Development and testing of a scale for assessing the quality of home nursing.

PubMed

Chiou, Chii-Jun; Wang, Hsiu-Hung; Chang, Hsing-Yi

2016-03-01

To develop a home nursing quality scale and to evaluate its psychometric properties. This was a 3-year study. In the first year, 19 focus group interviews with caregivers of people using home nursing services were carried out in northern, central and southern Taiwan. Content analysis was carried out and a pool of questionnaire items compiled. In the second year (2007), study was carried out on a stratified random sample selected from home nursing organizations covered by the national health insurance scheme in southern Taiwan. The study population was the co-resident primary caregivers of home care nursing service users. Item analysis and exploratory factor analysis were carried out on data from 365 self-administered questionnaires collected from 13 selected home care organizations. In the third year (2008), a random sample of participants was selected from 206 hospital-based home care nursing organizations throughout Taiwan, resulting in completion of 294 questionnaires from 27 organizations. Confirmatory factor analysis was then carried out on the scale, and the validity and reliability of the scale assessed. The present study developed a reliable and valid home nursing quality scale from the perspective of users of home nursing services. The scale comprised three factors: dependability, communication skills and service usefulness. This scale is of practical value for the promotion of long-term community care aging in local policies. The scale is ready to be used to assess the quality of services provided by home care nursing organizations. © 2015 Japan Geriatrics Society.

Care management and nursing governance in a maternity ward: grounded theory.

PubMed

Copelli, Fernanda Hannah da Silva; Oliveira, Roberta Juliane Tono de; Santos, José Luís Guedes Dos; Magalhães, Aline Lima Pestana; Gregório, Vitória Regina Petters; Erdmann, Alacoque Lorenzini

2017-01-01

To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward. Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding. The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care. Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards.

Health information needs of professional nurses required at the point of care.

PubMed

Ricks, Esmeralda; ten Ham, Wilma

2015-06-11

Professional nurses work in dynamic environments and need to keep up to date with relevant information for practice in nursing to render quality patient care. Keeping up to date with current information is often challenging because of heavy workload, diverse information needs and the accessibility of the required information at the point of care. The aim of the study was to explore and describe the information needs of professional nurses at the point of care in order to make recommendations to stakeholders to develop a mobile library accessible by means of smart phones when needed. The researcher utilised a quantitative, descriptive survey design to conduct this study. The target population comprised 757 professional nurses employed at a state hospital. Simple random sampling was used to select a sample of the wards, units and departments for inclusion in the study. A convenience sample of 250 participants was selected. Two hundred and fifty structured self-administered questionnaires were distributed amongst the participants. Descriptive statistics were used to analyse the data. A total of 136 completed questionnaires were returned. The findings highlighted the types and accessible sources of information. Information needs of professional nurses were identified such as: extremely drug-resistant tuberculosis, multi-drug-resistant tuberculosis, HIV, antiretrovirals and all chronic lifestyle diseases. This study has enabled the researcher to identify the information needs required by professional nurses at the point of care to enhance the delivery of patient care. The research results were used to develop a mobile library that could be accessed by professional nurses.

Emotional Intelligence in Applicant Selection for Care-Related Academic Programs

ERIC Educational Resources Information Center

Zysberg, Leehu; Levy, Anat; Zisberg, Anna

2011-01-01

Two studies describe the development of the Audiovisual Test of Emotional Intelligence (AVEI), aimed at candidate selection in educational settings. Study I depicts the construction of the test and the preliminary examination of its psychometric properties in a sample of 92 college students. Item analysis allowed the modification of problem items,…

Effect of patient selection method on provider group performance estimates.

PubMed

Thorpe, Carolyn T; Flood, Grace E; Kraft, Sally A; Everett, Christine M; Smith, Maureen A

2011-08-01

Performance measurement at the provider group level is increasingly advocated, but different methods for selecting patients when calculating provider group performance have received little evaluation. We compared 2 currently used methods according to characteristics of the patients selected and impact on performance estimates. We analyzed Medicare claims data for fee-for-service beneficiaries with diabetes ever seen at an academic multispeciality physician group in 2003 to 2004. We examined sample size, sociodemographics, clinical characteristics, and receipt of recommended diabetes monitoring in 2004 for the groups of patients selected using 2 methods implemented in large-scale performance initiatives: the Plurality Provider Algorithm and the Diabetes Care Home method. We examined differences among discordantly assigned patients to determine evidence for differential selection regarding these measures. Fewer patients were selected under the Diabetes Care Home method (n=3558) than the Plurality Provider Algorithm (n=4859). Compared with the Plurality Provider Algorithm, the Diabetes Care Home method preferentially selected patients who were female, not entitled because of disability, older, more likely to have hypertension, and less likely to have kidney disease and peripheral vascular disease, and had lower levels of predicted utilization. Diabetes performance was higher under Diabetes Care Home method, with 67% versus 58% receiving >1 A1c tests, 70% versus 65% receiving ≥1 low-density lipoprotein (LDL) test, and 38% versus 37% receiving an eye examination. The method used to select patients when calculating provider group performance may affect patient case mix and estimated performance levels, and warrants careful consideration when comparing performance estimates.

Nursing Home Quality, Cost, Staffing, and Staff Mix

ERIC Educational Resources Information Center

Rantz, Marilyn J.; Hicks, Lanis; Grando, Victoria; Petroski, Gregory F.; Madsen, Richard W.; Mehr, David R.; Conn, Vicki; Zwygart-Staffacher, Mary; Scott, Jill; Flesner, Marcia; Bostick, Jane; Porter, Rose; Maas, Meridean

2004-01-01

Purpose: The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. Design and Methods: A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing…

Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial.

PubMed

Orozco-Beltran, Domingo; Ruescas-Escolano, Esther; Navarro-Palazón, Ana Isabel; Cordero, Alberto; Gaubert-Tortosa, María; Navarro-Perez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Nuñez-Martinez, Miguel Angel; Bertomeu-Martinez, Vicente; Gil-Guillen, Vicente Francisco

2013-08-02

To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. Experimental study. Randomized clinical trial. Follow-up period: one year. primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations. NCT01826929.

Pharmacist intervention in patient selection of nonprescription and self-care products.

PubMed

Schimmelfing, John Taylor; Brookhart, Andrea L; Fountain, K Michele Brown; Goode, Jean-Venable Kelly R

To evaluate the potential outcomes of pharmacist intervention on patient selection of nonprescription and self-care products and to evaluate patient confidence and satisfaction with the assistance of the pharmacist. A prospective, convenience sample study was conducted at 3 locations of a national supermarket chain pharmacy in the Charlottesville, Virginia, area over 4 months. Patients were recruited for the study if they approached the pharmacy counter and requested assistance with nonprescription and self-care product selection or if the investigating pharmacists approached the patient in the self-care aisles. Men and nonpregnant women age 18 years and older were included in the study. Patients self-selected into the study by agreeing to participate in the study intervention and answering questions relating to their experience with the pharmacist consultation. The study intervention was the pharmacist consultation with the patient to assess the self-care complaint and to make an appropriate recommendation. Forty-two patients participated, the mean (±SD) age was 57 ± 20.8 years, and 62% of patients were female. Sixty percent of patients had used pharmacist help in the past in selecting nonprescription and self-care products. There were 87 total potential outcomes, and a mean of 2.1 potential outcomes per patient. The most potential common outcomes were reduced drug cost, avoided physician visit, corrected product use, and avoided a new prescription. Mean patient confidence (±SD) was 4.38 ± 0.96. Mean patient satisfaction was 4.98. Every patient (100%) stated that they would be more willing to ask for pharmacist help in the future with self-care product selection. The mean encounter time was 6 minutes. Pharmacists' active involvement in patient self-care consultation may help patients to select the most effective and safe product and improve patient outcomes. Patients are highly satisfied with pharmacists' help with the selection of nonprescription and self-care products and are more confident with future self-treatment. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol.

PubMed

Vázquez, María-Luisa; Vargas, Ingrid; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Albuquerque, Paulette; Eguiguren, Pamela; Cisneros, Angelica Ivonne; Rovere, Mario; Bertolotto, Fernando

2015-07-31

Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected--intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. This study complies with international and national legal stipulations on ethics. Conditions of the study procedure were approved by each country's ethical committee. A variety of dissemination activities are implemented addressing the main stakeholders. Registration No.257 Clinical Research Register of the Santa Fe Health Department, Argentina. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non-responders.

PubMed

Legerstee, Jeroen S; Tulen, Joke H M; Dierckx, Bram; Treffers, Philip D A; Verhulst, Frank C; Utens, Elisabeth M W J

2010-02-01

This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific components in a large clinical sample of anxiety-disordered children. Ninety-one children with an anxiety disorder were included in the present study. Children received a standardized stepped-care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child-focused CBT), secondary responders (anxiety disorder free after phase two: child-parent-focused CBT), and treatment non-responders. Treatment response was determined using a semi-structured clinical interview. Children performed a pictorial dot-probe task before and after stepped-care CBT (i.e., before phase one and after phase two CBT). Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre-treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped-care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non-responders did not show any changes in selective attention due to CBT. Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non-responders did not show any changes in selective attention. The pictorial dot-probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT.

CBT for Childhood Anxiety Disorders: Differential Changes in Selective Attention between Treatment Responders and Non-Responders

ERIC Educational Resources Information Center

Legerstee, Jeroen S.; Tulen, Joke H. M.; Dierckx, Bram; Treffers, Philip D. A.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.

2010-01-01

Background: This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific components in a large clinical sample of anxiety-disordered children. Methods: Ninety-one children with an anxiety disorder were included in the present…

Recruitment and Selection Strategies in Optometric Education towards Addressing Human Resource Disparities in Sub-Saharan Africa

ERIC Educational Resources Information Center

Moodley, V. R.; Loughman, James; Naidoo, K. S.

2015-01-01

The dire need for eye care services and a dearth of human resources (HR) in sub-Saharan Africa motivated the setting up of new optometry programmes. However, to make a meaningful impact, geographical, gender, economic and educational disparities must additionally be addressed. A qualitative study utilizing purposive sampling to select academic…

Kinship and Nonrelative Foster Care: The Effect of Placement Type on Child Well-Being

ERIC Educational Resources Information Center

Font, Sarah A.

2014-01-01

This study uses a national sample of 1,215 children, ages 6-17, who spent some time in formal kinship or nonrelative foster care to identify the effect of placement type on academic achievement, behavior, and health. Several identification strategies are used to reduce selection bias, including ordinary least squares, change score models,…

[Combining speech sample and feature bilateral selection algorithm for classification of Parkinson's disease].

PubMed

Zhang, Xiaoheng; Wang, Lirui; Cao, Yao; Wang, Pin; Zhang, Cheng; Yang, Liuyang; Li, Yongming; Zhang, Yanling; Cheng, Oumei

2018-02-01

Diagnosis of Parkinson's disease (PD) based on speech data has been proved to be an effective way in recent years. However, current researches just care about the feature extraction and classifier design, and do not consider the instance selection. Former research by authors showed that the instance selection can lead to improvement on classification accuracy. However, no attention is paid on the relationship between speech sample and feature until now. Therefore, a new diagnosis algorithm of PD is proposed in this paper by simultaneously selecting speech sample and feature based on relevant feature weighting algorithm and multiple kernel method, so as to find their synergy effects, thereby improving classification accuracy. Experimental results showed that this proposed algorithm obtained apparent improvement on classification accuracy. It can obtain mean classification accuracy of 82.5%, which was 30.5% higher than the relevant algorithm. Besides, the proposed algorithm detected the synergy effects of speech sample and feature, which is valuable for speech marker extraction.

Abstracting ICU Nursing Care Quality Data From the Electronic Health Record.

PubMed

Seaman, Jennifer B; Evans, Anna C; Sciulli, Andrea M; Barnato, Amber E; Sereika, Susan M; Happ, Mary Beth

2017-09-01

The electronic health record is a potentially rich source of data for clinical research in the intensive care unit setting. We describe the iterative, multi-step process used to develop and test a data abstraction tool, used for collection of nursing care quality indicators from the electronic health record, for a pragmatic trial. We computed Cohen's kappa coefficient (κ) to assess interrater agreement or reliability of data abstracted using preliminary and finalized tools. In assessing the reliability of study data ( n = 1,440 cases) using the finalized tool, 108 randomly selected cases (10% of first half sample; 5% of last half sample) were independently abstracted by a second rater. We demonstrated mean κ values ranging from 0.61 to 0.99 for all indicators. Nursing care quality data can be accurately and reliably abstracted from the electronic health records of intensive care unit patients using a well-developed data collection tool and detailed training.

The ties that bind: interorganizational linkages and physician-system alignment.

PubMed

Alexander, J A; Waters, T M; Burns, L R; Shortell, S M; Gillies, R R; Budetti, P P; Zuckerman, H S

2001-07-01

To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of interorganizational linkages were specified at the institutional, administrative, and technical core levels of the physician group and were developed from surveys sent to the administrator of each of the 61 physician groups in the sample. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively. After accounting for sample selection, fixed effects, and group and individual controls, physicians in groups with more valued practice service linkages display consistently higher alignment with systems than physicians in groups that have fewer such linkages. Results also suggest that centralized administrative control lowers physician-system alignment for selected measures of alignment. Governance interlocks exhibited only weak associations with alignment. Our findings suggest that alignment generally follows resource exchanges that promote value-added contributions to physicians and physician groups while preserving control and authority within the group.

E-mental health care among young adults and help-seeking behaviors: a transversal study in a community sample.

PubMed

Younes, Nadia; Chollet, Aude; Menard, Estelle; Melchior, Maria

2015-05-15

The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen's behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents' income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03). E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care.

Design and Weighting Methods for a Nationally Representative Sample of HIV-infected Adults Receiving Medical Care in the United States-Medical Monitoring Project

PubMed Central

Iachan, Ronaldo; H. Johnson, Christopher; L. Harding, Richard; Kyle, Tonja; Saavedra, Pedro; L. Frazier, Emma; Beer, Linda; L. Mattson, Christine; Skarbinski, Jacek

2016-01-01

Background: Health surveys of the general US population are inadequate for monitoring human immunodeficiency virus (HIV) infection because the relatively low prevalence of the disease (<0.5%) leads to small subpopulation sample sizes. Objective: To collect a nationally and locally representative probability sample of HIV-infected adults receiving medical care to monitor clinical and behavioral outcomes, supplementing the data in the National HIV Surveillance System. This paper describes the sample design and weighting methods for the Medical Monitoring Project (MMP) and provides estimates of the size and characteristics of this population. Methods: To develop a method for obtaining valid, representative estimates of the in-care population, we implemented a cross-sectional, three-stage design that sampled 23 jurisdictions, then 691 facilities, then 9,344 HIV patients receiving medical care, using probability-proportional-to-size methods. The data weighting process followed standard methods, accounting for the probabilities of selection at each stage and adjusting for nonresponse and multiplicity. Nonresponse adjustments accounted for differing response at both facility and patient levels. Multiplicity adjustments accounted for visits to more than one HIV care facility. Results: MMP used a multistage stratified probability sampling design that was approximately self-weighting in each of the 23 project areas and nationally. The probability sample represents the estimated 421,186 HIV-infected adults receiving medical care during January through April 2009. Methods were efficient (i.e., induced small, unequal weighting effects and small standard errors for a range of weighted estimates). Conclusion: The information collected through MMP allows monitoring trends in clinical and behavioral outcomes and informs resource allocation for treatment and prevention activities. PMID:27651851

Self-care resources and activity as predictors of quality of life in persons after myocardial infarction.

PubMed

Baas, Linda S

2004-01-01

An ex post facto correlational study was conducted to examine predictors of quality of life in persons 3 to 6 months after a myocardial infarction. Self-care resources, self-care knowledge (needs), activity level, and selected demographic variables were examined as predictor variables. A convenience sample of 86 subjects with a mean age of 61 years, was recruited for participation in this study. The study that explained 35% of the variance in quality of life included self-care resources available, activity level, and self-care needs. Modeling and Role Modeling Paradigm provided a useful explanation of how self-care resources and self-care knowledge can be applied to persons recovering from myocardial infarction.

Implementation of Duchenne Muscular Dystrophy Care Considerations.

PubMed

Andrews, Jennifer G; Conway, Kristin; Westfield, Christina; Trout, Christina; Meaney, F John; Mathews, Katherine; Ciafaloni, Emma; Cunniff, Christopher; Fox, Deborah J; Matthews, Dennis; Pandya, Shree

2018-06-20

Duchenne muscular dystrophy (DMD) is an X-linked disorder characterized by progressive muscle weakness and multisystem involvement. Recent advances in management of individuals with DMD have prolonged survival. Lack of standardized care spurred an international collaboration to develop consensus-based care considerations for diagnosis and management. In this study, we evaluate adherence to considerations at selected sites. We collaborated with the Muscular Dystrophy Surveillance, Tracking, and Research Network. Our sample included males with DMD and Becker muscular dystrophy <21 years as of December 31, 2010, with 1 health care encounter on or after January 1, 2012. We collected data from medical records on encounters occurring January 1, 2012, through December 31, 2014. Adherence was determined when frequency of visits or assessments were at or above recommendations for selected care considerations. Our analytic sample included 299 individuals, 7% of whom (20/299) were classified as childhood-onset Becker muscular dystrophy. Adherence for neuromuscular and respiratory clinician visits was 65% for the cohort; neuromuscular assessments and corticosteroid side effect monitoring measures ranged from 16% to 68%. Adherence was 83% for forced vital capacity and ≤58% for other respiratory diagnostics. Cardiologist assessments and echocardiograms were found for at least 84%. Transition planning for education or health care was documented for 31% of eligible males. Medical records data were used to identify areas in which practice aligns with the care considerations. However, there remains inconsistency across domains and insufficiency in critical areas. More research is needed to explain this variability and identify reliable methods to measure outcomes. Copyright © 2018 by the American Academy of Pediatrics.

Determination of hazardous ingredients in personal care products using laser-induced breakdown spectroscopy

NASA Astrophysics Data System (ADS)

Abrar, M.; Iqbal, T.; Fahad, M.; Andleeb, M.; Farooq, Z.; Afsheen, S.

2018-05-01

In the present work, the laser-induced breakdown spectroscopy technique is applied to explore the concentration of toxic elements present in cosmetic materials. The elemental analysis of chromium (Cr), magnesium (Mg), cadmium (Cd) and lead (Pb) are selected as major elements and manganese (Mn), sodium (Na), potassium (P), sulfur (S), silicon (Si) and titanium (Ti) as minor elements in cosmetic products. In this technique, a plasma plume is generated by using an Nd:YAG Laser of 532 nm wavelength and spectral lines for the respective samples are observed. Four different samples of cosmetic products are selected, i.e. two samples for lipstick and two for eyeshadow. The observed spectral lines of all major and minor elements are used to calculate their concentration in all samples through the intensity ratio method. Among selected lipstick and eyeshadow samples, one sample is branded, and one is collected from the local market. It is observed that chromium, magnesium and lead have strong spectral lines and consequently show high concentration. The calculated concentrations are then compared to permissible limits set by the Food and Drug Administration with regard to the cosmetics industry. The concentration of these toxic elements in selected local cosmetic samples exceeds the safe permissible limit for human use and could lead to serious health problems.

Staff satisfaction and its components in residential aged care.

PubMed

Chou, Shu-Chiung; Boldy, Duncan P; Lee, Andy H

2002-06-01

The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care. A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components. Seventy residential aged care facilities in Western Australia. The sample includes 610 nursing home and 373 hostel care staff. The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction. The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.

[Perceptions about continuous training of Chilean health care teachers].

PubMed

Pérez V, Cristhian; Fasce H, Eduardo; Coloma N, Katherine; Vaccarezza G, Giulietta; Ortega B, Javiera

2013-06-01

Continuous training of teachers, in discipline and pedagogical topics, is a key step to improve the quality of educational processes. To report the perception of Chilean teachers of undergraduate health care programs, about continuous training activities. Twenty teachers working at different undergraduate health care programs in Chile were interviewed. Maximum variation and theoretical sampling methods were used to select the sample. Data was analyzed by open coding, according to the Grounded Theory guidelines. Nine categories emerged from data analysis: Access to continuous training, meaning of training in discipline, activities of continuous training in discipline, meaning of continuous training in pedagogy, kinds of continuous training in pedagogy, quality of continuous training in pedagogy, ideal of continuous training in pedagogy, outcomes of continuous training in pedagogy and needs for continuous training in pedagogy. Teachers of health care programs prefer to participate in contextualized training activities. Also, they emphasize their need of training in evaluation and teaching strategies.

Financial Care for Older Adults With Dementia.

PubMed

Pan, Xi; Lee, Yeonjung; Dye, Cheryl; Roley, Laurie Theriot

2017-06-01

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding.

PubMed

Duysburgh, E; Zhang, W-H; Ye, M; Williams, A; Massawe, S; Sié, A; Williams, J; Mpembeni, R; Loukanova, S; Temmerman, M

2013-05-01

To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings. In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records. By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling and health education practices are poor; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are not used. Equipment required to provide assisted vaginal deliveries (vacuum extractor or forceps) was absent in all surveyed facilities. Quality of care in the three study sites can be improved with the available human resources and without major investments. This improvement could reduce maternal and neonatal mortality and morbidity. © 2013 Blackwell Publishing Ltd.

Features of effective medical knowledge resources to support point of care learning: a focus group study.

PubMed

Cook, David A; Sorensen, Kristi J; Hersh, William; Berger, Richard A; Wilkinson, John M

2013-01-01

Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to derive a model for an effective knowledge resource. We conducted 11 focus groups at an academic medical center and outlying community sites. We included a purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians. We transcribed focus group discussions and analyzed these using a constant comparative approach to inductively identify features that influence the selection of knowledge resources. We identified nine features that influence users' selection of knowledge resources, namely efficiency (with sub-features of comprehensiveness, searchability, and brevity), integration with clinical workflow, credibility, user familiarity, capacity to identify a human expert, reflection of local care processes, optimization for the clinical question (e.g., diagnosis, treatment options, drug side effect), currency, and ability to support patient education. No single existing resource exemplifies all of these features. The influential features identified in this study will inform the development of knowledge resources, and could serve as a framework for future research in this field.

Features of Effective Medical Knowledge Resources to Support Point of Care Learning: A Focus Group Study

PubMed Central

Cook, David A.; Sorensen, Kristi J.; Hersh, William; Berger, Richard A.; Wilkinson, John M.

2013-01-01

Objective Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to derive a model for an effective knowledge resource. Methods We conducted 11 focus groups at an academic medical center and outlying community sites. We included a purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians. We transcribed focus group discussions and analyzed these using a constant comparative approach to inductively identify features that influence the selection of knowledge resources. Results We identified nine features that influence users' selection of knowledge resources, namely efficiency (with sub-features of comprehensiveness, searchability, and brevity), integration with clinical workflow, credibility, user familiarity, capacity to identify a human expert, reflection of local care processes, optimization for the clinical question (e.g., diagnosis, treatment options, drug side effect), currency, and ability to support patient education. No single existing resource exemplifies all of these features. Conclusion The influential features identified in this study will inform the development of knowledge resources, and could serve as a framework for future research in this field. PMID:24282535

Materials and manufacturing processes for increased life/reliability. [of turbine wheels

NASA Technical Reports Server (NTRS)

Duttweiler, R. E.

