relative nontoxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. The active species is undissociated hypochlorous acid (HOCl). Hypochlorites are lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endospore-forming bacteria, fungi, and protozoa. Activity is reduced by the presence of heavy metal ions, a biofilm, organic material, low temperature, low pH, or UV radiation. Clinical uses in health-care facilities include hyperchlorination of potable water to prevent Legionella colonization, chlorination of water distribution systems used in hemodialysis centers, cleaning of environmental surfaces, disinfection of laundry, local use to decontaminate blood spills, disinfection of equipment, decontamination of medical waste prior to disposal, and dental therapy. Despite the increasing availability of other disinfectants, hypochlorites continue to find wide use in hospitals.
This article describes a low temperature/pressure unitary heating equipment which significantly improves building environmental conditions. In 1988, the State of Georgia Department of Human Resources considered closing Brook Run, then named the Georgia Retardation Center. Closing the 101-acre (41-hectare) mental health campus and relocating 377 permanent residents and 925 staff were being considered because of trauma caused by repeated failures of the campus' heating system. The 22-year-old central high temperature water (HTW) campus underground piping system that served HVAC and domestic hot water loads had been leaking 40 gallons per minute (21 million gallons per year) of water at 350F (177C) and 290 psig (1999 kPa). The campus heating system was no longer serviceable. The cost for repairing routine leaks had averaged $100,000 per year. In addition, over $5,000,000 in capital expenditures had been previously spent for system restoration. The facility had been cited for failure to meet federal and state temperature guidelines as a result of repeated wintertime catastrophic heating system failures. Discouraged residents' parents wrote personal checks payable to then-Governor Joe Frank Harris for Heat at Georgia Retardation Center. Ten buildings totaling 191,000 ft[sup 2] (17 744m[sup 2]) were included in the retrofit project. These included five permanent resident cottages, two workshop buildings, a theater, the administration building and the maintenance shop.
Gabriel, G.R. (Krewson Vickrey Gabriel Engineers, P.C., Marietta, GA (United States))
Objective To evaluate quality of routine and emergency intrapartum and postnatal care using a healthfacility assessment, and to estimate “effective coverage” of skilled attendance in Brong Ahafo, Ghana. Methods We conducted an assessment of all 86 healthfacilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the healthfacility assessment to surveillance data we estimated “effective coverage” of skilled attendance as the proportion of births in facilities of high quality. Findings Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as “low” or “substandard” for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was “low” or “substandard” in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in healthfacilities, only 18% were in facilities with “high” or “highest” quality in all dimensions. Conclusion Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated “effective coverage” of skilled attendance at 18%, thus revealing a large “quality gap.” Effective coverage could be a meaningful indicator of progress towards reducing maternal and newborn mortality.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (104th Congress, H.R. 3103, January 3, 1986), among many things, individual patient records and information be protected from unnecessary issue. This responsibility is assigned to the U.S. Department of Health and Human Services (HHS) which has issued a Privacy Rule most recently dated August 2002 with a revision being proposed in 2005 to strengthen penalties for inappropriate breaches of patient privacy. Despite this, speech privacy, in many instances in health care facilities need not be guaranteed by the facility. Nevertheless, the regulation implies that due regard be given to speech privacy in both facility design and operation. This presentation will explore the practical aspects of implementing speech privacy in health care facilities and make recommendations for certain specific speech privacy situations.
A study on the Huron service area healthfacility and service needs in Michigan is reported. The study was initiated by the East Central Michigan Comprehensive Health Planning Council in February 1974. The study defines health needs for the Huron service ...
As governments seek to expand access to quality health care services, policy makers in many countries are confronting the problem of informal payments to medical personnel. The aim of this study was to help health planners in Albania understand informal payments occurring in government healthfacilities. Researchers used in-depth interviews and focus groups with 131 general public and provider informants
Taryn Vian; Kristina Grybosk; Zamira Sinoimeri; Rachel Hall
Background As low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian healthfacilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care. Methods We conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics. Results Nearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities. Conclusions Although the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.
Objectives Few developing countries have the accurate civil registration systems needed to track progress in child survival. However, the health information systems in most of these countries do record facility births and deaths, at least in principle. We used data from two districts of Malawi to test a method for monitoring child mortality based on adjusting healthfacility records for incomplete coverage. Methods Trained researchers collected reports of monthly births and deaths among children younger than 5 years from all healthfacilities in Balaka and Salima districts of Malawi in 2010–2011. We estimated the proportion of births and deaths occurring in healthfacilities, respectively, from the 2010 Demographic and Health Survey and a household mortality survey conducted between October 2011 and February 2012. We used these proportions to adjust the healthfacility data to estimate the actual numbers of births and deaths. The survey also provided ‘gold-standard’ measures of under-five mortality. Results Annual under-five mortality rates generated by adjusting healthfacility data were between 35% and 65% of those estimated by the gold-standard survey in Balaka, and 46% and 50% in Salima for four overlapping 12-month periods in 2010–2011. The ratios of adjusted healthfacility rates to gold-standard rates increased sharply over the four periods in Balaka, but remained relatively stable in Salima. Conclusions Even in Malawi, where high proportions of births and deaths occur in healthfacilities compared with other countries in sub-Saharan Africa, routine Health Management Information Systems data on births and deaths cannot be used at present to estimate annual trends in under-five mortality.
Amouzou, Agbessi; Kachaka, Willie; Banda, Benjamin; Chimzimu, Martina; Hill, Kenneth; Bryce, Jennifer
This paper presents the risk associated with the release of toxic chemicals from a manufacturing facility, following the State of California's approach to risk assessment. The facility emits five toxic substances from eight stacks. The building downwash is considered during dispersion calculations. The zone of impact, identified using a risk criteria (i.e. excess cancer risk of 10 in a million),
Using a quasi-experimental design, changes in the numbers of mental healthfacilities between 1964 and 1974 were examined for a sample of 50 nonmetropolitan catchment areas that established a Community Mental Health Center (CMHC) before January 1973 and a sample that did not. Compared to non-CMHC areas, CMHC areas had a slightly greater number of general hospital psychiatric units in
In this study, we considered health and safety management for small-scale methane fermentation facilities that treat 2-5 ton of biomass daily based on several years operation experience with an approximate capacity of 5 t·d-1. We also took account of existing knowledge, related laws and regulations. There are no qualifications or licenses required for management and operation of small-scale methane fermentation facilities, even though rural sewerage facilities with a relative similar function are required to obtain a legitimate license. Therefore, there are wide variations in health and safety consciousness of the operators of small-scale methane fermentation facilities. The industrial safety and health laws are not applied to the operation of small-scale methane fermentation facilities. However, in order to safely operate a small-scale methane fermentation facility, the occupational safety and health management system that the law recommends should be applied. The aims of this paper are to clarify the risk factors in small-scale methane fermentation facilities and encourage planning, design and operation of facilities based on health and safety management.
The Department of Veterans Affairs (VA) Office of Inspector General's (OIG) Office of Healthcare Inspections (OHI) evaluated the efforts to manage nursing resources in Veterans Health Administration (VHA) medical facilities in light of the national nursin...
Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prepared for such incidents. The g...
A. G. Macintyre G. W. Christopher J. E. Eitzen R. Gum S. Weir
The Department of Veterans Affairs, Office of Inspector General, Office of Healthcare Inspections (OHI) completed an evaluation of Physician Credentialing and Privileging (C&P) in Veterans Health Administration (VHA) facilities. The purpose of this evalua...
Objective To describe the staffing and availability of medical equipment and medications and the performance of procedures at healthfacilities providing maternal and neonatal care at African, Asian, and Latin American sites participating in a multicenter trial to improve emergency obstetric/neonatal care in communities with high maternal and perinatal mortality. Study Design In 2009, prior to intervention, we surveyed 136 hospitals and 228 clinics in 7 sites in Africa, Asia, and Latin America regarding staffing, availability of equipment/ medications, and procedures including cesarean section. Results The coverage of physicians and nurses/midwives was poor in Africa and Latin America. In Africa, only 20% of hospitals had full-time physicians. Only 70% of hospitals in Africa and Asia had performed cesarean sections in the last 6 months. Oxygen was unavailable in 40% of African hospitals and 17% of Asian hospitals. Blood was unavailable in 80% of African and Asian hospitals. Conclusions Assuming that adequate facility services are necessary to improve pregnancy outcomes, it is not surprising that maternal and perinatal mortality rates in the areas surveyed are high. The data presented emphasize that to reduce mortality in these areas, resources that result in improved staffing and sufficient equipment, supplies, and medication, along with training, are required.
Manasyan, Albert; Saleem, Sarah; Koso-Thomas, Marion; Althabe, Fernando; Pasha, Omrana; Chomba, Elwyn; Goudar, Shivaprasad S.; Patel, Archana; Esamai, Fabian; Garces, Ana; Kodkany, Bhala; Belizan, Jose; McClure, Elizabeth M.; Derman, Richard J.; Hibberd, Patricia; Liechty, Edward A.; Hambidge, K. Michael; Carlo, Waldemar A.; Buekens, Pierre; Moore, Janet; Wright, Linda L.; Goldenberg, Robert L.
AND KEYWORDS Purpose of research The research aims at developing a user-perception assessment tool for healthfacilities in South Africa. It is intended to be integrated with a broader health-facility performance assessment tool for functionality, impact, and building durability and quality. Methodology The research approach assumes the post-modernist thinking and grounded theory. It used a pilot site method with interviews,
This article examines costs and develops a system of prospective reimbursement for the industry committed to long-term health care. Together with estimates of average cost functions--for purposes of determining those factors affecting the costs of long-term health care, the author examines in depth the cost effects of patient mix and facility quality. Policy implications are indicated. The article estimates cost savings and predicted improvements in facility performance resulting from adoption of a prospective reimbursement system.
This paper examines the issues involved in health risk assessments at hazardous waste sites and resource recovery facilities in Region II and emphasizes the programmatic aspects of the problem and the integration of risk assessment into the permitting process for these facilities. Suggestions for the RandD agenda and policy needs to support a risk assessment strategy in this area are also discussed.
Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…
Many school nurses across the nation have had the opportunity to be involved with school renovation and new construction projects in their districts. Renovation and new construction projects allow school nurses the opportunity to work with facilities planners, school officials, and architects to design school health office facilities that enhance…
Background The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249–584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in healthfacility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. Methods Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18–50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in healthfacilities. Results Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of healthfacility deliveries in recent years. Delivering a penultimate baby at a healthfacility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery. Conclusions The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a healthfacility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the healthfacility delivery rate observed in our study.
This study examined whether African American and Caucasian male youths had similar rates of referral to mental health services in a juvenile justice secure facility when controlling for differences obtained in the initial screening and assessment process. Data from the Massachusetts Youth Screening Instrument-2 (MAYSI-2), Initial Health Care Screening and Youth Level of Services\\/Case Management Inventory were analyzed from 937
Richard F. Dalton; Lisa J. Evans; Keith R. Cruise; Ronald A. Feinstein; Rhonda F. Kendrick
The booklet describes what each type of worker is allowed to do and presents an overview of the substantive content of the training, length of training, training costs, and kinds of facilities and staff needed. The types of workers include community health aide, homemaker-home health aide, social worker aide, food service supervisor, physical…
Health Services and Mental Health Administration (DHEW), Bethesda, MD.
In this study of the physical facilities of the nation's health professions schools, all schools of dentistry, medicine, optometry, osteopathy, pharmacy, podiatry, public health, and veterinary medicine, and all parent institutions of the schools, were surveyed in May of 1973. The major goals of this pioneering survey were to assess the nature and…
Health Resources Administration (DHEW/PHS), Bethesda, MD. Bureau of Health Manpower.
This study examined whether African American and Caucasian male youths had similar rates of referral to mental health services in a juvenile justice secure facility when controlling for differences obtained in the initial screening and assessment process. Data from the Massachusetts Youth Screening Instrument-2 (MAYSI-2), Initial Health Care…
Dalton, Richard F.; Evans, Lisa J.; Cruise, Keith R.; Feinstein, Ronald A.; Kendrick, Rhonda F.
Background Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings We analyze data from a survey of private healthfacilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. Conclusions/Significance The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private healthfacilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and healthfacility.
Remote radiation monitoring has been designed into the Vitrification portion of the Defense Waste Processing Facility (DWPF) at the Savannah River Site in South Carolina. Local alarms and remote readings are provided for area radiation levels, door alarms, airborne radioactivity, effluent air activity and liquid (process system) activity.
This monograph assists health care managers to cope successfully with the energy-induced transition era we are entering. It also provides a strategic planning framework and rationale for taking immediate action. Energy conservation planning, as an integra...
The purpose of this study was to examine the current status of health sciences libraries in Kuwait in terms of their staff, collections, facilities, use of information technology, information services, and cooperation. Seventeen libraries participated in the study. Results show that the majority of health sciences libraries were established during the 1980s. Their collections are relatively small. The majority of their staff is nonprofessional. The majority of libraries provide only basic information services. Cooperation among libraries is limited. Survey results also indicate that a significant number of health sciences libraries are not automated. Some recommendations for the improvement of existing resources, facilities, and services are made.
Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to explore experiences at such facilities among those who utilize them. Methods The study employed a mixed-method approach consisting of an interviewer administered questionnaires and in-depth interviews among selected care-takers seeking care for their underfive children at Korogwe and Muheza district hospitals in north-eastern Tanzania. Results The questionnaire survey included 560 caretakers. Of these 30 in-depth interviews were conducted. Fifty nine percent (206/348) of caretakers had not utilized their nearer PHC facilities during the index child's sickness episode. The reasons given for bypassing PHC facilities were lack of possibilities for diagnostic facilities (42.2%), lack of drugs (15.5%), closed healthfacility (10.2%), poor services (9.7%) and lack of skilled health workers (3.4%). In a regression model, the frequency of bypassing a PHC facility for child care increased significantly with decreasing travel time to the district hospital, shorter duration of symptoms and low disease severity. Findings from the in-depth interviews revealed how the lack of quality services at PHC facilities caused delays in accessing appropriate care and how the experiences of inadequate care caused users to lose trust in them. Conclusion The observation that people are willing to travel long distances to get better quality services calls for health policies that prioritize quality of care before quantity. In a situation with limited resources, utilizing available resources to improve quality of care at available facilities could be more appropriate for improving access to health care than increasing the number of facilities. This would also improve equity in health care access since the poor who can not afford travelling costs will then get access to quality services at their nearer PHC facilities.
Objective.?An initiative was implemented in July 2012 to decrease Clostridium difficile infections (CDIs) in Veterans Affairs (VA) acute care medical centers nationwide. This is a report of national baseline CDI data collected from the 21 months before implementation of the initiative. Methods.?Personnel at each of 132 data-reporting sites entered monthly retrospective CDI case data from October 2010 through June 2012 into a central database using case definitions similar to those of the National Healthcare Safety Network multidrug-resistant organism/CDI module. Results.?There were 958,387 hospital admissions, 5,286,841 patient-days, and 9,642 CDI cases reported during the 21-month analysis period. The pooled CDI admission prevalence rate (including recurrent cases) was 0.66 cases per 100 admissions. The nonduplicate/nonrecurrent community-onset not-healthcare-facility-associated (CO-notHCFA) case rate was 0.35 cases per 100 admissions, and the community-onset healthcare facility-associated (CO-HCFA) case rate was 0.14 cases per 100 admissions. Hospital-onset healthcare facility-associated (HO-HCFA), clinically confirmed HO-HCFA (CC-HO-HCFA), and CO-HCFA rates were 9.32, 8.40, and 2.56 cases per 10,000 patient-days, respectively. There were significant decreases in admission prevalence (P = .0006, Poisson regression), HO-HCFA (P = .003), and CC-HO-HCFA (P = .004) rates after adjusting for type of diagnostic test. CO-HCFA and CO-notHCFA rates per 100 admissions also trended downward (P = .07 and .10, respectively). Conclusions.?VA acute care medical facility CDI rates were higher than those reported in other healthcare systems, but unlike rates in other venues, they were decreasing or trending downward. Despite these downward trends, there is still a substantial burden of CDI in the system supporting the need for efforts to decrease rates further. PMID:25026621
Evans, Martin E; Simbartl, Loretta A; Kralovic, Stephen M; Jain, Rajiv; Roselle, Gary A
... 2013 Use of Electronic Health Records in Residential Care Communities On This Page Key findings Most residential ... National Survey of Residential Care Facilities Most residential care communities did not use electronic health records in ...
This manual is intended to provide useful information on the various new and pending health and safety regulations that affect hospitals. The governing bodies promulgating these regulations are the Occupational Safety and Health Administration (OSHA), the Environmental Protection Agency (EPA), and state and local governments. The majority of this document is dedicated to the OSHA Hazard Communication Standard (or federal Employee Right-to-Know Law) and the EPA Superfund Amendment Reauthorization Act (SARA) Title III Regulations (or federal Community Right-to-Know Law). PMID:10116963
Medical research facilities, indeed all the nation's constructed facilities, must be designed, operated, and maintained in a manner that supports the health, safety, and productivity of the occupants. The National Construction Goals, established by the National Science and Technology Council, envision substantial improvements in occupant health and worker productivity. The existing research and best practices case studies support this conclusion, but too frequently building industry professionals lack the knowledge to design, construct, operate, and maintain facilities at these optimum levels. There is a need for more research and more collaborative efforts between medical and facilities engineering researchers and practitioners in order to attain the National Construction Goals. Such collaborative efforts will simultaneously support attainment of the National Health Goals. This article is the summary report of the Healthy Buildings Committee for the Leadership Conference: Biomedical Facilities and the Environment sponsored by the National Institutes of Health, the National Association of Physicians for the Environment, and the Association of Higher Education Facilities Officers on 1--2 November 1999 in Bethesda, Maryland, USA.
Hodgson, M; Brodt, W; Henderson, D; Loftness, V; Rosenfeld, A; Woods, J; Wright, R
Background Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded healthfacilities, which are the major source of care for febrile patients. Methods In April–May 2011, we conducted a nationwide, geographically-stratified healthfacility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and healthfacility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. Results At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Conclusions Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved.
...non-government facilities to perform laboratory seed health testing and seed crop phytosanitary inspection...Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE...non-government facilities to perform laboratory seed health testing and seed crop phytosanitary...
The VA Office of Inspector General (OIG) Office of Healthcare Inspections evaluated nurse staffing in Veterans Health Administration (VHA) facilities. The purpose of the evaluation was to determine the extent to which VHA facilities implemented the staffi...
This paper presents the risk associated with the release of toxic chemicals from a manufacturing facility, following the State of California's approach to risk assessment. The facility emits five toxic substances from eight stacks. The building downwash is considered during dispersion calculations. The zone of impact, identified using a risk criteria (i.e. excess cancer risk of 10 in a million), is located in the southeast quandrant from the plant. The size of the impact area is 3.3 km(2). The cancer and non-cancer effects are considered for chromium (VI), benzene, formaldehyde, gasoline vapors, methylene chloride, and selenium using the California Air Pollution Control Officers Association Guidelines. No significant non-cancer effects are found due to the emissions. The maximum calculated risk is 1.197×10(-5) and is an extremely conservative value. Analysis shows that the use of realistic assumptions for exposure duration and unit risk factors during the risk calculations could reduce the zone of impact to 0 km(2). PMID:24193579
Background Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, healthfacility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of healthfacility delivery on neonatal mortality. Methods The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I2 test statistic was used to assess heterogeneity. Funnel plot, Begg’s test and Egger’s test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator. Results A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87) for healthfacility delivery as compared to home delivery. Conclusion Healthfacility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of healthfacilities, fulfilling the enabling environments and promoting their utilization during childbirth are essential in areas where home delivery is a common practice.
Abstract Objective To illustrate the use of a new method for defining the catchment areas of health-care facilities based on their utilization. Methods The catchment areas of six health-care facilities in Uganda were determined using the cumulative case ratio: the ratio of the observed to expected utilization of a facility for a particular condition by patients from small administrative areas. The cumulative case ratio for malaria-related visits to these facilities was determined using data from the Uganda Malaria Surveillance Project. Catchment areas were also derived using various straight line and road network distances from the facility. Subsequently, the 1-year cumulative malaria case rate was calculated for each catchment area, as determined using the three methods. Findings The 1-year cumulative malaria case rate varied considerably with the method used to define the catchment areas. With the cumulative case ratio approach, the catchment area could include noncontiguous areas. With the distance approaches, the denominator increased substantially with distance, whereas the numerator increased only slightly. The largest cumulative case rate per 1000 population was for the Kamwezi facility: 234.9 (95% confidence interval, CI: 226.2–243.8) for a straight-line distance of 5 km, 193.1 (95% CI: 186.8–199.6) for the cumulative case ratio approach and 156.1 (95% CI: 150.9–161.4) for a road network distance of 5 km. Conclusion Use of the cumulative case ratio for malaria-related visits to determine health-care facility catchment areas was feasible. Moreover, this approach took into account patients’ actual addresses, whereas using distance from the facility did not.
Charland, Katia; Kigozi, Ruth; Dorsey, Grant; Kamya, Moses R; Buckeridge, David L
The report is a supplement to an areawide plan for health care services as a basic guide in developing hospital and other health services in California's Imperial, Riverside, and San Diego counties. Data presented serve as guidelines in reviewing proposal...
Objective: It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. Methods: A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Results: Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Conclusions: Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.
Deslich, Stacie Anne; Thistlethwaite, Timothy; Coustasse, Alberto
Background Among the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in healthfacilities. This study aimed to identify the independent predictors of healthfacility delivery in Busia a rural district in Uganda with a view of suggesting measures for remedial action. Methods In a cross sectional survey, 500 women who had a delivery in the past two years (from November 16 2005 to November 15 2007) were interviewed regarding place of delivery, demographic characteristics, reproductive history, attendance for antenatal care, accessibility of health services, preferred delivery positions, preference for disposal of placenta and mother’s autonomy in decision making. In addition the household socio economic status was assessed. The independent predictors of healthfacility delivery were identified by comparing women who delivered in healthfacilities to those who did not, using bivariate and binary logistic regression analysis. Results Eight independent predictors that favoured delivery in a healthfacility include: being of high socio-economic status (adjusted odds ratio [AOR] 2.8 95% Confidence interval [95% CI]1.2–6.3), previous difficult delivery (AOR 4.2, 95% CI 3.0–8.0), parity less than four (AOR 2.9, 95% CI 1.6–5.6), preference of supine position for second stage of labour (AOR 5.9, 95% CI 3.5–11.1) preferring health workers to dispose the placenta (AOR 12.1, 95% CI 4.3–34.1), not having difficulty with transport (AOR 2.0, 95% CI 1.2–3.5), being autonomous in decision to attend antenatal care (AOR 1.9, 95% CI 1.1–3.4) and depending on other people (e.g. spouse) in making a decision of where to deliver from (AOR 2.4, 95% CI 1.4–4.6). A model with these 8 variables had an overall correct classification of 81.4% (chi square?=?230.3, P?0.001). Conclusions These data suggest that in order to increase healthfacility deliveries there is need for reaching women of low social economic status and of higher parity with suitable interventions aimed at reducing barriers that make women less likely to deliver in health units such as ensuring availability of transport and involving spouses in the birth plan.
Background A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact for health workers on the health, disability and quality of life of their clients, despite a severe shortage of medicines in the clinics. In order to better understand the potential reasons for the improved outcomes in the intervention group, the experiences of the participating health workers were explored through qualitative focus group discussions, as focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems. Methods Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 health workers from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training during the earlier randomised controlled trial. Results These focus group discussions suggest that the health workers in the intervention group perceived an increase in their communication, diagnostic and counselling skills, and that the clients in the intervention group noticed and appreciated these enhanced skills, while health workers and clients in the control group were both aware of the lack of these skills. Conclusion Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcome of patients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed. Trial registration ISRCTN 53515024
There is substantial public and scientific interest in the health consequences of exposures to ionising radiation in nuclear installations, in particular at nuclear fuels enrichment and production facilities. In this issue of Journal of Radiological Protection, McGeoghegan and Binks report on the follow-up of a cohort of over 19 000 uranium fuel and uranium hexafluoride production workers employed at the
BACKGROUND: The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics), which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In
Since a very long time, a significant number of patients have been seeking treatment at Complementary and Alternative Medicine healthfacilities, but the disease burden at these facilities has never been assessed and documented. Present cross-sectional study was carried out at Ayurvedic tertiary care hospital to document and to assess the rationale of disease reporting at Ayurvedic institutions of the northern state of India from January 2011 to October 2011. Almost half of the patients’ morbidities were not classified at all into any of the disease categories. The common reported morbidities at study hospital were: Respiratory (10.5%), neuromuscular (9.5%), digestive (9.2%) and circulatory (9.1%) disorders. As the majority of diseases were unclassified, so mainstreaming of the effective disease surveillance would be required to understand the morbidity pattern and successful treatment practices at healthfacilities.
Kumar, Dinesh; Quasmi, Nafis Ahmed; Chandel, Jameer Khan; Bhardwaj, Ashok Kumar; Raina, Sunil Kumar; Sharma, Y. K.
This study investigated how partners’ perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a healthfacility were agreement of partners on the importance of delivering in a healthfacility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility.
Danforth, E.J.; Rockers, P.C.; Mbaruku, G; Galea, S
Background: Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources.Conclusion: Effective health communication strategies contribute to positive experiences by health care users and these can be effected by: (1) involvement of health care providers in planning the construction of healthfacilities to give input about patient flow, infection prevention and control and provision of privacy, (2) effective complaints mechanisms for users to ensure that complaints are followed up and (3)encouraging users to arrive at the facility throughout the day, rather than the present practice where all users arrive at the clinic early in the morning. PMID:23902165
Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M
Objectives This study involved a survey of the facility investment experiences, which was designed to recognize the importance of health and safety problems, and industrial accident prevention. Ultimately, we hope that small scale industries will create effective industrial accident prevention programs and facility investments. Methods An individual survey of businesses’ present physical conditions, recognition of the importance of the health and safety problems, and facility investment experiences for preventing industrial accidents was conducted. The survey involved 1,145 business operators or management workers in small business places with fewer than 50 workers in six industrial complexes. Results Regarding the importance of occupational health and safety problems (OHS), 54.1% said it was “very important”. Received technical and financial support, and industrial accidents that occurred during the past three years were recognized as highly important for OHS. In an investigation regarding facility investment experiences for industrial accident prevention, the largest factors were business size, greater numbers of industrial accidents, greater technical and financial support received, and greater recognition of the importance of the OHS. The related variables that decided facility investment for industry accident prevention in a logistic regression analysis were the experiences of business facilities where industrial accidents occurred during the past three years, received technical and financial support, and recognition of the OHS. Those considered very important were shown to be highly significant. Conclusions Recognition of health and safety issues was higher when small businesses had experienced industrial accidents or received financial support. The investment in industrial accidents was greater when health and safety issues were recognized as important. Therefore, the goal of small business health and safety projects is to prioritize health and safety issues in terms of business management and recognition of importance. Therefore, currently various support projects are being conducted. However, there are issues regarding the limitations of the target businesses and inadequacies in maintenance and follow-up. Overall, it is necessary to provide various incentives for onsite participation that can lead to increased recognition of health and safety issues and practical investments, while perfecting maintenance and follow up measures by thoroughly revising existing operating systems.