1977-01-01

Improvements in both quality and durability of disk raw material for both military and commercial engines necessitated an entirely new concept in raw material process control which imposes careful selection, screening and sampling of the basic alloy ingredients, followed by careful monitoring of the melting parameters in all phases of the vacuum melting sequence. Special care is taken to preclude solidification conditions that produce adverse levels of segregation. Melt furnaces are routinely cleaned and inspected for contamination. Ingots are also cleaned and inspected before entering the final melt step.

Basic need status and health-promoting self-care behavior in adults.

PubMed

Acton, G J; Malathum, P

2000-11-01

Health-promoting self-care behavior emphasizing positive lifestyle practices may improve the health and quality of life of adults. One variable that may influence health-related decisions is the status of basic needs as described by Maslow. The purpose of this study was to investigate the relationships among basic need satisfaction, health-promoting self-care behavior, and selected demographic variables in a sample of community-dwelling adults. A convenience sample of 84 community-dwelling adults was recruited to complete the Basic Need Satisfaction Inventory, the Health-Promoting Lifestyle Profile II, and demographic information. Results of the study indicated that self-actualization, physical, and love/belonging need satisfaction accounted for 64% of the variance in health-promoting self-care behavior. The findings of this study are consistent with Maslow's theory of human motivation and suggest that persons who are more fulfilled and content with themselves and their lives, have physical need satisfaction, and have positive connections with others may be able to make better decisions regarding positive health-promoting self-care behaviors.

Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

PubMed Central

Ellis, Randall P.; Fernandez, Juan Gabriel

2013-01-01

Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

Experiencing cancer treatment decision-making in managed care.

PubMed

Wenzel, Jennifer; Shaha, Maya

2008-09-01

This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support.

Herschel-ATLAS: The Angular Correlation Function of Submillimetre Galaxies at High and Low Redshift

NASA Technical Reports Server (NTRS)

Maddox, S. J.; Dunne, L.; Rigby, E.; Eales, S.; Cooray, A.; Scott, D.; Peacock, J. A.; Negrello, M.; Smith, D. J. B.; Benford, D.;

Care demands on mothers caring for a child with Down syndrome: Malaysian (Sarawak) mothers' perspectives.

PubMed

Chan, Kim Geok; Lim, Khatijah Abdullah; Ling, How Kee

2015-10-01

This paper examines the experiences of mothers caring for a child with Down syndrome in the Malaysian (Sarawak) context. Qualitative interviews were conducted with 26 biological mothers of children with Down syndrome aged 18 years and below. They were accessed through selected child health clinics, community-based rehabilitation centres and schools using purposive sampling within two regions in Sarawak, one of the two Borneo States of Malaysia. Major themes emerging within the context of care demands were children's health, developmental delays, daily needs and behaviour issues. The insights obtained into the care demands experienced by mothers of children with Down syndrome have several implications for practice by care professionals. © 2014 Wiley Publishing Asia Pty Ltd.

Individual care plans for chronically ill patients within primary care in the Netherlands: Dissemination and associations with patient characteristics and patient-perceived quality of care.

PubMed

Jansen, Daphne L; Heijmans, Monique; Rijken, Mieke

2015-06-01

To examine the use of individual care plans (ICPs) within primary chronic illness care in the Netherlands, and to explore the relationships between ICP use, patient characteristics, and patient-perceived quality of care. Cross-sectional study using survey data from a panel of chronically ill patients and medical registration data provided by their general practices. A sample of 1377 patients with somatic chronic disease(s) randomly selected in general practices throughout the Netherlands, supplemented with a sample of 225 COPD patients, also recruited from general practices. (i) Percentage of ICP use based on self-report by chronically ill patients, and (ii) patient-perceived quality of care as assessed using the Patient Assessment of Chronic Illness Care (PACIC). ICP use among the total generic sample was low (9%), but slightly higher (13%) among patients diagnosed with diabetes or COPD, diseases for which disease management programmes have been set up in the Netherlands. Patients with a low educational level and patients with poor(er) self-rated health were more likely to have an ICP. Compared with patients without an ICP, patients with an ICP more often reported that the care they received was patient-centred, proactive, planned, and included collaborative goal setting, problem-solving, and follow-up support. Findings reveal a discrepancy between practice and policy aspirations regarding ICP use in primary chronic illness care. More research is needed to gain insight into the effectiveness of ICPs to improve the quality of chronic illness care in various patient populations.

Teacher Education, Motivation, Compensation, Workplace Support, and Links to Quality of Center-Based Child Care and Teachers' Intention to Stay in the Early Childhood Profession

ERIC Educational Resources Information Center

Torquati, Julia C.; Raikes, Helen; Huddleston-Casas, Catherine A.

2007-01-01

The purposes of this study were to present a conceptual model for selection into the early childhood profession and to test the model using contemporaneous assessments. A stratified random sample of center-based child care providers in 4 Midwestern states (n=964) participated in a telephone interview, and 223 were also assessed with the Early…

Chemistry and haematology sample rejection and clinical impact in a tertiary laboratory in Cape Town.

PubMed

Jacobsz, Lourens A; Zemlin, Annalise E; Roos, Mark J; Erasmus, Rajiv T

2011-10-14

Recent publications report that up to 70% of total laboratory errors occur in the pre-analytical phase. Identification of specific problems highlights pre-analytic processes susceptible to errors. The rejection of unsuitable samples can lead to delayed turnaround time and affect patient care. A retrospective audit was conducted investigating the rejection rate of routine blood specimens received at chemistry and haematology laboratories over a 2-week period. The reasons for rejection and potential clinical impact of these rejections were investigated. Thirty patient files were randomly selected and examined to assess the impact of these rejections on clinical care. A total of 32,910 specimens were received during the study period, of which 481 were rejected, giving a rejection rate of 1.46%. The main reasons for rejection were inappropriate clotting (30%) and inadequate sample volume (22%). Only 51.7% of rejected samples were repeated and the average time for a repeat sample to reach the laboratory was about 5 days (121 h). Of the repeated samples, 5.1% had results within critical values. Examination of patient folders showed that in 40% of cases the rejection of samples had an impact on patient care. The evaluation of pre-analytical processes in the laboratory, with regard to sample rejection, allowed one to identify problem areas where improvement is necessary. Rejected samples due to factors out of the laboratory's control had a definite impact on patient care and can thus affect customer satisfaction. Clinicians should be aware of these factors to prevent such rejections.

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system.

PubMed

Rehem, Tania Cristina Morais Santa Barbara; de Oliveira, Maria Regina Fernandes; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

2013-01-01

To estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. The hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. The sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH) was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. There are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

[Gender violence prevalence in female users of health services in Mexico].

PubMed

Olaiz, Gustavo; Rojas, Rosalba; Valdez, Rosario; Franco, Aurora; Palma, Oswaldo

2006-01-01

To identify the prevalence of violence against females among those who are health service beneficiaries in Mexico. The National Survey on Violence against Women (ENVIM, per its Spanish abbreviation) was applied in 2003 to female users of public primary and secondary health care services. The sampling framework was based on a stratified, probabilistic sample in two stages. First the health care units were selected with probability proportional to the number of physicians' offices in the unit, from a list of possible care units. Second, women 15 years and older who sought care at the health care unit were selected for participation in the study through systematic sampling. Univariate analysis and then bivariate analysis were carried out on the data collected with a questionnaire. The sample included 26 042 women between 15 and 92 years of age, with a mean age of 35.8 years. Physical violence during childhood was reported by 42% of the women. Only 7.8% answered yes to a general question about whether they experienced domestic partner violence, but 21.5% reported experiencing violence of any type during the last 12 months as measured by a scale including specific acts of psychological, economic, physical and sexual violence. The most frequently reported type of violence was psychological (19.6%). Of the women who had been pregnant, 14.1% reported having experienced violence during pregnancy, and 4.4% reported being hit in the abdomen. The prevalence of sexual violence was 17.3% and close to half reported being victims of this type of violence before age 15. Higher prevalence of violence was found among women with lower levels of formal education, living in a rented home, in areas with higher overcrowding indices, and users of Ministry of Health care services. Identifying and measuring violence is complex, given the diverse types of violence and how they are perceived and therefore reported by women themselves. This is an important public health problem, in view of the high frequency observed in this study and the immediate implications. These findings indicate the urgent need for interventions to prevent and treat violence.

Inviting parents to take part in paediatric palliative care research: a mixed-methods examination of selection bias.

PubMed

Crocker, Joanna C; Beecham, Emma; Kelly, Paula; Dinsdale, Andrew P; Hemsley, June; Jones, Louise; Bluebond-Langner, Myra

2015-03-01

Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents' experiences of advance care planning (ACP). We examined differences between eligible families invited and not invited to participate by clinicians using (1) field notes of discussions with clinicians during the invitation phase and (2) anonymised information from the service's clinical database. Families were eligible for the ACP study if their child was receiving care from a UK-based tertiary palliative care service (Group A; N = 519) or had died 6-10 months previously having received care from the service (Group B; N = 73). Rates of non-invitation to the ACP study were high. A total of 28 (5.4%) Group A families and 21 (28.8%) Group B families (p < 0.0005) were invited. Family-clinician relationship appeared to be a key factor associated qualitatively with invitation in both groups. In Group A, out-of-hours contact with family was statistically associated with invitation (adjusted odds ratio 5.46 (95% confidence interval 2.13-14.00); p < 0.0005). Qualitative findings also indicated that clinicians' perceptions of families' wellbeing, circumstances, characteristics, engagement with clinicians and anticipated reaction to invitation influenced invitation. We found evidence of selective invitation practices that could bias research findings. Non-invitation and selection bias should be considered, assessed and reported in palliative care studies. © The Author(s) 2014.

Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

PubMed Central

Viste, Kristin; Grytaas, Marianne A; Jørstad, Melissa D; Jøssang, Dag E; Høyden, Eivind N; Fotland, Solveig S; Jensen, Dag K; Løvås, Kristian; Thordarson, Hrafnkell; Almås, Bjørg; Mellgren, Gunnar

2013-01-01

Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment. PMID:24169597

The Local Universe as Seen in the Far-Infrared and Far-Ultraviolet: A Global Point of View of the Local Recent Star Formation

NASA Astrophysics Data System (ADS)

Buat, V.; Takeuchi, T. T.; Iglesias-Páramo, J.; Xu, C. K.; Burgarella, D.; Boselli, A.; Barlow, T.; Bianchi, L.; Donas, J.; Forster, K.; Friedman, P. G.; Heckman, T. M.; Lee, Y.-W.; Madore, B. F.; Martin, D. C.; Milliard, B.; Morissey, P.; Neff, S.; Rich, M.; Schiminovich, D.; Seibert, M.; Small, T.; Szalay, A. S.; Welsh, B.; Wyder, T.; Yi, S. K.

2007-12-01

We select far-infrared (FIR: 60 μm) and far-ultraviolet (FUV: 530 Å) samples of nearby galaxies in order to discuss the biases encountered by monochromatic surveys (FIR or FUV). Very different volumes are sampled by each selection, and much care is taken to apply volume corrections to all the analyses. The distributions of the bolometric luminosity of young stars are compared for both samples: they are found to be consistent with each other for galaxies of intermediate luminosities, but some differences are found for high (>5×1010 Lsolar) luminosities. The shallowness of the IRAS survey prevents us from securing a comparison at low luminosities (<2×109 Lsolar). The ratio of the total infrared (TIR) luminosity to the FUV luminosity is found to increase with the bolometric luminosity in a similar way for both samples up to 5×1010 Lsolar. Brighter galaxies are found to have a different behavior according to their selection: the LTIR/LFUV ratio of the FUV-selected galaxies brighter than 5×1010 Lsolar reaches a plateau, whereas LTIR/LFUV continues to increase with the luminosity of bright galaxies selected in FIR. The volume-averaged specific star formation rate (SFR per unit galaxy stellar mass, SSFR) is found to decrease toward massive galaxies within each selection. The mean values of the SSFR are found to be larger than those measured for optical and NIR-selected samples over the whole mass range for the FIR selection, and for masses larger than 1010 Msolar for the FUV selection. Luminous and massive galaxies selected in FIR appear as active as galaxies with similar characteristics detected at z~0.7.

Exposure to select phthalates and phenols through use of personal care products among Californian adults and their children.

PubMed

Philippat, Claire; Bennett, Deborah; Calafat, Antonia M; Picciotto, Irva Hertz

2015-07-01

Certain phenols and phthalates are used in many consumer products including personal care products (PCPs). We aimed to study the associations between the use of PCPs and urinary concentrations of biomarkers of select phenols and phthalates among Californian adults and their children. As an additional aim we compared phenols and phthalate metabolites concentrations measured in adults and children urine samples collected the same day. Our study relied on a subsample of 90 adult-child pairs participating in the Study of Use of Products and Exposure Related Behavior (SUPERB). Each adult and child provided one to two urine samples in which we measured concentrations of selected phenols and phthalate metabolites. We computed Spearman correlation coefficients to compare concentrations measured in adults and children urine samples collected the same day. We used adjusted linear and Tobit regression models to study the associations between the use of PCPs in the past 24h and biomarker concentrations. Benzophenone-3 and parabens concentrations were higher in adults compared to their children. Conversely children had higher mono-n-butyl phthalate and mono-isobutyl phthalate concentrations. No significant difference was observed for the other compounds. The total number of different PCPs used was positively associated with urinary concentrations of methyl, propyl and butyl parabens and the main metabolite of diethyl phthalate in adults. Among children, the use of a few specific products including liquid soap, hair care products and sunscreen was positively associated with urinary concentrations of some phenols or phthalate metabolites. These results strengthen the body of evidence suggesting that use of PCPs is an important source of exposure to parabens and diethyl phthalate in adults and provide data on exposure to selected phenols and phthalates through use of PCPs in children. Copyright © 2015 Elsevier Inc. All rights reserved.

Exposure to select phthalates and phenols through use of personal care products among Californian adults and their children

PubMed Central

Philippat, Claire; Bennett, Deborah; Calafat, Antonia M.; Picciotto, Irva Hertz

2016-01-01

Introduction Certain phenols and phthalates are used in many consumer products including personal care products (PCPs). Aims We aimed to study the associations between the use of PCPs and urinary concentrations of bio-markers of select phenols and phthalates among Californian adults and their children. As an additional aim we compared phenols and phthalate metabolites concentrations measured in adults and children urine samples collected the same day. Methods Our study relied on a subsample of 90 adult–child pairs participating in the Study of Use of Products and Exposure Related Behavior (SUPERB). Each adult and child provided one to two urine samples in which we measured concentrations of selected phenols and phthalate metabolites. We computed Spearman correlation coefficients to compare concentrations measured in adults and children urine samples collected the same day. We used adjusted linear and Tobit regression models to study the associations between the use of PCPs in the past 24 h and biomarker concentrations. Results Benzophenone-3 and parabens concentrations were higher in adults compared to their children. Conversely children had higher mono-n-butyl phthalate and mono-isobutyl phthalate concentrations. No significant difference was observed for the other compounds. The total number of different PCPs used was positively associated with urinary concentrations of methyl, propyl and butyl parabens and the main metabolite of diethyl phthalate in adults. Among children, the use of a few specific products including liquid soap, hair care products and sunscreen was positively associated with urinary concentrations of some phenols or phthalate metabolites. Discussion These results strengthen the body of evidence suggesting that use of PCPs is an important source of exposure to parabens and diethyl phthalate in adults and provide data on exposure to selected phenols and phthalates through use of PCPs in children. PMID:25929801

Brazilian immigrants' oral health literacy and participation in oral health care in Canada.

PubMed

Calvasina, Paola; Lawrence, Herenia P; Hoffman-Goetz, Laurie; Norman, Cameron D

2016-02-15

Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logistic regression modeling. Most of the sample had adequate OHL (83.1 %). Inadequate/marginal OHL was associated with not visiting a dentist in the preceding year (OR = 3.61; p = 0.04), not having a dentist as the primary source of dental information (OR = 5.55; p < 0.01), and not participating in shared dental treatment decision making (OR = 1.06; p = 0.05; OHL as a continuous variable) in multivariate logistic regressions controlling for covariates. A low average annual family income was associated with two indicators of poor participation in oral health care (i.e., not having visited a dentist in the previous year, and not having a dentist as regular source of dental information). Limited OHL was linked to lower participation in the oral health care system and with barriers to using dental services among a sample of Brazilian immigrants. More effective knowledge transfer will be required to help specific groups of immigrants to better navigate the Canadian dental care system.

Sample treatments prior to capillary electrophoresis-mass spectrometry.

PubMed

Hernández-Borges, Javier; Borges-Miquel, Teresa M; Rodríguez-Delgado, Miguel Angel; Cifuentes, Alejandro

2007-06-15

Sample preparation is a crucial part of chemical analysis and in most cases can become the bottleneck of the whole analytical process. Its adequacy is a key factor in determining the success of the analysis and, therefore, careful selection and optimization of the parameters controlling sample treatment should be carried out. This work revises the different strategies that have been developed for sample preparation prior to capillary electrophoresis-mass spectrometry (CE-MS). Namely the present work presents an exhaustive and critical revision of the different samples treatments used together with on-line CE-MS including works published from January 2000 to July 2006.

Assessing quality of life in diabetes: I. A practical guide to selecting the best instruments and using them wisely.

PubMed

Fisher, Lawrence; Tang, Tricia; Polonsky, William

2017-04-01

The rapid development of new medications and devices in diabetes research and clinical care has led to an increased need to assess their impact on health-related quality of life (HRQOL). Unfortunately, the lack of consensus definitions and guidelines has led to the use of HRQOL measures that are often imprecise and inappropriate. The goal of this report is to provide a practical structure to the definition and measurement of HRQOL in diabetes research and clinical care. Following a brief historical background to provide context, we define HRQOL and provide a three-step framework for scale selection: identify the specific, proximal intervention targets; decide how reaching these targets will affect HRQOL; and select appropriate measures based on sample diversity, the intervention and the targets using a 2×2 grid (generic vs. diabetes specific measures; global vs. component measures). Practical tips for scale selection include: gaining patient input to document important potential HRQOL effects, varying scale selection by patient characteristics, considering common HRQOL measurement problems, and considering the timing of HRQOL assessment. We emphasize the importance of a careful, planned evaluation of HRQOL in diabetes, rather than an "off the shelf" approach. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Nursing care at night: an evaluation using the Night Nursing Care Instrument.

PubMed

Oléni, Magnus; Johansson, Peter; Fridlund, Bengt

2004-07-01

Night nurses carry overall nursing responsibility for approximately half the time that patients spend in hospital. However, there is a paucity of literature that focuses on nursing care provided at night. The aim of this study was to evaluate nursing care provided at night from the perspective of both nurses and patients. The study, which had an evaluative and a comparative design, was carried out using the Night Nursing Care Instrument at a hospital in southern Sweden. Nurses (n = 178) on night duty were consecutively selected, while the patients (n = 356) were selected by convenience sampling. The results showed a statistically significant difference between nurses' assessments and patients' perceptions of the nursing care provided at night in nursing interventions (P < 0.0001). In the areas of medical interventions and evaluation, no statistically significant differences were found between nurses and patients. For eight of 11 items, patients reported that they were satisfied (> or =80%) with the nursing care provided at night. These findings suggest that night nurses need to improve their ability to assess patients' needs for nursing care at night. A first step in this direction is for them to become aware of how patients perceive night nursing. As a second step, nurses need to increase their knowledge of which nursing actions promote patients' rest at night.

The impact of selection bias on vaccine effectiveness estimates from test-negative studies.

PubMed

Jackson, Michael L; Phillips, C Hallie; Benoit, Joyce; Kiniry, Erika; Madziwa, Lawrence; Nelson, Jennifer C; Jackson, Lisa A

2018-01-29

Estimates of vaccine effectiveness (VE) from test-negative studies may be subject to selection bias. In the context of influenza VE, we used simulations to identify situations in which meaningful selection bias can occur. We also analyzed observational study data for evidence of selection bias. For the simulation study, we defined a hypothetical population whose members are at risk for acute respiratory illness (ARI) due to influenza and other pathogens. An unmeasured "healthcare seeking proclivity" affects both probability of vaccination and probability of seeking care for an ARI. We varied the direction and magnitude of these effects and identified situations where meaningful bias occurred. For the observational study, we reanalyzed data from the United States Influenza VE Network, an ongoing test-negative study. We compared "bias-naïve" VE estimates to bias-adjusted estimates, which used data from the source populations to correct for sampling bias. In the simulation study, an unmeasured care-seeking proclivity could create selection bias if persons with influenza ARI were more (or less) likely to seek care than persons with non-influenza ARI. However, selection bias was only meaningful when rates of care seeking between influenza ARI and non-influenza ARI were very different. In the observational study, the bias-naïve VE estimate of 55% (95% CI, 47--62%) was trivially different from the bias-adjusted VE estimate of 57% (95% CI, 49--63%). In combination, these studies suggest that while selection bias is possible in test-negative VE studies, this bias in unlikely to be meaningful under conditions likely to be encountered in practice. Researchers and public health officials can continue to rely on VE estimates from test-negative studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Self-Adapting Focused Review System. Probability sampling of medical records to monitor utilization and quality of care.

PubMed

Ash, A; Schwartz, M; Payne, S M; Restuccia, J D

1990-11-01

Medical record review is increasing in importance as the need to identify and monitor utilization and quality of care problems grow. To conserve resources, reviews are usually performed on a subset of cases. If judgment is used to identify subgroups for review, this raises the following questions: How should subgroups be determined, particularly since the locus of problems can change over time? What standard of comparison should be used in interpreting rates of problems found in subgroups? How can population problem rates be estimated from observed subgroup rates? How can the bias be avoided that arises because reviewers know that selected cases are suspected of having problems? How can changes in problem rates over time be interpreted when evaluating intervention programs? Simple random sampling, an alternative to subgroup review, overcomes the problems implied by these questions but is inefficient. The Self-Adapting Focused Review System (SAFRS), introduced and described here, provides an adaptive approach to record selection that is based upon model-weighted probability sampling. It retains the desirable inferential properties of random sampling while allowing reviews to be concentrated on cases currently thought most likely to be problematic. Model development and evaluation are illustrated using hospital data to predict inappropriate admissions.

Systematic evaluation of matrix effects in hydrophilic interaction chromatography versus reversed phase liquid chromatography coupled to mass spectrometry.

PubMed

Periat, Aurélie; Kohler, Isabelle; Thomas, Aurélien; Nicoli, Raul; Boccard, Julien; Veuthey, Jean-Luc; Schappler, Julie; Guillarme, Davy

2016-03-25

Reversed phase liquid chromatography (RPLC) coupled to mass spectrometry (MS) is the gold standard technique in bioanalysis. However, hydrophilic interaction chromatography (HILIC) could represent a viable alternative to RPLC for the analysis of polar and/or ionizable compounds, as it often provides higher MS sensitivity and alternative selectivity. Nevertheless, this technique can be also prone to matrix effects (ME). ME are one of the major issues in quantitative LC-MS bioanalysis. To ensure acceptable method performance (i.e., trueness and precision), a careful evaluation and minimization of ME is required. In the present study, the incidence of ME in HILIC-MS/MS and RPLC-MS/MS was compared for plasma and urine samples using two representative sets of 38 pharmaceutical compounds and 40 doping agents, respectively. The optimal generic chromatographic conditions in terms of selectivity with respect to interfering compounds were established in both chromatographic modes by testing three different stationary phases in each mode with different mobile phase pH. A second step involved the assessment of ME in RPLC and HILIC under the best generic conditions, using the post-extraction addition method. Biological samples were prepared using two different sample pre-treatments, i.e., a non-selective sample clean-up procedure (protein precipitation and simple dilution for plasma and urine samples, respectively) and a selective sample preparation, i.e., solid phase extraction for both matrices. The non-selective pretreatments led to significantly less ME in RPLC vs. HILIC conditions regardless of the matrix. On the contrary, HILIC appeared as a valuable alternative to RPLC for plasma and urine samples treated by a selective sample preparation. Indeed, in the case of selective sample preparation, the compounds influenced by ME were different in HILIC and RPLC, and lower and similar ME occurrence was generally observed in RPLC vs. HILIC for urine and plasma samples, respectively. The complementary of both chromatographic modes was also demonstrated, as ME was observed only scarcely for urine and plasma samples when selecting the most appropriate chromatographic mode. Copyright © 2015 Elsevier B.V. All rights reserved.