Rural nursing is a distinct practice and rural nurses in Australia constitute the largest group in the rural health workforce. However, the rural workforce is ageing and the turnover of nurses in rural areas is high. In addition, rural health services are experiencing recruitment and retention difficulties; very little is known about the recruitment and retention of new graduates nurses in rural health areas and the potential long-term investment they could offer to rural health services. A qualitative study explored the journey of transition for new graduate nurses employed in graduate nurse transition programs in northern New South Wales. This paper presents two major themes from the study that describe the factors that influenced the new graduate nurse to seek and accept a graduate nurse position within a rural health setting and the factors that influenced their retention. Findings indicate that previous connection with a rural area and positive experiences in a rural health care facility during undergraduate preparation were significant factors influencing the graduate nurses' decision to pursue a rural graduate nurse position. No guarantee of a permanent appointment upon completion of the graduate program, and graduates' disappointment with graduate nurse programs, were important factors influencing their retention within rural health care facilities. PMID:16619909
The United Nations named 2010 as a year of natural disasters, and launched a worldwide campaign to improve the safety of schools and hospitals from natural disasters. In the region of South East Europe, Croatia and Serbia have suffered the greatest impacts of natural disasters on their communities and healthfacilities. In this paper the disaster management approaches of the two countries are compared, with a special emphasis on the existing technological and legislative systems for safety and protection of healthfacilities and people. Strategic measures that should be taken in future to provide better safety for healthfacilities and populations, based on the best practices and positive experiences in other countries are recommended. Due to the expected consequences of global climate change in the region and the increased different environmental risks both countries need to refine their disaster preparedness strategies. Also, in the South East Europe, the effects of a natural disaster are amplified in the health sector due to its critical medical infrastructure. Therefore, the principles of environmental security should be implemented in public health policies in the described region, along with principles of disaster management through regional collaborations.
Radovic, Vesela; Vitale, Ksenija; Tchounwou, Paul B.
A previous report of the Office of Biostatistics of the New York State Department of Health, issued in 1971, summarized selected health statistics for the period 1960 through 1969, comparing counties in Upstate New York (New York State exclusive of New York City) in which nuclear facilities are located with counties without such facilities. This report will present comparisons extending
Background Uptake of healthfacilities for delivery care in Ethiopia has not been examined in the light of equality. We investigated differences in institutional deliveries by urbanity, administrative region, economic status and maternal education. Methods This study was based on nation-wide repeated surveys undertaken in the years 2000, 2005, and 2011. The surveys used a cluster sampling design. Women of reproductive age were interviewed on the place of their last delivery. Data was analyzed using logistic regressions to estimate the weighted association between birth in a healthfacility and study's predictors. Results Utilization of health institutions for deliveries has improved throughout the study period, however, rates remain low (5.4%,2000 and 11.8%,2011). Compared with women from rural places, women from urban areas had independent OR of a healthfacility delivery of 4.9 (95% CI: 3.4, 7.0), 5.0 (95% CI: 3.6, 6.9), and 4.6 (95% CI: 3.5, 6.0) in 2000, 2005, and 2011, respectively. Women with secondary/higher education had more deliveries in a healthcare facility than women with no education, and these gaps widened over the years (OR: 35.1, 45.0 and 53.6 in 2000, 2005, and 2011, respectively). Women of the upper economic quintile had 3.0–7.2 times the odds of healthcare facility deliveries, compared with the lowest quintile, with no clear trend over the years. While Addis-Ababa and Dire Dawa remained with the highest OR for deliveries in a healthfacility compared with Amhara, other regions displayed shifts in their relative ranking with Oromiya, SNNPR, Afar, Harari, and Somali getting relatively worse over time. Conclusions The disparity related to urbanity or education in the use of healthfacility for birth in Ethiopia is staggering. There is a small inequality between most regions except Addis Ababa/Dire Dawa and sign of abating inequity between economic strata except for the richest households.
Yesuf, Elias Ali; Kerie, Mirkuzie Woldie; Calderon-Margalit, Ronit
Background Maternal mortality among poor rural women in the Lao People’s Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at healthfacilities. This study explored why women and their families prefer home deliveries to deliveries at healthfacilities. Methods A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. Results Obstacles to giving birth at healthfacilities included: (1) Distance to the healthfacilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the healthfacilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a “hot bed” after delivery. The decision about where to give birth was commonly made by the woman’s husband, mother, mother-in-law or other relatives in consultation with the woman herself. Conclusion This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR’s high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be taught and encouraged to recognize the signs of at-risk pregnancies so as to be able to reach healthfacilities on time.
In this study, it was aimed to investigate the utilization of antibiotics at various health care facilities. Photocopies of 1250 prescriptions which were containing antibiotics and written out in primary health care facilities (PHCFs), public hospitals (PHs), private hospitals and university hospitals in 10 provinces across Turkey, were evaluated by some drug use indicators. The number of drugs per prescription was 3.23 ± 0.92 and it was highest in PHCFs (3.34 ± 0.84), (p < 0.05). The cost per prescription was 33.3 $, being highest in PHs while being lowest in PHCFs (38.6 $ and 28.2 $ respectively). Antibiotic cost per prescription was 16.7 $ and it was also highest and lowest in PHs and PHCFs respectively (p < 0.05). The most commonly prescribed group of antibiotics was “beta-lactam antibacterials, penicillins” (29.2%) while amoxicillin/clavulanic acid was the most commonly prescribed antibiotic (18.1%). Sixty-one percent of the antibiotics prescribed for acute infections was generics; among facilities being highest in PHCFs (66.5%) and among diagnosis being highest in acute pharyngitis. In general, the duration of antibiotic therapy was approximately 7 days for acute infections. Although much more drugs were prescribed in PHCFs than others, it was found to be in an inverse proportion with both the total cost of prescriptions and the cost of antibiotics. Broad-spectrum antibiotics, beta-lactamase combinations in particular, were considered to be more preferable in all health care facilities is also notable. These results do serve as a guide to achieve the rational use of antibiotics on the basis of health care facilities and indications.
Mollahaliloglu, Salih; Alkan, Ali; Donertas, Basak; Ozgulcu, Senay; Akici, Ahmet
During our graduation, we live deeply many practical of education in health that motivated us to carry through this study. The objectives are to describe practical educative developed by nurses; identify the people, the place and describe the results gotten with the educative practical. Study of the systemize bibliographical type. The information had been collected through the election and analysis, of articles on education in health, published in the Brazilian Magazine of Nursing (REBEn), in the period of 1995 to 2005. After the analysis, 38 articles had been selected and grouped. We could observe that the educative practical happen more frequently at the hospital, the used strategies have been very creative, they enclose users of all ages and the nurses are the ones that more develop educative practices. PMID:18572847
Carvalho, Viviane Lemes de Silva; Clementino, Viviane de Queiroz; Pinho, Lícia Maria de Oliveira
There are many ways to understand self-management. They vary from Government-dependent technical-administrative meanings (i.e. hospital self-management, in the context of health reform in Chile), to those related to efforts to abolish the State. Thus, the "self-management" concept was developed from the very beginning by the anarchist movement as one of its organizational principies. Henee, there is a need to break myths and prejudices about anarchist philosophy seen as a synonym of chaos, and to review its deeply constructive aspects and its highly moral character, hand in hand with genuine self-management in health. In this context, the work of Juan Gandulfo, a physician and anarchist, in the management of the Worker Polyclinic of the Industrial Workers of the World (IWW) and its diffusion media "The sanitary page" must be emphasized. The aim of this paper is to review the history of particular initiatives in self management, complementing them with some biographical aspects of Dr. Gandulfo's life. PMID:19621187
A recent report submitted to the United Nations Human Rights Council by the United Nations Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, has called for "an absolute ban" on the use of seclusion and restraint in mental healthfacilities. In Australia, seclusion and some, but not all, forms of restraint are regulated either by legislation or guidelines. This column explores some of the issues raised by the lack of national reporting requirements for these practices and moves by the National Mental Health Commission towards their reduction or elimination. PMID:24597370
Primary health care (PHC) services in Pakistan, particularly in rural areas, are in a dismal state. Inadequacies, unfairness and ignorance about the importance of the basic health care provided by these facilitates have led to a disorganized and poorly performing system. This paper reviews the situation in certain PHC facilities in Sindh province. Inadequate medicines and supplies, underutilized family planning services, lack of human resources, faulty equipment, and absence of a proper referral mechanism were some of the key findings. There is therefore an urgent need for radical improvement in the PHC system in order to maximize the appropriate use of PHC facilities. In order to do this, the paper argues that the stewardship role of the State must be strengthened. PMID:21972487
We conducted a healthfacility-based survey to estimate the prevalence of malaria among febrile patients at healthfacilities (HFs) in Maputo City. Patients answered a questionnaire on malaria risk factors and underwent malaria testing. A malaria case was defined as a positive result for malaria by microscopy in a patient with fever or history of fever in the previous 24 hours. Among 706 patients with complete information, 111 (15.7%) cases were identified: 105 were positive for Plasmodium falciparum only, two for Plasmodium ovale only, and four for both P. falciparum and P. ovale. Fever documented at study enrollment, age ? 5 years, rural HF, and travel outside Maputo City were statistically significantly associated with malaria by multivariate analysis. We found a high prevalence of laboratory-confirmed malaria among febrile patients in Maputo City. Further studies are needed to relate these findings with mosquito density to better support malaria prevention and control.
Macedo de Oliveira, Alexandre; Mutemba, Rosalia; Morgan, Juliette; Streat, Elizabeth; Roberts, Jacquelin; Menon, Manoj; Mabunda, Samuel
Objective This study aims to provide alternative care plans for mental health of North Korean refugees who are in protective facilities in China. Methods Personality Assessment Inventory (PAI) was utilized to measure the presence/absence of post traumatic stress disorder (PTSD) among 65 North Korean refugees. Results The gender differences in PAI t-scores showed that women exhibited meaningfully higher scores largely in anxiety (m=61.85), depression (m=65.23), and schizophrenia (m=60.98). In different age groups, schizophrenia in the 30 age bracket (m=65.23) was meaningfully higher than the teens (m=48.11). Aggression among the treatment features was the highest in the 20 age group (m=59.19) showing higher t-scores than the teens (m=39.67). Duration in the facility affected mental health in that the 3-5 years group (m=63.91) reported the highest in paranoia. Groups of under 1 year and less than 1-3 years showed meaningfully higher scores in nonsupport. The PTSD (including partial PTSD) rate of the group recorded 9.2%. Correlation between the PTSD and PAI scores showed that the full-PTSD group demonstrated higher average scores in negative impression, somatic complaints, anxiety, anxiety-related disorder, depression, paranoia, schizophrenia, antisocial features, suicide ideation, and treatment rejection than the non-PTSD group. Conclusion Mental health of North Korean refugees in China was worse in women, the thirties, and less than 3-5 years in the facility, and it deteriorated as the duration prolonged. To promote better psychological health of North Korean refugees in China, the attention and aid from the protection facilities and domestic and international interests are required.
This study aimed to evaluate whether a stair- promoting signed intervention could increase the use of the stairs over the elevator in a health-care facility. A time-series design was conducted over 12 weeks. Data were collected before, during and after displaying a signed intervention during weeks 4-5 and 8-9. Evalu- ation included anonymous counts recorded by an objective unobtrusive motion-sensing
A. L. Marshall; A. E. Bauman; C. Patch; J. Wilson; J. Chen
In December 2010, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation (HHE) at a snack food production facility in New York. The facility produces potato chips, corn chi...
C. Piacitelli K. J. Cummings M. Stanton R. L. Bailey
Background Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state’s Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. Methods The clustering methodology employs a 2-step K-means + Ward’s clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Results Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Conclusions Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.
Background Unsafe abortion in the developing world accounts for 13% of all maternal deaths. Ethiopia is one of the developing countries with the highest maternal mortality ratio (673 per 100,000 live births) in the world. Unsafe abortion was estimated to account for 32% of all maternal deaths in Ethiopia. Objective To assess post abortion care quality status in healthfacilities of Guraghe zone. Methods A facility based cross-sectional study design with both quantitative and qualitative methods was conducted. Patient interview, direct service observation, provider self administered questionnaire and inventory of equipment and supplies were used for the assessment. Six health centers, two hospitals and 422 post-abortion patients were included in the study. Results Patient-provider interaction was generally satisfactory from the patient’s perspective. The majority of the respondents (93.5%) said that they were treated with politeness and respect. More than half 226(56.5%) of the clients have received post abortion family planning. Overall, 83.5% of the patients were satisfied with the services. Those who said waiting time was long were less satisfied and unemployed women were more satisfied than others. Conclusion The study has revealed several improvements as well as problems in the provision of post-abortion care service in the studied healthfacilities.
Although healthfacilities are essential infrastructure during disasters and emergencies, they are also usually highly vulnerable installations in the case of the occurrence of large and major earthquakes. Hospitals are one of the most complex critical facilities in modern cities and they are used as first response in emergency situations. The operability of a hospital must be maintained after the occurrence of a local strong earthquake in order to satisfy the need for medical care of the affected population. If a healthfacility is seriously damaged, it cannot fulfill its function when most is needed. In this case, hospitals become a casualty of the disaster. To identify the level of physical exposure of hospitals to seismic hazards in Mexico City, we analyzed their geographic location with respect to the seismic response of the different type of soils of the city from past earthquakes, mainly from the events that occurred on September 1985 (Ms= 8.0) and April 1989 (Ms= 6.9). Seismic wave amplification in this city is the result of the interaction of the incoming seismic waves with the soft and water saturated clay soils, on which a large part of Mexico City is built. The clay soils are remnants of the lake that existed in the Valley of Mexico and which has been drained gradually to accommodate the growing urban sprawl. Hospital facilities were converted from a simple database of names and locations into a map layer of resources. This resource layer was combined with other map layers showing areas of seismic microzonation in Mexico City. This overlay was then used to identify those hospitals that may be threatened by the occurrence of a large or major seismic event. We analyzed the public and private hospitals considered as main healthfacilities. Our results indicate that more than 50% of the hospitals are highly exposed to seismic hazards. Besides, in most of these healthfacilities we identified the lack of preventive measures and preparedness to reduce their vulnerability. For proper interpretation, our results are also presented in a Geographical Information System (GIS) that provides elements to support government plans to mitigate the impact of future earthquakes.
A survey conducted to assess the extent which the urban poor in rapidly expanding Kuala Lumpur utilize maternal and child health services available to them. The sample consisted of 1,380 households with children below 6 years and yielded 1,233 children below 6 years of age. 74% of the children had been delivered in government hospitals and 86% of the pregnancies had antenatal care in governmental establishments. 89.2% had BCG immunization before they were 1 year old but 13.3% had not received DPT by that age. Immunization was mainly done in government clinics. The overall immunization coverage for the whole of Kuala Lumpur is expected to be higher than these figures limited to the urban poor. Health planners should increase healthfacilities in the city to accommodate the expanding population. There is a need to continually campaign for immunization to improve coverage among the urban poor. PMID:8266233
Sharps waste is part of infectious medical waste, management of which is a critical problem in Tanzanian healthfacilities. This study aimed at assessing the current status of sharps waste management in lower level healthfacilities (LLHFs) in Ilala Municipality in Tanzania. In this study a sample of 135 LLHFs (103 dispensaries, 13 clinics, 11 laboratories, and 8 health centers) was involved. The average number of workers per facility was 10, with positively skewed probability density function (up to 80 workers). The average patient-to-workers ratio was 5.87. About 59% of the LLHFs improvised sharps waste containers (SWCs). Sharps waste was transported by hands in 77% of LLHFs leading to high risks of exposure to needle stick injuries. Boots, aprons and masks were among the personal protective equipment (PPE) missing in most LLHFs, while latex gloves that cannot protect workers from injuries caused by sharps waste were readily available. Most facilities stored sharps waste for about 72 hours (before treatment), which is beyond the recommended maximum storage time of 24 hours. About 39.3% of LLHFs utilized on-site single-chamber incinerators for sharps waste treatment, which are of poor design, have rusted mechanical parts, short and rusted chimneys, and without automatic flame ignition burners. It is concluded that sharps waste management in LLHFs is poor, which puts workers, the public and the environment at risk of exposure to blood-borne pathogens. It is, therefore, important that the municipality should establish a waste processing center which will collect and incinerate all sharps waste. PMID:24409634
There is growing evidence of the public health and community harms associated with crack cocaine smoking, particularly the risk of blood-borne transmission through non-parenteral routes. In response, community advocates and policy makers in Vancouver, Canada are calling for an exemption from Health Canada to pilot a medically supervised safer smoking facility (SSF) for non-injection drug users (NIDU). Current reluctance on the part of health authorities is likely due to the lack of existing evidence surrounding the extent of related harm and potential uptake of such a facility among NIDUs in this setting. In November 2004, a feasibility study was conducted among 437 crack cocaine smokers. Univariate analyses were conducted to determine associations with willingness to use a SSF and logistic regression was used to adjust for potentially confounding variables (p < 0.05). Variables found to be independently associated with willingness to use a SSF included recent injection drug use (OR = 1.72, 95% CI: 1.09–2.70), having equipment confiscated or broken by police (OR = 1.96, 95% CI: 1.24–2.85), crack bingeing (OR = 2.16, 95% CI: 1.39–3.12), smoking crack in public places (OR = 2.48, 95% CI: 1.65–3.27), borrowing crack pipes (OR = 2.50, 95% CI: 1.86–3.40), and burns/ inhaled brillo due to rushing smoke in public places (OR = 4.37, 95% CI: 2.71–8.64). The results suggest a strong potential for a SSF to reduce the health related harms and address concerns of public order and open drug use among crack cocaine smokers should a facility be implemented in this setting.
Shannon, Kate; Ishida, Tomiye; Morgan, Robert; Bear, Arthur; Oleson, Megan; Kerr, Thomas; Tyndall, Mark W
The VA Office of Inspector General Office of Healthcare Inspections completed an evaluation of colorectal cancer (CRC) screening and follow-up activities in Veterans Health Administration facilities. The purpose of the evaluation was to follow up on the O...
Guidelines are presented for use by nurses in health care facilities in the assessment of patient needs and the development of nursing care plans. Nursing care is viewed as a continuing process of observing, evaluating, reporting, and recording physiologi...
The National Institute of Environmental Health Sciences (NIEHS) Kids Pages teach children about the connections between their health and the environment. The site encourages children to pursue careers in health, science, and the environment; explains the mission of the National Institute of Environmental Health Sciences; and assists children in learning to read and master challenging mathematics and science. It offers games and activities, a story time section, information on environmental health and science topics and careers, sing-along songs and a 'Guess this Tune' game, coloring pages, brainteasers and riddles, and jokes. This is available in Spanish as well.
Objectives This study assessed the health risks for children exposed to phthalate through several pathways including house dust, surface wipes and hand wipes in child facilities and indoor playgrounds. Methods The indoor samples were collected from various children's facilities (40 playrooms, 42 daycare centers, 44 kindergartens, and 42 indoor-playgrounds) in both summer (Jul-Sep, 2007) and winter (Jan-Feb, 2008). Hazard index (HI) was estimated for the non-carcinogens and the examined phthalates were diethylhexyl phthalate (DEHP), diethyl phthalate (DEP), dibutyl-n-butyl phthalate (DnBP), and butylbenzyl phthalate (BBzP). The present study examined these four kinds of samples, i.e., indoor dust, surface wipes of product and hand wipes. Results Among the phthalates, the detection rates of DEHP were 98% in dust samples, 100% in surface wipe samples, and 95% in hand wipe samples. In this study, phthalate levels obtained from floor dust, product surface and children's hand wipe samples were similar to or slightly less compared to previous studies. The 50th and 95th percentile value of child-sensitive materials did not exceed 1 (HI) for all subjects in all facilities. Conclusions For DEHP, DnBP and BBzP their detection rates through multi-routes were high and their risk based on health risk assessment was also observed to be acceptable. This study suggested that ingestion and dermal exposure could be the most important pathway of phthalates besides digestion through food.
Kim, Ho-Hyun; Yang, Ji-Yeon; Kim, Sun-Duk; Yang, Su-Hee; Lee, Chung-Soo; Shin, Dong-Chun
This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a healthfacility were agreement of partners on the importance of delivering in a healthfacility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility. PMID:19902806
Danforth, E J; Kruk, M E; Rockers, P C; Mbaruku, G; Galea, S
With proportion of neonatal mortality increasing within under-five deaths, innovative approaches and stronger health systems are needed in neonatal care. We present data of a scaled-up neonatal facility in a District Government Headquarters hospital in Southern India. The special care neonatal unit (SCNU) was a community propelled, public private partnership worked out on the principles of private funding of public institutions and effective budgeting of the public health care system. In the first phase the unit was optimized over 3 years with non-governmental organizations (NGO) and government support from a basic nursery to a SCNU. The unit was operational through fixed maintenance budget from government and mobilized funds from NGOs and beneficiaries. Community health workers were motivated for effective utilization. In the second phase the unit's performance was studied and statistically analyzed in two time frames before and 5 years into the upgradation process. Neonatal admissions from the district increased by 14.65%. Hospital stillbirth, early neonatal and perinatal mortality rates showed significant decline (p < 0.05). There was a 48.59% (CI: 25.46-77.80) increase in antenatal referrals from community health centers. Caesarian sections for neonatal parameters that affect obstetric decisions showed percent changes of 163.25 (CI: 31.18-430.45) and 73.4 (CI: 14.15-164.39) for prematurity and low birth weight (LBW), respectively. Significant decline in case fatality rates for LBW, sepsis and birth asphyxia (p < 0.001) were observed. The district perinatal mortality rate showed a decline. Within the purview of financial constraints of the public health system, private funding, public-private cooperation and effective budgeting may become significant. Motivation of health workers and community to effectively utilize public health care services sets an evolutionary process of referral and vertical linkage of health care system. PMID:17166935
The report describes the multi-user radiofrequency radiation exposure facilities for bio-effects research in use at the Health Effects Research Laboratory, Research Triangle Park, NC. Four facilities are described: (1) a 100 MHz CW exposure system, (2) a 2450 MHz CW exposure syst...
The purpose of this study was to determine the levels of automation for 21 clinical functions and the benefits and barriers to electronic health records use in skilled nursing facilities in one of the Midwestern states in the US. A cross-sectional design was implemented. Data were collected from nursing home administrators using a mail and online survey approach. A total of 156 usable questionnaires of 397 distributed were returned, for a 39.30% response rate. While many facilities reported fully automated Minimum Data Set assessments, licensed nurse clinical notes, and care plans, there remained a predominant reliance on paper for functions, such as diagnostic tests and consults. Although many facilities had advanced toward using automation to produce quality reports, they were lagging behind in the use of automated clinical decision support and summary reports. The top two barriers included the amount of capital needed and the cost for hardware and infrastructure. Facilities with paper records were more likely to identify those barriers for functions, such as clinical notes and assessments. The top three benefits were quality patient care monitoring, management control of performance, and anywhere/anytime easier access to clinical data. The study concludes with recommendations to nursing home leaders and other stakeholders. PMID:23774447
This volume contains the appendices that provide additional environment, safety, and health (ES and H) information to complement Volume 1 of this Standard. Appendix A provides a set of candidate DOE ES and H directives and external regulations, organized by hazard types that may be used to identify potentially applicable directives to a specific facility disposition activity. Appendix B offers examples and lessons learned that illustrate implementation of ES and H approaches discussed in Section 3 of Volume 1. Appendix C contains ISMS performance expectations to guide a project team in developing and implementing an effective ISMS and in developing specific performance criteria for use in facility disposition. Appendix D provides guidance for identifying potential Applicable or Relevant and Appropriate Requirements (ARARs) when decommissioning facilities fall under the Comprehensive Environmental Response, Compensation, Liability Act (CERCLA) process. Appendix E discusses ES and H considerations for dispositioning facilities by privatization. Appendix F is an overview of the WSS process. Appendix G provides a copy of two DOE Office of Nuclear Safety Policy and Standards memoranda that form the bases for some of the guidance discussed within the Standard. Appendix H gives information on available hazard analysis techniques and references. Appendix I provides a supplemental discussion to Sections 3.3.4, Hazard Baseline Documentation, and 3.3.6, Environmental Permits. Appendix J presents a sample readiness evaluation checklist.
Summary Background Historically, healthfacilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African healthfacilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in healthfacilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs. Methods Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit healthfacilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources. Findings Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV. Interpretation Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements. Funding UK Medical Research Council.
Unsafe abortion is one of the major medical and public health problems in developing countries including Ethiopia. However, there is a lack of up-to-date and reliable information on induced abortion distribution and its determinant factors in the country. This study was intended to assess induced abortion and associated factors in healthfacilities of Guraghe zone, Southern Ethiopia. Institution based cross-sectional study was conducted in eight healthfacilities in Guraghe zone. Client exit interview was conducted on 400 patients using a structured questionnaire. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with induced abortion. Out of 400 women, 75.5% responded that the current pregnancy that ended in abortion is unwanted. However, only 12.3% of the respondents have admitted interference to the current pregnancy. Having more than four pregnancies (AOR?=?4.28, CI: (1.24–14.71)), age of 30–34 years (AOR?=?0.15, CI: (0.04–0.55)), primary education (AOR?=?0.26, CI: (0.13–0.88)), and wanted pregnancy (AOR?=?0.44, CI: (0.14–0.65)) were found to have association with induced abortion. The study revealed high level of induced abortion which is underpinned by high magnitude of unwanted pregnancy. There is requirement for widespread expansion of increased access to high quality family planning service and post-abortion care.
The Health Financing and Sustainability (HFS) Project and the Centro de Estudios y Dates (CEDATOS) conducted an assessment of the health services of Ecuadors Seguro Social Cumpesino (SSC), a government social insurance program providing health care and ot...