Personality traits and career satisfaction of health care professionals.

PubMed

Richardson, John D; Lounsbury, John W; Bhaskar, Tripti; Gibson, Lucy W; Drost, Adam W

2009-01-01

Based on Holland's theorizing that vocational satisfaction arises from a good match between one's personality and career choice, one purpose of the study was to examine broad and narrow personality traits that characterize health care workers in comparison with professionals from other occupations. Also investigated were ways in which characteristic traits of health care workers were related to career satisfaction. Professionals utilizing the services of eCareerfit.com responded to online surveys that have been demonstrated to produce reliable and valid measures of broad and narrow personality traits and levels of career satisfaction. An independent sample t test was used to compare means of health care workers with those from other occupations. Pearson product-moment correlations were then computed to assess relationships between the traits and career satisfaction of health care professionals. Two traits that were particularly strong among health care workers were also significantly correlated with career satisfaction: work drive and conscientiousness. Other traits were found to be significantly related to career satisfaction in health care but were not uniquely high in the sample of health care professionals. To increase career satisfaction of health care professionals and thus to improve retention rates, administrators should consider focusing on recruiting and selecting individuals with higher levels of key personality traits.

Do men and women report their sexual partnerships differently? Evidence from Kisumu, Kenya.

PubMed

Clark, Shelley; Kabiru, Caroline; Zulu, Eliya

2011-12-01

It is generally believed that men and women misreport their sexual behaviors, which undermines the ability of researchers, program designers and health care providers to assess whether these behaviors compromise individuals' sexual and reproductive health. Data on 1,299 recent sexual partnerships were collected in a 2007 survey of 1,275 men and women aged 18-24 and living in Kisumu, Kenya. Chi-square and t tests were used to examine how sample selection bias and selective partnership reporting may result in gender differences in reported sexual behaviors. Correlation coefficients and kappa statistics were calculated in further analysis of a sample of 280 matched marital and nonmarital couples to assess agreement on reported behaviors. Even after adjustment for sample selection bias, men reported twice as many partnerships as women (0.5 vs. 0.2), as well as more casual partnerships. However, when selective reporting was controlled for, aggregate gender differences in sexual behaviors almost entirely disappeared. In the matched-couples sample, men and women exhibited moderate to substantial levels of agreement for most relationship characteristics and behaviors, including type of relationship, frequency of sex and condom use. Finally, men and women tended to agree about whether men had other nonmarital partners, but disagreed about women's nonmarital partners. Both sample selection bias and selective partnership reporting can influence the level of agreement between men's and women's reports of sexual behaviors. Although men report more casual partners than do women, accounts of sexual behavior within reported relationships are generally reliable.

The 'number needed to sample' in primary care research. Comparison of two primary care sampling frames for chronic back pain.

PubMed

Smith, Blair H; Hannaford, Philip C; Elliott, Alison M; Smith, W Cairns; Chambers, W Alastair

2005-04-01

Sampling for primary care research must strike a balance between efficiency and external validity. For most conditions, even a large population sample will yield a small number of cases, yet other sampling techniques risk problems with extrapolation of findings. To compare the efficiency and external validity of two sampling methods for both an intervention study and epidemiological research in primary care--a convenience sample and a general population sample--comparing the response and follow-up rates, the demographic and clinical characteristics of each sample, and calculating the 'number needed to sample' (NNS) for a hypothetical randomized controlled trial. In 1996, we selected two random samples of adults from 29 general practices in Grampian, for an epidemiological study of chronic pain. One sample of 4175 was identified by an electronic questionnaire that listed patients receiving regular analgesic prescriptions--the 'repeat prescription sample'. The other sample of 5036 was identified from all patients on practice lists--the 'general population sample'. Questionnaires, including demographic, pain and general health measures, were sent to all. A similar follow-up questionnaire was sent in 2000 to all those agreeing to participate in further research. We identified a potential group of subjects for a hypothetical trial in primary care based on a recently published trial (those aged 25-64, with severe chronic back pain, willing to participate in further research). The repeat prescription sample produced better response rates than the general sample overall (86% compared with 82%, P < 0.001), from both genders and from the oldest and youngest age groups. The NNS using convenience sampling was 10 for each member of the final potential trial sample, compared with 55 using general population sampling. There were important differences between the samples in age, marital and employment status, social class and educational level. However, among the potential trial sample, there were no demographic differences. Those from the repeat prescription sample had poorer indices than the general population sample in all pain and health measures. The repeat prescription sampling method was approximately five times more efficient than the general population method. However demographic and clinical differences in the repeat prescription sample might hamper extrapolation of findings to the general population, particularly in an epidemiological study, and demonstrate that simple comparison with age and gender of the target population is insufficient.

Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

PubMed

Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria; Bärnighausen, Till

2018-02-01

(1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Literature review, mathematical derivation, and Monte Carlo simulations. Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews. © 2016 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

Changes in selected biochemical indices resulting from various pre-sampling handling techniques in broilers.

PubMed

Chloupek, Petr; Bedanova, Iveta; Chloupek, Jan; Vecerek, Vladimir

2011-05-13

Since it is not yet clear whether it is possible to satisfactorily avoid sampling-induced stress interference in poultry, more studies on the pattern of physiological response and detailed quantification of stress connected with the first few minutes of capture and pre-sampling handling in poultry are required. This study focused on detection of changes in the corticosterone level and concentrations of other selected biochemical parameters in broilers handled in two different manners during blood sampling (involving catching, carrying, restraint, and blood collection itself) that lasted for various time periods within the interval 30-180 seconds. Stress effects of pre-sampling handling were studied in a group (n = 144) of unsexed ROSS 308 broiler chickens aged 42 d. Handling (catching, carrying, restraint, and blood sampling itself) was carried out in a gentle (caught, held and carried carefully in an upright position) or rough (caught by the leg, held and carried with lack of care in inverted position) manner and lasted for 30 s, 60 s, 90 s, 120 s, 150 s, and 180 s. Plasma corticosterone, albumin, glucose, cholesterol, lactate, triglycerides and total protein were measured in order to assess the stress-induced changes to these biochemical indices following handling in the first few minutes of capture. Pre-sampling handling in a rough manner resulted in considerably higher plasma concentrations of all biochemical indices monitored when compared with gentle handling. Concentrations of plasma corticosterone after 150 and 180 s of handling were considerably higher (P < 0.01) than concentrations after 30-120 s of handling regardless of handling technique. Concentrations of plasma lactate were also increased by prolonged handling duration. Handling for 90-180 seconds resulted in a highly significant elevation of lactate concentration in comparison with 30 s handling regardless of handling technique. Similarly to corticosterone concentrations, a strong positive correlation was found between plasma lactate and duration of pre-sampling handling. Other biochemical indices monitored did not show any correlation pattern in connection with duration of pre-sampling handling. These results indicate that the pre-sampling procedure may be a considerably stressful procedure for broilers, particularly when carried out with lack of care and exceeding 120 seconds.

Effects of financial disadvantage on use and non-use of after hours care in Australia.

PubMed

Kelaher, Margaret; Dunt, David; Day, Susan; Feldman, Peter

2006-11-01

Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.

Practical guidance on characterizing availability in resource selection functions under a use-availability design

USGS Publications Warehouse

Northrup, Joseph M.; Hooten, Mevin B.; Anderson, Charles R.; Wittemyer, George

2013-01-01

Habitat selection is a fundamental aspect of animal ecology, the understanding of which is critical to management and conservation. Global positioning system data from animals allow fine-scale assessments of habitat selection and typically are analyzed in a use-availability framework, whereby animal locations are contrasted with random locations (the availability sample). Although most use-availability methods are in fact spatial point process models, they often are fit using logistic regression. This framework offers numerous methodological challenges, for which the literature provides little guidance. Specifically, the size and spatial extent of the availability sample influences coefficient estimates potentially causing interpretational bias. We examined the influence of availability on statistical inference through simulations and analysis of serially correlated mule deer GPS data. Bias in estimates arose from incorrectly assessing and sampling the spatial extent of availability. Spatial autocorrelation in covariates, which is common for landscape characteristics, exacerbated the error in availability sampling leading to increased bias. These results have strong implications for habitat selection analyses using GPS data, which are increasingly prevalent in the literature. We recommend researchers assess the sensitivity of their results to their availability sample and, where bias is likely, take care with interpretations and use cross validation to assess robustness.

Assessment of indoor environment in Paris child day care centers.

PubMed

Roda, Célina; Barral, Sophie; Ravelomanantsoa, Hanitriniala; Dusséaux, Murielle; Tribout, Martin; Le Moullec, Yvon; Momas, Isabelle

2011-11-01

Children are sensitive to indoor environmental pollution. Up until now there has been a lack of data on air quality in child day care centers. The aim of this study is to document the indoor environment quality of Paris child day care centers by repeated measurements, and to compare pollutant levels in child day care centers with levels in Paris dwellings. We selected 28 child day care centers frequented by a random sample of babies who participated in the PARIS birth cohort environmental investigation, and visited the child day care centers for one week twice in one year. Biological contaminants assessed were fungi, endotoxin, dust mite allergens, and chemical pollutants: aldehydes, volatile organic compounds and nitrogen dioxide (NO2). Relative humidity, temperature, and carbon dioxide levels were measured simultaneously. A standardized questionnaire was used to gather information about the buildings and their inhabitants. Airborne endotoxin levels in child day care centers were higher than those found in Paris dwellings. Dust mite allergens in child day care centers were below the threshold level for sensitization in the majority of samples, and in common with dwelling samples. Penicillium and Cladosporium were the most commonly identified genera fungi. The child day care center indoor/outdoor ratio for most chemical pollutants was above unity except for NO2, the levels for NO2 being significantly higher than those measured in homes. Chemical and biological contamination in child day care centers appears to be low, apart from endotoxin and NO2. Failure to take child exposure in child day care centers into account could result in an overestimation of children's exposure to other pollutants. Copyright © 2011 Elsevier Inc. All rights reserved.

Assessing readability formula differences with written health information materials: application, results, and recommendations.

PubMed

Wang, Lih-Wern; Miller, Michael J; Schmitt, Michael R; Wen, Frances K

2013-01-01

Readability formulas are often used to guide the development and evaluation of literacy-sensitive written health information. However, readability formula results may vary considerably as a result of differences in software processing algorithms and how each formula is applied. These variations complicate interpretations of reading grade level estimates, particularly without a uniform guideline for applying and interpreting readability formulas. This research sought to (1) identify commonly used readability formulas reported in the health care literature, (2) demonstrate the use of the most commonly used readability formulas on written health information, (3) compare and contrast the differences when applying common readability formulas to identical selections of written health information, and (4) provide recommendations for choosing an appropriate readability formula for written health-related materials to optimize their use. A literature search was conducted to identify the most commonly used readability formulas in health care literature. Each of the identified formulas was subsequently applied to word samples from 15 unique examples of written health information about the topic of depression and its treatment. Readability estimates from common readability formulas were compared based on text sample size, selection, formatting, software type, and/or hand calculations. Recommendations for their use were provided. The Flesch-Kincaid formula was most commonly used (57.42%). Readability formulas demonstrated variability up to 5 reading grade levels on the same text. The Simple Measure of Gobbledygook (SMOG) readability formula performed most consistently. Depending on the text sample size, selection, formatting, software, and/or hand calculations, the individual readability formula estimated up to 6 reading grade levels of variability. The SMOG formula appears best suited for health care applications because of its consistency of results, higher level of expected comprehension, use of more recent validation criteria for determining reading grade level estimates, and simplicity of use. To improve interpretation of readability results, reporting reading grade level estimates from any formula should be accompanied with information about word sample size, location of word sampling in the text, formatting, and method of calculation. Copyright © 2013 Elsevier Inc. All rights reserved.

Effect of educational intervention based on the Health Belief Model on promoting self-care behaviors of type-2 diabetes patients.

PubMed

Shabibi, Parisa; Zavareh, Mohammad Sadegh Abedzadeh; Sayehmiri, Kourosh; Qorbani, Mostafa; Safari, Omid; Rastegarimehr, Babak; Mansourian, Morteza

2017-12-01

Diabetes is a chronic disease in which patients require lifelong self-care behaviors. The present study offset to determine the effect of educational intervention based on the Health Belief Model (HBM) on promoting self-care behaviors of type 2 diabetes patients in Ilam, Iran 2014. A quasi-experimental research was conducted based on HBM in which 70 type 2 diabetic patients from Ilam, western Iran in 2014 were selected by multi-stage random sampling. A self-designed questionnaire was used, and pre-test was administered, subsequently, the educational intervention sessions were provided in the form of presentation, questions and answers, group discussion, and practical demonstrations in four sessions over a period of one month. Two months after the intervention, the post-tests were administered. The data were analyzed via SPSS 20 applying independent samples t-test, paired samples t-test, and univariate and multivariate regressions at a significance level of less than 0.05. The mean scores of susceptibility, severity, perceived benefits and barriers, self-efficacy, and self-care behaviors were at average and lower levels before the intervention; nonetheless, after the educational intervention, the mean score of each HBM construct and the self-care behaviors significantly increased (p<0.001). Health education through HBM promotes the self-care behaviors of patients with type 2 diabetes.

New medical diagnoses and length of stay of acutely unwell older patients: Implications for funding models.

PubMed

Basic, David; Khoo, Angela

2015-09-01

To examine the relationship between newly made medical diagnoses and length of stay (LOS) of acutely unwell older patients. Consecutive patients admitted under the care of four geriatricians were randomly allocated to a model development sample (n = 937) or a model validation sample (n = 855). Cox regression was used to model LOS. Variables considered for inclusion in the development model were established risk factors for LOS and univariate predictors from our dataset. Variables selected in the development sample were tested in the validation sample. A median of five new medical diagnoses were made during a median LOS of 10 days. New diagnoses predicted an increased LOS (hazard ratio 0.90, 95% confidence interval 0.88-0.92). Other significant predictors of increased LOS in both samples were malnutrition and frailty. Identification of new medical diagnoses may have implications for Diagnosis Related Groups-based funding models and may improve the care of older people. © 2015 AJA Inc.

Evaluation of bias and logistics in a survey of adults at increased risk for oral health decrements.

PubMed

Gilbert, G H; Duncan, R P; Kulley, A M; Coward, R T; Heft, M W

1997-01-01

Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements. We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection. While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high-risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected. This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest.

Ionic liquids: solvents and sorbents in sample preparation.

PubMed

Clark, Kevin D; Emaus, Miranda N; Varona, Marcelino; Bowers, Ashley N; Anderson, Jared L

2018-01-01

The applications of ionic liquids (ILs) and IL-derived sorbents are rapidly expanding. By careful selection of the cation and anion components, the physicochemical properties of ILs can be altered to meet the requirements of specific applications. Reports of IL solvents possessing high selectivity for specific analytes are numerous and continue to motivate the development of new IL-based sample preparation methods that are faster, more selective, and environmentally benign compared to conventional organic solvents. The advantages of ILs have also been exploited in solid/polymer formats in which ordinarily nonspecific sorbents are functionalized with IL moieties in order to impart selectivity for an analyte or analyte class. Furthermore, new ILs that incorporate a paramagnetic component into the IL structure, known as magnetic ionic liquids (MILs), have emerged as useful solvents for bioanalytical applications. In this rapidly changing field, this Review focuses on the applications of ILs and IL-based sorbents in sample preparation with a special emphasis on liquid phase extraction techniques using ILs and MILs, IL-based solid-phase extraction, ILs in mass spectrometry, and biological applications. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Caring in telehealth.

PubMed

Varghese, Shainy B; Phillips, Carolyn A

2009-12-01

The overall goal of this study was to explore and describe the perceptions of advanced practice nurses (APNs) about caring while providing primary care using telehealth technology. This study used naturalistic inquiry methodology to elicit the subjective perceptions and reflections of a sample of APNs about how they convey caring in the context of telehealth. Thirteen APNs, selected by purposive and snowball sampling, participated in the study. The data for the study consisted of interviews conducted by e-mail using a semistructured interview guide. Data analysis used the constant comparison method; rigor and trustworthiness of the study procedures were established using the criteria of credibility, confirmability, dependability, and transferability. The findings of this study revealed that the APNs conveyed caring to their telehealth patients by (1) being with them, (2) personifying the images, and (3) possessing certain attributes. The major constructs that emerged from the data together formed a model of how APNs conveyed caring in telehealth. The findings provide insights and increase the understanding of how caring in telehealth was perceived by APNs. The findings of the study can make important contributions in improving our profession's preparation of future telehealth APNs. The study findings also can lend themselves to developing an instrument to measure caring in telehealth. The study findings also contribute to the nursing literature in a number of ways.

Physician gender, patient gender, and primary care.

PubMed

Franks, Peter; Bertakis, Klea D

2003-01-01

Studies of the effects of physician gender on patient care have been limited by selected samples, examining a narrow spectrum of care, or not controlling for important confounders. We sought to examine the role of physician and patient gender across the spectrum of primary care in a nationally representative sample, large enough to examine the role of gender concordance and adjust for confounding variables. We examined the relationships between physician and patient gender using nationally representative samples (the U. S. National Ambulatory Medical Care Surveys from 1985 to 1992) of encounters of 41,292 adult patients with 1470 primary care physicians (internists, family physicians, and obstetrician/gynecologists). Factors examined included physician (age, gender, region, rural location), patient (age, gender, race, insurance), and visit characteristics (diagnoses, gender-specific and nonspecific prevention, duration, continuity, and disposition). After multivariate adjustment, female physicians were more likely to see female patients, had longer visit durations, and were more likely to perform female prevention procedures and make some follow-up arrangements and referrals. Female physicians were slightly more likely to check patients blood pressure, but there were no significant differences in other nongender-specific prevention procedures or use of psychiatric diagnoses. Among encounters without breast or pelvic examinations, visit length was not related to physician gender, but length was longer in gender concordant visits than gender-discordant visits. Female physicians were more likely to deliver female prevention procedures, but few other physician gender differences in primary care were observed. Physician-patient gender concordance was a key determinant of encounters.

Sample Curation at a Lunar Outpost

NASA Technical Reports Server (NTRS)

Allen, Carlton C.; Lofgren, Gary E.; Treiman, A. H.; Lindstrom, Marilyn L.

2007-01-01

The six Apollo surface missions returned 2,196 individual rock and soil samples, with a total mass of 381.6 kg. Samples were collected based on visual examination by the astronauts and consultation with geologists in the science back room in Houston. The samples were photographed during collection, packaged in uniquely-identified containers, and transported to the Lunar Module. All samples collected on the Moon were returned to Earth. NASA's upcoming return to the Moon will be different. Astronauts will have extended stays at an out-post and will collect more samples than they will return. They will need curation and analysis facilities on the Moon in order to carefully select samples for return to Earth.

Nutritional status, dietary habits, nutritional knowledge and self-care assessment in a group of older adults attending community centres in Pavia, Northern Italy.

PubMed

Turconi, G; Rossi, M; Roggi, C; Maccarini, L

2013-02-01

The population of industrialised countries is ageing as a consequence of an increase in life expectancy. As a result of the increasing ageing process, the assessment of nutritional status and dietary habits, as well as the assessment of self-care, is needed to plan selected actions aimed at improving the quality of life in the third and fourth life spans. A cross-sectional study was carried out on a randomly selected sample of 200 healthy older adults (≥65 years old), attending community centres for older people in Pavia, Northern Italy. Ninety-two percent of the recruited subjects participated in the survey. Anthropometric measurements and the Mini Nutritional Assessment were performed. Dietary habits, nutritional knowledge and self-care were investigated using a questionnaire administered by two dietitians. The majority of subjects were low socio-economic status and overweight [mean (SD) body mass index = 28.4 (4.3) kg/m(2) ], 12% were malnourished according to their Mini Nutritional Assessment score and the majority of the arm muscle circumference measurements were below the 10th percentile, predicting accelerated loss of lean mass, even in the healthy independently living older adults. Only 30% of the sample had adequate dietary habits, whereas the ability to self-care was good for the whole sample. The unhealthy and unbalanced diet, frequently too rich in sugar and fats and low in protein intake, might explain being overweight and the loss of lean mass in the study subjects. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

Effects of electronic prescribing on formulary compliance and generic drug utilization in the ambulatory care setting: a retrospective analysis of administrative claims data.

PubMed

Ross, S Michael; Papshev, Diana; Murphy, Erin L; Sternberg, David J; Taylor, Jeffrey; Barg, Ronald

2005-06-01

Electronic prescribing (e-prescribing) provides formulary information at the point of care. The objective of this study was to assess the effects of e-prescribing on formulary compliance and generic utilization. This was a retrospective analysis of pharmacy claims data from a large national managed care organization. A sample of 95 providers using predominantly e-prescribing was randomly selected (e-prescriber group). A matched sample of 95 traditional prescribers was selected (traditional prescriber group), matched to the e-prescriber group by zip code and medical specialty. A total of 110,975 paid pharmacy claims, for the 12 months from August 1, 2001, through July 31, 2002, were analyzed to assess the effect of e-prescribing on formulary compliance and generic utilization. All paid pharmacy claims were examined for each group; for the e-prescriber group, this included all claims, not just those prescribed using an e-prescribing device. A written qualitative survey was distributed to physicians and office managers to assess e-prescribing usage, sources of formulary information, and effects of e-prescribing on office resources. Both predominantly e-prescribers and traditional prescribers demonstrated high levels of formulary compliance, 83.2% versus 82.8%, respectively (P=0.32). Formulary compliance for these groups did not differ from the overall prescriber population (82.0%). There was not a difference in generic drug utilization rates between e-prescribers and traditional prescribers (absolute rates 37.3% versus 36.9%, P=0.18). Qualitative survey responses supported previously reported research indicating reductions in calls both to and from pharmacies for prescription orders. An examination of paid pharmacy claims from a large, national managed care organization demonstrated no differences between predominantly e-prescribers and traditional prescribers in measures of formulary compliance or generic drug utilization. Future studies should examine keystroke data at the point of care to observe more detail about drug selection methods.

Mars Sample Return: The Value of Depth Profiles

NASA Technical Reports Server (NTRS)

Hausrath, E. M.; Navarre-Sitchler, A. K.; Moore, J.; Sak, P. B.; Brantley, S. L.; Golden, D. C.; Sutter, B.; Schroeder, C.; Socki, R.; Morris, R. V.;

Poor Consumer Comprehension and Plan Selection Inconsistencies Under the 2016 HealthCare.gov Choice Architecture.