D. DeRoeck J. Knowles T. Wittenberg L. Raney P. Cordova
This pilot study examines the associations between structural characteristics and the adoption and subsequent use of electronic health records (EHR; resident demographics, clinical notes, medication lists, problem lists, discharge summaries, and advance directives) as a process characteristic in assisted living facilities (ALFs). The study is guided conceptually by Donabedian's Structure-Process-Outcome (SPO) model. Primary survey data were collected from a randomly selected sample (N = 76) in Florida during 2009-2010. Analysis included descriptive and bivariate statistics. Descriptive results indicated that ALFs most frequently used an EHR to record medication lists. Characteristics, including size, profit status, resident case mix, and staffing, were associated at the bivariate level with the use of one or more functional domains of an EHR. Thus, the use of EHRs in ALFs is correlated with facility characteristics. PMID:24781968
The Guidelines for Design and Construction of Hospitals and Health Care Facilities is the most widely referred to design document in the USA and is influential throughout the world. The Facility Guidelines Institute (FGI) was founded to provide continuity in the guidelines revision process. FGI functions as a contractual, fundraising, and coordinating entity to develop and enhance the content and format of guidelines publications and of ancillary services that encourage and improve their application and use. The Guidelines and the methodology for revising them have been, and still are, in an evolutionary process. It is the desire of the AIA/AAH and FGI to see that the process continues to change and improve with each passing cycle. PMID:14963892
Background In Zambia, there has been a large scaling up of interventions to control malaria in recent years including the deployment of rapid diagnostic tests (RDTs) to improve malaria surveillance data as well as guide malaria treatment in healthfacilities. The practical challenge is the impact of RDT results on subsequent management of patients. This study explored the role of RDTs in malaria diagnosis and the health workers’ adherence to test results. Methods An observational prospective study was carried out at health centres in four districts, namely Chibombo, Chingola, Chipata, and Choma. Children under the age of five years with history of fever were recruited and the clinicians’ use of RDT results was observed to establish whether prescriptions were issued prior to the availability of parasitological results or after, and whether RDT results influenced their prescriptions. Results Of the 2, 393 recruited children, 2, 264 had both RDT and microscopic results. Two in three (68.6%) children were treated with anti-malarials despite negative RDT results and almost half (46.2%) of these were prescribed Coartem®. Only 465 (19.4%) of the 2,393 children were prescribed drugs before receiving laboratory results. A total of 76.5% children were prescribed drugs after laboratory results. Children with RDT positive results were 2.66 (95% CI (2.00, 3.55)) times more likely to be prescribed anti-malarial drugs. Children who presented with fever at admission (although history of fever or presence of fever at admission was an entry criterion) were 42% less likely to be prescribed an anti-malarial drug compared to children who had no fever (AOR?=?0.58; 95% CI (0.52, 0.65)). It was noted that proportions of children who were RDT- and microscopy-positive significantly declined over the years from 2005 to 2008. Conclusions RDTs may contribute to treatment of febrile illness by confirming malaria cases from non-malaria cases in children under the age of five. However, the adherence of the health workers to prescribing anti-malarials to only RDT-positive cases at healthfacility level will still require to be explored further as their role is crucial in more precise reporting of malaria cases in this era towards malaria elimination as the target.
This paper analyzes the stages of health care visits between a White male doctor and Native American women at a public healthfacility. The seven stages provide a framework of analysis wherein conflict between the patients and physician emerges. The nonsequential organizing features of the medical visit emerged during analysis using perspectival rhetorical analysis of audio-tape recordings and verbatim transcripts
This study assessed hepatitis B prevalence among pregnant women attending health care facilities in rural Bangladesh. Blood samples were collected from 480 participants. HBsAg was positive in 0.4% of subjects, anti-HBc was positive in 21.5% and anti-HBs was positive in 8.5% of subjects. HBsAg was more prevalent among the older age group. Hepatitis B has a low prevalence among pregnant women in rural Bangladesh. Existing hepatitis B vaccination schedule in the Expanded Program on Immunization (EPI) to vaccinate the children in rural Bangladesh is appropriate. PMID:22299410
Shamsuzzaman, Md; Singhasivanon, P; Kaewkungwal, J; Lawpoolsri, S; Tangkijvanich, P; Gibbons, Robert V; Rahman, M; Alamgir, A S M; Mahtab, M A
Background There is growing evidence that patients frequently bypass primary health care (PHC) facilities in favour of higher level hospitals regardless of substantial additional time and costs. Among the reasons given for bypassing are poor services (including lack of drugs and diagnostic facilities) and lack of trust in health workers. The World Health Report 2008 “PHC now more than ever” pointed to the importance of organizing health services around people’s needs and expectations as one of the four main issues of PHC reforms. There is limited documentation of user’s expectations to services offered at PHC facilities. The current study is a community extension of a hospital-based survey that showed a high bypassing frequency of PHC facilities among caretakers seeking care for their underfive children at two district hospitals. We aimed to explore caretakers’ perceptions and expectations to services offered at PHC facilities in their area with reference to their experiences seeking care at such facilities. Methods We conducted four community-based focus group discussions (FGD’s) with 47 caretakers of underfive children in Muheza district of Tanga region, Tanzania in October 2009. Results Lack of clinical examinations and laboratory tests, combined with shortage of drugs and health workers, were common experiences. Across all the focus group discussions, unpleasant health workers’ behaviors, lack of urgency and unnecessary delays were major complaints. In some places, unauthorized fees reduced access to services. Conclusion The study revealed significant disappointments among caretakers with regard to the quality of services offered at PHC facilities in their areas, with implications for their utilization and proper functioning of the referral system. Practices regarding partial drugs administrations, skipping of injections, unofficial payments and consultations by unskilled health care providers need urgent action. There is also a need for proper accountability mechanisms to govern appropriate allocation and monitoring of health care resources and services in Tanzania.
Background In Tanzania, half of all pregnant women access a healthfacility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase healthfacility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC healthfacilities and local community members. Methods Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC healthfacilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Results Health care users and health providers experienced poor quality caring and working environments in the healthfacilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. Conclusions There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go.
It is possible now to identify a small field of geographical studies exploring how space, place, environment and landscape are bound up in the worlds of people experiencing mental health problems. Some of these studies take seriously the institutions which have been provided to shelter, control, care for and even cure such people, and this interest has often touched upon the rise of the 'asylums' in Europe and North America (chiefly as an eighteenth- and nineteenth-century phenomenon). This paper surveys the geographical literature tackling asylums and other mental healthfacilities, and then offers an interpretation of the theoretical claims and substantive research undertaken in this respect by Michael Dear and various co-workers. Running through the paper is an argument about the need for studies of 'asylum geographies' to be attentive to what Gunnar Olsson terms 'ontological transformations' between thoughts and things. PMID:10671005
... page describes how scientists estimate cancer and other health risks from radiation exposures. Top of page How do ... other sources? Each radionuclide represents a somewhat different health risk. However, health physicists currently estimate that overall, if ...
Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prepared for such incidents. The greatest challenge for HCFs may be the sudden presentation of large numbers of contaminated individuals. Guidelines for managing contaminated patients have been based on traditional hazardous material response or military experience, neither of which is directly applicable to the civilian HCF. We discuss HCF planning for terrorist events that expose large numbers of people to contamination. Key elements of an effective HCF response plan include prompt recognition of the incident, staff and facility protection, patient decontamination and triage, medical therapy, and coordination with external emergency response and public health agencies. Controversial aspects include the optimal choice of personal protective equipment, establishment of patient decontamination procedures, the role of chemical and biological agent detectors, and potential environmental impacts on water treatment systems. These and other areas require further investigation to improve response strategies. PMID:10634341
Macintyre, A G; Christopher, G W; Eitzen, E; Gum, R; Weir, S; DeAtley, C; Tonat, K; Barbera, J A
Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed(-1)d(-1), using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed(-1)d(-1), for the public psychiatric hospitals, to up to 0.72 kg bed(-1)d(-1), for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed(-1)d(-1), for the psychiatric clinics, to up to 0.49 kg bed(-1)d(-1), for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively. PMID:22444895
In response to a request from the City of Harrisburg, Pennsylvania, a health hazard evaluation was conducted at the Harrisburg Steam Generation Facility (HSGF)(SIC-4953) concerning possible exposure to fly ash, combustion products and asbestos (1332214). The facility was a waste to energy site where municipal refuse was incinerated at approximately 1400 degrees-F. The steam generated was either sold directly or converted to electricity via an on site turbine. Employees used hard hats, safety shoes and glasses, work clothes and single use disposable dust and mist respirators. There was a potential for exposure to fly ash for employees working in the boiler and basement areas. Total particulate exposures ranged from 5 to llmg/m3 for laborers. The concentration of lead (7439921) exceeded the standards set by OSHA permissible exposure level of 0.05mg/kg in three of the personal breathing zone air samples. Amosite (12172735) and chrysotile (12001295) asbestos were identified in bulk samples of insulation and asbestos taken from a settled dust sample in the boiler area. Surface wipe samples indicated the possibility of hand to mouth contact with fly ash, particularly in the break and locker rooms. The author concludes that there is a need for reducing worker exposure to fly ash particulate. The author recommends engineering and work practice controls to reduce particulate exposures, increased cleaning and maintenance activities; and further evaluation of asbestos contamination at the facility.
We conducted a healthfacility-based survey of patients with fever during malaria transmission season to determine the proportion with laboratory-confirmed malaria in Luanda, Angola. We enrolled 864 patients at 30 facilities; each underwent a blood film for malaria and a questionnaire. Only 3.6% had a positive blood film. When stratified by distance of the facility to city center (< 15 km and > or = 15 km), the proportions were 1.5% (9/615) and 8.8% (22/249), respectively (P < 0.0001). Of patients traveling outside Luanda in the preceding 3 months, 6.8% (6/88) had malaria, compared with 3.2% (26/776) not traveling (P = 0.13). Children < 5 years of age were less likely to have malaria (2.4%; 12/510) than children ages 5-14 (8.7%; 9/104) and adults (4.0%; 10/250) (P = 0.03). The prevalence of laboratory-confirmed malaria in febrile patients in Luanda is very low, but increases with distance from the urban center. Prevention and treatment should be focused in surrounding rural areas. PMID:19270303
Thwing, Julie I; Mihigo, Jules; Fernandes, Alexandra Pataca; Saute, Francisco; Ferreira, Carolina; Fortes, Filomeno; de Oliveira, Alexandre Macedo; Newman, Robert D
Objective To assess the structural capacity for, and quality of, immediate and essential newborn care (ENC) in healthfacilities in rural Ghana, and to link this with demand for facility deliveries and admissions. Design Healthfacility assessment survey and population-based surveillance data. Setting Seven districts in Brong Ahafo Region, Ghana. Participants Heads of maternal/neonatal wards in all 64 facilities performing deliveries. Main outcome measures Indicators include: the availability of essential infrastructure, newborn equipment and drugs, and personnel; vignette scores and adequacy of reasons given for delayed discharge of newborn babies; and prevalence of key immediate ENC practices that facilities should promote. These are matched to the percentage of babies delivered in and admitted to each type of facility. Results 70% of babies were delivered in healthfacilities; 56% of these and 87% of neonatal admissions were in four referral level hospitals. These had adequate infrastructure, but all lacked staff trained in ENC and some essential equipment (including incubators and bag and masks) and/or drugs. Vignette scores for care of very low-birth-weight babies were generally moderate-to-high, but only three hospitals achieved high overall scores for quality of ENC. We estimate that only 33% of babies were born in facilities capable of providing high quality, basic resuscitation as assessed by a vignette plus the presence of a bag and mask. Promotion of immediate ENC practices in facilities was also inadequate, with coverage of early initiation of breastfeeding and delayed bathing both below 50% for babies born in facilities; this represents a lost opportunity. Conclusions Unless major gaps in ENC equipment, drugs, staff, practices and skills are addressed, strategies to increase facility utilisation will not achieve their potential to save newborn lives. Trial registration http://clinicaltrials.gov NCT00623337.
Vesel, Linda; Manu, Alexander; Lohela, Terhi J; Gabrysch, Sabine; Okyere, Eunice; ten Asbroek, Augustinus H A; Hill, Zelee; Agyemang, Charlotte Tawiah; Owusu-Agyei, Seth; Kirkwood, Betty R
In various settings, drug market policing strategies have been found to have unintended negative effects on health service use among injection drug users (IDU). This has prompted calls for more effective coordination of policing and public health efforts. In Vancouver, Canada, a supervised injection facility (SIF) was established in 2003. We sought to determine if local police impacted utilization of the SIF. We used generalized estimating equations (GEE) to prospectively identify the prevalence and correlates of being referred by local police to Vancouver's SIF among IDU participating in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort during the period of December 2003 to November 2005. Among 1090 SIF clients enrolled in SEOSI, 182 (16.7%) individuals reported having ever been referred to the SIF by local police. At baseline, 22 (2.0%) participants reported that they first learned of the SIF via police. In multivariate analyses, factors positively associated with being referred to the SIF by local police when injecting in public include: sex work (Adjusted Odds Ratio [AOR] = 1.80, 95%CI 1.28 – 2.53); daily cocaine injection (AOR = 1.54, 95%CI 1.14 – 2.08); and unsafe syringe disposal (AOR = 1.46, 95%CI 1.00 – 2.11). These findings indicate that local police are facilitating use of the SIF by IDU at high risk for various adverse health outcomes. We further found that police may be helping to address public order concerns by referring IDU who are more likely to discard used syringes in public spaces. Our study suggests that the SIF provides an opportunity to coordinate policing and public health efforts and thereby resolve some of the existing tensions between public order and health initiatives.
Background Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women’s health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Methods Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. Results The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a healthfacility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped healthfacilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Conclusions Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health.
The Bechtel Jacobs Company LLC (BJC) policy is to provide a safe and healthy workplace for all employees and subcontractors. The implementation of this policy requires that operations of the Environmental Management Waste Management Facility (EMWMF), located one-half mile west of the U.S. Department of Energy (DOE) Y-12 National Security Complex, be guided by an overall plan and consistent proactive approach to environment, safety and health (ES&H) issues. The BJC governing document for worker safety and health, BJC/OR-1745, 'Worker Safety and Health Program', describes the key elements of the BJC Safety and Industrial Hygiene (IH) programs, which includes the requirement for development and implementation of a site-specific Health and Safety Plan (HASP) where required by regulation (refer also to BJC-EH-1012, 'Development and Approval of Safety and Health Plans'). BJC/OR-1745, 'Worker Safety and Health Program', implements the requirements for worker protection contained in Title 10 Code of Federal Regulations (CFR) Part 851. The EMWMF site-specific HASP requirements identifies safe operating procedures, work controls, personal protective equipment, roles and responsibilities, potential site hazards and control measures, site access requirements, frequency and types of monitoring, site work areas, decontamination procedures, and outlines emergency response actions. This HASP will be available on site for use by all workers, management and supervisors, oversight personnel and visitors. All EMWMF assigned personnel will be briefed on the contents of this HASP and will be required to follow the procedures and protocols as specified. The policies and procedures referenced in this HASP apply to all EMWMF operations activities. In addition the HASP establishes ES&H criteria for the day-to-day activities to prevent or minimize any adverse effect on the environment and personnel safety and health and to meet standards that define acceptable waste management practices. The HASP is written to make use of past experience and best management practices to eliminate or minimize hazards to workers or the environment from events such as fires, falls, mechanical hazards, or any unplanned release to the environment.
Background In developing countries, Health and Demographic Surveillance Systems (HDSSs) provide a framework for tracking demographic and health dynamics over time in a defined geographical area. Many HDSSs co-exist with facility-based data sources in the form of Health Management Information Systems (HMIS). Integrating both data sources through reliable record linkage could provide both numerator and denominator populations to estimate disease prevalence and incidence rates in the population and enable determination of accurate health service coverage. Objective To measure the acceptability and performance of fingerprint biometrics to identify individuals in demographic surveillance populations and those attending health care facilities serving the surveillance populations. Methodology Two HDSS sites used fingerprint biometrics for patient and/or surveillance population participant identification. The proportion of individuals for whom a fingerprint could be successfully enrolled were characterised in terms of age and sex. Results Adult (18–65 years) fingerprint enrolment rates varied between 94.1% (95% CI 93.6–94.5) for facility-based fingerprint data collection at the Africa Centre site to 96.7% (95% CI 95.9–97.6) for population-based fingerprint data collection at the Agincourt site. Fingerprint enrolment rates in children under 1 year old (Africa Centre site) were only 55.1% (95% CI 52.7–57.4). By age 5, child fingerprint enrolment rates were comparable to those of adults. Conclusion This work demonstrates the feasibility of fingerprint-based individual identification for population-based research in developing countries. Record linkage between demographic surveillance population databases and health care facility data based on biometric identification systems would allow for a more comprehensive evaluation of population health, including the ability to study health service utilisation from a population perspective, rather than the more restrictive health service perspective.
Serwaa-Bonsu, Adwoa; Herbst, Abraham J.; Reniers, Georges; Ijaa, Wilfred; Clark, Benjamin; Kabudula, Chodziwadziwa; Sankoh, Osman
The 81/2008 Act has defined a model of a health and safety management system that can contribute to prevent the occupational health and safety risks. We have developed the structure of a health and safety management system model and the necessary tools for its implementation in health care facilities. The realization of a model is structured in various phases: initial review, safety policy, planning, implementation, monitoring, management review and continuous improvement. Such a model, in continuous evolution, is based on the responsibilities of the different corporate characters and on an accurate analysis of risks and involved norms. PMID:23393831
Contents: The health interview survey and you (Description of the survey, Your job performance in HIS); How to interview HIS (Household page, Probe pages, Condition page, Doctor visits pages, Hospital page, Prescribed medicine, Preventive care page, Medic...
There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with healthfacility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training and documentation, greater emphasis on community engagement, and insistence on user fee adherence. PMID:20211967
Although available evidence indicates that vouchers improve service utilization among the target populations, we do not know whether increased utilization results from improved access (new clients who would not have used services without the voucher) or from shifting clients from non-accredited to contracted service providers. This paper examines whether the safe motherhood voucher program in Kenya is associated with improved access to healthfacility delivery using information on births within two years preceding the survey in voucher and comparison sites. Data were collected in 2010-2011 and in 2012 among 2933 and 3094 women aged 15-49 years reporting 962 and 1494 births within two years before the respective surveys. Analysis entails cross-tabulations and estimation of multilevel random-intercept logit models. The results show that the proportion of births occurring at home declined by more than 10 percentage points while the proportion of births delivered in healthfacilities increased by a similar margin over time in voucher sites. The increase in facility-based births occurred in both public and private healthfacilities. There was also a significant increase in the likelihood of facility-based delivery (odds ratios [OR]: 2.04; 95% confidence interval [CI]: 1.40-2.98 in the 2006 voucher arm; OR: 1.72; 95% CI: 1.22-2.43 in the 2010-2011 voucher arm) in voucher sites over time. In contrast, there were no significant changes in the likelihood of facility-based delivery in the comparison arm over time. These findings suggest that the voucher program contributed to improved access to institutional delivery by shifting births from home to healthfacilities. However, available evidence from qualitative data shows that some women who purchased the vouchers did not use them because of high transportation costs to accredited facilities. The implication is that substantial improvements in service uptake could be achieved if the program subsidized transportation costs as well. PMID:24565156
Obare, Francis; Warren, Charlotte; Abuya, Timothy; Askew, Ian; Bellows, Ben
Background The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign.
A prototype air/fluid separator suction apparatus proposed as a possible design for use with the Health Maintenance Facility aboard Space Station Freedom (SSF) was evaluated. A KC-135 parabolic flight test was performed for this purpose. The flights followed the standard 40 parabola profile with 20 to 25 seconds of near-zero gravity in each parabola. A protocol was prepared to evaluate the prototype device in several regulator modes (or suction force), using three fluids of varying viscosity, and using either continuous or intermittent suction. It was felt that a matrixed approach would best approximate the range of utilization anticipated for medical suction on SSF. The protocols were performed in one-gravity in a lab setting to familiarize the team with procedures and techniques. Identical steps were performed aboard the KC-135 during parabolic flight.
Billica, Roger; Smith, Maureen; Murphy, Linda; Kizzee, Victor D.
OBJECTIVE: The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government healthfacilities, to inform government planning of child health programmes. METHODS: Generic MCE HealthFacility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 healthfacilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers. FINDINGS: Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver. CONCLUSION: These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.
Arifeen, S. E.; Bryce, J.; Gouws, E.; Baqui, A. H.; Black, R. E.; Hoque, D. M. E.; Chowdhury, E. K.; Yunus, M.; Begum, N.; Akter, T.; Siddique, A.
Background People with a mental illness experience a higher burden of smoking-related disease. Smoke-free policies in mental healthfacilities provide an opportunity to reduce smoking-related harms for patients and staff alike. Limited evidence regarding the effect of such policies on preventing smoking in mental healthfacilities has been reported. The aims of this study are to describe the extent of smoking and the provision of nicotine replacement therapy (NRT) to patients in a mental healthfacility with a smoke-free policy. Methods Cross-sectional studies of smoking (cigarette butt count and observed smoking) and nicotine dependence treatment (patient record audit) were undertaken over 9 consecutive weekdays in one mental healthfacility in Australia. A smoke-free policy incorporating a total smoking ban and guidelines for treating nicotine dependence among patients was implemented in the facility 4 years prior to the study. Results Two thousand one hundred and thirty seven cigarette butts were collected and 152 occasions of people smoking were observed. Staff members were observed to enforce the policy on 66% of occasions. Use of NRT was recorded for 53% of patients who were smokers. Conclusion Implementation of the smoke-free policy was less than optimal and as a consequence ineffective in eliminating smoking and in optimising the provision of NRT. Additional strategies to improve the provision of nicotine dependence treatment to patients and the monitoring of adherence are needed to ensure the intended benefits of smoke-free policies are realised.
This Department of Energy (DOE) technical standard (referred to as the Standard) provides guidance for integrating and enhancing worker, public, and environmental protection during facility disposition activities. It provides environment, safety, and health (ES and H) guidance to supplement the project management requirements and associated guidelines contained within DOE O 430.1A, Life-Cycle Asset Management (LCAM), and amplified within the corresponding implementation guides. In addition, the Standard is designed to support an Integrated Safety Management System (ISMS), consistent with the guiding principles and core functions contained in DOE P 450.4, Safety Management System Policy, and discussed in DOE G 450.4-1, Integrated Safety Management System Guide. The ISMS guiding principles represent the fundamental policies that guide the safe accomplishment of work and include: (1) line management responsibility for safety; (2) clear roles and responsibilities; (3) competence commensurate with responsibilities; (4) balanced priorities; (5) identification of safety standards and requirements; (6) hazard controls tailored to work being performed; and (7) operations authorization. This Standard specifically addresses the implementation of the above ISMS principles four through seven, as applied to facility disposition activities.
Between 1945-1973, the American Public Health Association (APHA), a membership organization for public professionals, accredited graduate programs in public health. In 1974, the APHA and the Association of Schools of Public Health (ASPH), a national association representing deans, faculty, and students of accredited schools of public health,…
Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in healthfacilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity healthfacilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 healthfacilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records. Conclusion The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement. Specific areas that require attention include supervision, regulation of maternity facilities; and ensuring that basic equipment, supplies, and trained personnel are available in order to handle obstetric complications in both public and private facilities.
There is little national information on the policies and procedures used by states to regulate residential treatment facilities for adults and children with mental illness. As a result, policymakers and program administrators face major difficulties in determining both the effectiveness of current policies and the potential need for new policies that are responsive to emerging trends in mental health care.
There is little national information on the policies and procedures used by states to regulate residential treatment facilities for adults and children with mental illness. As a result, policymakers and program administrators face major difficulties in determining both the effectiveness of current policies and the potential need for new policies that are responsive to emerging trends in mental health care.
Objective To establish the appropriateness of malaria case management at healthfacility level in four districts in Zambia. Methods This study was a retrospective evaluation of the quality of malaria case management at healthfacilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and healthfacility coverage. The review period was from January to December 2008. The sample included twelve lower level healthfacilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management. Results Out of 4?891 suspected malaria cases recorded at the 12 healthfacilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI95 21.3.1-23.7) were not subjected to any malaria test. Of the 2?247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria, years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices. Conclusions Malaria case management was characterised by poor adherence to treatment guidelines. The non-adherence was mainly in terms of: inconsistent use of confirmatory tests (rapid diagnostic test or microscopy) for malaria; prescribing anti-malarials which are not recommended (e.g. sulphadoxine-pyrimethamine) and prescribing anti-malarials to cases testing negative. Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.
BACKGROUND: Policy-makers evaluating country progress towards the Millennium Development Goals also examine trends in health inequities. Distance to healthfacilities is a known determinant of health care utilization and may drive inequalities in health outcomes; we aimed to investigate its effects on childhood mortality. METHODS: The Epidemiological and Demographic Surveillance System in Kilifi District, Kenya, collects data on vital events
Jennifer C Moïsi; Hellen Gatakaa; Abdisalan M Noor; Thomas N Williams; Evasius Bauni; Benjamin Tsofa; Orin S Levine; J Anthony G Scott
Background Maternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of healthfacility childbirth in rural and urban areas of three districts in Kenya, Tanzania and Zambia. Methods A population-based survey was conducted in 2007 as part of the ‘REsponse to ACcountable priority setting for Trust in health systems’ (REACT) project. Stratified random cluster sampling was used and the data included information on place of delivery and factors that might influence health care seeking behaviour. A total of 1800 women who had childbirth in the previous five years were analysed. The distal and proximate conceptual framework for analysing determinants of maternal mortality was modified for studying factors associated with place of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban–rural residence. Results There were substantial inter-district differences in proportion of healthfacility childbirth. Facility childbirth was 15, 70 and 37% in the rural areas of Malindi, Mbarali and Kapiri Mposhi respectively, and 57, 75 and 77% in the urban areas of the districts respectively. However, striking socio-economic inequities were revealed regardless of district. Furthermore, there were indications that repeated exposure to ANC services and HIV related counselling and testing were positively associated with healthfacility deliveries. Perceived distance was negatively associated with facility childbirth in rural areas of Malindi and urban areas of Kapiri Mposhi. Conclusion Strong socio-economic inequities in the likelihood of facility childbirths were revealed in all the districts added to geographic inequities in two of the three districts. This strongly suggests an urgent need to strengthen services targeting disadvantaged and remote populations. The finding of a positive association between HIV counselling/testing and odds in favor of giving birth at a healthfacility suggests potential positive effects can be achieved by strengthening integrated approaches in maternal health service delivery.
Severe weather events are likely occurrences on the Mississippi Gulf Coast. It is important to rapidly diagnose and mitigate the effects of storms on Stennis Space Center's rocket engine test complex to avoid delays to critical test article programs, reduce costs, and maintain safety. An Integrated Systems Health Management (ISHM) approach and technologies are employed to integrate environmental (weather) monitoring, structural modeling, and the suite of available facility instrumentation to provide information for readiness before storms, rapid initial damage assessment to guide mitigation planning, and then support on-going assurance as repairs are effected and finally support recertification. The system is denominated Katrina Storm Monitoring System (KStorMS). Integrated Systems Health Management (ISHM) describes a comprehensive set of capabilities that provide insight into the behavior the health of a system. Knowing the status of a system allows decision makers to effectively plan and execute their mission. For example, early insight into component degradation and impending failures provides more time to develop work around strategies and more effectively plan for maintenance. Failures of system elements generally occur over time. Information extracted from sensor data, combined with system-wide knowledge bases and methods for information extraction and fusion, inference, and decision making, can be used to detect incipient failures. If failures do occur, it is critical to detect and isolate them, and suggest an appropriate course of action. ISHM enables determining the condition (health) of every element in a complex system-of-systems or SoS (detect anomalies, diagnose causes, predict future anomalies), and provide data, information, and knowledge (DIaK) to control systems for safe and effective operation. ISHM capability is achieved by using a wide range of technologies that enable anomaly detection, diagnostics, prognostics, and advise for control: (1) anomaly detection algorithms and strategies, (2) fusion of DIaK for anomaly detection (model-based, numerical, statistical, empirical, expert-based, qualitative, etc.), (3) diagnostics/prognostics strategies and methods, (4) user interface, (5) advanced control strategies, (6) integration architectures/frameworks, (7) embedding of intelligence. Many of these technologies are mature, and they are being used in the KStorMS. The paper will describe the design, implementation, and operation of the KStorMS; and discuss further evolution to support other needs such as condition-based maintenance (CBM).