PubMed

Wang, Annabel Z; Scherr, Karen A; Wong, Charlene A; Ubel, Peter A

2017-01-01

Many health policy experts have endorsed insurance competition as a way to reduce the cost and improve the quality of medical care. In line with this approach, health insurance exchanges, such as HealthCare.gov, allow consumers to compare insurance plans online. Since the 2013 rollout of HealthCare.gov, administrators have added features intended to help consumers better understand and compare insurance plans. Although well-intentioned, changes to exchange websites affect the context in which consumers view plans, or choice architecture, which may impede their ability to choose plans that best fit their needs at the lowest cost. By simulating the 2016 HealthCare.gov enrollment experience in an online sample of 374 American adults, we examined comprehension and choice of HealthCare.gov plans under its choice architecture. We found room for improvement in plan comprehension, with higher rates of misunderstanding among participants with poor math skills (P < 0.05). We observed substantial variations in plan choice when identical plan sets were displayed in different orders (P < 0.001). However, regardless of order in which they viewed the plans, participants cited the same factors as most important to their choices (P > 0.9). Participants were drawn from a general population sample. The study does not assess for all possible plan choice influencers, such as provider networks, brand recognition, or help from others. Our findings suggest two areas of improvement for exchanges: first, the remaining gap in consumer plan comprehension and second, the apparent influence of sorting order - and likely other choice architecture elements - on plan choice. Our findings inform strategies for exchange administrators to help consumers better understand and select plans that better fit their needs.

Design and operation of the National Survey of Children with Special Health Care Needs, 2009-2010.

PubMed

Bramlett, Matthew D; Blumberg, Stephen J; Ormson, A Elizabeth; George, Jacquelyn M; Williams, Kim L; Frasier, Alicia M; Skalland, Benjamin J; Santos, Kathleen B; Vsetecka, Danielle M; Morrison, Heather M; Pedlow, Steven; Wang, Fang

2014-11-01

This report presents the development, plan, and operation of the 2009-2010 National Survey of Children with Special Health Care Needs, a module of the State and Local Area Integrated Telephone Survey. The survey is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. This survey was designed to produce national and state-specific prevalence estimates of children with special health care needs (CSHCN), to describe the types of services that they need and use, and to assess aspects of the system of care for CSHCN. A random-digit-dial sample of households with children under age 18 years was constructed for each of the 50 states and the District of Columbia. The sampling frame consisted of landline phone numbers and cellular(cell) phone numbers of households that reported a cell-phone-only or cell-phone-mainly status. Children in identified households were screened for special health care needs. If CSHCN were identified in the household, a detailed interview was conducted for one randomly selected child with special health care needs. Respondents were parents or guardians who knew about the children's health and health care. A total of 196,159 household screening interviews were completed from July 2009 through March 2011, resulting in 40,242 completed special-needs interviews, including 2,991 from cell-phone interviews. The weighted overall response rate was 43.7% for the landline sample, 15.2% for the cell-phone sample, and 25.5% overall. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Companion Animals and Elderly People: A Challenge for Evaluators of Social Support.

ERIC Educational Resources Information Center

Robb, Susanne S.; Stegman, Charles E.

1983-01-01

Measured selected health-related effects of association with companion-animals on humans. The sample consisted of predominantly elderly veterans (N=56), who did or did not live with pets, that comprised the census of a home care program. No significant differences were observed. (Author/JAC)

Naming Speed in Dyslexia and Dyscalculia

ERIC Educational Resources Information Center

Willburger, Edith; Fussenegger, Barbara; Moll, Kristina; Wood, Guilherme; Landerl, Karin

2008-01-01

In four carefully selected samples of 8- to 10-year old children with dyslexia (but age adequate arithmetic skills), dyscalculia (but age adequate reading skills), dyslexia/dyscalculia and controls a domain-general deficit in rapid automatized naming (RAN) was found for both dyslexia groups. Dyscalculic children exhibited a domain-specific deficit…

Autism Developmental Profiles and Cooperation with Oral Health Screening

ERIC Educational Resources Information Center

Du, Rennan Y.; Yiu, Cynthia C. Y.; Wong, Virginia C. N.; McGrath, Colman P.

2015-01-01

To determine the associations between autism developmental profiles and cooperation with an oral health screening among preschool children with autism spectrum disorders (ASDs). A random sample of Special Child Care Centres registered with the Government Social Welfare Department in Hong Kong was selected (19 out of 37 Centres). All preschool…

Pyrethroid Pesticides and Their Metabolites in Vacuum Cleaner Dust Collected from Homes and Day-Care Centers

EPA Science Inventory

The purpose of this study was to quantify the concentrations of 13 selected pyrethroid pesticides and their degradation products in samples of indoor dust that had been collected in vacuum cleaner bags during the Children's Total Exposure to Persistent Pesticides and Other Persis...

Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal.

PubMed

Pandey, Srijana; Karki, Supendra

2014-01-01

The importance of maternal health services in lessening maternal mortality and morbidity as well as neonatal deaths has received substantial recognition in the past decade. The lack of antenatal care has been identified as a risk factor for maternal mortality and other adverse pregnancy outcomes. The purpose of this study was to determine the factors affecting attendance of antenatal care services in Nepal. This is a cross-sectional descriptive study carried out in Central Nepal. Using semi-structured questionnaire, interviews were conducted with married women aged between 15-49 years, who had delivered their babies within one year. Systematic random sampling method was used to select the sample. Results were obtained by frequency distribution and cross-tabulation of the variables. More than half of the women were not aware of the consequences of lack of antenatal care. Age, education, income, type of family were strongly associated with the attendance at antenatal care service. In Nepal and in other developing countries, maternal mortality and morbidity continue to pose challenges to the health care delivery system. Variety of factors including socio-demographic, socio-economic, cultural and service availability as well as accessibility influences the use of maternal health services.

The Effect of Barkley's Family-Oriented Program on the Burden of Care on Families of Children with Attention Deficit-Hyperactive Disorder.

PubMed

Mousavi, Sharifeh; Pahlavanzadeh, Saeid; Mehrabi, Tayebeh

2017-01-01

Attention deficit-hyperactive disorder (ADHD) is the most common behavioral disorders during childhood whose treatment is greatly dependent on families; therefore, families of such children should improve their relation with them so that they could enjoy their lives. Hence, this study was conducted to evaluate the effect of Barkley's family-oriented program on the burden of care on such families. This clinical trial was conducted among 64 family care givers for children with ADHD. By simple sampling, samples passing the inclusion criteria were selected and randomly allocated into two groups of control and intervention. The intervention group received Barkley's family education program through 9 sessions; the control group participated in 3 group sessions and expressed their problems and experiences. Data were collected and analyzed using the Zarit Burden Interview. Burden of care was gradually reduced through the study in the intervention group, however, the mean score of burden of care did not have a significant reduction in the control group. Because Barkley's family-oriented program was able to reduce the burden of care in families of children with ADHD, it is recommended to develop similar programs and evaluate them through various studies.

Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial study design and sample characteristics.

PubMed

Kroenke, Kurt; Krebs, Erin; Wu, Jingwei; Bair, Matthew J; Damush, Teresa; Chumbler, Neale; York, Tish; Weitlauf, Sharon; McCalley, Stephanie; Evans, Erica; Barnd, Jeffrey; Yu, Zhangsheng

2013-03-01

Pain is the most common physical symptom in primary care, accounting for an enormous burden in terms of patient suffering, quality of life, work and social disability, and health care and societal costs. Although collaborative care interventions are well-established for conditions such as depression, fewer systems-based interventions have been tested for chronic pain. This paper describes the study design and baseline characteristics of the enrolled sample for the Stepped Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness trial conducted in five primary care clinics. SCOPE has enrolled 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomized them to either the stepped care intervention or usual care control group. Using a telemedicine collaborative care approach, the intervention couples automated symptom monitoring with a telephone-based, nurse care manager/physician pain specialist team to treat pain. The goal is to optimize analgesic management using a stepped care approach to drug selection, symptom monitoring, dose adjustment, and switching or adding medications. All subjects undergo comprehensive outcome assessments at baseline, 1, 3, 6 and 12 months by interviewers blinded to treatment group. The primary outcome is pain severity/disability, and secondary outcomes include pain beliefs and behaviors, psychological functioning, health-related quality of life and treatment satisfaction. Innovations of SCOPE include optimized analgesic management (including a stepped care approach, opioid risk stratification, and criteria-based medication adjustment), automated monitoring, and centralized care management that can cover multiple primary care practices. Published by Elsevier Inc.

Self-care behavior of type 2 diabetes mellitus patients in Bandar Abbas in 2015.

PubMed

Karimi, Fatemeh; Abedini, Sedigheh; Mohseni, Shokrollah

2017-11-01

Diabetes self-care helps to control the blood sugar which, in turn, results in a better state of health. However, more than 50% of diabetic patients do not have self-care capabilities. To determine type 2 diabetes self-care capabilities among patients visiting a Bandar Abbas diabetes clinic in 2016. The present descriptive-analytical research was of a cross-sectional type. The sample was comprised of 120 patients afflicted with type 2 diabetes, who had been selected through the simple randomized sampling method. The data collection instrument was a questionnaire comprised of two sections: demographic information, and a summary of patients' diabetes self-care activities. A 7-point Likert scale was used for the rating. The final score would be interpreted as any of the three levels: good (acceptable) (75-100), moderate (50-74) and poor (below 50). The data entered SPSS version 18.0 for the required statistical analyses. The mean age of the sample was 51.88±10.12 years. Of the 120 subjects, 86 were female (71.7%) and 34 were male (28.3%). The findings revealed that the self-care capability of 83 subjects (69.2%) was poor; capability of 28 subjects was moderate (23.3%) and the same score of good/acceptable in 9 subjects (7.5%). The results of the present research indicate that a large number of diabetic patients have a poor self-care capability. Due to the key role of such activities in a diabetic patient's life, it is suggested to include educational programs to increase the level of self-care capabilities among these patients.

Study of relation of continuing medical education to quality of family physicians' care.

PubMed

Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A

1988-10-01

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

Do Men and Women Report Their Sexual Partnerships Differently? Evidence from Kisumu, Kenya

PubMed Central

Clark, Shelley; Kabiru, Caroline; Zulu, Eliya

2012-01-01

CONTEXT It is generally believed that men and women misreport their sexual behaviors, which undermines the ability of researchers, program designers and health care providers to assess whether these behaviors compromise individuals’ sexual and reproductive health. METHODS Data on 1,299 recent sexual partnerships were collected in a 2007 survey of 1,275 men and women aged 18–24 and living in Kisumu, Kenya. Chi-square and t tests were used to examine how sample selection bias and selective partnership reporting may result in gender differences in reported sexual behaviors. Correlation coefficients and kappa statistics were calculated in further analysis of a sample of 280 matched marital and nonmarital couples to assess agreement on reported behaviors. RESULTS Even after adjustment for sample selection bias, men reported twice as many partnerships as women (0.5 vs. 0.2), as well as more casual partnerships. However, when selective reporting was controlled for, aggregate gender differences in sexual behaviors almost entirely disappeared. In the matched-couples sample, men and women exhibited moderate to substantial levels of agreement for most relationship characteristics and behaviors, including type of relationship, frequency of sex and condom use. Finally, men and women tended to agree about whether men had other nonmarital partners, but disagreed about women’s nonmarital partners. CONCLUSIONS Both sample selection bias and selective partnership reporting can influence the level of agreement between men’s and women’s reports of sexual behaviors. Although men report more casual partners than do women, accounts of sexual behavior within reported relationships are generally reliable. PMID:22227625

Public perceptions of key performance indicators of healthcare in Alberta, Canada.

PubMed

Northcott, Herbert C; Harvey, Michael D

2012-06-01

To examine the relationship between public perceptions of key performance indicators assessing various aspects of the health-care system. Cross-sequential survey research. Annual telephone surveys of random samples of adult Albertans selected by random digit dialing and stratified according to age, sex and region (n = 4000 for each survey year). The survey questionnaires included single-item measures of key performance indicators to assess public perceptions of availability, accessibility, quality, outcome and satisfaction with healthcare. Cronbach's α and factor analysis were used to assess the relationship between key performance indicators focusing on the health-care system overall and on a recent interaction with the health-care system. The province of Alberta, Canada during the years 1996-2004. Four thousand adults randomly selected each survey year. Survey questions measuring public perceptions of healthcare availability, accessibility, quality, outcome and satisfaction with healthcare. Factor analysis identified two principal components with key performance indicators focusing on the health system overall loading most strongly on the first component and key performance indicators focusing on the most recent health-care encounter loading most strongly on the second component. Assessments of the quality of care most recently received, accessibility of that care and perceived outcome of care tended to be higher than the more general assessments of overall health system quality and accessibility. Assessments of specific health-care encounters and more general assessments of the overall health-care system, while related, nevertheless comprise separate dimensions for health-care evaluation.

Virtual standardized patients: an interactive method to examine variation in depression care among primary care physicians

PubMed Central

Hooper, Lisa M.; Weinfurt, Kevin P.; Cooper, Lisa A.; Mensh, Julie; Harless, William; Kuhajda, Melissa C.; Epstein, Steven A.

2009-01-01

Background Some primary care physicians provide less than optimal care for depression (Kessler et al., Journal of the American Medical Association 291, 2581–90, 2004). However, the literature is not unanimous on the best method to use in order to investigate this variation in care. To capture variations in physician behaviour and decision making in primary care settings, 32 interactive CD-ROM vignettes were constructed and tested. Aim and method The primary aim of this methods-focused paper was to review the extent to which our study method – an interactive CD-ROM patient vignette methodology – was effective in capturing variation in physician behaviour. Specifically, we examined the following questions: (a) Did the interactive CD-ROM technology work? (b) Did we create believable virtual patients? (c) Did the research protocol enable interviews (data collection) to be completed as planned? (d) To what extent was the targeted study sample size achieved? and (e) Did the study interview protocol generate valid and reliable quantitative data and rich, credible qualitative data? Findings Among a sample of 404 randomly selected primary care physicians, our voice-activated interactive methodology appeared to be effective. Specifically, our methodology – combining interactive virtual patient vignette technology, experimental design, and expansive open-ended interview protocol – generated valid explanations for variations in primary care physician practice patterns related to depression care. PMID:20463864

Nurses, the Oppressed Oppressors: A Qualitative Study

PubMed Central

Rooddehghan, Zahra; ParsaYekta, Zohreh; Nasrabadi, Alireza Nikbakht

2015-01-01

Healthcare equity, defined as rightful and fair care provision, is a key objective in all health systems. Nurses commonly experience cases of equity/inequity when caring for patients. The present study was the first to explain nurses’ experience of equal care. A qualitative study sought to describe the experiences of 18 clinical nurses and nurse managers who were selected through purposive sampling. The inclusion criteria were the nurses’ familiarity with the subject of the study and willingness to participate. The data were collected through in-depth, unstructured, face-to-face interviews. The sampling continued up to data saturation. All the interviews were recorded and then transcribed word by word. The data were analyzed using thematic analysis. The major theme extracted in this study was the equation between submissiveness and oppression in nurses. It had two subthemes, namely the oppressed nurse and the oppressive nurse. The first subtheme comprised three categories including nurses’ occupational dissatisfaction, discrimination between nursing personnel, and favoring physicians over nurses. The second subtheme consisted of three categories, namely habit-oriented care provision, inappropriate care delegation, and care rationing while neglecting patient needs. When equal care provision was concerned, the participating nurses fluctuated between states of oppression and submissiveness. Hence, equal conditions for nurses are essential to equal care provision. In fact, fair behavior toward nurses would lead to equity nursing care provision and increase satisfaction with the healthcare system. PMID:26156912

Chinese primary care physicians and work attitudes.

PubMed

Shi, Leiyu; Hung, Li-Mei; Song, Kuimeng; Rane, Sarika; Tsai, Jenna; Sun, Xiaojie; Li, Hui; Meng, Qingyue

2013-01-01

China passed a landmark health care reform in 2009, aimed at improving health care for all citizens by strengthening the primary care system, largely through improvements to infrastructure. However, research has shown that the work attitudes of primary care physicians (PCPs) can greatly affect the stability of the overall workforce and the quality and delivery of health care. The purpose of this study is to investigate the relationship between reported work attitudes of PCPs and their personal, work, and educational characteristics. A multi-stage, complex sampling design was employed to select a sample of 434 PCPs practicing in urban and rural primary care settings, and a survey questionnaire was administered by researchers with sponsorship from the Ministry of Health. Four outcome measures describing work attitudes were used, as well as a number of personal-, work-, and practice-related factors. Findings showed that although most PCPs considered their work as important, a substantial number also reported large workloads, job pressure, and turnover intentions. Findings suggest that policymakers should focus on training and educational opportunities for PCPs and consider ways to ease workload pressures and improve salaries. These policy improvements must accompany reform efforts that are already underway before positive changes in reduced disparities and improved health outcomes can be realized in China.

Quality and provider choice: a multinomial logit-least-squares model with selectivity.

PubMed Central

Haas-Wilson, D; Savoca, E

1990-01-01

A Federal Trade Commission survey of contact lens wearers is used to estimate a multinomial logit-least-squares model of the joint determination of provider choice and quality of care in the contact lens industry. The effect of personal and industry characteristics on a consumer's choice among three types of providers--opticians, ophthalmologists, and optometrists--is estimated via multinomial logit. The regression model of the quality of care has two features that distinguish it from previous work in the area. First, it uses an outcome rather than a structural or process measure of quality. Quality is measured as an index of the presence of seven potentially pathological eye conditions caused by poorly fitted lenses. Second, the model controls for possible selection bias that may arise from the fact that the sample observations on quality are generated by consumers' nonrandom choices of providers. The multinomial logit estimates of provider choice indicate that professional regulations limiting the commercial practices of optometrists shift demand for contact lens services away from optometrists toward ophthalmologists. Further, consumers are more likely to have their lenses fitted by opticians in states that require the licensing of opticians. The regression analysis of variations in quality across provider types shows a strong positive selection bias in the estimate of the quality of care received by consumers of ophthalmologists' services. Failure to control for this selection bias results in an overestimate of the quality of care provided by ophthalmologists. PMID:2312308

Rapid LC-MS method for the detection of common fragrances in personal care products without sample preparation.

PubMed

Famiglini, Giorgio; Termopoli, Veronica; Palma, Pierangela; Capriotti, Fabiana; Cappiello, Achille

2014-05-01

An LC-MS method for the analysis of personal care and household products without sample preparation is presented. The method takes advantage of the Direct-electron ionization (EI) LC-MS interface for the quantitation of principal components, as well as for the identification of unknown or undeclared ingredients. The technique has proven its inertness toward matrix effects and the electron ionization allows quantitation and library identification. Commercially available products (shower gel, perfume, and hand cream) were diluted with methanol and injected directly into a nano-LC column. Limonene, linalool, and citral were selected as target compounds because of their use as fragrances in toiletry and detergent products. These and all other fragrances are commonly determined with GC-MS analysis, prior to sample cleanup, a procedure that can lead to analytes loss. The selected compounds are not detected with ESI because of their poor or very low response. Figures of merit and validation studies were executed and special attention was devoted to matrix-effects evaluation, because a sample preparation procedure is not involved. No matrix effects were observed, and the repeatability was excellent even after several weeks of operation. Products composition was investigated in full scan mode to determine the presence of unknown or not listed ingredients. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[Repercussions of the Maria da Penha law in tackling gender violence].

PubMed

Meneghel, Stela Nazareth; Mueller, Betânia; Collaziol, Marceli Emer; de Quadros, Maíra Meneghel

2013-03-01

This paper presents the declarations about the Maria da Penha law made by a sample of women victims and care workers who handle situations of gender violence in the city of Porto Alegre. The data are part of a study that investigated the critical path followed by women who decide to denounce violence. The statements were selected from 45 semi-structured interviews answered by 21 women and 25 professionals from the police, legal, social and health services and nongovernmental institutions. Data were analyzed using NVivo software and one of the categories selected was the Maria da Penha law. Most respondents mentioned the positive and innovatory aspects of the law, though they also pointed out its limitations. The care workers see the legal device as an important tool for tackling violence, aligned with international conventions, bringing innovations and broadening women's access to justice. In terms of weaknesses, both women and care workers stress the inefficiency in the implementation of protective measures, the lack of material resources and manpower, the fragmentation of the health care network and the movement of conservative sectors in society to delegitimize the law.

Hummingbird Comet Nucleus Analysis Mission

NASA Technical Reports Server (NTRS)

Kojiro, Daniel; Carle, Glenn C.; Lasher, Larry E.

2000-01-01

Hummingbird is a highly focused scientific mission, proposed to NASA s Discovery Program, designed to address the highest priority questions in cometary science-that of the chemical composition of the cometary nucleus. After rendezvous with the comet, Hummingbird would first methodically image and map the comet, then collect and analyze dust, ice and gases from the cometary atmosphere to enrich characterization of the comet and support landing site selection. Then, like its namesake, Hummingbird would carefully descend to a pre-selected surface site obtaining a high-resolution image, gather a surface material sample, acquire surface temperature and then immediately return to orbit for detailed chemical and elemental analyses followed by a high resolution post-sampling image of the site. Hummingbird s analytical laboratory contains instrumentation for a comprehensive molecular and elemental analysis of the cometary nucleus as well as an innovative surface sample acquisition device.

Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

PubMed

Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet

2017-05-01

Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

Implementing a tobacco-free hospital campus in Ireland: lessons learned.

PubMed

McArdle, D; Kabir, Z

2018-05-01

The Irish Health Service Executive (HSE) had set a target that all HSE facilities should implement the HSE Tobacco Free Campus (TFC) policy by 2015. The aims of this study are to examine hospital staff awareness and to assess the progress of selected HSE health care facilities towards a TFC policy. Three health care facilities that were conveniently located were self-selected in County Cork, namely, an acute hospital, a mental health service and an older person's facility. Three different types of quantitative data were collected between May and September 2016 drawn on Standards 3, 4 and 5 of the European Network for Tobacco Free Health Care Services (ENSH-Global) tools: (1) face-to-face consultation with health care facility managers on their progress towards the HSE TFC policy, (2) self-administered questionnaire to a purposive sample of 153 staff members across three health care facilities and (3) physical observation of signs of smoking and smoking-related information across each health care facility for objective verification of compliance. Of the 153 staff who completed the questionnaire, 64% were females, 39% were nurses, 20% were smokers and 76% agreed with the TFC policy. However, only 26% of the 153 staff had received training on motivational and tobacco cessation techniques. Seventy-seven percent of the 153 staff stated that the campus was not tobacco-free. Physical observation suggested signs of smoking within the campus across all three health care facilities surveyed. Staff awareness of the HSE TFC policy across selected health care facilities in Ireland is positive but is not sufficient. There are gaps in the implementation process of the HSE TFC policy in the health care facilities. Therefore, proper communication on the importance of the ENSH-Global standards and cessation training to all staff is necessary to help reduce smoking rates across the health care facilities and also to move towards a Tobacco Free Campus in Ireland.

High School Gay Youth: Invisible Diversity.

ERIC Educational Resources Information Center

Reed, Donald B.

The high school experiences of gay young men, the management of these experiences, and the relationships of these experiences and their management with organizational and personal factors provide the focus of this study of a small, carefully selected sample of gay young men who attended public high schools in the state of Washington. An…

Motivation to Provide Help to Older Parents in Norway, Spain, and Israel

ERIC Educational Resources Information Center

Katz, Ruth; Gur-Yaish, Nurit; Lowenstein, Ariela

2010-01-01

We explore from a cross-national perspective three motivations in adult children to provide help to older parents: affectual solidarity, parental need for care, and filial norms. The sample is 1,055 adult children from Norway, Spain, and Israel, countries selected because they represent different family cultures and welfare regimes. Affectual…

Quantifying Uncertainties from Presence Data Sampling Methods for Species Distribution Modeling: Focused on Vegetation.

NASA Astrophysics Data System (ADS)

Sung, S.; Kim, H. G.; Lee, D. K.; Park, J. H.; Mo, Y.; Kil, S.; Park, C.

2016-12-01

The impact of climate change has been observed throughout the globe. The ecosystem experiences rapid changes such as vegetation shift, species extinction. In these context, Species Distribution Model (SDM) is one of the popular method to project impact of climate change on the ecosystem. SDM basically based on the niche of certain species with means to run SDM present point data is essential to find biological niche of species. To run SDM for plants, there are certain considerations on the characteristics of vegetation. Normally, to make vegetation data in large area, remote sensing techniques are used. In other words, the exact point of presence data has high uncertainties as we select presence data set from polygons and raster dataset. Thus, sampling methods for modeling vegetation presence data should be carefully selected. In this study, we used three different sampling methods for selection of presence data of vegetation: Random sampling, Stratified sampling and Site index based sampling. We used one of the R package BIOMOD2 to access uncertainty from modeling. At the same time, we included BioCLIM variables and other environmental variables as input data. As a result of this study, despite of differences among the 10 SDMs, the sampling methods showed differences in ROC values, random sampling methods showed the lowest ROC value while site index based sampling methods showed the highest ROC value. As a result of this study the uncertainties from presence data sampling methods and SDM can be quantified.

Quality of in-hospital stroke care according to evidence-based performance measures: results from the first audit of stroke, Catalonia, Spain.

PubMed

Abilleira, Sònia; Gallofré, Miquel; Ribera, Aida; Sánchez, Emília; Tresserras, Ricard

2009-04-01

Evidence-based standards are used worldwide to determine quality of care. We assessed quality of in-hospital stroke care in all acute-care hospitals in Catalonia by determining adherence to 13 evidence-based performance measures (PMs) of process of care. Data on PMs were collected by retrospective review of medical records of consecutive stroke admissions (January to June, 2005). Compliance with PMs was calculated according to 3 hospital levels determined by their annual stroke case-load (level 1, <150 admissions/yr; level 2, 150 to 350; and level 3, >350). We defined sampling weights that represented each patient's inverse probability of inclusion in the study sample. Sampling weights were applied to produce estimates of compliance. Factors that predicted good/bad compliance were determined by multivariate weighted logistic regression models. An external monitoring of 10% of cases recruited at each hospital was undertaken, after random selection, to assess quality of data. We analyzed data from 1791 stroke cases (17% of all stroke admissions). Global interobserver agreement was 0.7. Eight PMs achieved compliances >or=75%, 4 of which were more than 90%, and the remaining showed adherences

MEMENTA-'Mental healthcare provision for adults with intellectual disability and a mental disorder'. A cross-sectional epidemiological multisite study assessing prevalence of psychiatric symptomatology, needs for care and quality of healthcare provision for adults with intellectual disability in Germany: a study protocol.

PubMed

Koch, Andrea; Vogel, Anke; Holzmann, Marco; Pfennig, Andrea; Salize, Hans Joachim; Puschner, Bernd; Schützwohl, Matthias

2014-05-20

The study 'Mental healthcare provision for adults with intellectual disability and a mental disorder' (MEMENTA) is a cross-sectional epidemiological study carried out in three different regions of Germany. Its main aim is to assess the prevalence of mental disorders in adults with intellectual disability (ID) as well as quality of mental healthcare for this population. The target population are persons aged between 18 and 65 years with a mild or moderate ID. The study population will be recruited through service providers. A representative sample is realised by two-stage sampling. First, institutions providing services for people with ID (sheltered workshops) are selected in a stratified cluster sampling, with strata being (1) types of service-providing non-governmental organisations and (2) sizes of their sheltered workshops. Then persons working in selected sheltered workshops are selected by simple random sampling. An estimated number of 600 adults with ID will be included. Information will be obtained from the group leaders in the sheltered workshops, informal carers or staff members in sheltered housing institutions and the person with ID. Besides the main outcome parameter of psychiatric symptomatology and problem behaviour, other outcome parameters such as needs for care, quality of life, caregiver burden, health services utilisation and costs for care are assessed using well-established standardised instruments. If a comorbid mental disorder is diagnosed, quality of mental healthcare will be assessed with open questions to all interview partners and, in addition, problem-focused interviews with a small subgroup. Analyses will be carried out using quantitative and qualitative methods. Approval of all three local ethics committees was obtained. Research findings will add much needed empirical information in order to improve services provided to this vulnerable group of patients. NCT01695395. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Validation by school nurses of the Nursing Intervention Classification for computer software.

PubMed

Redes, S; Lunney, M

1997-01-01

Validation of standardized nursing language for use by specialty nurses is important for the design of computer software. The purposes of this study were to validate the usefulness of the 433 interventions in the Nursing Intervention Classification (NIC) for school nurses and to identify interventions that could be omitted from computer software for school nurses. A school nursing listserv, SCHLRN-L, was used to recruit volunteers. Ninety-three volunteers from the listserv also recruited 26 school nurses who were not members of the listserv. The total sample was 102 school nurses from 25 states and other areas, 76 listserv volunteers, and 26 others. E-mail was used to send and receive the survey forms to portions of the sample. A majority of interventions (n = 241; 56%) were selected as used by more than 50% of the sample. Of these, 53 direct care interventions were selected as used by more than 80% of the sample. Fifty interventions were not used by 100% of the sample. E-mail was a useful means to obtain a national sample and collect data.

Quality of life in Chinese patients with schizophrenia treated in primary care.

PubMed

Li, Yan; Hou, Cai-Lan; Ma, Xin-Rong; Zhong, Bao-Liang; Zang, Yu; Jia, Fu-Jun; Lin, Yong-Qiang; Lai, Kelly Y C; Chiu, Helen F K; Ungvari, Gabor S; Hall, Brian J; Cai, Mei-Ying; Ng, Chee H; Xiang, Yu-Tao

2017-08-01

In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. This study examined the quality of life (QOL) in patients with schizophrenia treated in primary care and explored the demographic and clinical characteristics associated with QOL. Altogether, 612 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. QOL, psychotic and depressive symptoms, extra-pyramidal symptoms and insight were assessed using standardized instruments. Data analyses were conducted with the one sample t-test and multiple linear regression analyses. Compared with the normative data for the Chinese general population, significantly lower scores in physical and mental QOL domains were found in the patient group. Older age, being unemployed, major medical conditions, no smoking, more severe depressive and negative symptoms, more frequent insomnia, and suicidality were independently associated with poor physical QOL. Male gender, more severe depressive and anxiety symptoms, more frequent insomnia, and suicidality were independently associated with poor mental QOL. Patients with schizophrenia treated in primary care had lower level of QOL in comparison with general population. Effective measures need to be implemented to improve their QOL. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Changes in Selected Biochemical Indices Resulting from Various Pre-sampling Handling Techniques in Broilers

PubMed Central

2011-01-01

Background Since it is not yet clear whether it is possible to satisfactorily avoid sampling-induced stress interference in poultry, more studies on the pattern of physiological response and detailed quantification of stress connected with the first few minutes of capture and pre-sampling handling in poultry are required. This study focused on detection of changes in the corticosterone level and concentrations of other selected biochemical parameters in broilers handled in two different manners during blood sampling (involving catching, carrying, restraint, and blood collection itself) that lasted for various time periods within the interval 30-180 seconds. Methods Stress effects of pre-sampling handling were studied in a group (n = 144) of unsexed ROSS 308 broiler chickens aged 42 d. Handling (catching, carrying, restraint, and blood sampling itself) was carried out in a gentle (caught, held and carried carefully in an upright position) or rough (caught by the leg, held and carried with lack of care in inverted position) manner and lasted for 30 s, 60 s, 90 s, 120 s, 150 s, and 180 s. Plasma corticosterone, albumin, glucose, cholesterol, lactate, triglycerides and total protein were measured in order to assess the stress-induced changes to these biochemical indices following handling in the first few minutes of capture. Results Pre-sampling handling in a rough manner resulted in considerably higher plasma concentrations of all biochemical indices monitored when compared with gentle handling. Concentrations of plasma corticosterone after 150 and 180 s of handling were considerably higher (P < 0.01) than concentrations after 30-120 s of handling regardless of handling technique. Concentrations of plasma lactate were also increased by prolonged handling duration. Handling for 90-180 seconds resulted in a highly significant elevation of lactate concentration in comparison with 30 s handling regardless of handling technique. Similarly to corticosterone concentrations, a strong positive correlation was found between plasma lactate and duration of pre-sampling handling. Other biochemical indices monitored did not show any correlation pattern in connection with duration of pre-sampling handling. Conclusions These results indicate that the pre-sampling procedure may be a considerably stressful procedure for broilers, particularly when carried out with lack of care and exceeding 120 seconds. PMID:21569531

The Effect of Mother's Voice on Arterial Blood Sampling Induced Pain in Neonates Hospitalized in Neonate Intensive Care Unit.

PubMed

Azarmnejad, Elham; Sarhangi, Forogh; Javadi, Mahrooz; Rejeh, Nahid

2015-04-19

Due to devastating effects of pain in neonates, it is very important to ease it though safe and feasible methods. This study was to determine the effect of familiar auditory stimuli on the arterial blood sampling (ABS) induced pain in term neonates. This study was done on 30 newborns hospitalized in neonate intensive care unit (NICU) of a hospital in Tehran. Research samples were selected by using convenience sampling and randomly divided into two groups of control and test. In the test group, the recorded mothers' voices were played for the newborns before and after blood sampling procedure. Then, pain measures were recorded 10 minutes before, during and 10 minutes after blood collection based on Neonatal Infant Pain Scale (NIPS); then the pain level changes were reviewed and studied. The findings showed significant differences between the control and test groups that indicating the effect of mother's voice on reducing the pain of neonates during the ABS (p<0.005). Research findings demonstrate that mother's voice reduces ABS induced pain in the term neonates.

Alternative sample sizes for verification dose experiments and dose audits

NASA Astrophysics Data System (ADS)

Taylor, W. A.; Hansen, J. M.

1999-01-01

ISO 11137 (1995), "Sterilization of Health Care Products—Requirements for Validation and Routine Control—Radiation Sterilization", provides sampling plans for performing initial verification dose experiments and quarterly dose audits. Alternative sampling plans are presented which provide equivalent protection. These sampling plans can significantly reduce the cost of testing. These alternative sampling plans have been included in a draft ISO Technical Report (type 2). This paper examines the rational behind the proposed alternative sampling plans. The protection provided by the current verification and audit sampling plans is first examined. Then methods for identifying equivalent plans are highlighted. Finally, methods for comparing the cost associated with the different plans are provided. This paper includes additional guidance for selecting between the original and alternative sampling plans not included in the technical report.

Effects of stress management program on the quality of nursing care and intensive care unit nurses

PubMed Central

Pahlavanzadeh, Saied; Asgari, Zohreh; Alimohammadi, Nasrollah

2016-01-01

Background: High level of stress in intensive care unit nurses affects the quality of their nursing care. Therefore, this study aimed to determine the effects of a stress management program on the quality of nursing care of intensive care unit nurses. Materials and Methods: This study is a randomized clinical trial that was conducted on 65 nurses. The samples were selected by stratified sampling of the nurses working in intensive care units 1, 2, 3 in Al-Zahra Hospital in Isfahan, Iran and were randomly assigned to two groups. The intervention group underwent an intervention, including 10 sessions of stress management that was held twice a week. In the control group, placebo sessions were held simultaneously. Data were gathered by demographic checklist and Quality Patient Care Scale before, immediately after, and 1 month after the intervention in both groups. Then, the data were analyzed by Student's t-test, Mann–Whitney, Chi-square, Fisher's exact test, and analysis of variance (ANOVA) through SPSS software version 18. Results: Mean scores of overall and dimensions of quality of care in the intervention group were significantly higher immediately after and 1 month after the intervention, compared to pre-intervention (P < 0.001). The results showed that the quality of care in the intervention group was significantly higher immediately after and 1 month after the intervention, compared to the control group (P < 0.001). Conclusions: As stress management is an effective method to improve the quality of care, the staffs are recommended to consider it in improvement of the quality of nursing care. PMID:27186196

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study

PubMed Central

Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

2017-01-01

Objectives To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. Design A cross-sectional study using a community-based survey. Setting Yaoundé, Cameroon. Participants All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Primary outcome measures Unmet needs for emergency care. Results Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Conclusions Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. PMID:28167749

Optimum allocation for a dual-frame telephone survey.

PubMed

Wolter, Kirk M; Tao, Xian; Montgomery, Robert; Smith, Philip J

2015-12-01

Careful design of a dual-frame random digit dial (RDD) telephone survey requires selecting from among many options that have varying impacts on cost, precision, and coverage in order to obtain the best possible implementation of the study goals. One such consideration is whether to screen cell-phone households in order to interview cell-phone only (CPO) households and exclude dual-user household, or to take all interviews obtained via the cell-phone sample. We present a framework in which to consider the tradeoffs between these two options and a method to select the optimal design. We derive and discuss the optimum allocation of sample size between the two sampling frames and explore the choice of optimum p , the mixing parameter for the dual-user domain. We illustrate our methods using the National Immunization Survey , sponsored by the Centers for Disease Control and Prevention.

Delivery of preventive care: the national Canadian Family Physician Cancer and Chronic Disease Prevention Survey.

PubMed

Katz, Alan; Lambert-Lanning, Anita; Miller, Anthony; Kaminsky, Barbara; Enns, Jennifer

2012-01-01

To determine family physicians' practice of, knowledge about, and attitudes toward delivering preventive care during periodic health examinations (PHEs). A stratified sample of 5013 members of the College of Family Physicians of Canada were randomly selected to receive a questionnaire by mail. Descriptive analysis was performed on a national data set of 1010 respondents. Canada. A sample of family physicians from each Canadian province. Physicians were asked questions about whether they addressed aspects of preventive care, such as tobacco smoking, nutrition, physical activity, alcohol intake, and sun exposure with patients during PHEs. The questions were designed to gauge attitudes and identify barriers to the provision of preventive care. Most respondents (87% to 89%) indicated that they were comfortable counseling their patients about issues such as nutrition, physical activity, and alcohol consumption; however, many of these respondents did not refer their patients to specialists or provide them with additional resources to educate patients about the health risks of their conditions. While tobacco smoking risks and cessation were addressed by most family physicians (79%) during PHEs, other topics, such as sun exposure, were often overlooked. The results of this survey indicate that while many family physicians follow the evidence-based guidelines for preventive care, current levels of preventive care in the primary care setting are below national standards. It is critical that Canadians receive optimal preventive care to improve the outlook of the chronic disease burden on the health care system.

Computational fragment-based screening using RosettaLigand: the SAMPL3 challenge

NASA Astrophysics Data System (ADS)

Kumar, Ashutosh; Zhang, Kam Y. J.

2012-05-01

SAMPL3 fragment based virtual screening challenge provides a valuable opportunity for researchers to test their programs, methods and screening protocols in a blind testing environment. We participated in SAMPL3 challenge and evaluated our virtual fragment screening protocol, which involves RosettaLigand as the core component by screening a 500 fragments Maybridge library against bovine pancreatic trypsin. Our study reaffirmed that the real test for any virtual screening approach would be in a blind testing environment. The analyses presented in this paper also showed that virtual screening performance can be improved, if a set of known active compounds is available and parameters and methods that yield better enrichment are selected. Our study also highlighted that to achieve accurate orientation and conformation of ligands within a binding site, selecting an appropriate method to calculate partial charges is important. Another finding is that using multiple receptor ensembles in docking does not always yield better enrichment than individual receptors. On the basis of our results and retrospective analyses from SAMPL3 fragment screening challenge we anticipate that chances of success in a fragment screening process could be increased significantly with careful selection of receptor structures, protein flexibility, sufficient conformational sampling within binding pocket and accurate assignment of ligand and protein partial charges.

Occurrence, fate and risk assessment of personal care products in river-groundwater interface.

PubMed

Serra-Roig, Maria Pau; Jurado, Anna; Díaz-Cruz, M Silvia; Vázquez-Suñé, Enric; Pujades, Estanislao; Barceló, Damià

2016-10-15

This work presents the occurrence and fate of selected personal care products (PCPs) in the urban river-groundwater interface. To this end, urban river and groundwater samples were collected in Sant Adrià del Besòs (NE of Spain) and a total of 16 PCPs were analyzed including benzophenone derivatives, camphor derivatives, p-aminobenzoic acid derivatives, triazoles and parabens in three different campaigns (from May 2010 to July 2014). These compounds reach the aquifer through the recharge of Besòs River that receives large amounts of effluents from waste water treatment plants. Results have shown that most of the compounds were not or barely detected (maximum concentrations around 200ng/L) in groundwater samples during the different sampling campaigns. Only two triazoles, namely benzotriazole (BZT) and methyl benzotriazol (MeBZT) were found at high concentrations in groundwater samples (maximum concentration around 2000ng/L). The fate of PCPs in the aquifer was assessed using mixing analysis considering the seasonal variability of the Besòs River. Overall, measured groundwater concentrations were significantly much lower than those estimated by the mixing of the river water. This observation suggested that most of the PCPs are naturally removed when river water infiltrates the aquifer. However, some compounds were more persistent in the aquifer. These compounds were in descending order: the triazoles BZT and MeBZT followed by the camphor derivative 4MBC and the paraben MePB. The measured concentrations allowed us to assess the environmental risk posed by the selected UV-filters and parabens in the river and groundwater samples. Hazard Quotients (HQs) for different aquatic species were calculated in order to characterize the ecotoxicity potential of the studied compounds in the river-groundwater interface. HQ values were always below 1 indicating that at the concentrations observed in the surface or aquifer water of Besòs River these compounds pose no risk to the selected aquatic organisms. Copyright © 2016 Elsevier B.V. All rights reserved.

Suitability of pharmaceuticals and personal care products (PPCPs) and artificial sweeteners (ASs) as wastewater indicators in the Pearl River Delta, South China.

PubMed

Yang, Yuan-Yuan; Liu, Wang-Rong; Liu, You-Sheng; Zhao, Jian-Liang; Zhang, Qian-Qian; Zhang, Min; Zhang, Jin-Na; Jiang, Yu-Xia; Zhang, Li-Juan; Ying, Guang-Guo

2017-07-15

Wastewater indicator is a useful tool for evaluating the wastewater impact on natural water, but there is little information about the suitability of wastewater indicators for different regions. This study aimed to select suitable wastewater indicators in the Pearl River Delta region, south China by screening a range of wastewater related organic compounds. The screening campaign was carried out by investigating the occurrence and removal efficiencies of 93 pharmaceuticals and personal care products (PPCPs) and 5 artificial sweeteners (ASs) in nine wastewater treatment plants (WWTPs) located in the region, and the occurrence of these target compounds in the contaminated and clean surface water of the Pearl River. An ideal wastewater indicator should be hydrophilic, source-specific for domestic wastewater, ubiquitous in contaminated surface water with detection frequency (DF) >80% and absent in background water samples. For liable indicators, high removal rates (>90%) should be observed in WWTPs and they should be detected in all the influent samples at concentrations fifty times higher than their limits of quantification. For conservative indicators, low removal rates (<50%) should be observed in WWTPs and they should be detected in all the effluent samples at concentrations fifty times higher than their limits of quantification. Based on the above criteria, sucralose and fluconazole were selected as conservative indicators in the region, while cyclamate, saccharin, methyl paraben, ethyl paraben, propyl paraben, paracetamol, salicylic acid and caffeine were selected as liable indicators. Copyright © 2017 Elsevier B.V. All rights reserved.

Contaminants of emerging concern in a mixed land use watershed: A two year study of occurrence and seasonal variation

USDA-ARS?s Scientific Manuscript database

The occurrence and variation of twenty-six contaminants of emerging concern (CECs) were evaluated in water samples collected from four stream sites over two years in the Zumbro River watershed, Minnesota, U.S.A. Selected CECs included pharmaceuticals and personal care products (PPCPs), pesticides, v...

Depression Screening Patterns for Women in Rural Health Clinics

ERIC Educational Resources Information Center

Tudiver, Fred; Edwards, Joellen Beckett; Pfortmiller, Deborah T.

2010-01-01

Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female…

Variables Associated with Disrupted Placement in a Select Sample of Abused and Neglected Children.

ERIC Educational Resources Information Center

Cooper, Carolyn S.

1987-01-01

Examination of the placement history of 172 abused and/or neglected children found that children had a more disrupted foster care placement history if they: (1) had severe behavior problems; (2) were very young when first removed from the natural home; or (3) had drug-addicted and/or alcoholic parents. (Author/DB)

Engaging African American landowners in sustainable forest management

Treesearch

John Schelhas; Sarah Hitchner; Cassandra Johnson Gaither; Rory Fraser; Viniece Jennings; Amadou Diop

2016-01-01

The Sustainable Forestry and African American Land Retention Program is a comprehensive effort to address the long-standing problem of underparticipation of African Americans in forest management. We conducted rapid appraisal baseline research for pilot projects in this program in three Southern states using a carefully selected purposive sample to enhance our...

X-ray diffraction imaging (topography) of electroopticcrystals by synchrotron radiation

NASA Technical Reports Server (NTRS)

Steiner, Bruce; Kuriyama, Masao; Dobbyn, Ronald C.; Laor, Uri

1988-01-01

Information of special interest to crystal growers and device physicists now available from monochromatic synchrotron diffraction imaging (topography) is reviewed. Illustrations are taken from a variety of electro-optic crystals. Aspects of the detailed understanding of crystal growth processes obtainable from carefully selected samples are described. Finally, new experimental opportunities now available for exploitation are indicated.

Reasons for attending dental-care services in Ouagadougou, Burkina Faso.

PubMed Central

Varenne, Benoît; Msellati, Philippe; Zoungrana, Célestin; Fournet, Florence; Salem, Gérard

2005-01-01

OBJECTIVE: To determine why patients attend dental-care facilities in Ouagadougou, Burkina Faso and to improve understanding of the capacity of oral health-care services in urban west Africa. METHODS: We studied a randomly selected sample of patients attending 15 dental-care facilities in Ouagadougou over a 1-year period in 2004. Data were collected using a simple daily record form. FINDINGS: From a total of 44,975 patients, the final sample was established at 14,591 patients, of whom 55.4% were new patients and 44.6% were "booking patients". Most patients seeking care (71.9%) were aged 15-44 years. Nongovernmental not-for-profit dental services were used by 41.5% of all patients, 36% attended private dental-care services, and 22.5% of patients visited public services. The most common complaint causing the patient to seek dental-care services was caries with pulpal involvement (52.4%), and 60% of all complaints were associated with pain. The patients' dental-care requirements were found to differ significantly according to sex, health insurance coverage and occupation. CONCLUSION: Urban district health authorities should ensure provision of primary health-care services, at the patients' first point of contact, which are directed towards the relief of pain. In addition to the strengthening of outreach emergency care, health centres should also contribute to the implementation of community-based programmes for the prevention of oral disease and the promotion of oral health. Exchange of experiences from alternative oral health-care systems relevant to developing countries is urgently needed for tackling the growing burden of oral disease. PMID:16211155

Home health care and patterns of subsequent VA and medicare health care utilization for veterans.