Background In many areas of the world where HIV prevalence is high, rates of unintended pregnancy have also been shown to be high. Of all pregnancies worldwide in 2008, 41% were reported as unintended and approximately 50% of these ended in abortion. To address these problems family planning is the best solution. Therefore, the purpose of the study was to assess modern contraceptive use among females on ART in healthfacilities of Gimbie town, Western Ethiopia. Methods A facility based cross-sectional study was conducted in Gimbie town, western Ethiopia from December 2012 to January 2013. HIV infected women of reproductive age group (15-49 years) who came for ART care follow up during the data collection period were included in the study. Data was collected using an interviewer administered questionnaire. Binary logistic regression and multivariate analysis were employed using SPSS version 17. Results Three hundred ninety five women on ART have participated in the study. More than half, 224 (56.7%), of the respondents were using modern contraceptive, of whom 67 (30%) use dual contraceptive method. Having information on modern contraception is positively associated with modern contraceptive use with (AOR=6.3, 95% CI (1.67, 24.1)) and respondents who have family size ?4 were 50% less contraceptive users than those who have family size >4 (AOR=0.51, 95% CI (0.27, 0.96)). Conclusion In this study contraceptive use among HIV positive women is better than the general population. However, use of dual methods, long acting and permanent method of contraceptives were found to be low. Continuous and targeted information provision on modern contraceptive should be done.
Background Growing levels of both obesity and chronic disease in the general population pose a major public health problem. In the UK, an innovative 'health and weight' cohort trials facility, the 'South Yorkshire Cohort', is being built in order to provide robust evidence to inform policy, commissioning and clinical decisions in this field. This protocol reports the design of the facility and outlines the recruitment phase methods. Method/Design The South Yorkshire Cohort health and weight study uses the cohort multiple randomised controlled trial design. This design recruits a large observational cohort of patients with the condition(s) of interest which then provides a facility for multiple randomised controlled trials (with large representative samples of participants, long term outcomes as standard, increased comparability between each trial conducted within the cohort and increased efficiency particularly for trials of expensive interventions) as well as ongoing information as to the natural history of the condition and treatment as usual. This study aims to recruit 20,000 participants to the population based South Yorkshire Cohort health and weight research trials facility. Participants are recruited by invitation letters from their General Practitioners. Data is collected using postal and/or online patient self completed Health Questionnaires. NHS numbers will be used to facilitate record linkage and access to routine data. Participants are eligible if they are: aged 16 - 85 years, registered with one of 40 practices in South Yorkshire, provide consent for further contact from the researchers and to have their information used to look at the benefit of health treatments. The first wave of data is being collected during 2010/12 and further waves are planned at 2 - 5 year intervals for the planned 20 year duration of the facility. Discussion The South Yorkshire Cohort combines the strengths of the standard observational, longitudinal cohort study design with a population based cohort facility for multiple randomised controlled trials in a range of long term health and weight related conditions (including obesity). This infrastructure will allow the rapid and cheap identification and recruitment of patients, and facilitate the provision of robust evidence to inform the management and self-management of health and weight.
Introduction: Unsafe injections are a major source of infection with blood borne pathogens including hepatitis B virus, hepatitis C virus and human immunodeficiency virus. World Health Organization estimates the burden of disease associated with unsafe injection practices to be about 1.3 million early deaths, loss of about 26 million years of life and an annual burden of 535 million US dollars in direct medical costs. The present study was aimed at determining the prevalence of needle stick injury and the level of reporting among resident doctors in University of Benin Teaching Hospital, Benin. Methodology: A descriptive cross-sectional study was carried out from September 2009 to March 2010 among 152 resident doctors in a tertiary healthfacility in Benin City. The study population was stratified based on their specialty of training. Proportional allocation was applied to obtain the number of participants to be selected from each stratum. Self-administered questionnaire was used to collect data and analysis was by Statistical Package for Scientific Solution (SPSS) version 16.0. (IBM SPSS solution for Education) Result: The prevalence of needle stick injury among the respondents was 61.8%. The most frequent reason for non-reporting was; the injury was due to a clean needle 68.9%. Awareness of reporting was 92.1% but the level of reporting was 14.9%. Conclusion: The prevalence of needle stick injury was high, awareness of reporting was high but the level of reporting was low. Behavior change communication models are required to bring about a positive change in the practice of reporting. PMID:24909460
Background Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care – the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana’s policies. Methods We used time-series methods to assess the impact of Ghana’s 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality. Results Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p?=?0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes. Conclusion Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.
Dzakpasu, Susie; Soremekun, Seyi; Manu, Alexander; ten Asbroek, Guus; Tawiah, Charlotte; Hurt, Lisa; Fenty, Justin; Owusu-Agyei, Seth; Hill, Zelee
Background Convulsions is one of the key signs of severe malaria among children under five years of age, potentially leading to serious complications or death. Several studies of care-seeking behaviour have revealed that local illness concepts linked to convulsions (referred to as degedege in Tanzanian Kiswahili) called for traditional treatment practices while modern treatment was preferred for common fevers. However, recent studies found that even children with convulsions were first brought to healthfacilities. This study integrated ethnographic and public health approaches in order to investigate this seemingly contradictory evidence. Carefully drawn random samples were used to maximize the representativity of the results. Methods The study used a cultural epidemiology approach and applied a locally adapted version of the Explanatory Model Interview Catalogue (EMIC), which ensures a comprehensive investigation of disease perception and treatment patterns. The tool was applied in three studies; i) the 2004 random sample cross-sectional community fever survey (N = 80), ii) the 2004–2006 longitudinal degedege study (N = 129), and iii) the 2005 cohort study on fever during the main farming season (N = 29). Results 71.1% of all convulsion cases were brought to a healthfacility in time, i.e. within 24 hours after onset of first symptoms. This compares very favourably with a figure of 45.6% for mild fever cases in children. The patterns of distress associated with less timely healthfacility use and receipt of anti-malarials among children with degedege were generalized symptoms, rather than the typical symptoms of convulsions. Traditional and moral causes were associated with less timely healthfacility use and receipt of anti-malarials. However, the high rate of appropriate action indicates that these ideas were not so influential any more as in the past. Reasons given by caretakers who administered anti-malarials to children without attending a healthfacility were either that facilities were out of stock, that they lacked money to pay for treatment, or that facilities did not provide diagnosis. Conclusion The findings from this sample from a highly malaria-endemic area give support to the more recent studies showing that children with convulsions are more likely to use healthfacilities than traditional practices. This study has identified health system and livelihood factors, rather than local understandings of symptoms and causes relating to degedege as limiting health-seeking behaviours. Improvements on the supply side and the demand side are necessary to ensure people's timely and appropriate treatment: Quality of care at healthfacilities needs to be improved by making diagnosis and provider compliance with treatment guidelines more accurate and therapies including drugs more available and affordable to communities. Treatment seeking needs to be facilitated by strengthening livelihoods including economic capabilities.
Background Tanzania has been a pioneer in establishing community-level services, yet challenges remain in sustaining these systems and ensuring adequate human resource strategies. In particular, the added value of a cadre of professional community health workers is under debate. While Tanzania has the highest density of primary health care facilities in Africa, equitable access and quality of care remain a challenge. Utilization for many services proven to reduce child and maternal mortality is unacceptably low. Tanzanian policy initiatives have sought to address these problems by proposing expansion of community-based providers, but the Ministry of Health and Social Welfare (MoHSW ) lacks evidence that this merits national implementation. The Tanzania Connect Project is a randomized cluster trial located in three rural districts with a population of roughly 360,000 ( Kilombero, Rufiji, and Ulanga). Description of intervention Connect aims to test whether introducing a community health worker into a general program of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilization, and alter reproductive, maternal, newborn and child health seeking behavior; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre — Community Health Agents (CHA) — who were recruited from and work in their communities. To support the CHA, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. In addition, Connect’s district-wide emergency referral strengthening intervention includes clinical and operational improvements. Evaluation design Designed as a community-based cluster-randomized trial, CHA were randomly assigned to 50 of the 101 villages within the Health and Demographic Surveillance System (HDSS) in the three study districts. To garner detailed information on household characteristics, behaviors, and service exposure, a random sub-sample survey of 3,300 women of reproductive age will be conducted at the baseline and endline. The referral system intervention will use baseline, midline, and endline facility-based data to assess systemic changes. Implementation and impact research of Connect will assess whether and how the presence of the CHA at village level provides added life-saving value to the health system. Discussion Global commitment to launching community-based primary health care has accelerated in recent years, with much of the implementation focused on Africa. Despite extensive investment, no program has been guided by a truly experimental study. Connect will not only address Tanzania’s need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities. Trial registration: ISRCTN96819844
There has been increased interest in and experimentation with demand-side mechanisms such as the use of vouchers that place purchasing power in the hands of targeted consumers to improve the uptake of healthcare services in low-income settings. A key measure of the success of such interventions is the extent to which the programmes have succeeded in reaching the target populations. This article estimates the coverage of facility deliveries by a maternal health voucher programme in South-western Uganda and examines whether such coverage is correlated with district-level characteristics such as poverty density and the number of contracted facilities. Analysis entails estimating the voucher coverage of healthfacility deliveries among the general population and poor population (PP) using programme data for 2010, which was the most complete calendar year of implementation of the Uganda safe motherhood (SM) voucher programme. The results show that: (1) the programme paid for 38% of estimated deliveries among the PP in the targeted districts, (2) there was a significant negative correlation between the poverty density in a district and proportions of births to poor women that were covered by the programme and (3) improving coverage of healthfacility deliveries for poor women is dependent upon increasing the sales and redemption rates. The findings suggest that to the extent that the programme stimulated demand for SM services by new users, it has the potential of increasing facility-based births among poor women in the region. In addition, the significant negative correlation between the poverty density and the proportions of facility-based births to poor women that are covered by the voucher programme suggests that there is need to increase both voucher sales and the rate of redemption to improve coverage in districts with high levels of poverty.
There has been increased interest in and experimentation with demand-side mechanisms such as the use of vouchers that place purchasing power in the hands of targeted consumers to improve the uptake of healthcare services in low-income settings. A key measure of the success of such interventions is the extent to which the programmes have succeeded in reaching the target populations. This article estimates the coverage of facility deliveries by a maternal health voucher programme in South-western Uganda and examines whether such coverage is correlated with district-level characteristics such as poverty density and the number of contracted facilities. Analysis entails estimating the voucher coverage of healthfacility deliveries among the general population and poor population (PP) using programme data for 2010, which was the most complete calendar year of implementation of the Uganda safe motherhood (SM) voucher programme. The results show that: (1) the programme paid for 38% of estimated deliveries among the PP in the targeted districts, (2) there was a significant negative correlation between the poverty density in a district and proportions of births to poor women that were covered by the programme and (3) improving coverage of healthfacility deliveries for poor women is dependent upon increasing the sales and redemption rates. The findings suggest that to the extent that the programme stimulated demand for SM services by new users, it has the potential of increasing facility-based births among poor women in the region. In addition, the significant negative correlation between the poverty density and the proportions of facility-based births to poor women that are covered by the voucher programme suggests that there is need to increase both voucher sales and the rate of redemption to improve coverage in districts with high levels of poverty. PMID:24173430
Background Health care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® Weight Management Program, but it is unclear if veterans most in need of MOVE!® services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE!® utilization (defined as 1 or more visits) across all VHA facilities. Methods Using national administrative data in a retrospective cohort study of eligible overweight (25?= body mass index (BMI)?30 and at least one obesity associated comorbidity) and obese (BMI?>?=30) VHA outpatients, we examined variation in and predictors of MOVE!® utilization in fiscal year (FY) 2010 using generalized linear mixed models. Results 4.39% (n?=?90,230) of all eligible overweight and obese patients using VHA services utilized MOVE!® services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE!® visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity. Conclusions Although substantial variation exists across VHA facilities in MOVE!® utilization rates, Veterans most in need of obesity management services were more likely to access MOVE!®, although at a low level. However, there may still be many Veterans who might benefit but are not accessing these services. More research is needed to examine the barriers and facilitators of MOVE!® utilization, particularly in facilities with unusually high and low reach.
The Environmental Health Assessment Program (EHAP) in the Oregon Department of Human Services (DHS) developed this public health assessment to address the risk of negative health effects associated with exposure to contaminants in the water and soil from ...
In the fall of 2004, the Muskegon County Health Department requested assistance from the Michigan Department of Community Health (MDCH) in evaluating the public health implications of exposure to sediments in two Muskegon-area creeks, Ryerson Creek and Li...
The Trauma Information Pages, provided by psychologist David Baldwin, provide information about traumatic stress for clinicians and researchers in the field. The pages include information on trauma symptoms, connections to trauma resources including full text articles and an EMDR (eye movement desensitization and reprocessing) bibliography, general support information including grief, stress, and mental health pointers, disaster handouts and links, and links to other trauma and trauma related sites. The Trauma Pages are searchable.
Background The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences. Methods This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to healthfacilities was estimated using multivariate logistic regression. Results Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety. Conclusion The relationship between women's post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.
Recently, National Aeronautics and Space Administration (NASA) initiated a program to achieve the significant improvement in aviation safety. One of the technical challenges is the design and development of accelerated experiments that mimic critical damage cases encountered in engine components. The Nondestructive Evaluation (NDE) Group at the NASA Glenn Research Center (GRC) is currently addressing the goal concerning propulsion health management and the development of propulsion system specific technologies intended to detect potential failures prior to catastrophe. For this goal the unique disk spin simulation system was assembled at NASA GRC, which allows testing of rotors with the spinning speeds up to 10K RPM, and at the elevated temperature environment reaching 540 C (1000 F). It is anticipated that the facility can be employed for detection of Low Cycle Fatigue disk cracking and further High Cycle Fatigue blade vibration. The controlled crack growth studies at room and elevated temperatures can be conducted on the turbine wheels, and various NDE techniques can be integrated and assessed as in-situ damage monitoring tools. Critical rotating parts in advanced gas turbine engines such as turbine disks frequently operate at high temperature and stress for long periods of time. The integrity of these parts must be proven by non-destructive evaluation (NDE) during various machining steps ranging from forging blank to finished shape, and also during the systematic overhaul inspections. Conventional NDE methods, however, have unacceptable limits. Some of these techniques are time-consuming and inconvenient for service aircraft testing. Almost all of these techniques require that the vicinity of the damage is known in advance. These experimental techniques can provide only local information and no indication of the structural strength at a component and/or system level. The shortcomings of currently available NDE methods lead to the requirement of new damage detection techniques that can provide global information on the rotating components/system, and, in addition, they do not require direct human access to the operating system. During this period of research considerable effort was directed towards the further development of experimental facility and development of the vibration-based crack detection methodology for rotating disks and shafts. A collection of papers and reports were written to describe the results of this work. The attached captures that effort and represents the research output during the grant period.
This paper explores the relationship between mental health problems and visitation for prison inmates. Logistic regression analyses indicated that inmates with mental health problems have lower odds of visitation. Interaction effects indicated that visitation for Hispanic inmates differed depending upon whether inmates reported mental health problems. Hispanic males reporting a history of mental health problems had increased probabilities of visitation
In March 2008, an enteric outbreak was reported from a correctional facility in Central East Ontario to the Haliburton, Kawartha, Pine Ridge District Health Unit. The clinical and epidemiological data were compatible with the presence of norovirus in this enteric outbreak. This report summarizes the outbreak investigation conducted and the various public health measures undertaken through a coordinated response by the facilityhealth care and correctional staff and local and provincial health authorities to contain the infection within the facility. Correctional facilities present unique challenges to the implementation of infection control measures, and the investigators eventually recommended that the facility be closed to transfers and new admissions until the outbreak was brought under control. PMID:24078622
Abstract Objective To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998–2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure. Methods Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery. Findings During 1998–2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery. Conclusion Expenditure on facility-based delivery greatly increased in rural China over 1998–2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.
Objectives Improvement activities, surveillance and research in maternal and neonatal health in Afghanistan rely heavily on medical record data. This study investigates accuracy in delivery care records from three hospitals across workshifts. Design Observational cross-sectional study. Setting The study was conducted in one maternity hospital, one general hospital maternity department and one provincial hospital maternity department. Researchers observed vaginal deliveries and recorded observations to later check against data recorded in patient medical records and facility registers. Outcome measures We determined the sensitivity, specificity, area under the receiver operator characteristics curves (AUROCs), proportions correctly classified and the tendency to make performance seem better than it actually was. Results 600 observations across the three shifts and three hospitals showed high compliance with active management of the third stage of labour, measuring blood loss and uterine contraction at 30?min, cord care, drying and wrapping newborns and Apgar scores and low compliance with monitoring vital signs. Compliance with quality indicators was high and specificity was lower than sensitivity. For adverse outcomes in birth registries, specificity was higher than sensitivity. Overall AUROCs were between 0.5 and 0.6. Of 17 variables that showed biased errors, 12 made performance or outcomes seem better than they were, and five made them look worse (71% vs 29%, p=0.143). Compliance, sensitivity and specificity varied less among the three shifts than among hospitals. Conclusions Medical record accuracy was generally poor. Errors by clinicians did not appear to follow a pattern of self-enhancement of performance. Because successful improvement activities, surveillance and research in these settings are heavily reliant on collecting accurate data on processes and outcomes of care, substantial improvement is needed in medical record accuracy.
Broughton, Edward I; Ikram, Abdul Naser; Sahak, Ihsanullah
Background: Hitherto efforts to implement data driven prevention guidelines for hospital-acquired infections (HAI) in Nigeria have been limited by the inadequate knowledge of the risks of these infections. This study evaluated the occurrence of HAI in a foremost tertiary healthfacility over a 5-year period for the purpose of reinforcing control efforts. Materials and Methods: A retrospective survey of records from the infection control unit of the University College Hospital, Ibadan, Nigeria, was done for the years 2005-09. For the 5 years studied 22,941 in-patients were reviewed and the data of those who developed infections during admission were retrieved and analyzed. The prevalence, types, and causative organisms of HAI were determined. The chi-square test was used to evaluate associations. Results: The prevalence of HAI over the 5-year period was 2.6% (95% CI: 2.4–2.8). Surgical and medical wards had the most infections (48.3%) and (20.5%) respectively. Urinary tract infection (UTI) and surgical site infection (30.7%) were the most prevalent (43.9%) HAI. UTIs were significantly higher in surgical and medical wards, surgical site infections in obstetrics and gynecology wards, and soft tissue infections and bacteremia in pediatric wards (P<0.05). Gram-negative infections occurred about four times as often as gram-positive infections with Klebsiella sp. and staphylococcus aureus being the predominant isolates (34.3%) and (20.1%) respectively. Conclusion: Efforts to limit HAI should be guided by local surveillance data if progress is to be made in improving the quality of patient care in Nigeria.
OBJECTIVES: To quantify the main reasons for referral of infants and children from first-level healthfacilities to referral hospitals in sub-Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. METHODS: In an observational study at first-level healthfacilities in Uganda, the United Republic of Tanzania, and Niger, over 3-5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. FINDINGS: We studied 7195 children aged 2-59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible. CONCLUSION: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children.
Simoes, Eric A. F.; Peterson, Stefan; Gamatie, Youssouf; Kisanga, Felix S.; Mukasa, Gelasius; Nsungwa-Sabiiti, Jesca; Were, M. Wilson; Weber, Martin W.
Duringa randomized controlled trial of insecticide (permethrin)-treat ed bed nets (ITNs) in an area with intense malaria transmission in western Kenya, we monitored 20,915 sick child visits (SCVs) by children less than five years of age visiting seven peripheral healthfacilities. The SCVs were monitored over a four-year period both before (1995-1996) and duringthe intervention (1997-1998). Results are used to
PENELOPE A. PHILLIPS-HOWARD; BERNARD L. NAHLEN; KATHLEEN A. WANNEMUEHLER; MARGARETTE S. KOLCZAK; Kuile ter F. O; JOHN E. GIMNIG; KRIS OLSON; JANE A. ALAII; AMOS ODHACHA; JOHN M. VULULE; WILLIAM A. HAWLEY
... Kennedy Shriver National Institute of Child Health and Human Development www.nichd.nih.gov • Nemours Foundation’s Center for ... Kennedy Shriver National Institute of Child Health and Human Development, Nemours Foundation (KidsHealth) The JAMA Patient Page is ...
Early case identification and prompt treatment of new sputum smear positive case are important to reduce the spread of tuberculosis (TB). Present study was planned to study the associated factors for duration to contact the healthfacility since appearance of symptoms and treatment default. Methodology. It was prospective cohort study of TB patients already registered for treatment in randomly selected TB units (TUs) in Himachal Pradesh, India. Relative risk (RR) was calculated as risk estimate to find out the explanatory variables for early contact and default. Results. Total 1607 patients were recruited and 25 (1.5%) defaulted treatment. Patients from nuclear family (aRR: 1.37; 1.09–1.73), ashamed of TB (aRR: 1.32; 1.03–1.70), wishing to disclose disease status (aRR: 1.79; 1.43–2.24), but aware of curable nature (aRR: 1.67; 1.17–2.39) and preventable (aRR: 1.35; 1.07–1.70) nature of disease, contacted healthfacility early since appearance of symptoms. Conclusion. Better awareness and less misconceptions about disease influences the early contact of healthfacility and low default rate in North India.
Although healthfacilities are essential infrastructure during disasters and emergencies, they are also usually highly vulnerable installations in the case of the occurrence of large and major earthquakes. Hospitals are one of the most complex critical facilities in modern cities and they are used as first response in emergency situations. The operability of a hospital must be maintained after the occurrence of a local strong earthquake in order to satisfy the need for medical care of the affected population. If a healthfacility is seriously damaged, it cannot fulfill its function when most is needed. In this case, hospitals become a casualty of the disaster. To identify the level of physical exposure of hospitals to seismic hazards in Mexico City, we analyzed their geographic location with respect to the seismic response of the different type of soils of the city from past earthquakes, mainly from the events that occurred on September 1985 (Ms= 8.0) and April 1989 (Ms= 6.9). Seismic wave amplification in this city is the result of the interaction of the incoming seismic waves with the soft and water saturated clay soils, on which a large part of Mexico City is built. The clay soils are remnants of the lake that existed in the Valley of Mexico and which has been drained gradually to accommodate the growing urban sprawl. Hospital facilities were converted from a simple database of names and locations into a map layer of resources. This resource layer was combined with other map layers showing areas of seismic microzonation in Mexico City. This overlay was then used to identify those hospitals that may be threatened by the occurrence of a large or major seismic event. We analyzed the public and private hospitals considered as main healthfacilities. Our results indicate that more than 50% of the hospitals are highly exposed to seismic hazards. Besides, in most of these healthfacilities we identified the lack of preventive measures and preparedness to reduce their vulnerability. For proper interpretation, our results are also presented in a Geographical Information System (GIS) that provides elements to support government plans to mitigate the impact of future earthquakes.
Background The Internet is a widely used source of information for patients searching for medical/health care information. While many studies have assessed existing medical/health care information on the Internet, relatively few have examined methods for design and delivery of such websites, particularly those aimed at the general public. Objective This study describes a method of evaluating material for new medical/health care websites, or for assessing those already in existence, which is correlated with higher rankings on Google's Search Engine Results Pages (SERPs). Methods A website quality assessment (WQA) tool was developed using criteria related to the quality of the information to be contained in the website in addition to an assessment of the readability of the text. This was retrospectively applied to assess existing websites that provide information about generic medicines. The reproducibility of the WQA tool and its predictive validity were assessed in this study. Results The WQA tool demonstrated very high reproducibility (intraclass correlation coefficient=0.95) between 2 independent users. A moderate to strong correlation was found between WQA scores and rankings on Google SERPs. Analogous correlations were seen between rankings and readability of websites as determined by Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Conclusions The use of the WQA tool developed in this study is recommended as part of the design phase of a medical or health care information provision website, along with assessment of readability of the material to be used. This may ensure that the website performs better on Google searches. The tool can also be used retrospectively to make improvements to existing websites, thus, potentially enabling better Google search result positions without incurring the costs associated with Search Engine Optimization (SEO) professionals or paid promotion.
The Agency for Toxic Substances and Disease Registry and Michigan Department of Community Health received a petition about the dioxin contamination along the Tittabawassee River downstream of the city of Midland. Elevated concentrations of dioxin and diox...
This manual consists of six sections: Properties of Plutonium, Siting of Plutonium Facilities, Facility Design, Radiation Protection, Emergency Preparedness, and Decontamination and Decommissioning. While not the final authority, the manual is an assemblage of information, rules of thumb, regulations, and good practices to assist those who are intimately involved in plutonium operations. An in-depth understanding of the nuclear, physical, chemical, and biological properties of plutonium is important in establishing a viable radiation protection and control program at a plutonium facility. These properties of plutonium provide the basis and perspective necessary for appreciating the quality of control needed in handling and processing the material. Guidance in selecting the location of a new plutonium facility may not be directly useful to most readers. However, it provides a perspective for the development and implementation of the environmental surveillance program and the in-plant controls required to ensure that the facility is and remains a good neighbor. The criteria, guidance, and good practices for the design of a plutonium facility are also applicable to the operation and modification of existing facilities. The design activity provides many opportunities for implementation of features to promote more effective protection and control. The application of ''as low as reasonably achievable'' (ALARA) principles and optimization analyses are generally most cost-effective during the design phase. 335 refs., 8 figs., 20 tabs.
Endosulfan concentrations and its distribution in air, soil, sediment and foodstuffs in the area surrounding a production facility in Huai'an, China were investigated because of its threats to the environment and human health. Air concentrations for endosulfan ?, endosulfan II and endosulfan sulfate measured in this study were several orders of magnitude higher than those reported previously for this region. Surface soil concentration ranges of endosulfan I, endosulfan II, and endosulfan sulfate were greater than in sediment. Endosulfan II was the greatest contributor to total endosulfan concentrations in both surface sediment and soil followed by endosulfan sulfate and endosulfan ?. However, a different concentration profile was observed in fish and crop samples, with endosulfan sulfate having the highest concentration followed by endosulfan I and endosulfan II. The concentration of ?endosulfans (endosulfans ? and II) in soil decreased rapidly with increasing distance from the plant by a factor of 10 within 45km. Trace amounts of ?endosulfans were observed in deep soil layers which implied that these compounds are transported through the leaching of pore water in soil. This demonstrated that emissions from the manufacturing facility can lead to ground water contamination in the area near the plant. A screening level human health risk assessment of ?endosulfans based on the worst-case scenario was performed for people living in the vicinity of the manufacturing facility. The hazard indices were at least 2 orders of magnitude of <1, indicating no adverse health effects are likely to occur at current exposure levels, and the risk to human health is generally acceptable. PMID:24491393
The workshop was convened to examine how to ensure continued functionality of health care facilities during and after earthquakes. The workshop was arranged to reflect the key elements that lead to post-earthquake functionality: (1) structural behavior; (...