PubMed

Van Houtven, Courtney Harold; Jeffreys, Amy S; Coffman, Cynthia J

2008-10-01

The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HHC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched controls. We also consider crossover between the VA and Medicare. This is a retrospective study using propensity score and stratified analysis to control for selection bias on observable characteristics. We examined the full cohort of 2002 VA HHC users (n = 24,169) and a 2:1 sample of age- and race-based nonusers (n = 53,356). Utilization measures included VA and Medicare outpatient, inpatient, nursing home, and hospice use, as well as VA home-based primary care, respite care, and adult day health care. VA HHC users had a higher absolute probability of outpatient use by around 3%, of inpatient use by 12%, and nursing home use by 6% than their propensity-score-matched controls. Veterans who used HHC services had a higher rate of VA service use in the subsequent year than controls did, even after we adjusted for differences in observed health status, eligibility advantages, and supplemental insurance status. High utilization for VA home health users spilled over into high Medicare utilization.

Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients.

PubMed

Floyd, Shawn; Craig, Sarah W; Topley, Darla; Tullmann, Dorothy

2016-01-01

Cardiothoracic surgical patients are at high risk for complications related to immobility, such as increased intensive care and hospital length of stay, intensive care unit readmission, pressure ulcer development, and deep vein thrombosis/pulmonary embolus. A progressive mobility protocol was started in the thoracic cardiovascular intensive care unit in a rural academic medical center. The purpose of the progressive mobility protocol was to increase mobilization of postoperative patients and decrease complications related to immobility in this unique patient population. A matched-pairs design was used to compare a randomly selected sample of the preintervention group (n = 30) to a matched postintervention group (n = 30). The analysis compared outcomes including intensive care unit and hospital length of stay, intensive care unit readmission occurrence, pressure ulcer prevalence, and deep vein thrombosis/pulmonary embolism prevalence between the 2 groups. Although this comparison does not achieve statistical significance (P < .05) for any of the outcomes measured, it does show clinical significance in a reduction in hospital length of stay, intensive care unit days, in intensive care unit readmission rate, and a decline in pressure ulcer prevalence, which is the overall goal of progressive mobility. This study has implications for nursing, hospital administration, and therapy services with regard to staffing and cost savings related to fewer complications of immobility. Future studies with a larger sample size and other populations are warranted.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

PubMed

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-02-01

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

Detection of cerebrospinal fluid leakage by specific measurement of transferrin glycoforms.

PubMed

Kwon, Seok-Joon; Zhang, Fuming; Dordick, Jonathan S; Sonstein, William J; Linhardt, Robert J

2015-10-01

A simple and rapid detection of cerebrospinal fluid (CSF) leakage would benefit spine surgeons making critical postoperative decisions on patient care. We have assessed novel approaches to selectively determine CSF β2-transferrin (β2TF), an asialo-transferrin (aTF) biomarker, without interference from serum sialo-transferrin (sTF) in test samples. First, we performed mild periodate oxidation to selectively generate aldehyde groups in sTF for capture with magnetic hydrazide microparticles, and selective removal with a magnetic separator. Using this protocol sTF was selectively removed from mixtures of CSF and serum containing CSF aTF (β2TF) and serum sTF, respectively. Second, a two-step enzymatic method was developed with neuraminidase and galactose oxidase for generating aldehyde groups in sTF present in CSF and serum mixtures for magnetic hydrazide microparticle capture. After selectively removing sTF from mixtures of CSF and serum, ELISA could detect significant TF signal only in CSF, while the TF signal in serum was negligible. The new approach for selective removal of only sTF in test samples will be promising for the required intervention by a spine surgeon. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Comparing the Effect of Echinacea and Chlorhexidine Mouthwash on the Microbial Flora of Intubated Patients Admitted to the Intensive Care Unit.

PubMed

Safarabadi, Mehdi; Ghaznavi-Rad, Ehsanollah; Pakniyat, Abdolghader; Rezaie, Korosh; Jadidi, Ali

2017-01-01

Providing intubated patients admitted to the intensive care units with oral healthcare is one of the main tasks of nurses in order to prevent Ventilator-Associated Pneumonia (VAP). This study aimed at comparing the effects of two mouthwash solutions (echinacea and chlorhexidine) on the oral microbial flora of patients hospitalized in the intensive care units. In this clinical trial, 70 patients aged between18 and 65 years undergoing tracheal intubation through the mouth in three hospitals in Arak, were selected using simple random sampling and were randomly divided into two groups: the intervention group and the control group. The oral health checklist was used to collect the data (before and after the intervention). The samples were obtained from the orally intubated patients and were then cultured in selective media. Afterwards, the aerobic microbial growth was investigated in all culture media. The data were analyzed using SPSS software. The microbial flora in the echinacea group significantly decreased after the intervention ( p < 0.0001) and it was also the case withmicrobial flora of the patients in the chlorhexidine group ( p < 0.001). After 4 days, the oral microbial flora of the patients in the intervention group was lower than that of the patients in the control group ( p < 0.001). The results showed that the echinacea solution was more effective in decreasing the oral microbial flora of patients in the intensive care unit. Given the benefits of the components of the herb Echinacea, it can be suggested as a viable alternative to chlorhexidine.

They think they know but do they? Misalignment of perceptions of lifestyle modification knowledge among health professionals.

PubMed

Parker, Whadi-Ah; Steyn, Nelia P; Levitt, Naomi S; Lombard, Carl J

2011-08-01

The present study aimed to evaluate the knowledge and practices of public-sector primary-care health professionals and final-year students regarding the role of nutrition, physical activity and smoking cessation (lifestyle modification) in the management of chronic diseases of lifestyle within the public health-care sector. A comparative cross-sectional descriptive quantitative study was conducted in thirty primary health-care facilities and four tertiary institutions offering medical and/or nursing programmes in Cape Town in the Western Cape Metropole. Stratified random sampling, based on geographical location, was used to select the health facilities while convenience sampling was used to select students at the tertiary institutions. A validated self-administered knowledge test was used to obtain data from the health professionals. Differential lifestyle modification knowledge exists among both health professionals and students, with less than 10 % achieving the desired scores of 80 % or higher. The majority of health professionals seem to be promoting the theoretical concepts of lifestyle modification but experience difficulty in providing practical advice to patients. Of the health professionals evaluated, doctors appeared to have the best knowledge of lifestyle modification. Lack of time, lack of patient adherence and language barriers were given as the main barriers to providing lifestyle counselling. The undergraduate curricula of medical and nursing students should include sufficient training on lifestyle modification, particularly practical advice on diet, physical activity and smoking cessation. Health professionals working at primary health-care facilities should be updated by providing lifestyle modification education as part of continuing medical education.

Pathways to Depression Care: Help-Seeking Experiences of Low-Income Latinos with Diabetes and Depression

PubMed Central

Cabassa, Leopoldo J.

2013-01-01

This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression. PMID:22367667

Factors associated with aggressive behavior between residents and staff in nursing homes.

PubMed

Stutte, Karin; Hahn, Sabine; Fierz, Katharina; Zúñiga, Franziska

The aim of this secondary data analysis of the cross-sectional Swiss Nursing Homes Human Resources Project (SHURP) study was to describe the prevalence of residents' verbal, physical and sexual aggression toward care workers in Swiss nursing homes and to explore their association with context and care worker factors. The study's sample incorporated data from 155 randomly selected nursing homes, including 402 units. Among care workers (n = 3919), 66% reported experiencing verbal, 42% physical and 15% sexual aggression. Logistic regression analyses indicated that non-special care units and care workers' higher perception of staffing and resources adequacy and higher age were associated with a decreased likelihood of aggression, whereas emotional exhaustion was associated with an increased likelihood. Our results suggest an association of aggressive resident behavior with modifiable context and care worker factors. Knowledge about this may contribute to a continuous improvement process, enhancing residents' well-being alongside care workers' safety and satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

The quality of care in occupational therapy: an assessment of selected Michigan hospitals.

PubMed

Kirchman, M M

1979-07-01

In this study, a methodology was developed and tested for assessing the quality of care in occupational therapy between educational and noneducational clinical settings, as measured by process and outcome. An instrument was constructed for an external audit of the hospital record. Standards drafted by the investigator were established as normative by a panel of experts for use in judging the programs. Hospital records of 84 patients with residual hemiparesis or hemiplegia in three noneducational settings and of 100 patients with similar diagnoses in two educational clinical settings from selected Michigan facilities were chosen by proportionate stratified random sampling. The process study showed that occupational therapy was of significantly higher quality in the educational settings. The outcome study did not show significant differences between types of settings. Implications for education and practice are discussed.

Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history.

PubMed

Kassar, Samir B; Melo, Ana M C; Coutinho, Sônia B; Lima, Marilia C; Lira, Pedro I C

2013-01-01

To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history. This was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers. The logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR=3.08), hospitalization during pregnancy (OR=2.48), inadequate prenatal care (OR=2.49), lack of ultrasound examination during prenatal care (OR=3.89), transfer of the newborn to another unit after birth (OR=5.06), admittance of the newborn at the ICU (OR=5.00), and low birth weight (OR=2.57). Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR=1.73) and with no children younger than five years (OR=10.10). Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Impact of universal gowning and gloving on health care worker clothing contamination.

PubMed

Williams, Calvin; McGraw, Patty; Schneck, Elyse E; LaFae, Anna; Jacob, Jesse T; Moreno, Daniela; Reyes, Katherine; Cubillos, G Fernando; Kett, Daniel H; Estrella, Ronald; Morgan, Daniel J; Harris, Anthony D; Drees, Marci

2015-04-01

To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice. Cross-sectional surveys. Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study. All HCWs performing direct patient care in the study ICUs were eligible to participate. Surveys were performed first during the BUGG intervention study period (July-September 2012) with universal gowning/gloving and again after BUGG study conclusion (October-December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift. A total of 348 HCWs participated (21-92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2-0.6). Pathogens identified included S. aureus (25 species, including 7 methicillin-resistant S. aureus [MRSA]), Enterococcus spp. (25, including 1 vancomycin-resistant Enterococcus [VRE]), Pseudomonas spp. (4), Acinetobacter spp. (4), and Klebsiella (2). Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.

SEIPS-based process modeling in primary care.

PubMed

Wooldridge, Abigail R; Carayon, Pascale; Hundt, Ann Schoofs; Hoonakker, Peter L T

2017-04-01

Process mapping, often used as part of the human factors and systems engineering approach to improve care delivery and outcomes, should be expanded to represent the complex, interconnected sociotechnical aspects of health care. Here, we propose a new sociotechnical process modeling method to describe and evaluate processes, using the SEIPS model as the conceptual framework. The method produces a process map and supplementary table, which identify work system barriers and facilitators. In this paper, we present a case study applying this method to three primary care processes. We used purposeful sampling to select staff (care managers, providers, nurses, administrators and patient access representatives) from two clinics to observe and interview. We show the proposed method can be used to understand and analyze healthcare processes systematically and identify specific areas of improvement. Future work is needed to assess usability and usefulness of the SEIPS-based process modeling method and further refine it. Copyright © 2016 Elsevier Ltd. All rights reserved.

Home-Based Care and Perceived Quality of Life Among People Living with HIV in Ho Chi Minh City, Viet Nam.

PubMed

Bui, Quyen Thi Tu; Brickley, Deborah Bain; Tieu, Van Thi Thu; Hills, Nancy K

2018-03-31

We conducted a cross-sectional study to examine the perceptions of quality of life among people living with HIV who received home-based care services administered through outpatient clinics in Ho Chi Minh City, Viet Nam. Data were collected from a sample of 180 consecutively selected participants (86 cases, 94 controls) at four outpatient clinics, all of whom were on antiretroviral therapy. Quality of life was evaluated using the WHOQOL-BREF instrument. In adjusted analysis, those who received home-based care services had a quality of life score 4.08 points higher (on a scale of 100) than those who did not receive home-based care services (CI 95%, 2.32-5.85; p < 0.001). The findings suggest that home-based care is associated with higher self-perceptions of quality of life among people living with HIV.

SEIPS-Based Process Modeling in Primary Care

PubMed Central

Wooldridge, Abigail R.; Carayon, Pascale; Hundt, Ann Schoofs; Hoonakker, Peter

2016-01-01

Process mapping, often used as part of the human factors and systems engineering approach to improve care delivery and outcomes, should be expanded to represent the complex, interconnected sociotechnical aspects of health care. Here, we propose a new sociotechnical process modeling method to describe and evaluate processes, using the SEIPS model as the conceptual framework. The method produces a process map and supplementary table, which identify work system barriers and facilitators. In this paper, we present a case study applying this method to three primary care processes. We used purposeful sampling to select staff (care managers, providers, nurses, administrators and patient access representatives) from two clinics to observe and interview. We show the proposed method can be used to understand and analyze healthcare processes systematically and identify specific areas of improvement. Future work is needed to assess usability and usefulness of the SEIPS-based process modeling method and further refine it. PMID:28166883

Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design.

PubMed

Pymont, Carly; McNamee, Paul; Butterworth, Peter

2018-03-20

This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents' prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15-$35; or >$35) were less likely to become FAs than those who incurred no or low (

The Quality of Toddler Child Care and Cognitive Skills at 24 Months: Propensity Score Analysis Results from the ECLS-B.

PubMed

Ruzek, Erik; Burchinal, Margaret; Farkas, George; Duncan, Greg J

2014-01-01

Over half of the toddlers in the U.S. experience routine nonparental care, but much less is known about early care than about preschool care. This study analyzed 2-year-old child care and child outcome data from the nationally representative ECLS-B sample of children born in 2001. At two-years of age, 51% of children experienced exclusive parental care, 18% relative care, 15% family child care, and 16% center care. More children in nonparental care were in medium quality care (61%) than in high quality (26%) or low quality (13%) care. Low-income children were more likely than non-low income children to be cared for by their parents and, when in care, were more often in lower quality care. The impact of toddler care quality on cognitive skills was estimated using propensity score adjustments to account for potential selection confounds due to family and child characteristics. Children's cognitive scores were higher in high or medium quality care than in low quality care, but no evidence emerged suggesting that poverty moderated the quality effects. Nevertheless, this suggests that increasing the proportion of low-income children in high quality care could reduce the achievement gap because low-income children are very unlikely to experience high quality care.

The Quality of Toddler Child Care and Cognitive Skills at 24 Months: Propensity Score Analysis Results from the ECLS-B

PubMed Central

Ruzek, Erik; Burchinal, Margaret; Farkas, George; Duncan, Greg J.

2013-01-01

Over half of the toddlers in the U.S. experience routine nonparental care, but much less is known about early care than about preschool care. This study analyzed 2-year-old child care and child outcome data from the nationally representative ECLS-B sample of children born in 2001. At two-years of age, 51% of children experienced exclusive parental care, 18% relative care, 15% family child care, and 16% center care. More children in nonparental care were in medium quality care (61%) than in high quality (26%) or low quality (13%) care. Low-income children were more likely than non-low income children to be cared for by their parents and, when in care, were more often in lower quality care. The impact of toddler care quality on cognitive skills was estimated using propensity score adjustments to account for potential selection confounds due to family and child characteristics. Children’s cognitive scores were higher in high or medium quality care than in low quality care, but no evidence emerged suggesting that poverty moderated the quality effects. Nevertheless, this suggests that increasing the proportion of low-income children in high quality care could reduce the achievement gap because low-income children are very unlikely to experience high quality care. PMID:24347815

Private or NHS General Dental Service care in the United Kingdom? A study of public perceptions and experiences.

PubMed

Hancock, M; Calnan, M; Manley, G

1999-12-01

Recent changes in the NHS General Dental Service have led to a reduction in the availability of NHS dental care and increased charges. This study explores public and user views and experiences of NHS and private dental care in the light of these changes. The study employed a combination of quantitative and qualitative methods. The first phase involved a postal survey of a random sample of adults on the electoral registers in a county in Southern England, which yielded a response rate of 55 per cent (n = 1506). Follow-up face-to-face interviews were carried out with sub-samples (n = 50) selected from survey respondents. The evidence shows greater satisfaction with certain aspects of private care than with NHS dental care and suggests that the decline in perceived quality of NHS care is less to do with the quality of dental technical skills and more to do with perceived access and availability. However, there was general support for the egalitarian principles associated with NHS dentistry, although payment for dental care by users was acceptable even though dentistry on the NHS was preferred. The shift in the balance of NHS and private dental care reflects the interests and preferences of dentists rather than of the public. It suggests, however, that a continued shift towards private practice is a trend that the public will not find acceptable, which might limit the extent of expansion of private practice.

A nursing career in mental health care: choices and motives of nursing students.

PubMed

Hoekstra, Hanneke J; van Meijel, Berno B; van der Hooft-Leemans, Truus G

2010-01-01

This article describes the results of a study into how first-year nursing students' perceptions of psychiatric patients and mental health care influence their choice of specialization in mental health care and future working in this sector. A descriptive qualitative study design with semi-structured interviews. Respondents were selected through purposive sampling among all first-year bachelor students attending a Dutch school of nursing. First-year nursing students have stereotype, mostly negative perceptions of psychiatric patients and mental health care. These perceptions strongly influence their future professional choices. The respondents provided various reasons for their decision not to major in mental health care, one of these being that the school did too little to counsel and inform them about mental health issues and a career in mental health care. As a result, their unrealistic perceptions prevailed. If schools offering bachelor of nursing programmes do not sufficiently counsel and inform students about mental health care, students will leave school with their stereotype, negative perception of mental health care intact. Mental health care institutions will run a great risk of losing potentially good nurses.

Smoking behaviour and health care costs coverage: a European cross-country comparison.

PubMed

Rezayatmand, Reza; Groot, Wim; Pavlova, Milena

2017-12-01

The empirical evidence about the effect of smoking on health care cost coverage is not consistent with the expectations based on the notion of adverse selection. This evidence is mostly based on correlational studies which cannot isolate the adverse selection effect from the moral hazard effect. Exploiting data from the Survey of Health, Aging, and Retirement in Europe, this study uses an instrumental variable strategy to identify the causal effect of daily smoking on perceived health care cost coverage of those at age 50 or above in 12 European countries. Daily smoking is instrumented by a variable indicating whether or not there is any other daily smoker in the household. A self-assessment of health care cost coverage is used as the outcome measure. Among those who live with a partner (72% of the sample), the result is not statistically significant which means we find no effect of smoking on perceived health care cost coverage. However, among those who live without a partner, the results show that daily smokers have lower self-assessed perceived health care cost coverage. This finding replicates the same counter-intuitive relationship between smoking and health insurance presented in previous studies, but in a language of causality. In addition to this, we contribute to previous studies by a cross-country comparison which brings in different institutional arrangements, and by using the self-assessed perceived health care cost coverage which is broader than health insurance coverage.

Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol

PubMed Central

Vázquez, María-Luisa; Vargas, Ingrid; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Albuquerque, Paulette; Eguiguren, Pamela; Cisneros, Angelica Ivonne; Rovere, Mario; Bertolotto, Fernando

2015-01-01

Introduction Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. Methods and analysis A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected—intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. Ethics and dissemination This study complies with international and national legal stipulations on ethics. Conditions of the study procedure were approved by each country's ethical committee. A variety of dissemination activities are implemented addressing the main stakeholders. Registration No.257 Clinical Research Register of the Santa Fe Health Department, Argentina. PMID:26231753

Case mix of home health patients under capitated and fee-for-service payment.

PubMed Central

Shaughnessy, P W; Schlenker, R E; Hittle, D F

1995-01-01

OBJECTIVE. We compare case mix of Medicare home health patients under HMO and FFS payment. STUDY DESIGN. A pseudo-experimental design was employed to study case mix using three types of Medicare-certified home health agencies (HHAs): HMO-owned agencies, pure FFS agencies that admit few Medicare HMO patients (less than 5 percent of admissions are Medicare HMO patients), and mixed (or contractual) agencies that admit at least 15 Medicare FFS patients and 15 Medicare HMO patients per month. SAMPLES OF PROVIDERS AND PATIENTS. Random samples of Medicare-aged patients (> or = 65 years) were selected at admission between June 1989 and November 1991 from the 38 study HHAs. Sample sizes by agency type were: 308 patients from 9 HMO-owned agencies; 529 patients from 15 pure FFS agencies; and 381 HMO patients and 414 FFS patients from 14 contractual agencies. DATA. Primary longitudinal data were prospectively collected at admission for all patients on health status indicators, demographics, admission source, and home environment. MEASURES. The most important case-mix measures were functional and physiologic indicators of health status, including (instrumental) activities of daily living ([I]ADLs). Selected indicators of demographic variables, prior location, living situation, characteristics of informal caregivers, mental/behavioral factors, and resource needs were also used. PRINCIPAL FINDINGS. (a) The case mix of Medicare FFS patients compared with Medicare HMO patients was more intense in terms of impairments in ADLs, IADLs, and various physiologic conditions. Pressure ulcers as well as neurological and orthopedic impairments requiring rehabilitation care were also more prevalent among FFS patients. (b) Relative to HMO patients admitted to contractual agencies, HMO patients admitted to HMO-owned agencies were moderately more dependent in ADLs and IADLs. However, only 62 percent of HMO patients admitted to HMO-owned agencies, in contrast to 77 percent of HMO patients admitted to contractual agencies, had been hospitalized during the 30 days prior to home health admission. (c) In all, the case mix of patients receiving care from HMO-owned agencies is more heterogeneous than the case mix of HMO patients receiving care from contractual agencies. CONCLUSIONS. The case-mix (and selected utilization) findings indicate that HMOs use home health care differently than does the FFS sector. The greater diversity of case mix for HMO-owned agencies and the narrower or less diverse case mix that characterizes HMO patients receiving home care on a contractual basis point to the likelihood of cost differences among the two types of HMO patients and FFS patients, and raise the question of possible outcome differences. PMID:7721587

Are nursing home survey deficiencies higher in facilities with greater staff turnover.

PubMed

Lerner, Nancy B; Johantgen, Meg; Trinkoff, Alison M; Storr, Carla L; Han, Kihye

2014-02-01

To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies. The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States. This study focused on the 1151 NNHS facilities with complete deficiency data. Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models. High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10-2.13), Resident Behavior (OR 1.42, 95% CI 1.03-1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12-2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50-2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25-2.33). When both CNA turnover and licensed nurse turnover were included in the same model, high licensed nurse turnover was significantly associated with Quality of Care and total deficiencies, whereas CNA turnover was not associated with that category of deficiencies. Turnover in nursing homes for both licensed nurses and CNAs is associated with quality problems as measured by deficiencies. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

PubMed Central

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

Introduction The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. Methods A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Result Only 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. Conclusion The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization. PMID:26986563

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

PubMed

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization.

Quality of Health Care for Children in Australia, 2012-2013.

PubMed

Braithwaite, Jeffrey; Hibbert, Peter D; Jaffe, Adam; White, Les; Cowell, Christopher T; Harris, Mark F; Runciman, William B; Hallahan, Andrew R; Wheaton, Gavin; Williams, Helena M; Murphy, Elisabeth; Molloy, Charlotte J; Wiles, Louise K; Ramanathan, Shanthi; Arnolda, Gaston; Ting, Hsuen P; Hooper, Tamara D; Szabo, Natalie; Wakefield, John G; Hughes, Clifford F; Schmiede, Annette; Dalton, Chris; Dalton, Sarah; Holt, Joanna; Donaldson, Liam; Kelley, Ed; Lilford, Richard; Lachman, Peter; Muething, Stephen

2018-03-20

The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. Quality of care for each clinical condition and overall. Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate.