G. C. Lee M. Ettouney M. Grigoriu J. Hauer J. Nigg
This project will examine the feasibility of implementing Medicare's mental health prospective payment system (PPS) for Tricare beneficiaries treated in inpatient psychiatric facilities. Background information will be presented on both Tricare's...
The Health Hazard Evaluation Program received a request from a union regarding a federal law enforcement agency's district facilities in Illinois. The request concerned perceived low morale, job stress, and communication problems between employees and the...
This document updates and replaces all previously published guidelines for the prevention of 'Mycobacterium tuberculosis' transmission in health-care facilities. The purpose of this revision is to emphasize the importance of a) the hierarchy of control me...
This health and safety plan establishes the procedures and requirements that will be used to minimize health and safety risks to persons performing Engineering Test Reactor and Materials Test Reactor characterization sampling activities, as required by the Occupational Safety and Health Administration standard, 29 CFR 1910.120. It contains information about the hazards involved in performing the tasks, and the specific actions and equipment that will be used to protect persons working at the site.
Since the introduction of drugs to prevent vertical transmission of HIV, the purpose of and approach to HIV testing of pregnant women has increasingly become an area of major controversy. In recent years, many strategies to increase the uptake of HIV testing have focused on offering HIV tests to women in pregnancy-related services. New global guidance issued by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) specifically notes these services as an entry point for provider-initiated HIV testing and counseling (PITC). The guidance constitutes a useful first step towards a framework within which PITC sensitive to health, human rights and ethical concerns can be provided to pregnant women in healthfacilities. However, a number of issues will require further attention as implementation moves forward. It is incumbent on all those involved in the scale up of PITC to ensure that it promotes long-term connection with relevant health services and does not result simply in increased testing with no concrete benefits being accrued by the women being tested. Within health services, this will require significant attention to informed consent, pre- and post-test counseling, patient confidentiality, referrals and access to appropriate services, as well as reduction of stigma and discrimination. Beyond health services, efforts will be needed to address larger societal, legal, policy and contextual issues. The health and human rights of pregnant women must be a primary consideration in how HIV testing is implemented; they can benefit greatly from PITC but only if it is carried out appropriately. PMID:18315722
Public accountability has re-emerged as a top priority for health systems all over the world, and particularly in developing countries where governments have often failed to provide adequate public sector services for their citizens. One approach to strengthening public accountability is through direct involvement of clients, users or the general public in health delivery, here termed ‘community accountability’. The potential benefits of community accountability, both as an end in itself and as a means of improving health services, have led to significant resources being invested by governments and non-governmental organizations. Data are now needed on the implementation and impact of these initiatives on the ground. A search of PubMed using a systematic approach, supplemented by a hand search of key websites, identified 21 papers from low- or middle-income countries describing at least one measure to enhance community accountability that was linked with peripheral facilities. Mechanisms covered included committees and groups (n?=?19), public report cards (n?=?1) and patients’ rights charters (n?=?1). In this paper we summarize the data presented in these papers, including impact, and factors influencing impact, and conclude by commenting on the methods used, and the issues they raise. We highlight that the international interest in community accountability mechanisms linked to peripheral facilities has not been matched by empirical data, and present a conceptual framework and a set of ideas that might contribute to future studies.
Community participation in health (CPH) has been advocated as a health-improving strategy for many decades. However, CPH comes in many different forms, one of which is the use of healthfacility committees (HFCs) on which there is community representation. This paper presents the findings of a systematic literature review of: (a) the evidence of HFCs' effectiveness, and (b) the factors that influence the performance and effectiveness of HFCs. Four electronic databases and the websites of eight key organizations were searched. Out of 341 potentially relevant publications, only four provided reasonable evidence of the effectiveness of HFCs. A further 37 papers were selected and used to draw out data on the factors that influence the functioning of HFCs. A conceptual model was developed to describe the key factors. It consists of, firstly, the features of the HFC, community and facility, and their interactions; secondly, process factors relating to the way HFCs are established and supported; and finally, a set of contextual factors. The review found some evidence that HFCs can be effective in terms of improving the quality and coverage of health care, as well as impacting on health outcomes. However, the external validity of these studies is inevitably limited. Given the different potential roles/functions of HFCs and the complex and multiple set of factors influencing their functioning, there is no 'one size fits all' approach to CPH via HFCs, nor to the evaluation of HFCs. However, there are plenty of experiences and lessons in the literature which decision makers and managers can use to optimize HFCs. PMID:22155589
... hand corner of the player. TV and Adult HealthHealthDay June 26, 2014 Related MedlinePlus Pages Exercise ... Rockville Pike, Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of HealthPage ...
Background & objectives: Diarrhoeal disease is the fifth leading cause of all mortality globally. To this burden, rotavirus contributes over half a million deaths annually. This pilot study was conducted to determine the economic burden of diarrhoeal episodes on families from different geographical regions accessing medical facilities in India. Methods: Participants were enrolled from four study sites with eight reporting hospitals, categorized as non-profit and low cost, private and government facilities between November 2008 and February 2009. Questionnaires detailing healthcare utilization, medical and non-medical expenditure and lost income were completed by families of children < 5 yr of age hospitalized for gastroenteritis. All available faecal samples were tested for rotavirus. Results: A total of 211 patients were enrolled. The mean total cost of a hospitalized diarrhoeal episode was 3633 (US$ 66.05) for all facilities, with a marked difference in direct costs between governmental and non-governmental facilities. Costs for rotavirus positive hospitalizations were slightly lower, at 2956 (US$ 53.75). The median cost of a diarrhoeal episode based on annual household expenditure was 6.4 per cent for all-cause diarrhoea and 7.6 per cent for rotavirus diarrhoea. Of the 124 samples collected, 66 (53%) were positive for rotavirus. Interpretation & conclusions: Data on direct costs alone from multiple facilities show that diarrhoeal disease constitutes a large economic burden on Indian families. Affordable, effective vaccines would greatly reduce the economic burden of severe gastroenteritis on patients, families and the government.
Juveniles with mental health and other specialized needs are overrepresented in the juvenile justice system, and while juvenile corrections have not historically provided standardized and evidence-based mental health services for its incarcerated youth, the demand is evident. The reality is that juveniles with serious mental illness are committed…
Underwood, Lee A.; Phillips, Annie; von Dresner, Kara; Knight, Pamela D.
The objective of this inventory was to provide basic data concerning the effectiveness of new health manpower training programs for comparison with future studies and documented information, for planning purposes. It was necessary to define the components of the health manpower training network and to identify individuals responsible for its…
Recent terrorist and epidemic events have underscored the potential for disasters to generate large numbers of casualties. Few surplus resources to accommodate these casualties exist in our current health care system. Plans for “surge capacity” must thus be made to accommodate a large number of patients. Surge planning should allow activation of multiple levels of capacity from the health care
John L. Hick; Dan Hanfling; Jonathan L. Burstein; Craig DeAtley; Donna Barbisch; Gregory M. Bogdan; Stephen Cantrill
... of blindness among adults. 6 Top of pageHealth Risk Behaviors that Cause Chronic Diseases Health risk behaviors ... of page The Cost of Chronic Diseases and Health Risk Behaviors The majority of US health care and ...
This paper illustrates the importance of monitoring healthfacility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector healthfacilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at healthfacilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these healthfacilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal. PMID:23528186
IntroductionHIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics.MethodsIntegration involved three key modifications: i) amalgamation
Stephanie M. Topp; Julien M. Chipukuma; Mark Giganti; Linah K. Mwango; Like M. Chiko; Bushimbwa Tambatamba-Chapula; Chibesa S. Wamulume; Stewart Reid; Landon Myer
Health Service AreaPage ofHealth Service Area (SEER 17)Page ofHealth Service Area (SEER 17 excl AK)Page ofHealth Service Area (SEER 13)Page ofHealth Service Area (SEER 9)Page ofHSA # (NCI Modified) Health Service Area (NCI Modified) Description State-county FIPS Butler,
SUMMARY Understanding the spatial distribution of disease is critical for effective disease control. Where formal address networks do not exist, tracking spatial patterns of clinical disease is difficult. Geolocation strategies were tested at rural healthfacilities in western Kenya. Methods included geocoding residence by head of compound, participatory mapping and recording the self-reported nearest landmark. Geocoding was able to locate 72·9% [95% confidence interval (CI) 67·7-77·6] of individuals to within 250 m of the true compound location. The participatory mapping exercise was able to correctly locate 82·0% of compounds (95% CI 78·9-84·8) to a 2 × 2·5 km area with a 500 m buffer. The self-reported nearest landmark was able to locate 78·1% (95% CI 73·8-82·1) of compounds to the correct catchment area. These strategies tested provide options for quickly obtaining spatial information on individuals presenting at healthfacilities. PMID:24787145
By 1985, the population in the county of Kauai is expected to increase from its present level of 26,200 to a minimum of 31,400 or a maximum of 41,000. This report evaluates existing resources and facilities and presents a plan to provide medical facilitie...
Medical facility purchasing is a field for which there is little historical background of curriculum development. To determine the content of an educational curriculum in the field, data on the frequency, supervision, and difficulty of performance in 208 task elements were obtained from a survey of 131 individuals in 29 institutions. In addition a…
...infections. In October 2002, the CDC posted hand hygiene guidelines for health care settings...that-- Compared with soap and water hand washing, ABHRs are more effective in reducing bacteria on hands, cause less skin irritation/...
...infections. In October 2002, the CDC posted hand hygiene guidelines for health care settings...that-- Compared with soap and water hand washing, ABHRs are more effective in reducing bacteria on hands, cause less skin irritation/...
Lymphatic filariasis (LF) is a vector-borne parasitic disease that can clinically manifest as disabling lymphedema. Although the LF elimination program aims to reduce disability and to interrupt transmission, there has been a scarcity of disease morbidity management programs, particularly on a national scale. This report describes the implementation of the first nationwide LF lymphedema management program. The program, which was initiated in Togo in 2007, focuses on patient behavioral change. Its goal is two-fold: to achieve a sustainable program on a national-scale, and to serve as a model for other countries. The program has five major components: 1) train at least one health staff in lymphedema care in each healthfacility in Togo; 2) inform people with a swollen leg that care is available at their dispensary; 3) train patients on self-care; 4) provide a support system to motivate patients to continue self-care by training community health workers or family members and providing in home follow-up; and 5) integrate lymphedema management into the curriculum for medical staff. The program achieved the inclusion of lymphedema management in the routine healthcare package. The evaluation after three years estimated that 79% of persons with a swollen leg in Togo were enrolled in the program. The adherence rate to the proposed World Health Organization treatment of washing, exercise, and leg elevation was more than 70% after three years of the program, resulting in a stabilization of the lymphedema stage and a slight decrease in reported acute attacks among program participants. Health staff and patients consider the program successful in reaching and educating the patients. After the external funding ended, the morbidity management program is maintained through routine Ministry of Health activities.
Mathieu, Els; Dorkenoo, Ameyo M.; Datagni, Michael; Cantey, Paul T.; Morgah, Kodjo; Harvey, Kira; Ziperstein, Joshua; Drexler, Naomi; Chapleau, Gina; Sodahlon, Yao
Many of today's healthcare facilities were constructed at least 50 years ago, and a growing number have outlived their useful lives. Despite renovations and renewals, they often fall short of providing an appropriate care setting. Clinicians and staff develop a mixture of compromises and workarounds simply to make things function. Evidence-based design principles are often absent from new healthcare facilities, perhaps because of lack of awareness of the principles or because implementing them may fall foul of short-term and short-sighted budgetary decisions. In planning a new healthcare facility in 2008, the executive team at Vancouver Island Health Authority decided to adopt the evidence-based design approach. They conducted site visits to newly constructed hospitals across North America and beyond, to determine best practices in terms of design and construction. These engagements resulted in the implementation of 102 evidence-based design principles and attributes in Victoria's Royal Jubilee hospital, a 500-bed Patient Care Centre. This $350M project was completed on time and on budget, showing that using evidence need not result in delays or higher costs. To date, the results of the evidence-based design are promising, with accolades coming from patients, staff and clinical partners, and a number of immediate and practical benefits for patients, families and care teams alike. PMID:24863125
Background: Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases, personnel, and materials that are organized to collect data which are utilized for informed decision making. The knowledge about DSN is very important for the reporting of notifiable diseases. Objective: The aim of this study is to examine the awareness and knowledge of health-care workers about DSN, and availability of facility records in Anambra State, Nigeria. Materials and Methods: The study was a descriptive cross-sectional one in which relevant data were collected from health-care workers selected by a multistage sampling technique. Qualitative information was also elicited by key informant interviews, whereas an observational checklist, preceded by a desk review was used to examine the availability of facility records. Results: Although 89.8% of the health-care workers were aware of the DSN system, only 33.3, 31.1, and 33.7% of them knew the specific uses of forms IDSR 001, IDSR 002, and IDSR 003 (IDSR: Integrated Diseases Surveillance and Response), respectively. Knowledge of use of the various forms at the facility and local government area (LGA) levels were generally low, although the observational checklist revealed that IDSR 001 and IDSR 002 forms were predominantly found in primary health-care facilities. HMIS forms were less likely to be available in secondary health-care facilities (?2=7.67, P=0.005). Conclusions: Regular training and retraining of concerned health-care workers on DSN at the LGA level is recommended. This should run concurrently with adequate and regular provision of IDSR forms, copies of the standard case definitions, and other necessary logistics to the health-care facilities by the local and state governments.
Nnebue, Chinomnso C.; Onwasigwe, Chika N.; Adogu, Prosper O. U; Onyeonoro, Ugochukwu U.
Background Poor-quality life-saving medicines are a major public health threat, particularly in settings with a weak regulatory environment. Insufficient amounts of active pharmaceutical ingredients (API) endanger patient safety and may contribute to the development of drug resistance. In the case of malaria, concerns relate to implications for the efficacy of artemisinin-based combination therapies (ACT). In Papua New Guinea (PNG), Plasmodium falciparum and P. vivax are both endemic and healthfacilities are the main source of treatment. ACT has been introduced as first-line treatment but other drugs, such as primaquine for the treatment of P. vivax hypnozoites, are widely available. This study investigated the quality of antimalarial drugs and selected antibiotics at all levels of the healthfacility supply chain in PNG. Methods and Findings Medicines were obtained from randomly sampled healthfacilities and selected warehouses and hospitals across PNG and analysed for API content using validated high performance liquid chromatography (HPLC). Of 360 tablet/capsule samples from 60 providers, 9.7% (95% CI 6.9, 13.3) contained less, and 0.6% more, API than pharmacopoeial reference ranges, including 29/37 (78.4%) primaquine, 3/70 (4.3%) amodiaquine, and one sample each of quinine, artemether, sulphadoxine-pyrimethamine and amoxicillin. According to the package label, 86.5% of poor-quality samples originated from India. Poor-quality medicines were found in 48.3% of providers at all levels of the supply chain. Drug quality was unrelated to storage conditions. Conclusions This study documents the presence of poor-quality medicines, particularly primaquine, throughout PNG. Primaquine is the only available transmission-blocking antimalarial, likely to become important to prevent the spread of artemisinin-resistant P. falciparum and eliminating P. vivax hypnozoites. The availability of poor-quality medicines reflects the lack of adequate quality control and regulatory mechanisms. Measures to stop the availability of poor-quality medicines should include limiting procurement to WHO prequalified products and implementing routine quality testing.
Hetzel, Manuel W.; Page-Sharp, Madhu; Bala, Nancy; Pulford, Justin; Betuela, Inoni; Davis, Timothy M. E.; Lavu, Evelyn K.
Objective To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire. Methods Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey. Results Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p < 0.0001), obstetric inpatients (p < 0.0001), other inpatients (p < 0.0001), and fee-exempt inpatients (p < 0.001) were significantly different than the wealth distribution in the community population, with poorer patients underrepresented among inpatients. The wealth distribution of pediatric inpatients (p = 0.2242) did not significantly differ from the population at large. Conclusion The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.
Healthfacility ledgers of 11 rural h ealthfacilities in western Kenya wer e reviewed to evaluate diagnostic and prescribing practices. Clinics lacked laboratory facilities. Of 14,267 sick child visits (SCVs), 76% were diagnosed with malaria and\\/or upper respiratory infections. Other diagnoses were recorded in less than 5% of SCVs. Although two- thirds of malaria cases were diagnosed with co-infections, less than
PENELOPE A. PHILLIPS-HOWARD; KATHLEEN A. WANNEMUEHLER; Kuile ter F. O; WILLIAM A. HAWLEY; MARGARETTE S. KOLCZAK; AMOS ODHACHA; JOHN M. VULULE; BERNARD L. NAHLEN
This paper endeavours to identify the background characteristics of health centre users in Trinidad and Tobago and their perceptions of the efficiency of the services provided. Multistage sampling was employed to select 1451 users. Data were obtained during structured interviews on regular clinic days. Of the people using the health centres, 80.4% were unemployed and 75.9% were women. People aged over 60 accounted for 25.4% of the sample. Users included a disproportionately high number of persons from the lower socioeconomic categories. The proportions of persons of different ethnic and religious groups closely reflected those in the country's general population. Approximately 74% of the interviewees were satisfied with the performance of the doctors in the health centres. For nurses the satisfaction rating was about 10% higher. The greatest needs for improvement were perceived to be in pharmacists' and doctors' services, with particular reference to waiting times.
Background Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely\\u000a unknown. We conducted a health impact assessment of landfilling and incineration in three European countries: Italy, Slovakia\\u000a and England.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures\\u000a were 619, 121
Francesco Forastiere; Chiara Badaloni; Kees de Hoogh; Martin K von Kraus; Marco Martuzzi; Francesco Mitis; Lubica Palkovicova; Daniela Porta; Philipp Preiss; Andrea Ranzi; Carlo A Perucci; David Briggs
The Agency for Toxic Substances and Disease Registry (ATSDR) was petitioned by a resident of Oregon, Ohio to assess the potential health impact on area residents from exposure to air emissions from the Sunoco Refinery (Sun). The Sunoco Refinery is located...
A five-year obstetric care plan for three Michigan counties (Clinton, Eaton, and Ingham) is presented by the Capitol Area Wide Comprehensive Health Planning Association. The plan is designed for a projected 5,760 deliveries in the year 1980, with an avera...
This report is a summary of the functional analysis of the activities of those engaged in social service occupations in medical settings, which was conducted as part of the UCLA Allied Health Professions Project. A task inventory composed of 192 tasks relating to intake, information and referral, treatment, supportive, community and administrative…
Taxation for urban waste management has been reformed in Italy by the introduction of an environmental law in 2006. In the planning phase of waste management, externalities generated by new facilities remain widely unaccounted, with a consequent distortion for prices, often raising local conflicts. The paper presents a survey based on the choice modelling methodology, aimed to evaluate on a monetary scale the disamenity effect perceived by incinerator and landfills in an Italian urban context: the city of Turin. In a random utility framework the behaviour of respondents, whose choices are found to be driven by the endowment of information about technological options, socio-economic characteristics as income, education, family composition, and also by their health status was modelled. Furthermore, empirical evidence that the behaviour in residential location choices is affected by different aspects of the respondent life and in particular by the health status was found. Distinct estimates of willingness to accept compensation for disamenity effects of incinerator (Euro 2670) and landfill (Euro 3816) are elicited. The effect of health status of the respondents, their level of information about the waste disposal infrastructure, the presence of a subjective strong aversion (NIMBY) and the actual endowment and concentration of infrastructures are demonstrated to be significant factors determining the choice behaviour, but differentiated and specific for incinerators and landfills. PMID:22588111
Background Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral healthfacilities level has never been investigated. Methods A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria). The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the healthfacility level. The outcome measured was the proportion of malaria cases among all healthfacility attendance (all causes diseases) in both arms throughout the high transmission season. Results A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all healthfacility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%–22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%–71.5%), respectively in the intervention and control arms (p << 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32). The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs. 2,595), with malaria accounting for 87.4% of all disease episodes recorded in the intervention area and for 34.1% in the control area (P < 0.0001). Of all the malaria cases treated in the intervention arm, only 6.7% were treated at the healthfacility level. Conclusion These findings suggest that implementation of HMM, by reducing the workload in healthfacilities, might contributes to an overall increase of the performance of the peripheral healthfacilities.
Tiono, Alfred B; Kabore, Youssouf; Traore, Abdoulaye; Convelbo, Nathalie; Pagnoni, Franco; Sirima, Sodiomon B
Background The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007 and subsidized ALu was made available in both healthfacilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment. Methods Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS) and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days. Results Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%); an increase in healthfacility attendance as first treatment option for patients older than five years (27% to 52%); higher treatment coverage with anti-malarials (86% to 96%) and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs). Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%). The availability of outlets (healthfacilities or drug shops) is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent. Conclusions An integrated approach aimed at improving understanding and treatment of malaria has led to tangible improvements in terms of people's actions for the treatment of malaria. However, progress was hindered by the low availability of the first-line treatment after the switch to ACT.
Background The public healthcare sector in developing countries faces many challenges including weak healthcare systems and under-resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Global references demonstrate that information technology has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of hospital information systems implementation on service delivery, user adoption and organisational culture within two hospital settings in South Africa. Methods Ninety-four interviews with doctors, nurses and hospital administrators were conducted in two public sector tertiary healthcare facilities (in two provinces) to record end-user perceptions. Structured questionnaires were used to conduct the interviews with both qualitative and quantitative information. Results Noteworthy differences were observed among the three sample groups of doctors, nurses and administrators as well as between our two hospital groups. The impact of automation in terms of cost and strategic value in public sector hospitals is shown to have yielded positive outcomes with regard to patient experience, hospital staff workflow enhancements, and overall morale in the workplace. Conclusion The research provides insight into the reasons for investing in system automation, the associated outcomes, and organisational factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation.
Designing a web home page involves many decisions that affect how the page will look, the kind of technology required to use the page, the links the page will provide, and kinds of patrons who can use the page. The theme of information literacy needs to be built into every web page; users need to be taught the skills of sorting and applying…
Introduction Current evidence on the root-causes of deaths among children younger than 5years is critical to direct international efforts to improve child survival, focus on health promotion and achieve Millennium Development Goal 4. We report a hospital-based estimate for 2005-2007 of the major causes of death in children in this age-group in south-west Nigeria. Methods We used retrospective data from the intensive care unit of a second-tier healthfacility to extract the presenting complaints, clinical diagnosis, treatment courses, prognosis and outcome among children aged 6—59months. SPSS-19 was used for data analysis. Results Of the 301 children (58% males, 42% females) admitted into the ICU within the period of study, 173 (26%) presented with complaints related to the gastrointestinal system, 138 (21%) with respiratory symptoms and 196 (29%) with complaints of fever. Overall, 708 investigations were requested for among which were full blood count (215, 30%) and blood slides for malaria parasite (166, 23%). Infection ranked highest (181, 31%) in clinicians’ diagnosis, followed by haematological health problems (109, 19%) and respiratory illnesses (101, 17%). There were negative correlations between outcome of the illness and patient’s weight (r=-0.195, p=0.001) and a strong positive correlation between prognosis and outcome of admission (r=0.196, p=0.001). Of the 59 (20%) children that died, presentation of respiratory tract illnesses were significantly higher in females (75%) than in males (39%) (?²=7.06; p=0.008) and diagnoses related to gastrointestinal pathology were significantly higher in males (18%) than in females (0%) (?²=4.07; p=0.05). Majority of the deaths (21%) occurred among children aged 1.0 to 1.9years old and among weight group of 5.1-15.0kg. Conclusion The major causes of deaths among under-five years old originate from respiratory, gastrointestinal and infectious diseases – diseases that were recognized as major causes of childhood mortality about half a century earlier. Realization of MDG4 - to reduce child mortality by two-thirds – is only possible if the government and donor agencies look beyond the health sector to find hidden causative factors such as education and housing and within the health sector such as vibrant maternal, new-born, and child health interventions.
Background Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely unknown. We conducted a health impact assessment of landfilling and incineration in three European countries: Italy, Slovakia and England. Methods A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km of an incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined with air pollution dispersion modelling for particulate matter (PM10) and nitrogen dioxide (NO2). For incinerators, we estimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributable cases of congenital anomalies and low birth weight infants. Results About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England, respectively. The additional contribution to NO2 levels within a 3 km radius was 0.23, 0.15, and 0.14 ?g/m3, respectively. Lower values were found for PM10. Assuming that the incinerators continue to operate until 2020, we are moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0, and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, the attributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. The total exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderately confident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3 whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively. Conclusions The current health impacts of landfilling and incineration can be characterized as moderate when compared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact on public health. There are several uncertainties and critical assumptions in the assessment model, but it provides insight into the relative health impact attributable to waste management.
BackgroundCommunication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities.MethodsFacilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached
Julia Neily; Peter D Mills; Pamela Lee; Brian Carney; Priscilla West; Katherine Percarpio; Lisa Mazzia; Douglas E Paull; James P Bagian
Background Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates. Methods Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Results Private healthfacilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Conclusions Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector healthfacilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries.
Background Irrational prescribing and dispensing of antimalarials has been identified as a contributing factor in the emergence of malaria parasites resistant to existing antimalarial drugs. Factors that contribute to such irrational prescribing and dispensing should therefore be identified to address this problem. The aim of this study was to assess irrational antimalarial drug dispensing and prescribing practices in public healthfacilities. Methods A descriptive-retrospective cross-sectional study was conducted between January and June 2011 in order to assess prescribing and dispensing practices for antimalarial drugs in three public hospitals and nine health centers in Dar es Salaam, Tanzania. Thirty-two drug dispensers were interviewed using a structured questionnaire. A total of 4,320 prescriptions for the period January to December 2010 were collected and assessed for antimalarial drug prescribing patterns. Results The majority (84.6%) of drug dispensers had poor knowledge regarding the basic information required from patients before dispensing artemether-lumefantrine. Seventeen of 32 drug dispensers did not know the basic information that should be given to patients in order to increase absorption of artemether-lumefantrine after oral intake. Most drug dispensers also showed limited knowledge about the dosage and contraindications for artemether-lumefantrine. Eighty-seven percent of all prescriptions contained artemether-lumefantrine as the only antimalarial drug, 77.1% contained at least one analgesic, and 26.9% contained at least one antibiotic, indicating unnecessary use of analgesics and antibiotics with antimalarial drugs. A substantial number of prescriptions contained antimalarial drugs that have already been declared ineffective for the treatment of malaria in Tanzania, providing additional evidence of inadequate knowledge among health care workers concerning treatment policy. Conclusion Despite the government’s efforts to increase public awareness regarding use of artemether-lumefantrine as first-line treatment for uncomplicated malaria, there is still irrational prescribing, dispensing, and use of this combination. Based on the results of this study, it is proposed that regular on-the-job training and continuing education be provided to drug dispensers and prescribers in public healthfacilities.
This report is a health risk assessment that addresses continuous releases of tritium to the environment from the National Tritium Labeling Facility (NTLF) at the Lawrence Berkeley Laboratory (LBL). The NTLF contributes approximately 95% of all tritium releases from LBL. Transport and transformation models were used to determine the movement of tritium releases from the NRLF to the air, surface water, soils, and plants and to determine the subsequent doses to humans. These models were calibrated against environmental measurements of tritium levels in the vicinity of the NTLF and in the surrounding community. Risk levels were determined for human populations in each of these zones. Risk levels to both individuals and populations were calculated. In this report population risks and individual risks were calculated for three types of diseases--cancer, heritable genetic effects, and developmental and reproductive effects.
Construction and renovation projects in health care facilities are a risk for certain patients, particularly those who are immunocompromised. A proactive approach must be taken to limit construction-related nosocomial infections. This requires having a multidisciplinary team, supported by administration, to plan and implement preventive measures throughout the duration of the construction project. The ICP should be an active team member in all phases of the project. The ICP plays a major role by providing education to personnel; ensuring that preventive measures are identified, initiated, and maintained; and carrying out surveillance for infections in patients. By ensuring that the appropriate preventive measures are in place and clear lines of communication exist among the personnel, patient safety will be enhanced. PMID:11593827
Background Although rates of maternal and neonatal mortality have decreased in many countries over the last two decades, they remain unacceptably high, particularly in sub-Saharan Africa. Nevertheless, we know little about the quality of facility-based maternal and newborn care in low-income countries and little about the association between quality of care and health worker training, supervision, and incentives in these settings. We therefore sought to examine the quality of facility-based maternal and newborn health care by describing the implementation of recommended practices for maternal and newborn care among health care facilities. We also aimed to determine whether increased training, supervision, and incentives for health workers were associated with implementing these recommended practices. We chose to study these aims in the Republic of Rwanda, where rates of maternal and newborn mortality are high and where substantial attention is currently focused on strengthening health workforce capacity and quality. Methods We used data from the 2007 Rwanda Service Provision Assessment. Using observations from 455 facilities and interviews from 1357 providers, we generated descriptive statistics to describe the use of recommended practices and frequencies of provider training, supervision, and incentives in the areas of antenatal, delivery, and newborn care. We then constructed multivariable regression models to examine the associations between using recommended practices and health provider training, supervision, and incentives. Results Use of recommended practices varied widely, and very few facilities performed all recommended practices. Furthermore, in most areas of care, less than 25% of providers reported having had any pre-service or in-service training in the last 3?years. Contrary to our hypotheses, we found no evidence that training, supervision, or incentives were consistently associated with using recommended practices. Conclusion Our findings highlight the need to improve facility-based maternal and newborn care in Rwanda and suggest that current approaches to workforce training, supervision, and incentives may not be adequate for improving these critical practices.
Background Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural healthfacility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC). Methods In-depth interviews were conducted with a total of 17 healthfacility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of healthfacilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach. Results Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation. Conclusion The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.
Background Research in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. We estimated the effect of health-facility admission on maternal survival, and how this effect varies with skilled attendant coverage across India. Methods/Findings Using unmatched population-based case-control analysis of national datasets, we compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls). Probability of maternal death decreased with increasing skilled attendant coverage, among both women who were and were not admitted to a health-facility, however, the risk of death among women who were admitted was higher (at 50% coverage, OR?=?2.32, 95% confidence interval 1.85–2.92) than among those women who were not; while at higher levels of coverage, the effect of health-facility admission was attenuated. In a secondary analysis, the probability of maternal death decreased with increasing coverage among both women admitted for delivery or delivered at home but there was no effect of admission for delivery on mortality risk (50% coverage, OR?=?1.0, 0.80–1.25), suggesting that poor quality of obstetric care may have attenuated the benefits of facility-based care. Subpopulation analysis of obstetric hemorrhage cases and report of ‘excessive bleeding’ in controls showed that the probability of maternal death decreased with increasing skilled attendant coverage; but the effect of health-facility admission was attenuated (at 50% coverage, OR?=?1.47, 0.95–1.79), suggesting that some of the effect in the main model can be explained by women arriving at facility with complications underway. Finally, highest risk associated with health-facility admission was clustered in women with education 8 years. Conclusions The effect of health-facility admission did vary by skilled attendant coverage, and this effect appears to be driven partially by reverse causality; however, inequitable access to and possibly poor quality of healthcare for primary and emergency services appears to play a role in maternal survival as well.
Introduction There is a paucity of information on utilisation of emergency medical services in Nigeria. This study was conducted to determine the pattern of respiratory diseases seen among adults in an emergency room(ER) and their mortality within twenty- four hours in a healthfacility in Nigeria. Methods We carried out a retrospective study on adult patients that presented with respiratory condition from November 2004 to December 2010 at the emergency room of Federal Medical Centre Ido-Ekiti, south western, Nigeria. Results A total of 3671 cases were seen, 368 were respiratory cases accounting for 10.2 % of the total emergency room visitations. The male to female patients ratio was 1.2:1 and their mean was 49 9 ± 20.3 years. Pneumonia (34.5%) was the most common cases seen in the ER, followed PTB (29.4%), acute asthma (24.5%) , acute exacerbation of COPD (10.3%), upper airway tract obstruction and malignant pleural effusion were 0.5% respectively. Fourteen of the PTB cases (3.8%) were complicated by cor-pulmonale, 9(2.5%) by pleural effusion, 4(1.1%) by massive haemoptysis and 2(0.5%) by pneumothorax. Twenty-four hours mortality was 7.4% and 44.4% of the death was due to PTB, 37.0% was due to pneumonia and 14.8% due to acute asthma attack. The overall mortalities also had a bimodal age group distribution as the highest death was recorded in ages 30-39 and ?70 years. Conclusion Pneumonia and PTB were the leading respiratory diseases among adults causing of emergency room visit and early mortality in this healthfacility in Nigeria.
Background Anticoagulation patient self-testing (PST) represents an alternative approach to warfarin monitoring by enabling patients to use coagulometers to test their international normalized ratio (INR) values. PST offers several advantages that potentially improve warfarin management. Objective To describe implementation and associated performance of a PST demonstration program at an Indian Health Service (IHS) facility. Methods A non-consecutive case series analysis of patients from a pharmacy-managed PST demonstration program was performed at an IHS facility in Oklahoma between July 2008 and February 2009. Results Mean time in therapeutic range (TTR) for the seven patients showed a small, absolute increase during the twelve weeks of PST compared to the twelve weeks prior to PST. Four of the seven patients had an increase in TTR during the twelve week course of PST compared to their baseline TTR. Three of four patients with increased TTR in the final eight week period of PST achieved a TTR of 100%. Of the three patients who experienced a decrease in TTR after initiating self-testing, two initially presented with a TTR of 100% prior to PST and one patient had a TTR of 100% for the final eight weeks of PST. The two patients not achieving a TTR of 100% during the twelve week PST period demonstrated an increase in TTR following the first four weeks of PST. Conclusions Although anticoagulation guidelines now emphasize patient self-management (PSM) only, optimal PST remains an integral process in PSM delivery. In the patients studied, the results of this analysis suggest that PST at the IHS facility provided a convenient, alternative method for management of chronic warfarin therapy for qualified patients. More than half of the patients demonstrated improvement in TTR. Although there is a learning curve immediately following PST initiation, the mean TTR for the entire PST period increased modestly when compared to the time period prior to PST.
Schupbach, Ryan R.; Bousum, John M.; Miller, Michael J.
This page allows users to search the CDC and National Center for Health Statistics sites (NCHS). Collectively, these sites contain a huge amount of health and disease data from a large number of surveys. These include: National Health Interview Survey, National Immunization Survey, National Health and Nutrition Examination Survey, National Survey of Family Growth, National Health Care Survey , National Employer Health Insurance Survey, National Vital Statistics System, and Mortality Data.
This Necessary and Sufficient (N and S) set of standards is for Other Industrial, Radiological, and Non-Radiological Hazard Facilities at Oak Ridge National Laboratory (ORNL). These facility classifications are based on a laboratory-wide approach to classify facilities by hazard category. An analysis of the hazards associated with the facilities at ORNL was conducted in 1993. To identify standards appropriate for these Other Industrial, Radiological, and Non-Radiological Hazard Facilities, the activities conducted in these facilities were assessed, and the hazards associated with the activities were identified. A preliminary hazards list was distributed to all ORNL organizations. The hazards identified in prior hazard analyses are contained in the list, and a category of other was provided in each general hazard area. A workshop to assist organizations in properly completing the list was held. Completed hazard screening lists were compiled for each ORNL division, and a master list was compiled for all Other Industrial, Radiological Hazard, and Non-Radiological facilities and activities. The master list was compared against the results of prior hazard analyses by research and development and environment, safety, and health personnel to ensure completeness. This list, which served as a basis for identifying applicable environment, safety, and health standards, appears in Appendix A.
... the Act for an employer to fire, demote, transfer or discriminate in any way against a worker ... Health Care and Social Service Workers Hearing Conservation Heat Stress Card How To Prepare For Workplace Emergencies ...
This risk assessment calculates the probability of experiencing health effects, including cancer incidence due to tritium exposure for three groups of people: (1) LBNL workers near the LBNL facility--Building 75--that uses tritium; (2) other workers at LBNL and nearby neighbors; and (3) people who use the UC Berkeley campus area, and some Berkeley residents. All of these groups share the same probability of health effects from the background radiation from natural sources in the Berkeley area environment, including an increased risk of developing a cancer of 11,000 chances per million. In calculating risk the authors assumed continuous operation in Building 75 for at least a human lifetime. Under this assumption, LBNL workers located near Building 75 have an additional risk of 60 chances out of one million to suffer a cancer; other workers at LBNL and people who live near LBNL have an additional risk of six chances out of one million over a lifetime of exposure; and users of the UC Berkeley campus area and other residents of Berkeley have an additional risk of less than once chance out of one million over a lifetime.
McKone, T.E.; Brand, K.P. [Lawrence Livermore National Lab., CA (United States). Health and Ecological Assessment Div.; Shan, C. [Lawrence Berkeley National Lab., CA (United States). Earth Sciences Div.
Background Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR) Health Information System (HIS). Methods Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population) were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. Results Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5) was higher than in Africa on average (1.8). Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1). The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD) visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient visits attributable to host community members was higher than that for refugees. There was no statistically significant difference between the size of the male and female populations across refugee settlements. Across all settlements reporting to the UNHCR database, the percent of the refugee population that was less than five years of age is 16% on average. Conclusions The availability of a centralized database of health information across UNHCR-supported refugee settlements is a rich resource. The SPHERE standard for emergencies of 1-4 visits per person per year appears to be relevant for Asia in the post-emergency phase, but not for Africa. In Africa, a post-emergency standard of 1-2 visits per person per year should be considered. Although it is often assumed that the size of the female population in refugee settlements is higher than males, we found no statistically significant difference between the size of the male and female populations in refugee settlements overall. Another assumption---that the under-fives make up 20% of the settlement population during the emergency phase---does not appear to hold for the post-emergency phase; under-fives made up about 16% of refugee settlement populations.
Research shows that community socioeconomic status (SES) predicts, based on food service types available, whether a population has access to healthy food. It is not known, however, if a relationship exists between SES and risk for foodborne illness (FBI) at the community level. Geographic information systems (GIS) give researchers the ability to pinpoint health indicators to specific geographic locations and detect resulting environmental gradients. It has been used extensively to characterize the food environment, with respect to access to healthy foods. This research investigated the utility of GIS in determining whether community SES and/or demographics relate to access to safe food, as measured by food service critical health code violations (CHV) as a proxy for risk for FBI. Health inspection records documenting CHV for 10,859 food service facilities collected between 2005 and 2008 in Philadelphia, PA, were accessed. Using an overlay analysis through GIS, CHV were plotted over census tracts of the corresponding area. Census tracts (n = 368) were categorized into quintiles, based on poverty level. Overall, food service facilities in higher poverty areas had a greater number of facilities (with at least one CHV) and had more frequent inspections than facilities in lower poverty areas. The facilities in lower poverty areas, however, had a higher average number of CHV per inspection. Analysis of CHV rates in census tracts with high concentrations of minority populations found Hispanic facilities had more CHV than other demographics, and Hispanic and African American facilities had fewer days between inspections. This research demonstrates the potential for utilization of GIS mapping for tracking risks for FBI. Conversely, it sheds light on the subjective nature of health inspections, and indicates that underlying factors might be affecting inspection frequency and identification of CHV, such that CHV might not be a true proxy for risk for FBI. PMID:21902922
The research moves from the current global and local context and from shared development strategies. From the observation and the analysis of contemporary environmental and energy issues and redefined directions of growth of human activity, it is addressing the question of environmental sustainability and energy conservation of building hospital systems. The work has developed a field survey relating the specific topic of energy saving and efficiency of the Park Hospital in the Italian Lombardy Region. This has been articulated in a diagnosis of technology and efficiency of regional hospitals, implemented through a census, and in a subsequent identification of interventional cases, in order to show its economic, environmental and health performance of the energy efficiency consumption and the environmentally sound. PMID:21425653
Background: Diarrheal disease forms one of the two major killer diseases in children under five years of age in the developing world. There are inherent cultural practices for management of diarrhea at the domestic level. Also, the treatment practices at health centers vary, with inappropriate use of antibiotics, and iv fluids observed commonly, while ORS is less frequently used. Methodology: Cross sectional study was carried out using pretested interview schedule between January and December 2006, in villages of Kashmir Valley. Results: The ORS use rate is low (24.4% and 8.4%) respectively in past and current episode. Cultural practices include harmful ones like starving to overcome the episode. The rate of Antibiotic use is higher with 77.9%. Conclusion: Kashmir valley faces the same problems in effective diarrhea management as in other developing regions of India and the world, viz. less ORS use, high antibiotic use and harmful cultural practices like giving bowel rest.
Ahmed, Fayaz; Farheen, Aesha; Ali, Imtiyaz; Thakur, M; Muzaffar, A; Samina, M
Introduction Logistics management information system for health commodities remained poorly implemented in most of developing countries. To assess the status of laboratory logistics management information system for HIV/AIDS and tuberculosis laboratory commodities in public healthfacilities in Addis Ababa. Methods A cross-sectional descriptive study was conducted from September 2010-January 2011 at selected public healthfacilities. A stratified random sampling method was used to include a total of 43 facilities which, were investigated through quantitative methods using structured questionnaires interviews. Focus group discussion with the designated supply chain managers and key informant interviews were conducted for the qualitative method. Results There exists a well-designed logistics system for laboratory commodities with trained pharmacy personnel, distributed standard LMIS formats and established inventory control procedures. However, majority of laboratory professionals were not trained in LMIS. Majority of the facilities (60.5%) were stocked out for at least one ART monitoring and TB laboratory reagents and the highest stock out rate was for chemistry reagents. Expired ART monitoring laboratory commodities were found in 25 (73.5%) of facilities. Fifty percent (50%) of the assessed hospitals and 54% of health centers were currently using stock/bin cards for all HIV/AIDS and TB laboratory commodities in main pharmacy store, among these only 25% and 20.8% of them were updated with accurate information matching with the physical count done at the time of visit for hospitals and health centers respectively. Conclusion Even though there exists a well designed laboratory LMIS, keeping quality stock/bin cards and LMIS reports were very low. Key ART monitoring laboratory commodities were stock out at many facilities at the day of visit and during the past six months. Based on findings, training of laboratory personnel's managing laboratory commodities and keeping accurate inventory control procedures were recommended.
The document discusses institutions concerned with health and related functions, education beyond the high school level, and penal, rehabilitative and protective functions in Shelby County. It reviews and evaluates the adequacy of existing health, penal a...
ENSO PAGE, provided by the National Weather Service in the San Francisco Bay Area, is a collection of links dealing with a variety of ENSO (El Nino/Southern Oscillation) related topics such as impacts, sea surface temperature charts, indices and analyses, and background information. According to the National Oceanic and Atmospheric Adminstration (NOAA), El Nino is "a disruption of the ocean-atmosphere system in the tropical Pacific having important consequences for weather around the globe." It is caused by a change in trade wind patterns in the central and western Pacific ocean, and causes a large volume of ocean to be warmed (typically about 20 degrees of latitude by 90 degrees of longitude). It happens at irregular intervals and has global climatic consequences (regional flooding and droughts, in particular).
Background The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs). Methods Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957–2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques. Results During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (?13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (?1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (?69.2%). The slope of the MMR did not appear to be altered by the change in abortion law. Conclusion Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal healthfacilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.
OBJECTIVE: The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. METHODS: Data collected through observation-based surveys in randomly selected first-level healthfacilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). FINDINGS: Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI.They are also more likely to receive the first dose of the drug before leaving the healthfacility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the healthfacility. CONCLUSIONS: IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level healthfacilities in low-income and middle-income countries.
This paper presents a selection of the results reported in the study "Factors Influencing the Recruitment and Retention of Rural and Remote Area Nurses in Queensland" (Hegney et al 2001). The main aim of this study was to determine why nurses in those rura and remote areas of Queensland that reported higher than State average turnover rates between February 1999 and May 2000, chose to leave their employment. The study therefore investigated the factors that influenced nurses' decisions to leave rural and remote area practice, the factors that influenced them to remain in practice and those factors nurses considered irrelevant to leaving or staying in rural/remote area nursing. This paper reports those factors the participants believed influenced them to leave rural and remote area nursing in Queensland. While the findings cannot be generalised to the Australian nursing workforce or to nurses not employed by Queensland Health, the study does confirm the findings of prev ous Australian research and formulates recommendations to assist future nursing workforce planning and policy. PMID:12054393
Hegney, Desley; McCarthy, Alexandra; Rogers-Clark, Cath; Gorman, Don
Generic safety and health aspects of commercial-scale (60 to 600 million L/y) anhydrous ethanol production were identified. Several common feedstocks (grains, roots and fibers, and sugarcane) and fuels (coal, natural gas, wood, and bagasse) were evaluated throughout each step of generic plant operation, from initial milling and sizing through saccharification, fermentation, distillation, and stillage disposal. The fermentation, digestion, or combustion phases are not particularly hazardous, although the strong acids and bases used for hydrolysis and pH adjustment should be handled with the same precautions that every industrial solvent deserves. The most serious safety hazard is that of explosion from grain dust or ethanol fume ignition and boiler/steam line overpressurization. Inhalation of ethanol and carbon dioxide vapors may cause intoxication or asphyxiation in unventilated areas, which could be particularly hazardous near equipment controls and agitating vats. Contact with low-pressure process steam would produce scalding burns. Benzene, used in stripping water from ethanol in the final distillation column, is a suspected leukemogen. Substitution of this fluid by alternative liquids is addressed.
The US Centers for Disease Control and Prevention recently issued new recommendations to screen persons born between 1945 and 1965 for hepatitis C virus. Federal facilities in the US Indian Health Service were surveyed on knowledge and support for the hepatitis C virus recommendations, as well as barriers and concerns. PMID:23838897
Reilley, Brigg; Leston, Jessica; Redd, John T; Geiger, Rebecca
DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Smith P, Gassaway J, DaVanzo JE. Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities.
Gerben DeJong; Wenqiang Tian; Randall J. Smout; Susan D. Horn; Koen Putman; Pamela Smith; Julie Gassaway; Joan E. DaVanzo
The paging problem is that of deciding which pages to keep in a memory of k pages in order to minimize the number of page faults. We develop the marking algorithm, a randomized on-line algorithm for the paging problem. We prove that its expected cost on any sequence of requests is within a factor of 2Hk of optimum. (Where Hk
Amos Fiat; Richard M. Karp; Michael Luby; Lyle A. Mcgeoch; Daniel Dominic Sleator; Neal E. Young
Objective The World Health Organization (WHO) estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic sequelae. The purpose of this study was to identify the risk factors of birth asphyxia and the hospital outcome of affected neonates. Materials & Methods This study was a prospective case-control study on term neonates in a tertiary hospital in Yaounde, with an Apgar score of < 7 at the 5th minute as the case group, that were matched with neonates with an Apgar score of ? 7 at the 5th minute as control group. Statistical analysis of relevant variables of the mother and neonates was carried out to determine the significant risk factors. Results The prevalence of neonatal asphyxia was 80.5 per 1000 live births. Statistically significant risk factors were the single matrimonial status, place of antenatal visits, malaria, pre-eclampsia/eclampsia, prolonged labor, arrest of labour, prolonged rupture of membranes, and non-cephalic presentation. Hospital mortality was 6.7%, that 12.2% of them had neurologic deficits and/or abnormal transfontanellar ultrasound/electroencephalogram on discharge, and 81.1% had a satisfactory outcome. Conclusion The incidence of birth asphyxia in this study was 80.5% per1000 live birth with a mortality of 6.7%. Antepartum risk factors were: place of antenatal visit, malaria during pregnancy, and preeclampsia/eclampsia. Whereas prolonged labor, stationary labor, and term prolonged rupture of membranes were intrapartum risk faktors. Preventive measures during prenatal visits through informing and communicating with pregnant women should be reinforced.
The Department of Energy's occupational safety and property protection performance in fiscal year 1980 was excellent in all reported categories with loss rates generally less than one-third of comparable industry figures. The Department of Energy's fiscal year 1980 incidence rate per 200,000 work hours was 1.1 lost workday cases and 18.2 lost workdays compared to 1.1 lost workday cases and 17.2 lost workdays during fiscal year 1979. The recorded occupational illness rate, based on only 70 cases, was 0.05 cases per 200,000 work hours compared to 0.06 cases per 200,000 work hours for fiscal year 1979. Ten fatalities involving Federal or contractor employees occurred in fiscal year 1980 compared to nine for fiscal year 1979. Four of those in fiscal year 1980 resulted from two aircraft accidents. Total reported property loss during fiscal year 1980 was $7.1 million with $3.5 million attributable to earthquake damage sustained by the Lawrence Livermore and Sandia National Laboratories on January 24, 1980. A total of 131 million vehicle miles of official vehicular travel during fiscal year 1980 resulted in 768 accidents and $535,145 in property damages. The 104,986 monitored Department of Energy and Department of Energy contractor employees received a total dose of 9040 REM in calendar year 1979. Both the total dose and the 1748 employees receiving radiation exposures greater than 1 REM in 1979 represent a continuing downward trend from the calendar year 1978 total dose of 9380 REM and the 1826 employees who received radiation exposures greater than 1 REM. The fifty-nine appraisals conducted indicate that generally adequate plans have been developed and effective organizational structures have been established to carry out the Department of Energy's Environmental Protection, Safety, and Health Protection (ES and H) Program.
Harold Varmus, M.D., co-recipient of a Nobel Prize for studies of the genetic basis of cancer, began his tenure as NCI Director on July 12, 2010. He previously served as President and Chief Executive Officer of Memorial Sloan-Kettering Cancer Center (MSKCC) and as Director of the National Institutes of Health (NIH).
3M produced perfluorochemicals (PFCs) at their Cottage Grove facility from the late 1940s until 2002 (on a pilot scale or in full production), using an electrofluorochemical process. PFC products were produced, handled, used or packaged at several locatio...
Background The malaria test positivity rate (TPR) is increasingly used as an indicator of malaria morbidity because TPR is based on laboratory-confirmed cases and is simple to incorporate into existing surveillance systems. However, temporal trends in TPR may reflect changes in factors associated with malaria rather than true changes in malaria morbidity. This study examines the effects of age, area of residence and diagnostic test on TPR at two healthfacilities in regions of Uganda with differing malaria endemicity. Methods The analysis included data from diagnostic blood smears performed at healthfacilities in Walukuba and Aduku between January 2009 and December 2010. The associations between age and time and between age and TPR were evaluated independently to determine the potential for age to confound temporal trends in TPR. Subsequently, differences between observed TPR and TPR adjusted for age were compared to determine if confounding was present. A similar analysis was performed for area of residence. Temporal trends in observed TPR were compared to trends in TPR expected using rapid diagnostic tests, which were modelled based upon sensitivity and specificity in prior studies. Results Age was independently associated with both TPR and time at both sites. At Aduku, age-adjusted TPR increased relative to observed TPR due to the association between younger age and TPR and the gradual increase in age distribution. At Walukuba, there were no clear differences between observed and age-adjusted TPR. Area of residence was independently associated with both TPR and time at both sites, though there were no clear differences in temporal trends in area of residence-adjusted TPR and observed TPR at either site. Expected TPR with pLDH- and HRP-2-based rapid diagnostic tests (RDTs) was higher than observed TPR at all time points at both sites. Conclusions Adjusting for potential confounders such as age and area of residence can ensure that temporal trends in TPR due to confounding are not mistakenly ascribed to true changes in malaria morbidity. The potentially large effect of diagnostic test on TPR can be accounted for by calculating and adjusting for the sensitivity and specificity of the test used.
... right-hand corner of the player. Men's Health Month HealthDay June 6, 2014 Related MedlinePlus Pages Men's Health Nutrition Transcript In honor of "Men's Health Month" the Academy of Nutrition and Dietetics has a ...
... EPA Home Air Indoor Air Radon Health Risks Health Risks (September 2009) The United Nation's World Health Organization ( ... page, 26 K) . For More Information on Radon Health Risks Radon Frequently Asked Questions EPA's 2003 Updated Radon ...
The purpose of this report is to present to Secretary of Energy James Watkins the findings and recommendations of the Occupational Safety and Health Administration's (OSHA) evaluation of the Department of Energy's (DOE) programs for worker safety and health at DOE's government-owned contractor-operated (GOCO) nuclear facilities. The OSHA evaluation is based on an intensive and comprehensive review and analysis of DOE's worker safety and health programs including: written programs; safety and health inspection programs; and the adequacy of resource, training, and management controls. The evaluation began on April 10, 1990 and involved over three staff years before its conclusion. The evaluation was initiated by former Secretary of Labor Elizabeth Dole in response to Secretary of Energy James Watkins' request that OSHA assist him in determining the actions needed to assure that DOE has an exemplary safety and health program in place at its GOCOs. 6 figs.