[Simultaneous determination of 22 typical pharmaceuticals and personal care products in environmental water using ultra performance liquid chromatography- triple quadrupole mass spectrometry].

PubMed

Wu, Chunying; Gu, Feng; Bai, Lu; Lu, Wenlong

2015-08-01

An analytical method for simultaneous determination of 22 typical pharmaceuticals and personal care products (PPCPs) in environmental water samples was developed by ultra performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-MS/MS). An Oasis HLB solid phase extraction cartridge, methanol as washing solution, water containing 0. 1% formic acid-methanol (7:3, v/v) as the mobile phases were selected for sample pretreatment and chromatographic separation. Based on the optimized sample pretreatment procedures and separation condition, the target recoveries ranged from 73% to 125% in water with the relative standard deviations ( RSDs) from 8.8% to 17.5%, and the linear ranges were from 2 to 2 000 µg/L with correlation coefficients (R2) not less than 0.997. The method can be applied to simultaneous determination of the 22 typical PPCPs in environmental water samples because of its low detection limits and high recoveries. It can provide support and help for the related research on water environmental risk assessment and control of the micro-organic pollutants.

Control of diabetes and fibrinogen levels as well as improvement in health care might delay low cognitive performance in societies aging progressively.

PubMed

Lopes, Daniele Almeida; Moraes, Suzana Alves de; Freitas, Isabel Cristina Martins de

2015-01-01

To know the prevalence and factors associated to low cognitive performance in a representative sample of the adult population in a society aging progressively. Cross-sectional population-based study carried out in a three-stage sampling: 81 census tracts (primary sampling unity) were randomly selected, followed by 1,672 households and 2,471 participants (weighted sample) corresponding to the second and third stages, respectively. The outcome prevalence was calculated according sociodemographic, behavioral and health related variables. Crude and adjusted prevalence ratios were estimated using Poisson regression. The prevalence of low cognitive performance was high, mainly among females, and indicated linear trends into categories of age, schooling, income, plasma fibrinogen and self-reported health status. In multivariate models, gender, diabetes, fibrinogen and self-reported health status presented positive associations, while schooling, employment and sitting time presented negative associations with the outcome. Interventions related to diabetes and fibrinogen levels control as well as improvement in health care might delay low cognitive performance in societies aging progressively as such the study population.

Occurrence and risk assessment of pharmaceuticals and personal care products and endocrine disrupting chemicals in reclaimed water and receiving groundwater in China.

PubMed

Li, Zhen; Xiang, Xi; Li, Miao; Ma, Yeping; Wang, Jihua; Liu, Xiang

2015-09-01

Groundwater recharge using reclaimed water is considered a promising method to alleviate groundwater depletion. However, pollutants in reclaimed water could be recharged into groundwater during this process, thereby posing a risk to groundwater and human health. In this study, 12 cities in northern China were selected for reclaimed water and groundwater sampling. Analysis of the samples revealed the presence of nine pharmaceutical and personal care products (PPCPs) and five endocrine disrupting compounds (EDCs). In reclaimed water, all the PPCPs and EDCs were found, with sulpiride (SP) and estriol (E3) being most frequently detected. In groundwater samples, only ketoprofen (KP), mefenamic acid (MA), nalidixic acid (NA) and SP were detected among PPCPs, while bisphenol-A (BPA) was dominant among the target EDCs. The risk quotients (RQs) of all target PPCPs and EDCs except 17α-ethinyl estradiol (EE2) and E3 were below 1 in groundwater samples, indicating that EE2 and E3 deserve priority preferential treatment before recharging. Copyright © 2015 Elsevier Inc. All rights reserved.

[Epidemiology of atherogenic dyslipidemia in an urban area of the city of Barcelona].

PubMed

Caballero Sarmiento, Rafael

2014-01-01

We performed a descriptive cross-sectional epidemiological study data on lipid profile and blood glucose of sample collected in 2021 consecutive and anonymous patients. We calculated the prevalence of atherogenic dyslipidemia by sex, according to several cutoff HDL cholesterol in women, and in the whole sample, and its association with diabetes. There is in the study selection bias, as it is performed in patients attending in a Primary Care Laboratory and not in a sample of the general population. Prevalence epidemiological data are therefore approximate and provisional. Copyright © 2013 Elsevier España, S.L. y SEA. All rights reserved.

Dentists' Preferences for Diagnosis, Management and Referral of Chronic Oro-Facial Pain: Results from a National Survey

ERIC Educational Resources Information Center

Aggarwal, Vishal R.; Joughin, Amy; Zakrzewska, Joanna; Appelbe, Priscilla; Tickle, Martin

2012-01-01

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire…

Employment in Perspective: Women in the Labor Force. First Quarter 1988. Report 752.

ERIC Educational Resources Information Center

Bureau of Labor Statistics (DOL), Washington, DC.

A special survey on employer child-care practices conducted by the Bureau of Labor Statistics (BLS) in the summer of 1987 sampled 10,345 establishments with 10 or more employees selected from the BLS establishment universe file and classified by industry and size. The survey showed that over the last decade, the number of mothers in the labor…

Factors Associated with Nurses' Intention to Report Child Abuse: A National Survey of Taiwanese Nurses

ERIC Educational Resources Information Center

Feng, J.Y.; Levine, M.

2005-01-01

Objective:The objectives were to determine the experiences of Taiwanese nurses with a new child abuse reporting law and to assess attitudinal correlates of nurses' intention to report. Method: A stratified quota sampling technique was used to select registered nurses working in pediatric, psychiatric and emergency care units in Taiwan. A total of…

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study.

PubMed

Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

2017-02-06

To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. A cross-sectional study using a community-based survey. Yaoundé, Cameroon. All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Unmet needs for emergency care. Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The functions of hospital-based home care for people with severe mental illness in Taiwan.

PubMed

Huang, Xuan-Yi; Lin, Mei-Jue; Yang, Tuz-Ching; Hsu, Yuan-Shan

2010-02-01

The purposes of this study were to understand the functions of hospital-based home care for people with severe mental illness in Taiwan, and the factors that affect functions of professionals who provide hospital-based home care. Hospital-based home care is a service which provides those people with serious mental illnesses who are in crisis and who are candidates for admission to hospital. Home care has been shown to have several advantages over inpatient treatment. However, there is a lack of knowledge about the functions of hospital-based home care for people with severe mental illness in Taiwan. This qualitative study was based on the grounded theory method of Strauss and Corbin. The study was conducted in six different hospital areas in central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Several functions were found when these professionals provided hospital-based home care services for people with severe mental illness in Taiwan, including stabilising the clients illness, supplying emergency care services, improving life-coping abilities, employment and welfare assistance, emotional support for both clients and carers, assistance with future and long-term arrangements and assistance with communication between carers and clients. Hospital-based home care provides several important services for helping clients and their families to live in the community. The recommendations based on the findings of this study can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling clients with severe mental illness and their carers.

Muddling through the Health System: Experiences of Three Groups of Black Women in Three Regions

PubMed Central

Gary, F; Still, C; Mickels, P; Hassan, M; Evans, E

2018-01-01

Health care disparities are a well-documented concern among patients and providers who care for minority groups in the United States. In this study, focus groups were created from an original sample of 606 Black women representing three regions in the United States: the South, the Midwest, and the Virgin Islands. Composed of 10 randomly selected members each (n = 30), the focus groups provided insights into the nature of these disparities, with some suggestions for viable solutions. Participants voiced concerns about cultural taboos about discussing menopause, financial concerns, and negative experiences with health care leading to distrust in medical systems. The primary solution proposed was an increase in Black health care professionals who would have increased rapport with, empathy for, and understanding of the concerns of Black women. PMID:26371357

Ethical issues experienced by intensive care unit nurses in everyday practice.

PubMed

Fernandes, Maria I D; Moreira, Isabel M P B

2013-02-01

This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies.

Public Attitudes about Health Information Technology, and Its Relationship to Health Care Quality, Costs, and Privacy

PubMed Central

Gaylin, Daniel S; Moiduddin, Adil; Mohamoud, Shamis; Lundeen, Katie; Kelly, Jennifer A

2011-01-01

Objective To understand Americans' attitudes concerning health information technology's (IT's) potential to improve health care and differences in those attitudes based on demographics and technological affinity. Data Sources/Study Setting A random-digit-dial sample with known probability of selection for every household in the United States with a telephone, plus a supplemental sample of cell phone users. Telephone interviews were conducted from August 2009 through November 2009. Study Design Data were analyzed to present univariate estimates of Americans' opinions of health IT, as well as multivariate logistic regressions to assess hypotheses relating individuals' characteristics to their opinions. Characteristics used in our model include age, race, ethnicity, gender, income, and affinity to technology. Findings A large majority (78 percent) favor use of electronic medical records (EMRs); believe EMRs could improve care and reduce costs (78 percent and 59 percent, respectively); believe benefits of EMR use outweigh privacy risks (64 percent); and support health care information sharing among providers (72 percent). Regression analyses show more positive attitudes among those with higher incomes and greater comfort using electronic technologies. Conclusion The findings suggest that American's believe that health IT adoption is an effective means to improve the quality and safety of health care. PMID:21275986

[Information technology for the management of health care data: the EPIweb project].

PubMed

Vittorini, Pierpaolo; Necozione, Stefano; di Orio, Ferdinando

2005-01-01

In the US, the Center for Disease Control and Prevention has produced has increased the permeability of the computer science technologies, in order to achieve a better and more efficient management of health care data. In this context, the present paper proposes a discussion regarding a web-based information system, called EPIweb. This system allows researchers to select the centers for the data entry, collect and elaborate health care data, produce technical reports and discuss results. Such a system aims to be easy-to-use, totally configurable and particularly suitable for the management of multicenter studies. The paper shows the EPIweb features, proposes a sample system run, and concludes with a discussion regarding both the advantages and the possible improvements and extensions.

Credibility Elements of eWOM Messages in the Context of Health Care Services. A Romanian Perspective

PubMed Central

Purcarea, VL; Gheorghe, IR; Petrescu, CM

2013-01-01

The purpose of this paper is to investigate the Romanian consumers’ determinants of eWOM messages’ perceived credibility in the context of health care services. We selected a sample of 127 women and we administered a questionnaire. We used the partial least squares to uncover the established relationships between the variables of the model, namely the argument strength and the source credibility of a eWOM message and the intention to purchase a health care service based on the information embedded in the eWOM messages. The results revealed that all variables had positive direct correlations with each other but the argument strength of a message has the highest impact on the intention. PMID:24146683

Credibility elements of eWOM messages in the context of health care services. A Romanian perspective.

PubMed

Purcarea, V L; Gheorghe, I R; Petrescu, C M

2013-09-15

The purpose of this paper is to investigate the Romanian consumers' determinants of eWOM messages' perceived credibility in the context of health care services. We selected a sample of 127 women and we administered a questionnaire. We used the partial least squares to uncover the established relationships between the variables of the model, namely the argument strength and the source credibility of a eWOM message and the intention to purchase a health care service based on the information embedded in the eWOM messages. The results revealed that all variables had positive direct correlations with each other but the argument strength of a message has the highest impact on the intention.

Perspectives on barriers and facilitators to self-care in Lebanese cardiac patients: A qualitative descriptive study.

PubMed

Dumit, Nuhad Yazbik; Noureddine, Samar Nayef; Magilvy, Joan Kathy

2016-08-01

Cardiovascular disease is the leading cause of mortality worldwide. Cardiac self-care practices are essential for managing cardiac illness and improving quality of life. However, these practices may be affected by factors that may hinder or facilitate self-care especially in countries that experience political and economic instabilities. The purpose of this study was to explore self-care practices among Lebanese cardiac patients. Another aim was to reveal factors that might influence these self-care practices. This is a qualitative descriptive study. Participants were recruited from a referral medical center in Beirut, Lebanon and interviews took place in their homes. Purposive sample of 15 adult participants, seven females and eight males, diagnosed with coronary artery disease at least a year ago and not in critical condition recruited from the cardiology clinics of the medical center. Data were collected through semi-structured audio-recorded interviews that took place in their places of residents. Three themes emerged from the data: I. The behaviors of cardiac patients demonstrated selected self-care practices; II. Patients identified barriers to self-care reflective of the Lebanese political and socio-economic situation; and, III. Patients described facilitators to self-care consistent with the Lebanese socio-cultural values and norms. The most common self-care practices included taking medications and eating properly. Participants emphasized avoiding stress and being upset as a self-protective measure for cardiac health. Health care costs, family responsibilities, psychological factors and the country's political situation impeded self-care practices whereas family support facilitated them. Lebanese patients reported select self-care practices in dealing with their cardiac illness. Barriers and facilitators to their self-care behaviors reflected the Lebanese context and culture. Thus health care providers must assess their patients' practices within their sociocultural context so that interventions to promote self-care are tailored accordingly. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey

PubMed Central

Wong, William C. W.; Jiang, Sunfang; Ong, Jason J.; Peng, Minghui; Wan, Eric; Zhu, Shanzhu; Lam, Cindy L. K.; Kidd, Michael R.; Roland, Martin

2017-01-01

PURPOSE China introduced a national policy of developing primary care in 2009, establishing 8,669 community health centers (CHCs) by 2014 that employed more than 300,000 staff. These facilities have been underused, however, because of public mistrust of physicians and overreliance on specialist care. METHODS We selected a stratified random sample of CHCs throughout China based on geographic distribution and urban-suburban ratios between September and December 2015. Two questionnaires, 1 for lead clinicians and 1 for primary care practitioners (PCPs), asked about the demographics of the clinic and its clinical and educational activities. Responses were obtained from 158 lead clinicians in CHCs and 3,580 PCPs (response rates of 84% and 86%, respectively). RESULTS CHCs employed a median of 8 physicians and 13 nurses, but only one-half of physicians were registered as PCPs, and few nurses had training specifically for primary care. Although virtually all clinics were equipped with stethoscopes (98%) and sphygmomanometers (97%), only 43% had ophthalmoscopes and 64% had facilities for gynecologic examination. Clinical care was selectively skewed toward certain chronic diseases. Physicians saw a median of 12.5 patients per day. Multivariate analysis showed that more patients were seen daily by physicians in CHCs organized by private hospitals and those having pharmacists and nurses. CONCLUSIONS Our survey confirms China’s success in establishing a large, mostly young primary care workforce and providing ongoing professional training. Facilities are basic, however, with few clinics providing the comprehensive primary care required for a wide range of common physical and mental conditions. Use of CHCs by patients remains low. PMID:28483889

Race, gender, and language concordance in the primary care setting.

PubMed

Martin, Brian C; Shi, Leiyu; Ward, Ryan D

2009-01-01

The purpose of this paper is to examine race, gender and language concordance in terms of importance to primary care. The 2003 Medical Expenditure Panel Survey Household Component (MEPS) was used. Four distinguishing primary care attributes and selected measures were operationalized primarily from a sample subset that identified a usual source of care (USC): accessibility to USC; interface between primary care and specialist services; treatment decisions; and preventive services received from the USC. Bivariate and multivariate results are reported. Adjusting for covariates, the following items remained statistically significant: race--choosing primary care physician as USC, USC having office hours, and going to USC for new health problems; gender--choosing primary care physician as USC and USC having office hours; and language--lack of difficulty contacting the USC after hours. However, these items appear to be isolated cases rather than indicators that concordance plays a key role in determining primary care quality. Language barriers/communication issues are the only areas where improvement appears warranted. While the study has strong accessibility and interpersonal relationship measures, service coordination and comprehensiveness indicators are limited. The analyses' cross-sectional nature also poses a problem in drawing causal relationships and conclusive findings. Finally, sample size limitations preclude stratified analyses across racial/ethnic groups, an important consideration as the relationships between concordance and quality may vary across groups. This study indicates that more research is needed in this area to determine future resource allocation and policy direction. The unique contribution of the study is to suggest that race and gender concordance may not accurately predict primary health care quality.

The Relationship between Religious Coping and Self-Care Behaviors in Iranian Medical Students.

PubMed

Sharif Nia, Hamid; Pahlevan Sharif, Saeed; Goudarzian, Amir Hossein; Allen, Kelly A; Jamali, Saman; Heydari Gorji, Mohammad Ali

2017-12-01

In recent years, researchers have identified that coping strategies are an important contributor to an individual's life satisfaction and ability to manage stress. The positive relationship between religious copings, specifically, with physical and mental health has also been identified in some studies. Spirituality and religion have been discussed rigorously in research, but very few studies exist on religious coping. The aim of this study was to determine the relationship between religious coping methods (i.e., positive and negative religious coping) and self-care behaviors in Iranian medical students. This study used a cross-sectional design of 335 randomly selected students from Mazandaran University of Medical Sciences, Iran. A data collection tool comprised of the standard questionnaire of religious coping methods and questionnaire of self-care behaviors assessment was utilized. Data were analyzed using a two-sample t test assuming equal variances. Adjusted linear regression was used to evaluate the independent association of religious copings with self-care. Adjusted linear regression model indicated an independent significant association between positive (b = 4.616, 95% CI 4.234-4.999) and negative (b = -3.726, 95% CI -4.311 to -3.141) religious coping with self-care behaviors. Findings showed a linear relationship between religious coping and self-care behaviors. Further research with larger sample sizes in diverse populations is recommended.

Understanding patient requirements for technology systems that support pain management in palliative care services: A qualitative study.

PubMed

Allsop, Matthew J; Taylor, Sally; Bennett, Michael I; Bewick, Bridgette M

2017-11-01

Approaches to pain management using electronic systems are being developed for use in palliative care. This article explores palliative care patients' perspectives on managing and talking about pain, the role of technology in their lives and how technology could support pain management. Face-to-face interviews were used to understand patient needs and concerns to inform how electronic systems are developed. A total of 13 interviews took place with a convenience sample of community-based patients with advanced cancer receiving palliative care through a hospice. Data were analysed using framework analysis. Four meta-themes emerged: Technology could be part of my care; I'm trying to understand what is going on; My pain is ever-changing and difficult to control; and I'm selective about who to tell about pain. Patients described technology as peripheral to existing processes of care. To be relevant, systems may need to take account of the complexity of a patient's pain experience alongside existing relationships with health professionals.

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study.

PubMed

Shahsavari, Hooman; Nasrabadi, Alireza Nikbakht; Almasian, Mohammad; Heydari, Heshmatolah; Hazini, Abdolrahim

2018-01-01

Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. The purpose of this study was to explore the administrative aspects of the delivery of home health care services. This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

HIV disclosure in rural China: Predictors and relationship to access to care

PubMed Central

Ding, Yingying; Li, Li; Ji, Guoping

2011-01-01

This study examined the main reasons and predictors of HIV disclosure and its relationship to access to care among people living with HIV (PLH) in a rural area of China. A sample of 88 PLH from three counties was interviewed in 2009. In our sample, the rates of disclosure were higher within and outside family. Trust (31%), needing help (28%), and close relationships (26%) were the three main reasons of selecting the person to disclose by a PLH. Using a multivariate analysis, level of HIV disclosure to partners and members within the community was only significantly associated with use of antiretroviral treatment (ART) (β =2.76; 95% Confidence Interval: 0.77, 4.74). After adjusting for demographics, time since HIV diagnosis and ART, we found HIV disclosure (β =0.07; 95% Confidence Interval: 0.01, 0.13) was a significant predictor for access to care. In order to improve PLHs’ access to health services and care, future intervention programs should consider both the potential benefits and risks associated with HIV disclosure (intentional and unintentional), and assist PLHs to prepare for HIV disclosure and reduce potential negative impacts that come with it. PMID:21480006

[Epidemiology of emotional and behavioral problems in children and adolescents reared in orphanages: a national comparative study].

PubMed

Simşek, Zeynep; Erol, Neşe; Oztop, Didem; Ozer Ozcan, Ozlem

2008-01-01

We examined the prevalence of emotional and behavioral problems, and associated factors in children and adolescents aged 6-18 years that were reared in orphanages. We aimed to compare these children and adolescents with a nationally representative age-matched sample that were raised by their own families and to identify mental health service needs in orphanages. This cross-sectional study included 674 children and adolescents aged 6-18 years that were selected from orphanages using stratified and probability cluster sampling. A socio-demographic information form, and the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and Youth Self-Report Form (YSR) were used for data collection. According to the information provided by caregivers, teachers, and youths, the prevalence of problem behaviors ranged between 18.3% and 47% among those in institutional care versus between 9% and 11% among the national sample. Among those in institutional care, the prevalence of externalizing problems (21.4%-41.9%) was significantly higher than the prevalence of internalizing problems (6.2%-40.1%). At the syndrome level, the prevalence of social problems (5.7%-11.7%), thought disorders (7.2%-18.4%), and attention problems (7.7%-31.4%) among the youths in institutional care was higher than among the national sample (1.6%-5.8%). Age at first admission, receiving institutional care because of neglect and abuse, moves 2 or more times between institutions, recurrent physical illness, receiving poor quality care, lack of regular contact with parents or relatives, lack of regular contact with teachers and the institutional staff, poor problem-solving skills, fatalistic beliefs, tobacco and alcohol use, the feeling of stigmatization, and low-level competency were significantly associated with an increased risk of behavioral and emotional problems. In this representative study, only 2.4% of the children received any mental health care services. There is an urgent need to develop alternative care models and routine screening for mental health. The training of professionals and development of mental health services for children in institutional care should be a priority.

A comprehensive approach to psychometric assessment of instruments used in dementia educational interventions for health professionals: a cross-sectional study.