Background Literature reports have indicated an increase in research evidence suggesting association between periodontal disease and the risk of pre-term birth (PTB) and low birth weight (LBW). Periodontal diseases in Uganda have been documented as a public health problem, but their association to adverse pregnancy outcomes is unknown. This study was conducted to assess the association between periodontital diseases in postpartum mothers and PTB and LBW of babies in Mulago and Mbarara referral hospitals. Methods This was a cross sectional study using medical records, clinical examination and oral interview of mothers at the two tertiary healthfacilities. Mothers with singleton babies from Mulago (n?=?300) and Mbarara Hospital (n?=?100) were recruited for the study. The women were clinically examined for periodontal disease by 2 trained and calibrated dentists. Data on PTB and LBW were retrieved from medical records. The data were analyzed to determine the relationship between the four parameters for periodontal disease (bleeding gingiva, periodontal pockets, gingival recession and calculus with plaque deposits) and the adverse pregnancy outcomes. Frequency distribution was used to describe the data. Bivariate and multivariate analyses were used to study the association between the periodontal diseases and adverse pregnancy outcomes. Results Approximately 26% and 29% of the postpartum mothers examined had bleeding gingiva and periodontal pockets of 4 mm or more deep, respectively. Advanced periodontitis i.e. pocket depth???6 mm was recorded in 13 (3.6%) of the mothers. Calculus with plaque deposits were recorded in 86% (n?=?343) of the mothers. Gingival recession was recorded in 9.0% of the mothers and significantly and directly related to birth weight (p?0.05). Conclusion Periodontal conditions of postpartum mothers in this study were found to be better than previously reported amongst the Ugandan population. Bivariate analysis showed a significant association only between gingival recession and low birth weight. However, this finding should be interpreted with caution as it could have occurred by chance.
On this site you will find the resource needed to teach a German Level I Course. There are links below for lesson plans and a link to the student page. This page is an introductory page for the teacher. Below are four links that will provide teachers with additional resources to use in their classrooms. Teacher Page - Lesson Plans Teacher Page - Resources Student Page - Deutsch Klasse Student WebQuests ...
Background. Workplace turnover is destructive to nursing and patient outcomes as it leads to losing competent and qualified nurses. However, developments of coping strategies demand a clear understanding of workplace variables that either motivate nurses to remain employed or lead them to leave their current jobs. Objective. This study was designed toassess factors influencing job satisfaction and intention to turnover among nurses in Sidama zone public healthfacilities, in Southern Ethiopia. Method. Cross-sectional study design was carried out on 278 nurses using both qualitative and quantitative data collection methods from May 12 to June 05, 2010. Result. A total of 242 nurses were interviewed giving a response rate of 87%. Nearly two-third (68.6%) of the participants were female, and the mean age was 28 (±6.27) years for both sexes. All job satisfaction subscale except benefit and salary subscale were significant predictors of overall job satisfaction. Satisfactions with work environment and group cohesion (AOR: 0.25 [95% CI: 0.12, 0.51]), single cohesion (AOR: 2.56 [95% CI: 1.27, 5.13]), and working in hospital (AOR: 2.19 [95% CI: 1.12, 4.30]) were the final significant predictors of anticipated turnover of Sidama zone nurses. Conclusions. More than any factors managers should consider the modification of working environment and group cohesions rather than trying to modify nurses to retain and maintain more experienced nurses for the organizations. PMID:24707397
BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF), with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs). OBJECTIVE: To identify the educational needs of HCPs working in LTCF with regard to pain management. METHODS: A qualitative research design using the nominal group technique was undertaken. Seventy-two HCPs (21 physicians/pharmacists, 15 occupational/physical therapists, 24 nurses and 21 orderlies) were recruited from three LTCF in Quebec. Each participant was asked to provide and prioritize a list of the most important topics to be addressed within a continuing education program on chronic pain management in LTCF. RESULTS: Forty topics were generated across all groups, and six specific topics were common to at least three out of the four HCP groups. Educational need in pain assessment was ranked the highest by all groups. Other highly rated topics included pharmacological treatment of pain, pain neurophysiology, nonpharmacological treatments and how to distinguish pain expression from other behaviours. CONCLUSION: The present study showed that despite an average of more than 10 years of work experience in LTCF, HCPs have significant educational needs in pain management, especially pain assessment. These results will help in the development of a comprehensive pain management educational program for HCPs in LTCF.
Background Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa. Methods On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools. Results We located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services. Conclusions Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs’ health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
Background A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected healthfacilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care. Methods A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice. Results Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have <3 years of education (Adjusted Odds ratio [AOR] 19.2, 95% confidence interval [CI] 1.7 - 212.8) and with more than three deliveries in a life time (AOR 3.8, 95% CI 2.3 - 6.4). Mothers with perceived similarity in delivery attendance among skilled and unskilled delivery attendants were associated with unsafe delivery practice (AOR 1.9, 95% CI 1.1 - 3.4). Mother's with lower knowledge score on safe delivery (%) were more likely to have unskilled delivery attendance (AOR 36.5, 95% CI 4.3 - 309.3). Conclusion Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality.
Background Despite Malawi government’s policy to support women to deliver in healthfacilities with the assistance of skilled attendants, some women do not access this care. Objective The study explores the reasons why women delivered at home without skilled attendance despite receiving antenatal care at a health centre and their perceptions of perinatal care. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using a semi- structured interview guide that collected information on women’s perception on perinatal care. A total of 12 in- depth interviews were conducted with women that had delivered at home in the period December 2010 to March 2011. The women were asked how they perceived the care they received from health workers before, during, and after delivery. Data were manually analyzed using thematic analysis. Results Onset of labor at night, rainy season, rapid labor, socio-cultural factors and health workers’ attitudes were related to the women delivering at home. The participants were assisted in the delivery by traditional birth attendants, relatives or neighbors. Two women delivered alone. Most women went to the healthfacility the same day after delivery. Conclusions This study reveals beliefs about labor and delivery that need to be addressed through provision of appropriate perinatal information to raise community awareness. Even though, it is not easy to change cultural beliefs to convince women to use healthfacilities for deliveries. There is a need for further exploration of barriers that prevent women from accessing health care for better understanding and subsequently identification of optimal solutions with involvement of the communities themselves.
... Survey, 2012, tables VIII, IX [PDF - 697 KB] Health risk factors Percent of adolescents 12-19 years of ... Survey Centers for Disease Control and Prevention: Adolescent Health Youth Risk Behavior Surveillance System Email page link Print page ...
... Pregnancy Prevention Quiz Workplace Safety and Health Noise Meter: Hearing Loss Prevention Top of Page Print page ... Genomics Group B Strep Health Care Health Disparities Heart Disease and Stroke (Cardiovascular Disease) HIV/AIDS Immunizations ...
... Asbestos Exposure, and your Health . Top of PageHealth Risks of Asbestos Exposure Chronic exposure to asbestos may ... action that you can take to improve your health and decrease your risk of cancer. Top of Page Conditions Associated with ...
Background Identifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request. However, enhancing women’s awareness on and access to safe and legal abortion services, particularly in rural areas, remains a challenge in Nepal despite a decade of the initiation of safe abortion services. Methods Between January 2011 and December 2012, an operations research study was carried out using quasi-experimental design to determine the effectiveness of engaging female community health volunteers, auxiliary nurse midwives, and nurses to provide medical abortion services from outreach healthfacilities to increase the accessibility and acceptability of women to medical abortion. This paper describes key components of the operations research study, key research findings, and follow-up actions that contributed to create a conducive environment and evidence in scaling up medical abortion services in rural areas of Nepal. Results It was found that careful planning and implementation, continuous advocacy, and engagement of key stakeholders, including key government officials, from the planning stage of study is not only crucial for successful completion of the project but also instrumental for translating research results into action and policy change. While challenges remained at different levels, medical abortion services delivered by nurses and auxiliary nurse midwives working at rural outreach healthfacilities without oversight of physicians was perceived to be accessible, effective, and of good quality by the service providers and the women who received medical abortion services from these rural healthfacilities. Conclusions This research provided further evidence and a road-map for expanding medical abortion services to rural areas by mid-level service providers in minimum clinical settings without the oversight of physicians, thus reducing complications and deaths due to unsafe abortion.
The document supplements the South Dakota State Health Plan in the area of medical facilities. Medical facilities are defined as those entities which provide institutional health services. This includes hospitals, long-term care facilities, kidney disease...
This document contains the human health and ecological risk assessment for the Resource Recovery and Conservation Act (RCRA) permit renewal for the Explosives Waste Treatment Facility (EWTF). Volume 1 is the text of the risk assessment, and Volume 2 (provided on a compact disc) is the supporting modeling data. The EWTF is operated by the Lawrence Livermore National Laboratory (LLNL) at Site 300, which is located in the foothills between the cities of Livermore and Tracy, approximately 17 miles east of Livermore and 8 miles southwest of Tracy. Figure 1 is a map of the San Francisco Bay Area, showing the location of Site 300 and other points of reference. One of the principal activities of Site 300 is to test what are known as 'high explosives' for nuclear weapons. These are the highly energetic materials that provide the force to drive fissionable material to criticality. LLNL scientists develop and test the explosives and the integrated non-nuclear components in support of the United States nuclear stockpile stewardship program as well as in support of conventional weapons and the aircraft, mining, oil exploration, and construction industries. Many Site 300 facilities are used in support of high explosives research. Some facilities are used in the chemical formulation of explosives; others are locations where explosive charges are mechanically pressed; others are locations where the materials are inspected radiographically for such defects as cracks and voids. Finally, some facilities are locations where the machined charges are assembled before they are sent to the onsite test firing facilities, and additional facilities are locations where materials are stored. Wastes generated from high-explosives research are treated by open burning (OB) and open detonation (OD). OB and OD treatments are necessary because they are the safest methods for treating explosives wastes generated at these facilities, and they eliminate the requirement for further handling and transportation that would be required if the wastes were treated off site.
The Superfund Health Investigation and Education (SHINE) program in the Oregon Department of Human Services developed this public health assessment to address the risk of consuming fish and shellfish caught in Portland Harbor. In 2002, the Agency for Toxi...
The Health Assessment Section (HAS) at the Ohio Department of Health was asked by the United States Environmental Protection Agency (US EPA) to evaluate site information associated with lead-contaminated soils at the Brentwood Estates subdivision in Fairf...
The Missouri Department of Health and Senior Services (DHSS), in cooperation with the Agency for Toxic Substances and Disease Registry (ATSDR), is evaluating the public health impact of the Annapolis Lead Mine (ALM) Site. ATSDR is a federal agency authori...
The California Department of Health Services (CDHS) prepared this public health assessment (PHA) under a cooperative agreement with the federal Agency for Toxic Substances and Disease Registry (ATSDR). PHAs provide communities with information on the spec...
Minimum standards and guidelines to be applied by State agencies and New Jersey health systems agencies in the examination of certificate-of-need applications and in the development of planning activities for radiation oncology units in health care facili...
The Agency for Toxic Substances and Disease Registry (ATSDR) prepared this public health assessment (PHA) to evaluate potential health hazards from past, current, and future exposures to contaminants originating from the Naval Weapons Industrial Reserve P...
...Commission (``CFTC'') and Securities and Exchange Commission...swap execution facilities and security-based swap execution facilities...Interpretation & Guidance Web page at http://www.cftc...swap execution facilities and security-based swap execution...
Over 400,000 prisoners are incarcerated in State and Federal prisons, local jails, and juvenile detention facilities. Disadvantaged socioeconomic classes are disproportionately represented in prison populations; over 40% of all jail inmates are black, ove...
Background Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in healthfacilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. Discussion In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries. Trial Registration ClinicalTrials.gov NCT01073488
Background A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact on the health, disability and quality of life of clients, despite a severe shortage of medicines in the clinics (Jenkins et al. Submitted 2012). As focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems (Sharfritz and Roberts. Health Transit Rev 4:81–85, 1994), the experiences of the participating clients were explored through qualitative focus group discussions in order to better understand the potential reasons for the improved outcomes in the intervention group. Methods Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 clients from the intervention group clinics where staff had received the training programme, and 10 clients from the control group where staff had not received the training during the earlier randomised controlled trial. Results These focus group discussions suggest that the clients in the intervention group noticed and appreciated enhanced communication, diagnostic and counselling skills in their respective health workers, whereas clients in the control group were aware of the lack of these skills. Confidentiality emerged from the discussions as a significant client concern in relation to the volunteer cadre of community health workers, whose only training comes from their respective primary care health workers. Conclusion Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcomes for clients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed. Trial registration ISRCTN 53515024.
... please visit this page: About CDC.gov . Data Access Data Access Interactive Tables and Databases Health Data Interactive Getting ... use and expenditures Health conditions Health insurance and access Mortality and life expectancy Pregnancy and birth Risk ...
This is the home page of IBM Research with hyperlinks to pages covering their activities in numerous scientific disciplines, including electrical engineering, materials science, physics, communications technology, semiconductor technology, storage, and server & embedded systems.
The association between pancreatic cancer mortality and exposure to contaminants from railroad refueling facilities was investigated by the Montana Department of Health and Environmental Sciences and ATSDR. Through a review of death records and a spatial ...
ATSDR evaluated the potential for contamination at the Naval Support Activity, Mechanicsburg (NSA) to cause harm to human health. The NSA, a naval support facility, encompasses 824 acres of land in Hampden Township and Cumberland County, Pennsylvania. In ...
Links to tutorials using Open Office. Using Open Office Tutorials - You may want to use a pair of headphones so you can listen as well as watch. Open Office Tutorial - Formating your Page - format margins, indents, double spacing, and work cited on its own page. Open Office Tutorial - Works Cited Page - shows how to do the hanging indent Open Office Tutorial - Headers, page numbering, and saving - shows how to insert ...
In December 1980 the Agricultural Research Service (ARS) requested technical assistance in evaluation of the prevalence and causes of occupational allergies at its ninety-eight facilities devoted to raising colonies of insects for entomological research. ...
NASA's Goddard Space Flight Center has a new Internet World Wide Web home page designed to inform the public about NASA activities. Home page sections include Goddard missions, space sciences, Earth sciences, Goddard organizations, the newsroom, public services and information, and education. The home page is available at URL: http://pao.gsfc.nasa.gov/gsfc.html.
STUDY OBJECTIVE--The Small Area Health Statistics Unit (SAHSU) was established at the London School of Hygiene and Tropical Medicine in response to a recommendation of the enquiry into the increased incidence of childhood leukaemia near Sellafield, the nuclear reprocessing plant in West Cumbria. The aim of this paper was to describe the Unit's methods for the investigation of health around
P Elliott; A J Westlake; M Hills; I Kleinschmidt; L Rodrigues; P McGale; K Marshall; G Rose
The testimony concerned the National Institute for Occupational Safety and Health (NIOSH) activities related to the health and safety of workers employed at nuclear facilities. Three NIOSH studies were noted, including an evaluation in progress at the Feed Materials Production Center in Fernald, Ohio, a study of radiation exposure at the Goodyear Atomic Corporation (GAC) in Piketon, Ohio, and a study of deaths from cancer at the Portsmouth Naval Shipyard in Kittery, Maine. In the first study the union representatives at the FMPC had several health and safety issues that they wanted NIOSH to evaluate. Additional requests have been made by the union at this facility in relation to reported uranium releases from the site. NIOSH recommended that all potentially exposed workers undergo bioassay testing to determine lung burdens of uranium. At GAC workers requested an evaluation because of exposure to radiation from uranium hexafluoride. Total mortality for radiation workers was significantly below that expected, including cancer deaths, even those from leukemia. Total mortality for nonradiation-exposed workers indicated an increase in the number of deaths due to leukemia. In a further study a significantly increased risk for workers whose cumulative lifetime exposure was at least 1.00 rem was noted for malignancies of the trachea, bronchus, or lung.
Background Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. Methods/Design Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas. The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates. Discussion UNEST is designed to directly feed into the operationalization of maternal and newborn care in the national VHT strategy, thereby helping to inform scale-up in rural Uganda. The study is registered as a randomized controlled trial, number ISRCTN50321130.
The Human Health Risk Assessment (HHRA) portion of the WTI Risk Assessment involves the integration of information about the facility with site-specific data for the surrounding region and population to characterize the potential human health risks due to emissions from the facility. The estimation of human health risks is comprised of the following general steps: (1) identification of substances of potential concern; (2) estimation of the nature and magnitude of chemical releases from the WTI facility; (3) prediction of the atmospheric transport of the emitted contaminants; (4) determination of the types of adverse effects associated with exposure to the substances of potential concern (referred to as hazard identification), and the relationship between the level of exposure and the severity of any health effect (referred to as dose-response assessment); (5) estimation of the magnitude of exposure (referred to as exposure assessment); and (6) characterization of the health risks associated with exposure (referred to as risk characterization).
The Medical Library Bulletin of the Thames Regions reflected the development of health-service libraries over the 20 years it existed. Originally begun as a practical aid to improving services by encouraging co-operation, improving communication and giving instructive advice, it charted the work of health-service librarians and the growth of their services. The articles contained in it covered professional developments and wider political issues as they occurred, and illustrated the extension of the librarians' knowledge and skills. Leslie Morton, Library Adviser to the British Postgraduate Medical Federation, edited almost every issue, starting at a time when there was little guidance or professional literature available for health-service librarians. PMID:16109019
The Washington State Department of Health (DOH) prepared a health consultation in August 2004 evaluating exposure to metals contamination resulting from historic operation of the LeRoi smelter in the town of Northport, Washington. As follow-up to this rep...
Introduction Within healthcare settings, HIV-related stigma is a recognized barrier to access of HIV prevention and treatment services and yet, few efforts have been made to scale-up stigma reduction programs in service delivery. This is in part due to the lack of a brief, simple, standardized tool for measuring stigma among all levels of healthfacility staff that works across diverse HIV prevalence, language and healthcare settings. In response, an international consortium led by the Health Policy Project, has developed and field tested a stigma measurement tool for use with healthfacility staff. Methods Experts participated in a content-development workshop to review an item pool of existing measures, identify gaps and prioritize questions. The resulting questionnaire was field tested in six diverse sites (China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis). Respondents included clinical and non-clinical staff. Questionnaires were self- or interviewer-administered. Analysis of item performance across sites examined both psychometric properties and contextual issues. Results The key outcome of the process was a substantially reduced questionnaire. Eighteen core questions measure three programmatically actionable drivers of stigma within healthfacilities (worry about HIV transmission, attitudes towards people living with HIV (PLHIV), and healthfacility environment, including policies), and enacted stigma. The questionnaire also includes one short scale for attitudes towards PLHIV (5-item scale, ? = 0.78). Conclusions Stigma-reduction programmes in healthcare facilities are urgently needed to improve the quality of care provided, uphold the human right to healthcare, increase access to health services, and maximize investments in HIV prevention and treatment. This brief, standardized tool will facilitate inclusion of stigma measurement in research studies and in routine facility data collection, allowing for the monitoring of stigma within healthcare facilities and evaluation of stigma-reduction programmes. There is potential for wide use of the tool either as a stand-alone survey or integrated within other studies of healthfacility staff.
The purpose is to evaluate the prototype Advanced Life Support (ALS) Pack which was developed for the Health Maintenance Facility (HMF). This pack will enable the Crew Medical Officer (CMO) to have ready access to advanced life support supplies and equipment for time critical responses to any situation within the Space Station Freedom. The objectives are: (1) to evaluate the design of the pack; and (2) to collect comments for revision to the design of the pack. The in-flight test procedures and other aspects of the KC-135 parabolic test flight to simulate weightlessness are presented.
Krupa, Debra T.; Gosbee, John; Murphy, Linda; Kizzee, Victor D.
In the early 1990s, concern about the Oak Ridge Reservation's past releases of contaminants to the environment prompted Tennessees public health officials to pursue an in-depth study of potential off-site health effects at Oak Ridge. This study, the Oak Ridge dose reconstruction, was supported by an agreement between the U.S. Department of Energy (DOE) and the State of Tennessee, and
J Alexander; B Brooks; P Erwin; J Holloway; P Lipford; N Morin; R Peelle; J Smith; P Voilleque; N. Zawia
Background A large proportion of the 340,000 HIV-positive children in South Africa live in rural areas, yet there is little sub-Saharan\\u000a data comparing rural paediatric antiretroviral therapy (ART) programme outcomes with urban facilities. We compared clinical,\\u000a immunological and virological outcomes between children at seven rural and 37 urban facilities across four provinces in South\\u000a Africa.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We conducted a retrospective cohort study
Geoffrey Fatti; Peter Bock; Ashraf Grimwood; Brian Eley
Background: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. Materials and Methods: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. Results: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4–98.4%) and natal services (92.7%; 95% CI 89.2–95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ?30 years (X2 = 4.61, P = 0.032), married (X2 = 9.70, P = 0.008) and multiparous (X2 = 9.14, P = 0.028), as well as utilisation of formal healthfacility for antenatal (X2 = 26.94, P = 0.000) and natal (X2 = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. Conclusions: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services.
The public healthcare sector in developing countries face many challenges, including weak healthcare systems and under resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Healthcare delivery, access to healthcare and cost containment has the potential for improvement through more efficient healthcare resource management. Global references demonstrate that information technology (IT) has the ability to assist in this
The Agency for Toxic Substances and Disease Registry (ATSDR) prepared this public health assessment (PHA) to evaluate exposure pathways and to respond to community members' concerns about past and current exposures to contaminants at Fort Wainwright, Alas...
In July, 2004, the Yerington Paiute Tribe (YPT) requested that the Agency for Toxic Substances and Disease Registry (ATSDR) conduct a public health assessment of the Yerington Anaconda Mine site (YAM). The assessments purpose was to determine whether expo...
This report addresses the public health threat of possible vapor intrusion from contaminated ground water into buildings above the highest ground water contamination near the Raytheon hazardous waste site in St. Petersburg, Florida. The Florida Department...
The Oregon Department of Human Services/Superfund Health Investigation and Education program (ODHS/SHINE), the Agency for Toxic Substances and Disease Registry (ATSDR), the Oregon Department of Environmental Quality (ODEQ), and the U.S. Environmental Prot...
We are providing this memorandum to advise of serious female veteran housing safety, security, and privacy issues discovered during on-going audit work that require immediate Veterans Health Administration management attention. These issues emerged while ...
Environmental and breathing-zone samples were analyzed for carbon monoxide, carbon-dioxide, ozone, formaldehyde, and organic solvents at the Philadelphia Airport Control Tower, Philadelphia, Pennsylvania, and the New York Terminal Radar Approach Control, Westbury, New York in October to November 1984, and March, 1985. The evaluation was requested by the Federal Aviation Administration because of employee complaints of eye irritation and respiratory problems. The ventilation systems at both facilities were evaluated. An unspecified number of employees were interviewed. At the Philadelphia facility, carbon-dioxide exposures of up to 1,100 parts per million (ppm) were measured. A carbon-dioxide concentration of 1,000ppm or more was considered indicative of inadequate outside air supply. All other exposures were well below their relevant standards or non detectable. Eye, skin, throat, and respiratory irritation were the most commonly reported symptoms. Problems in the design of the ventilation systems such as no outside air utilization during periods of extreme temperature and intakes and exhausts being located in the same area were noted. The authors conclude that a health hazard does not exist at either facility. The complaints probably stem from the ventilation systems. Recommendations include modifying and repairing the ventilation systems.
This clearinghouse page provides links to thousands of web sites from around the world devoted to arachnids (spiders and their relatives). The links are organized into categories: researchers and societies, subjects (kids' pages, poison, spider myths, and others), arachnids by order, and specialized pages (scientific papers, image-only sites, spider silk, and others). Non-English sites are grouped by language; there are many sites in Dutch, French, German, and Spanish.
Background The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental healthfacilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. Method At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit’s therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. Results 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users’ autonomy and experiences of care. Associations between QuIRC ratings and service users’ ratings of their quality of life and the unit’s therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Conclusions Ratings of the quality of longer term mental healthfacilities made by service managers were positively associated with service users’ autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users’ autonomy.
We aimed to investigate the potential role of pet dogs and cats in the epidemiology of extended spectrum ?-lactamase-producing Enterobacteriaceae. Twenty bacterial isolates were recovered from rectal swabs obtained from 110 dogs and cats. The occurrence of extended spectrum ?-lactamase-producing Enterobacteriaceae in pets spotlights the emergence of a significant public health threat. PMID:24792717
The USA is entering an era of energy diversity, and increasing nuclear capacity and concerns focus on accidents, security,\\u000a waste, and pollution. Physical buffers that separate outsiders from nuclear facilities often support important natural ecosystems\\u000a but may contain contaminants. The US Nuclear Regulatory Commission (NRC) licenses nuclear reactors; the applicant provides\\u000a environmental assessments that serve as the basis for Environmental
... July 17, 2014 Related MedlinePlus Page Exercise and Physical Fitness THURSDAY, July 17, 2014 (HealthDay News) -- Being a ... rights reserved. More Health News on: Exercise and Physical Fitness Recent Health News Page last updated on 18 ...
The Health Information portion of the National Institutes of Health website covers a wide range of topics. This consumer-oriented site includes Quick Links, on the left side of the page, to such topics as "Child & Teen Health", "Men's Health", "Minority Health", and "Seniors' Health". To browse health categories, the visitor can browse several different ways. They can browse under "Body Location/Systems", "Conditions/Diseases", "Procedures", and "Health and Wellness". On the left side of the page the visitor can also choose to search for Health Topics alphabetically and for those more inclined toward audio learning, visitors can listen to NIH Radio by clicking on "MP3 audio reports" on the right side of the page. The Research in Action feature in the top middle of the page offers insight into how humans hear. Just click on the picture above Research in Action to be taken to the article. For visitors who just can't find what they need on the Health Information site, there are a slew of Related Links near the bottom of the page, including Health Information on the Web, Health Newsletters, Health Databases, and Federal Health Agencies.
An oil distribution and storage station was subjected to an Environmental Auditory and results showed soil contamination in part of the surface. An assessment of the site was required in order to fulfill a complete characterization of the contaminants present in soil and groundwater, as well as to establish the probable sources of contamination. Besides, a health risk assessment was
R. M. Flores-Serrano; L. G. Torres; C. Flores; A. Castro; R. Iturbe
The purpose of this paper is to provide a summary analysis and comparison of various environment, safety, and health (ES&H) management systems required of, or suggested for use by, the Departrnent of Energy Defense Programs` sites. The summary analysis is provided by means of a comparison matrix, a set of Vean diagrams that highlights the focus of the systems, and
Occupational safety and health (OSH) in Universiti Kebangsaan Malaysia (UKM) is being considered as an important program to measure employee and student welfare and well-being. During academic session, apart from attending lectures, laboratory works, tutorial and library search, majority of students spend most of their time in residential…
The National Institute for Clinical Excellence (2005) published guidance on the management of disturbed behav- iour in mental health settings and emergency departments. The guidance included some of the recommendations made in the Independent Inquiry into the death of David Bennett (2003). One important recommendation requires that staff implementing physical interventions (restraint) and\\/or parenteral rapid tranquilisation are able to effectively
The Agency for Toxic Substances and Disease Registry (ATSDR) prepared this health consultation at the request of the Environmental Protection Agency (EPA) Region 10. The initial ATSDR evaluation for the site was completed in 1990. As part of the 2007 Seco...
BACKGROUND: The World Health Organization has recommended that anaemia be used as an additional indicator to monitor malaria burden at the community level as malaria interventions are nationally scaled up. To date, there are no published evaluations of this recommendation. METHODS: To evaluate this recommendation, a comparison of anaemia and parasitaemia among 6-30 month old children was made during two
Don P Mathanga; Carl H Campbell Jr; Jodi Vanden Eng; Adam Wolkon; Rachel N Bronzan; Grace J Malenga; Doreen Ali; Meghna Desai
Argues that the preservation of areas like the Shoreline Park (California) wetlands depends on educating students about the value of natural resources. Describes the creation of a Web page on the wetlands for third-grade students by seventh-grade art and ecology students. Outlines the technical process of developing a Web page. (DSK)
This Mississippi State University Geosciences web page contains detailed information about nannobacteria. It includes a brief history of nannobacteria, information regarding the controversy surrounding them, and implications of their existence. The page also includes a link to a more detailed history of nannobacteria, written by Robert Folk, the "Father of Nannobacteria" as well as a photo gallery.
Lynch, F. L.; Kirkland, Brenda L.; University, Mississippi S.
... en... Favorites Delicious Digg Google Bookmarks Child Care Facilities More Information Prevention Measures Control Measures for Outbreaks ... Risk Factors Treatment Biology Prevention & Control Child Care Facilities Prevention Oubreak Control Camps Disease Resources for Health ...
The paper presents the concept of training specialists in anesthesia-resuscitation for high-technology-delivering facilities. This concept is based on the module-axial type of education based on two basic principles: from complex to simple (from general to particular) (the so-called axis) and the modular organization of an educational process. Education implies the obligatory teaching of the axis (the structuring of the already available knowledge) and specialized programs (modules) are incorporated into a course of subjects if there is a practical need, which permits a student to achieve the necessary level of knowledge and skills. PMID:20101792
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IMPORTANCE Hypertension is a major public health problem in sub-Saharan Africa, but the lack of affordable treatment and the poor quality of health care compromise antihypertensive treatment coverage and outcomes. OBJECTIVE To report the effect of a community-based health insurance (CBHI) program on blood pressure in adults with hypertension in rural Nigeria. DESIGN, SETTING, AND PARTICIPANTS We compared changes in outcomes from baseline (2009) between the CBHI program area and a control area in 2011 through consecutive household surveys. Households were selected from a stratified random sample of geographic areas. Among 3023 community-dwelling adults, all nonpregnant adults (aged ?18 years) with hypertension at baseline were eligible for this study. INTERVENTION Voluntary CBHI covering primary and secondary health care and quality improvement of health care facilities. MAIN OUTCOMES AND MEASURES The difference in change in blood pressure from baseline between the program and the control areas in 2011, which was estimated using difference-in-differences regression analysis. RESULTS Of 1500 eligible households, 1450 (96.7%) participated, including 564 adults with hypertension at baseline (313 in the program area and 251 in the control area). Longitudinal data were available for 413 adults (73.2%) (237 in the program area and 176 in the control area). Baseline blood pressure in respondents with hypertension who had incomplete data did not differ between areas. Insurance coverage in the hypertensive population increased from 0% to 40.1% in the program area (n?=?237) and remained less than 1% in the control area (n?=?176) from 2009 to 2011. Systolic blood pressure decreased by 10.41 (95% CI, -13.28 to -7.54) mm Hg in the program area, constituting a 5.24 (-9.46 to -1.02)-mm Hg greater reduction compared with the control area (P?=?.02), where systolic blood pressure decreased by 5.17 (-8.29 to -2.05) mm Hg. Diastolic blood pressure decreased by 4.27 (95% CI, -5.74 to -2.80) mm Hg in the program area, a 2.16 (-4.27 to -0.05)-mm Hg greater reduction compared with the control area, where diastolic blood pressure decreased by 2.11 (-3.80 to -0.42) mm Hg (P?=?.04). CONCLUSIONS AND RELEVANCE Increased access to and improved quality of health care through a CBHI program was associated with a significant decrease in blood pressure in a hypertensive population in rural Nigeria. Community-based health insurance programs should be included in strategies to combat cardiovascular disease in sub-Saharan Africa. PMID:24534947
Hendriks, Marleen E; Wit, Ferdinand W N M; Akande, Tanimola M; Kramer, Berber; Osagbemi, Gordon K; Tanovic, Zlata; Gustafsson-Wright, Emily; Brewster, Lizzy M; Lange, Joep M A; Schultsz, Constance
... page: About CDC.gov . NIOSH Home Health Hazard Evaluations NIOSH Health Hazard Evaluation Program Home Request an HHE HHE Request Form ... reduce hazards and prevent work-related illness. The evaluation is done at no cost to the employees, ...
An areawide health plan for 21 central Nebraska counties is presented. The document consists of individual county plans with a common framework of five components: community health services, health manpower, healthfacilities and services, emergency medic...
... Data Related Links Accessibility NCHS Home FastStats Home Child Health (Data are for the U.S.) Health status Percent ... Disease Control and Prevention: Children National Institute for Child Health and Human Development KIDS Count Email page link ...
The San Jose Facility of Fairchild Semiconductor Corporation, commonly referred to as Fairchild Camera, is a proposed National Priorities List site located in San Jose, California. Several volatile organic compounds (VOCs), including acetone, 1,1-dichloroethene, Isopropyl alcohol tetrachloroethylene, 1,1,2-trichloro-1,2,2-trifluoroethane (Freon-113), 1,1,1-trichloroethane, and xylenes were detected in on-site and off-site ground water and in on-site subsurface soil. The Fairchild Corporation has performed several remedial activities at the site since 1981, and these have drastically reduced the vertical and horizontal extent of site-related contamination. Because of very high contaminant levels in on-site ground water and subsurface soil, the site is of potential public health importance.
Located in Los Angeles, California, the 280-acre Del Amo hazardous waste site contains contamination resulting from a synthetic rubber manufacturing facility consisting of three plants, which formerly operated on the site from 1943 through the mid to late 1960s. Primary contaminants associated with a 3.7-acre waste disposal area located near the southern boundary of the Del Amo site include volatile aromatic hydrocarbons (such as benzene and ethylbenzene) and polycyclic aromatic hydrocarbons (such as naphthalene, benzo(a)pyrene, phenanthrene, and chrysene). Based on the information available for review, CDHS and ATSDR conclude that the Del Amo site presently poses an indeterminate public health hazard to nearby residents and workers.
...2013-10-01 false Facilities construction. 136.110 Section 136...HEALTH Grants for Development, Construction, and Operation of Facilities...Services Â§ 136.110 Facilities construction. In addition to other...
Guidelines for the integrated management of childhood illness (IMCI) in peripheral healthfacilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural healthfacilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used.
A group of 124 Enterobacteriaceae isolates resistant to third generation cephalosporins, and collected in distinct health care facilities of different Portuguese regions was analysed. The great majority of the isolates were also resistant to fourth generation cephalosporins (83.9%), monobactam (96%), amoxicillin plus clavulanic acid (85.5%), and piperacillin plus tazobactam (66.9%). Overall, 84.7% (105/124) were multidrug resistant. Molecular methods enabled us to identify 86.3% (107/124) extended-spectrum ?-lactamases (ESBL) producers, revealing a diversity of class A ?-lactamases from different families, like TEM (TEM-1, TEM-10, TEM-24, and TEM-52), SHV (SHV-1, SHV-12, and SHV-28), CTX-M (CTX-M-1, CTX-M-9, CTX-M-14, CTX-M-15, and CTXM-32), and GES (GES-1). We have also detected class C enzymes like plasmid-mediated AmpC ?-lactamases (PMA?s, DHA-1, and CMY-2) and chromosomal AmpCs in Enterobacter and Citrobacter spp. The PMA? genetic context mapping suggests association with mobile elements, plasmid importation and the potential emergence of these ?-lactamases. The most prevalent ?-lactamase detected was CTX-M-15 (66.1%) and in 41.1% of the isolates it was associated with TEM-, OXA-type ?-lactamases and Aac(6)?Ib-cr, which might indicate that the respective genotype has settled in our country. Indeed, CTX-M-15 was distributed amongst distinct clinical settings of several health care facilities (93.5%) from various regions. We provide evidence of a concerning clinical situation that includes vast occurrence of ESBLs, the settling of CTX-M ?-lactamases, and the report of plasmidic and chromosomal AmpC in Portugal. PMID:24871975
Background Owing to improved management of HIV and its associated opportunistic infections, many HIV-positive persons of reproductive age are choosing to exercise their right of parenthood. This study explored the knowledge of health workers from two Ghanaian districts on the reproductive rights and options available to HIV-positive women who wish to conceive. Methods Facility-based cross-sectional in design, the study involved the entire population of nurse counselors (32) and medical officers (3) who provide counseling and testing services to clients infected with HIV. Both structured and in-depth interviews were conducted after informed consent. Results Two main perspectives were revealed. There was an overwhelmingly high level of approbation by the providers on HIV-positive women’s right to reproduction (94.3%). At the same time, the providers demonstrated a lack of knowledge regarding the various reproductive options available to women infected with HIV. Site of facility, and being younger were associated with practices that violated client’s right to contraceptive counseling (p?0.05) in each case. Some of the providers openly expressed their inability to give qualified guidance to HIV-positive women on the various reproductive options. Conclusions Taken together, these findings suggest that many HIV-positive clients do not receive comprehensive information about their reproductive options. These findings highlight some of the problems that service providers face as HIV counselors. Both service providers and policy makers need to recognize these realities and incorporate reproductive health issues of HIV-persons into the existing guidelines.
Designed and maintained by Professor Michael E. Nielsen of the Psychology Department at Georgia Southern University, this site offers numerous resources for people interested in psychological aspects of religious belief and behavior. The site is designed as an introduction to the psychology of religion, rather than a comprehensive treatment. Resources are grouped into three main categories: general resource pages, science and religion pages, and pages devoted to new religious movements. Contents include notable people in the psychology of religion; a bibliography; course syllabi; journal TOCs; essays on the field, on science and religion, and on several aspects of new religious movements; and related links.
... surgery. Cornea Iris Pupil Lens Retinal vessels Retina Optic nerve Anatomy of the eye Macula Nerve signals to brain Author: Jill Jin, MD, MPH Source: National Eye Institute The JAMA Patient Page is a public service ...
... of the American Medical Association JAMA PATIENT PAGE Insomnia I nsomnia (trouble falling asleep or staying asleep) ... 21, 2003, issue of JAMA. POSSIBLE CAUSES OF INSOMNIA FOR MORE INFORMATION • National Sleep Foundation www.sleepfoundation. ...
JAMA PATIENT PAGE Statins How statins lower cholesterol in your blood Cholesterol from food enters blood Atherosclerotic plaque B L O O D ... role, diet and exercise are not always enough. STATIN USE: BENEFITS AND RISKS If you have had ...
... of the American Medical Association JAMA PATIENT PAGE Gout G out is an excruciatingly painful inflammatory disease ... produce inflammation in the joints and surrounding tissues. Gout has been linked to major medical conditions such ...
Use the two chemical element web sites below to evaluate which site is more reliable. Which is more authoritative? Which is more accurate? Which is more current? How does their coverage or detail compare? Is there advertising on the page? Is there bias or objectivity? ChemicalElements.com Web Elements Evaluation Criteria by Susan E. Beck - links to a page that will help you evaluate each website. ...
The High Bandwidth Page is a good starting point for those who have decided it's time they learn more about all the hoopla surrounding high-bandwidth Internet access, especially to the home. The page provides links to extensive information about cable modems, ISDN, and the newest group of letters to hit the Net: ADSL. Also provided are sections on video telephones and general articles related to high bandwidth. A good individual effort by Gary Zaret.
The Norwegian Radiation Protection Authority (NRPA) has been involved in studies related to the Mayak PA and the consequences of activities undertaken at the site for a number of years. This paper strives to present an overview of past and present activities at the Mayak PA and subsequent developments in the quantification of health effects on local populations caused by discharges of radioactive waste into the Techa River. Assessments of doses to affected populations have relied on the development of dose reconstruction techniques for both external and internal doses. Contamination levels are typically inhomogeneous and decrease with increasing distance from the discharge point. Citations made in this paper give a comprehensive, though not exhaustive, basis for further reading about this topic. PMID:19440276
Standring, William J F; Dowdall, Mark; Strand, Per
The Norwegian Radiation Protection Authority (NRPA) has been involved in studies related to the Mayak PA and the consequences of activities undertaken at the site for a number of years. This paper strives to present an overview of past and present activities at the Mayak PA and subsequent developments in the quantification of health effects on local populations caused by discharges of radioactive waste into the Techa River. Assessments of doses to affected populations have relied on the development of dose reconstruction techniques for both external and internal doses. Contamination levels are typically inhomogeneous and decrease with increasing distance from the discharge point. Citations made in this paper give a comprehensive, though not exhaustive, basis for further reading about this topic.
Standring, William J.F.; Dowdall, Mark; Strand, Per
The UCSD-Nature Signaling Gateway Molecule Pages (http://www.signaling-gateway.org/molecule) provides essential information on more than 3800 mammalian proteins involved in cellular signaling. The Molecule Pages contain expert-authored and peer-reviewed information based on the published literature, complemented by regularly updated information derived from public data source references and sequence analysis. The expert-authored data includes both a full-text review about the molecule, with citations, and highly structured data for bioinformatics interrogation, including information on protein interactions and states, transitions between states and protein function. The expert-authored pages are anonymously peer reviewed by the Nature Publishing Group. The Molecule Pages data is present in an object-relational database format and is freely accessible to the authors, the reviewers and the public from a web browser that serves as a presentation layer. The Molecule Pages are supported by several applications that along with the database and the interfaces form a multi-tier architecture. The Molecule Pages and the Signaling Gateway are routinely accessed by a very large research community.
Background Most African countries have adopted artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. The World Health Organization now recommends limiting anti-malarial treatment to those with a positive malaria test result. Limited data exist on how these policies have affected ACT prescription practices. Methods Data were collected from all outpatients presenting to six public healthfacilities in Uganda as part of a sentinel site malaria surveillance programme. Training in case management, encouragement of laboratory-based diagnosis of malaria, and regular feedback were provided. Data for this report include patients with laboratory confirmed malaria who were prescribed anti-malarial therapy over a two-year period. Patient visits were analysed in two groups: those considered ACT candidates (defined as uncomplicated malaria with no referral for admission in patients???4 months of age and???5 kg in weight) and those who may not have been ACT candidates. Associations between variables of interest and failure to prescribe ACT to patients who were ACT candidates were estimated using multivariable logistic regression. Results A total of 51,355 patient visits were included in the analysis and 46,265 (90.1%) were classified as ACT candidates. In the ACT candidate group, 94.5% were correctly prescribed ACT. Artemether-lumefantrine made up 97.3% of ACT prescribed. There were significant differences across the sites in the proportion of patients for whom there was a failure to prescribe ACT, ranging from 3.0-9.3%. Young children and woman of childbearing age had higher odds of failure to receive an ACT prescription. Among patients who may not have been ACT candidates, the proportion prescribed quinine versus ACT differed based on if the patient had severe malaria or was referred for admission (93.4% vs 6.5%) or was below age or weight cutoffs for ACT (41.4% vs 57.2%). Conclusions High rates of compliance with recommended ACT use can be achieved in resource-limited settings. The unique healthfacility-based malaria surveillance system operating at these clinical sites may provide a framework for improving appropriate ACT use at other sites in sub-Saharan Africa.
Many practical issues in medical ethics depend on an understanding of the concept of health. The main question is whether it is a purely descriptive or a partly evaluative or normative concept. After posing some puzzles about the concept, the views of C Boorse, who thinks it is descriptive, are discussed and difficulties are found for them. An evaluative treatment
Objective Tuberculosis transmission in healthcare facilities contributes significantly to the TB epidemic, particularly in high HIV settings. Although improving ventilation may reduce transmission, there is a lack of evidence to support low-cost practical interventions. We assessed the efficacy of wind-driven roof turbines to achieve recommended ventilation rates, compared to current recommended practices for natural ventilation (opening windows), in primary care clinic rooms in Khayelitsha, South Africa. Methods Room ventilation was assessed (CO2 gas tracer technique) in 4 rooms where roof turbines and air-intake grates were installed, across three scenarios: turbine, grate and window closed, only window open, and only turbine and grate open, with concurrent wind speed measurement. 332 measurements were conducted over 24 months. Findings For all 4 rooms combined, median air changes per hour (ACH) increased with wind speed quartiles across all scenarios. Higher median ACH were recorded with open roof turbines and grates, compared to open windows across all wind speed quartiles. Ventilation with open turbine and grate exceeded WHO-recommended levels (60 Litres/second/patient) for 95% or more of measurements in 3 of the 4 rooms; 47% in the remaining room, where wind speeds were lower and a smaller diameter turbine was installed. Conclusion High room ventilation rates, meeting recommended thresholds, may be achieved using wind-driven roof turbines and grates, even at low wind speeds. Roof turbines and air-intake grates are not easily closed by staff, allowing continued ventilation through colder periods. This simple, low-cost technology represents an important addition to our tools for TB infection control.
Plasmodium vivax is now recognized as a cause of severe and fatal infection in many parts of the world. This prospective observational study was undertaken in a tertiary health setting to understand the spectrum of the disease burden and associated complications due to P. vivax malaria in central India. A malaria clinic under Regional Medical Research Centre for Tribals is operational at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur in central India, where all fever cases and cases with history of fever were referred for screening of malaria parasite by microscopy and rapid diagnostic test kits. Confirmation of all the cases was done by PCR targeting 18s ribosomal RNA gene of the parasite to exclude mixed infection with P. falciparum. Severe vivax malaria was found in 22 (11·1%) out of 198 vivax patients. Cerebral malaria, seizures, severe malaria anaemia, and respiratory distress each were observed in 32% subjects. Multi-organ dysfunction syndrome was common (36%). Mortality was recorded in two patients and neurological sequelae were also observed in two patients at the time of discharge. This is the first report from Central India where P. vivax has been shown to be associated with severe signs of malaria. Severe vivax malaria is a relatively new clinical entity and further studies from different parts of the world are needed to understand clinical spectrum and burden of P. vivax not only for successful treatment, but also for designing and developing effective malaria control measures. PMID:24188240
ABSTP~CT. A formal model is presented for paging algorithms under \\/-order nonstationary assumptions about program behavior. When processing a program under paging in a given memory, a given paging policy generates a certain (expected) number of page calls, i.e., its \\
Alfred V. Aho; Peter J. Denning; Jeffrey D. Ullman
This report describes health and safety concerns associated with the Mixed and Low-level Waste Treatment Facility at the Idaho National Engineering Laboratory. Various hazards are described such as fire, electrical, explosions, reactivity, temperature, and radiation hazards, as well as the potential for accidental spills, exposure to toxic materials, and other general safety concerns.
This report describes health and safety concerns associated with the Mixed and Low-level Waste Treatment Facility at the Idaho National Engineering Laboratory. Various hazards are described such as fire, electrical, explosions, reactivity, temperature, and radiation hazards, as well as the potential for accidental spills, exposure to toxic materials, and other general safety concerns.
... Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE Â§ 4.4 Use of Library facilities. (a) General. The Library facilities are available to any person...
In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/])
Moreira, Adriana da Silva Rezende; Huf, Gisele; Vieira, Maria Armanda; Fonseca, Leila; Ricks, Monica; Kritski, Afranio Lineu
The aim of this study was to investigate the risk factors for preterm births in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon, and to describe their outcomes. We conducted a cross-sectional analytical study of hospital records over eight years. The incidence of prematurity was 26.5 % of admissions over a period of 7 years 7 months. After controlling for confounding factors, we identified attending antenatal care visits in a health centre (Odds ratio [OR] 6.19; 95% Confidence interval [CI] 1.15 - 33.22; p = 0.033), having a urinary tract infection (OR 39.04; 95% CI 17.19 - 88.62; p < 0.001), multiple gestation (OR 3.82; 95% CI 2.68 - 5.43; p <0.001) and congenital malformations (OR 2.78; 95% CI 1.24 - 6.22; p = 0.013) increased the odds of preterm birth. On the other hand being a student mother (OR 0.44; 95% CI 0.20 - 0.98; p = 0.047), being married (OR 0.40 95% CI 0.19 - 0.84; p = 0.016) and more antenatal visits (OR 0.23; 95% CI 0.15 - 0.35; p <0.001) reduced the odds of preterm birth Neonatal mortality in these preterm neonates was 36.6%, in which 69% occurred in the early neonatal period. The main causes of death were neonatal infections (27.6%), neonatal asphyxia (11.9%) and congenital malformations (10.3%). We recommend enhanced prenatal care and management of pathologies which arise during pregnancy. PMID:24558784
The inactivation of virus-contaminated nonporous inanimate surfaces was investigated using adenovirus type 8, a common cause of epidemic keratoconjunctivitis. A 10-?l inoculum of adenovirus was placed onto each stainless steel disk (1-cm diameter), and the inoculum was allowed to air dry for 40 min. Twenty-one different germicides (including disinfectants and antiseptics) were selected for this study based on their current uses in health care. After a 1- or 5-minute exposure to 50 ?l of the germicide, the virus-germicide test mixture was neutralized and assayed for infectivity. Using an efficacy criterion of a 3-log10 reduction in the titer of virus infectivity and regardless of the virus suspending medium (i.e., hard water, sterile water, and hard water with 5% fetal calf serum), only five disinfectants proved to be effective against the test virus at 1 min: 0.55% ortho-phthalaldehyde, 2.4% glutaraldehyde, 2.65% glutaraldehyde, ?6,000 ppm chlorine, and ?1,900 ppm chlorine. Four other disinfectants showed effectiveness under four of the five testing conditions: 70% ethanol, 65% ethanol with 0.63% quaternary ammonium compound, 79.6% ethanol with 0.1% quaternary ammonium compound, and 0.2% peracetic acid. Of the germicides suitable for use as an antiseptic, 70% ethanol achieved a 3-log10 reduction under four of the five test conditions. These results emphasize the need for proper selection of germicides for use in disinfecting noncritical surfaces and semicritical medical devices, such as applanation tonometers, in order to prevent outbreaks of epidemic keratoconjunctivitis.
Rutala, William A.; Peacock, Jeffrey E.; Gergen, Maria F.; Sobsey, Mark D.; Weber, David J.
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Background Adherence to Highly active antiretroviral therapy (HAART) is a major predictor of the success of HIV/AIDS treatment. Good adherence to HAART is necessary to achieve the best virologic response, lower the risk of drug resistance and reduce morbidity and mortality. This study therefore aimed to determine the prevalence and determinants of adherence to HAART amongst PLHIV accessing treatment in a tertiary location in Cross River State, Nigeria. Methods A cross-sectional study was conducted among patients on HAART attending the Presidential Emergency plan for AIDS relief (PEPFAR) clinic of the University of Calabar Teaching Hospital between October–December 2011. A total of 411 PLHIV visiting the study site during the study period were interviewed. PLHIV who met the inclusion criteria were consecutively recruited into the study till the desired sample size was attained. Information was obtained from participants using a semi-structured, pretested, interviewer administered questionnaire. Adherence was measured via patients self report and were termed adherent if they took at least 95% of prescribed medication in the previous week prior to the study. Data were summarized using proportions, and ?2 test was used to explore associations between categorical variables. Predictors of adherence to HAART were determined by binary logistic regression. Level of significance was set at p?0.05. Results The mean age of PLHIV who accessed treatment was 35.7?±?9.32 years. Females constituted 68.6% of all participants. The self reported adherence rate based on a one week recall prior to the study was 59.9%. The major reasons cited by respondents for skipping doses were operating a busy schedule, simply forgot medications, felt depressed, and travelling out of town. On logistic regression analysis, perceived improved health status [OR 3.11; CI: 1.58-6.11], reduced pill load [OR 1.25; 95% CI: 0.46-2.72] and non-use of herbal remedies [OR 1.83; 95% CI: 1.22-2.72] were the major predictors for adherence to HAART. However, payment for ART services significantly decreased the likelihood of adherence to HAART. [OR 0.46; 95% CI: 0.25-0.87.]. Conclusions The adherence rate reported in this study was quite low. Appropriate adherence enhancing intervention strategies targeted at reducing pill load and ensuring an uninterrupted access to free services regimen is strongly recommended.
Not everyone has the ability to journey over to the British Library in London, but anyone with a good Internet connection can journey through the pages of this august institution's most prized volumes. The Turning the Pages site brings together digitized version of over a dozen sumptuous tomes for the web-browsing public and curious scholars. Visitors can page through the first atlas of Europe (compiled by none other than Mercator), view William Blake's famed notebook, and take in the genius of Mozart's Thematic Catalogue, complete with musical examples. Additionally, visitors have the ability to take a look through newly added materials, such as a 15th century Lisbon Hebrew Bible and an Ethiopian bible from 1700.
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This is the home page for the National Oceanic and Atmospheric Administration (NOAA). The goal of the National Oceanic and Atmospheric Administration is to describe and predict changes in the Earth's environment, and conserve and wisely manage the Nation's coastal and marine resources. This page provides access to the many component organizations, educational resources, and opportunities at the National Oceanic and Atmospheric Administration. Some of the resources include: weather forecasts, threats assessment, excessive heat outlook, heat and drought awareness, fire satellite images, and current weather satellite images. In addition, it contains news stories related to current atmospheric and oceanic issues as well as media advisories.
This site teaches students to determine how fluid a liquid really is by measuring its viscosity. The Teacher Page provides background information on viscosity and its relevance to volcanology (the viscosity of magma influences how it will behave in eruptions and lava flows), the formula for determining viscosity, an explanation of the experiment (procedures are on the Student Page), links to the Viscosity Data Tables and the Viscosity Histogram, and densities and viscosities of common liquids and lavas. This activity is part of Exploring Planets in the Classroom's volcanology section.
Hosted by the University of Pennsylvania Library, the Online Books Page Web site "facilitates access to books that are freely readable over the Internet...and aims to encourage the development of such online books, for the benefit and edification of all." The over 18,000 listings can be searched or browsed by author, title, and subject, of which every major physical science subject is represented. Each listing is linked to an outside Web site, making its availability unpredictable, but the shear number of books that are accessible make the Online Books Page a great resource.
This National Aeronautics and Space Administration (NASA) hurricane resource page includes the latest news stories from the extraordinary hurricane season of 2005, feature articles, satellite images and biographies of NASA hurricane experts. Two features of this page are a re-creation of the storm season with satellite images of all of the major storms of the season and a satellite image of Katrina showing it from development through landfall. This site also includes links to National Oceanic and Atmospheric Administration (NOAA) hurricane resources.
Created by Len Abrams, the goal of the African Water Page is to "increase communication on the Continent of Africa between people working in water." Issues for discussion include "water policy, water resource management, water supply and environmental sanitation, water conservation and demand management." Visitors to this page can find information about recent policy initiatives in South Africa, water related documents concerning South Africa, Zimbabwe, the African continent, and some international topics. Also included are links to South and Southern African and International sites.
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...Suitable as Facilities to Assist the Homeless Correction In notice document 2013-20287...bottom of the page, the heading ``Oregon'' should read as follows: Suitable/Unavailable Properties Building Oregon 2. On the same page, in the...
The diagnosis of illness is important for quality patient care and patient safety and is greatly aided by diagnostic testing. For diagnostic tests, such as pathology and radiology, to positively impact patient care, the tests must be processed and the physician and patient must be noti