PubMed

Wang, Yao; Xiao, Lily Dongxia; He, Guo-Ping

2015-02-01

Suboptimal care for people with dementia in hospital settings has been reported and is attributed to the lack of knowledge and inadequate attitudes in dementia care among health professionals. Educational interventions have been widely used to improve care outcomes; however, Chinese-language instruments used in dementia educational interventions for health professionals are lacking. The aims of this study were to select, translate and evaluate instruments used in dementia educational interventions for Chinese health professionals in acute-care hospitals. A cross-sectional study design was used. A modified stratified random sampling was used to recruit 442 participants from different levels of hospitals in Changsha, China. Dementia care competence was used as a framework for the selection and evaluation of Alzheimer's Disease Knowledge Scale and Dementia Care Attitudes Scale for health professionals in the study. These two scales were translated into Chinese using forward and back translation method. Content validity, test-retest reliability and internal consistency were assessed. Construct validity was tested using exploratory factor analysis. Known-group validity was established by comparing scores of Alzheimer's Disease Knowledge Scale and Dementia Care Attitudes Scale in two sub-groups. A person-centred care scale was utilised as a gold standard to establish concurrent validity of these two scales. Results demonstrated acceptable content validity, internal consistency, test-retest reliability and concurrent validity. Exploratory factor analysis presented a single-factor structure of the Chinese Alzheimer's Disease Knowledge Scale and a two-factor structure of the Chinese Dementia Care Attitudes Scale, supporting the conceptual dimensions of the original scales. The Chinese Alzheimer's Disease Knowledge Scale and Chinese Dementia Care Attitudes Scale demonstrated known-group validity evidenced by significantly higher scores identified from the sub-group with a longer work experience compared to those in the sub-group with less work experience. The use of dementia care competence as a framework to inform the selection and evaluation of instruments used in dementia educational interventions for health professionals has wide applicability in other areas. The results support that Chinese Alzheimer's Disease Knowledge Scale and Chinese Dementia Care Attitudes Scale are reliable and valid instruments for health professionals to use in acute-care settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

Occurrence, fate and ecotoxicological risk of personal care products in urban river-groundwater interface

NASA Astrophysics Data System (ADS)

Jurado, Anna; Pau Serra, Maria; Díaz-Cruz, M. Silvia; Vázquez-Suñé, Enric; Pujades, Estanislao; Barceló, Damià

2016-04-01

This work presents the occurrence and fate of selected personal care products (PCPs) in the urban river-groundwater interface. To this end, urban groundwater and river samples were collected in Sant Adrià del Besòs (NE of Spain) and a total of 16 PCPs were analyzed including benzophenone derivatives, camphor derivatives, p-aminobenzoic acid derivatives, triazoles and parabens in three different campaigns (from May 2010 to July 2014). These compounds reach the aquifer through the recharge of River Besòs that receives large amounts of effluents from waste water treatment plants. Results shown that most of compounds were not or barely detected (maximum concentrations around 30 ng/L) in groundwater samples during the different sampling campaigns. Only two triazoles, named as benzotriazole (BZT) and methyl benzotriazol (MeBZT) were found at high concentrations in groundwater samples (maximum concentration around 2000 ng/L). The fate of PCPs in the aquifer was assessed using mixing analysis considering the temporal variability of the River Besòs. Overall, measured groundwater concentrations were significantly much lower than those estimated by the mixing of the river water. This observation suggested that most of the PCPs are naturally removed when river water infiltrates the aquifer. However, some compounds were more persistent in the aquifer. These compounds were in descending order: the triazoles MeBZT and BZT followed by the camphor derivative 4MBC. The measured concentrations allowed us to assess the environmental risk posed by the selected UV-Fs (e.g. benzophenone derivatives) in the river-groundwater samples. Hazard Quotients (HQs) for diferent aquatic species were calculated in order to characterise the ecotoxicity potential of the studied compounds in the river-groundwater interface. HQ values will be presented and discussed in the presentation.

Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial

PubMed Central

2013-01-01

Background To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. Methods/design Experimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents. Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use. Discussion This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations. Trial registration NCT01826929 PMID:23915267

Factual knowledge about AIDS and dating practices among high school students from selected schools.

PubMed

Nyachuru-Sihlangu, R H; Ndlovu, J

1992-06-01

Following various educational strategies by governmental and non-governmental organisations to educate youths and school teachers about HIV infection and prevention, this KABP survey was one attempt to evaluate the results. The study sample of 478 high school students was drawn from four randomly selected schools in Mashonaland and Matabeleland including high and low density, government and mission co-educational schools. The sample was randomly selected and stratified to represent sex and grade level. The KABP self administered questionnaire was used. The paper analyses the relationship between the knowledge and dating patterns. Generally, respondents demonstrated a 50pc to 80pc accuracy of factual knowledge. Of the 66pc Forms I through IV pupils who dated, 30pc preferred only sexually involved relationships and a small number considered the possibility of HIV/AIDS infection. A theoretically based tripartite coalition involving the school, the family health care services for education, guidance and support to promote responsible behaviour throughout childhood was suggested.

Towards quality indicators for assertive outreach programmes for severely impaired substance abusers: concept mapping with Dutch experts.

PubMed

Roeg, Diana; van de Goor, Ien; Garretsen, Henk

2005-06-01

We investigated the concept of 'quality of assertive outreach programmes for severely impaired substance abusers' with the aim of developing a conceptual framework as the basis for an assessment instrument. We held a concept-mapping session with 13 experts in 2003. Fifty measurable elements of quality were mentioned and rated in terms of relative importance on a Likert-type response scale. Subsequently, the experts grouped the statements that were similar in content. The resulting concept map and additional interpretation made up the final quality framework. SETTING/STUDY PARTICIPANTS: Theoretical sampling was used to select Dutch managers, team leaders, and service providers from different assertive outreach delivery systems for substance abusers. Variation in both perspective and region was reflected in the sample. Nine aspects of quality were formulated: preconditions for care, preconditions for service providers' work, relationship to regular care, service providers' activities and goals, service providers' skills, the role of repression, optimal care for the client, goals of assertive outreach, and nuisance reduction to society. Each aspect was presented using a selection of measurable elements. According to the experts, optimal assertive outreach depends on a broad range of aspects that were later classified in three regions: structure, process, and outcomes. Saturation of the elements has not been proved so far. Nevertheless, it is promising that the framework's regions are supported by theory and that it is largely in accordance with clients' perspectives on assertive community treatment.

Identifying Depressed Older Adults in Primary Care: A Secondary Analysis of a Multisite Randomized Controlled Trial

PubMed Central

Voils, Corrine I.; Olsen, Maren K.; Williams, John W.; for the IMPACT Study Investigators

2008-01-01

Objective: To determine whether a subset of depressive symptoms could be identified to facilitate diagnosis of depression in older adults in primary care. Method: Secondary analysis was conducted on 898 participants aged 60 years or older with major depressive disorder and/or dysthymic disorder (according to DSM-IV criteria) who participated in the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) study, a multisite, randomized trial of collaborative care for depression (recruitment from July 1999 to August 2001). Linear regression was used to identify a core subset of depressive symptoms associated with decreased social, physical, and mental functioning. The sensitivity and specificity, adjusting for selection bias, were evaluated for these symptoms. The sensitivity and specificity of a second subset of 4 depressive symptoms previously validated in a midlife sample was also evaluated. Results: Psychomotor changes, fatigue, and suicidal ideation were associated with decreased functioning and served as the core set of symptoms. Adjusting for selection bias, the sensitivity of these 3 symptoms was 0.012 and specificity 0.994. The sensitivity of the 4 symptoms previously validated in a midlife sample was 0.019 and specificity was 0.997. Conclusion: We identified 3 depression symptoms that were highly specific for major depressive disorder in older adults. However, these symptoms and a previously identified subset were too insensitive for accurate diagnosis. Therefore, we recommend a full assessment of DSM-IV depression criteria for accurate diagnosis. PMID:18311416

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-01-01

Background: Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. Objectives: The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. Materials and Methods: This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Results: Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. Conclusions: The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality. PMID:27175303

The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia.

PubMed

Bayou, Yibeltal T; Mashalla, Yohana S; Thupayagale-Tshweneagae, Gloria

2016-06-15

There are recent efforts made to eliminate inequalities in the utilisation of basic health care services. More emphasis is given for improvement of health in developing countries including maternal and child health. However, disparities for the fast-growing population of urban poor are masked by the urban averages. The aim of this paper is to report on the findings of antenatal care adequacy among slum residents in Addis Ababa, Ethiopia. This was a quantitative and cross-sectional community based study design which employed a stratified two-stage cluster sampling technique to determine the sample. Data was collected using structured questionnaire administered to 870 women aged 15-49 years. Weighted 'backward selection' logistic regression models were employed to identify predictors of adequacy of antenatal care. Majority of slum residents did not have adequate antenatal care services with only 50.3, 20.2 and 11.0 % of the slum resident women initiated antenatal care early, received adequate antenatal care service contents and had overall adequate antenatal care services respectively. Educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.7 times more likely to receive overall adequate care compared to those with no formal education. Similarly, clients of private healthcare facilities were 2.2 times respectively more likely to receive overall adequate antenatal care compared to those clients of public healthcare facilities. In order to improve ANC adequacy in the study area, the policy-making, planning, and implementation processes should address the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Pilot study of quality of care training and knowledge in Sub-Saharan African medical schools

PubMed Central

Abbas, Yasmin; Odunleye, Temitope; Broughton, Edward; Bossert, Thomas

2017-01-01

Objectives To identify the level of knowledge and competencies related to quality of care during medical education in sub-Saharan African medical schools.  Methods A cross-sectional study design was utilized to examine the capacity of medical schools in sub-Saharan African (SSA) countries to teach about the concepts of quality of care and the inclusion of these concepts in their curriculum. A purposeful convenience sampling technique was used to select participants from 25 medical schools in 5 sub-Saharan African countries. Respondents included medical school deans or senior academic personnel.  A survey was developed using the Institute of Medicine’s definition of quality of care as the guiding framework.  Sample means and summary statistics were used to present the results of the survey responses. Results While 45% of the schools surveyed are teaching on at least one of the six domains of the Institute of Medicine’s definition of quality of care, there are some schools who report not teaching about quality at all, or that they “do not know”. Despite these low numbers, when asked about topics related to quality of care, many schools are teaching applied management related topics and almost all schools teach about equity and patient-centered care. Conclusions The results have important impacts both for incorporating quality of care into medical education and for practitioners.  The tool developed for this study can be used in future qualitative and quantitative studies to further understanding of how to improve the teaching and learning about quality of care in medical schools. Keywords: quality of care, medical schools, sub-Saharan Africa, medical errors, healthcare improvement PMID:28753130

Participation in the Child and Adult Care Food Program Is Associated with Healthier Nutrition Environments at Family Child Care Homes in Mississippi.

PubMed

Erinosho, Temitope; Vaughn, Amber; Hales, Derek; Mazzucca, Stephanie; Gizlice, Ziya; Ward, Dianne

2018-05-01

Describe foods and beverages offered, nutrition practices, and nutrition policies of family child care homes in Mississippi and differences by participation in the Child and Adult Care Food Program (CACFP). Cross-sectional study conducted between fall, 2015 and spring, 2016. Mississippi. Random, stratified sample of 134 family child care homes that enroll 3- to 5-year-olds. Providers completed a modified version of the Environment and Policy Assessment and Observation-self-report tool. Foods and beverages offered at lunch, provider practices regarding nutrition, and presence or absence of written nutrition policies. Descriptive statistics, likelihood ratio chi-square, and t tests. Most homes (>75%) provided components from the fruit, vegetable, grain/bread, meat/meat alternative, and milk food groups at lunch. At some homes, the food and beverage selections offered were high in fat, sugar, and refined grains. Providers at CACFP-participating homes (P < .05) reported healthier beverage selections, more healthful nutrition practices, and more written nutrition policies compared with providers at non-CACFP homes. Interventions and regulatory standards are needed, particularly in non-CACFP homes, to ensure that food and beverage offerings, provider practices, and policies regarding nutrition support the development of healthful dietary behaviors in early childhood. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Management of patients with coronary heart disease in family medicine: correlates of quality of care.

PubMed

Tušek-Bunc, Ksenija; Petek, Davorina

2018-04-10

Family medicine plays an important role in quality of care (QoC) of coronary heart disease (CHD) patients. This study's aim was to determine the quality of secondary cardiovascular disease prevention in the everyday practice of family physicians. This study was observational cross-sectional. About 36 randomly selected family medicine practices stratified by size and location in Slovenia. CHD patients randomly selected from a patient register available in family medicine practices. The instrument for assessment of quality included a form for collecting data from medical records, a general practice assessment questionnaire and a patient questionnaire. QoC was defined by two composite variables, namely risk factor registration and CHD patient process of care, as the two care outcomes. In multivariate analysis, we performed multilevel regression analysis to identify the associations between QoC, the patient and the practice characteristics. The final sample included 423 CHD patients from 36 family medicine practices. Risk factor registration was associated with the practice organisation score (P = 0.004), practice size (P = 0.042), presence of comorbid atherosclerotic diseases (P = 0.043) and a lower age of CHD patients (P = 0.001). CHD patient process of care was associated with the practice organisation score (0.045) and a lower age of CHD patients (P = 0.035). The most important factors affecting the quality of CHD patient care were linked to the organisational characteristics of the family medicine practices.

Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention.

PubMed

Mahomed, Ozayr H; Naidoo, Salsohni; Asmall, Shaidah; Taylor, Myra

2015-09-25

Deficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases. The aim of this study was to establish if the implementation of a structured clinical record (SCR) as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level. A quasi-experimental study (before and after study with a comparison group) was conducted across 30 primary health care clinics (PHCs) located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS) method was used to determine the number of records required to be reviewed per diagnostic condition per facility. There was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes). A multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training) has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa.

Children's Literature Resources on War, Terrorism, and Natural Disasters for Pre-K to Grade 3

ERIC Educational Resources Information Center

Roberts, Sherron Killingsworth; Crawford, Patricia A.

2009-01-01

This article presents picture books that are considered as a sample of children's literature selections on war, terrorism, and natural disasters for pre-K to 3rd-grade children which were chosen with both young children and their teachers and parents in mind. The authors recommend these books to be used as read-alouds, so that caring adults who…

Multi-residue screening of prioritised human pharmaceuticals, illicit drugs and bactericides in sediments and sludge.

PubMed

Langford, Katherine H; Reid, Malcolm; Thomas, Kevin V

2011-08-01

A robust multi-residue method was developed for the analysis of a selection of pharmaceutical compounds, illicit drugs and personal care product bactericides in sediments and sludges. Human pharmaceuticals were selected for analysis in Scottish sewage sludge and freshwater sediments based on prescription, physico-chemical and occurrence data. The method was suitable for the analysis of the selected illicit drugs amphetamine, benzoylecgonine, cocaine, and methamphetamine, the pharmaceuticals atenolol, bendroflumethiazide, carbamazepine, citalopram, diclofenac, fluoxetine, ibuprofen, and salbutamol, and the bactericides triclosan and triclocarban in sewage sludge and freshwater sediment. The method provided an overall recovery of between 56 and 128%, RSDs of between 2 and 19% and LODs of between 1 and 50 ng g(-1). Using the methodology the human pharmaceuticals atenolol, carbamazepine and citalopram and the bactericides triclosan and triclocarban were detected in Scottish sewage sludge. The illicit drugs cocaine, its metabolite benzoylecgonine, amphetamine and methamphetamine were not detected in any of the samples analysed. Triclosan and triclocarban were present at the highest concentrations with triclocarban detected in all but one sample and showing a pattern of co-occurrence in both sludge and sediment samples.

Assessment of Motivational Cognitions in Diabetes Self-Care: the Motivation Thought Frequency Scales for Glucose Testing, Physical Activity and Healthy Eating.

PubMed

Parham, Sophie C; Kavanagh, David J; Gericke, Christian A; King, Neil; May, Jon; Andrade, Jackie

2017-06-01

There is a need for improved measurement of motivation for diabetes self-care. The Elaborated Intrusion Theory of Desire offers a coherent framework for understanding and identifying the cognitive-affective events that constitute the subjective experience of motivation and may therefore inform the development of such an instrument. Recent research has shown the resultant Motivation Thought Frequency scale (MTF) to have a stable factor structure (Intensity, Incentives Imagery, Self-Efficacy Imagery, Availability) when applied to physical activity, excessive snacking or alcohol use in the general population. The current study aimed to confirm the four-factor structure of the MTF for glucose testing, physical activity and healthy eating in people with type 2 diabetes. Associations with self-reports of concurrent diabetic self-care behaviours were also examined. Confirmatory factor analyses tested the internal structure, and multiple regressions assessed the scale's relationship with concurrent self-care behaviours. The MTF was completed by 340 adults with type 2 diabetes, and 237 from that sample also reported self-care behaviours. Separate MTFs assessed motivation for glucose testing, physical activity and healthy eating. Self-care was assessed using questions from the Summary of Diabetes Self-Care Activities. The MTF for each goal achieved an acceptable fit on all indices after selected errors within factors were allowed to intercorrelate. Intensity and Self-Efficacy Imagery provided the strongest and most consistent correlations with relevant self-care behaviours. Results provide preliminary support for the MTF in a diabetes sample. Testing of its sensitivity to change and its predictive utility over time is needed.

Guidelines for Measuring Disease Episodes: An Analysis of the Effects on the Components of Expenditure Growth.

PubMed

Dunn, Abe; Liebman, Eli; Rittmueller, Lindsey; Shapiro, Adam Hale

2017-04-01

To provide guidelines to researchers measuring health expenditures by disease and compare these methodologies' implied inflation estimates. A convenience sample of commercially insured individuals over the 2003 to 2007 period from Truven Health. Population weights are applied, based on age, sex, and region, to make the sample of over 4 million enrollees representative of the entire commercially insured population. Different methods are used to allocate medical-care expenditures to distinct condition categories. We compare the estimates of disease-price inflation by method. Across a variety of methods, the compound annual growth rate stays within the range 3.1 to 3.9 percentage points. Disease-specific inflation measures are more sensitive to the selected methodology. The selected allocation method impacts aggregate inflation rates, but considering the variety of methods applied, the differences appear small. Future research is necessary to better understand these differences in other population samples and to connect disease expenditures to measures of quality. © Health Research and Educational Trust.

Assistance received by employed caregivers and their care recipients: who helps care recipients when caregivers work full time?

PubMed

Scharlach, Andrew E; Gustavson, Kristen; Dal Santo, Teresa S

2007-12-01

This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member or friend aged 50 or older, identified through random sampling of California households. We assessed care recipient impairment and service problems; the amounts and types of assistance received from caregivers, family and friends, and paid providers; and caregiver utilization of support services. Care recipients of caregivers employed full time were less likely to receive large amounts of care from their caregivers, more likely to receive personal care from paid care providers, more likely to use community services, and more likely to experience service problems than were care recipients of nonemployed caregivers. Employed caregivers were more likely to use caregiver support services than were nonemployed caregivers. Accommodation to caregiver full-time employment involves selective supplementation by caregivers and their care recipients, reflecting increased reliance on formal support services as well as increased vulnerability to service problems and unmet care recipient needs. These findings suggest the need for greater attention to the well-being of disabled elders whose caregivers are employed full time.

The technological influence on health professionals' care: translation and adaptation of scales1

PubMed Central

Almeida, Carlos Manuel Torres; Almeida, Filipe Nuno Alves dos Santos; Escola, Joaquim José Jacinto; Rodrigues, Vitor Manuel Costa Pereira

2016-01-01

Objectives: in this study, two research tools were validated to study the impact of technological influence on health professionals' care practice. Methods: the following methodological steps were taken: bibliographic review, selection of the scales, translation and cultural adaptation and analysis of psychometric properties. Results: the psychometric properties of the scale were assessed based on its application to a sample of 341 individuals (nurses, physicians, final-year nursing and medical students). The validity, reliability and internal consistency were tested. Two scales were found: Caring Attributes Questionnaire (adapted) with a Cronbach's Alpha coefficient of 0.647 and the Technological Influence Questionnaire (adapted) with an Alpha coefficient of 0.777. Conclusions: the scales are easy to apply and reveal reliable psychometric properties, an additional quality as they permit generalized studies on a theme as important as the impact of technological influence in health care. PMID:27143537

WHO/INRUD patient care and facility-specific drug use indicators at primary health care centres in Eastern province, Saudi Arabia.

PubMed

El Mahalli, A A; Akl, O A M; Al-Dawood, S F; Al-Nehab, A A; Al-Kubaish, H A; Al-Saeed, S; Elkahky, A A A; Salem, A M A A

2012-11-01

This study aimed to measure the performance of primary health care centres in Eastern province, Saudi Arabia, using the WHO/International Network of Rational Use of Drugs patient care and facility-specific drug use indicators. In a cross-sectional study, 10 health centres were selected using systematic random sampling. A total of 300 patients were interviewed while visiting the centre from January to March 2011 and 10 pharmacists from the same centres were interviewed. Average consultation time was 7.3 min (optimal > or = 30 min), percentage of drugs adequately labelled was 10% (optimal 100%) and patient's knowledge of correct dosage was 79.3% (optimal 100%). The percentage of key drugs in stock was only 59.2% (optimal 100%). An overall index of rational facility-specific drug use was calculated and applied to rank the health centres for benchmarking.

Reduction of 30-Day Preventable Pediatric Readmission Rates With Postdischarge Phone Calls Utilizing a Patient- and Family-Centered Care Approach.

PubMed

Flippo, Renee; NeSmith, Elizabeth; Stark, Nancy; Joshua, Thomas; Hoehn, Michelle

2015-01-01

The purpose of this project was to evaluate the effectiveness of postdischarge phone calls on 30-day preventable readmission rates within the pediatric hospital setting. Because the unit of care identified was patients and their families, a patient- and family-centered care approach was used. The project used an exploratory design and was conducted at a 154-bed pediatric hospital facility. A sample of 15 patients meeting project inclusion criteria was selected before and after the intervention, and medical records were reviewed to identify if a 30-day preventable readmission had occurred. Medical record review revealed four preintervention readmissions, providing an overall preintervention readmission rate of 26%. Only one readmission was discovered after the intervention, yielding an overall postintervention readmission rate of 6%. The sample size was not large enough to show statistical significance, but clinical significance was seen, with readmission rates for the project target population decreasing below the rates recorded in 2012. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Impact of changes in Medicare Home Health care reimbursement on month-to-month Home Health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures.

PubMed

FitzGerald, John D; Mangione, Carol M; Boscardin, John; Kominski, Gerald; Hahn, Bevra; Ettner, Susan L

2006-09-01

Beginning October 1, 1997, Medicare implemented a series of major changes to the Home Health (HH) reimbursement system. Reimbursements were first significantly reduced under the Interim Payment System (IPS) and then relaxed slightly until implementation of the HH Prospective Payment System (PPS) on October 1, 2000. The objective of this study was to examine the impact of reimbursement policy on HH care utilization. We postulated that in response to the initial changes, there would be reductions in both the probability of any HH use and the number of HH visits per HH user. Under PPS, we postulated there would be further reduction in number of HH visits. We tested whether the policy response differed by HH agency structure and whether subgroups of patients were differentially affected. An interrupted time-series analysis was conducted to examine month-to-month probability of HH selection and the number of HH visits among users. A 100% sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected. Under the IPS, the probability of any HH use and number of visits per episode of HH care fell until the IPS was refined in October 1998. With implementation of the PPS, HH visits fell commensurately. Differentially larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals. Changes in month-to-month utilization of HH services were sharp and well correlated with policy implementation dates, strengthening the evidence for a causal association between policy and patient care in the midst of a sea of concurrent policy changes. Greater reductions in HH visits were noted for vulnerable groups.

Quantification of diabetes consultations by the main primary health care nurse groups in Auckland, New Zealand.

PubMed

Daly, Barbara; Arroll, Bruce; Sheridan, Nicolette; Kenealy, Timothy; Scragg, Robert

2016-09-01

Diabetes prevalence continues to increase, with most diabetes patients managed in primary care. This report quantifies the number of diabetes consultations undertaken by primary healthcare nurses in Auckland, New Zealand. Of 335 primary healthcare nurses randomly selected, 287 (86%) completed a telephone interview in 2006-2008. On a randomly sampled day (from the past seven) for each nurse, 42% of the nurses surveyed (n=120) consulted 308 diabetes patients. From the proportion of nurses sampled in the study, it is calculated that the number of diabetes patients consulted by primary healthcare nurses per week in Auckland between September 2006 and February 2008 was 4210, with 61% consulted by practice, 23% by specialist and 16% by district nurses. These findings show that practice nurses carry out the largest number of community diabetes consultations by nurses. Their major contribution needs to be incorporated into future planning of the community management of diabetes.

Pediatric Palliative Care in Iran: Applying Regionalization of Health Care Systems

PubMed

Khanali Mojen, Leila; Rassouli, Maryam; Eshghi, Peyman; Zendedel, Kazem; Akbari Sari, Ali; Heravi Karimooi, Majideh; Tahmasebi, Mamak; Shirin Abadi Farahani, Azam

2018-05-26

Background: Establishing palliative care services is a priority in the health system of Iran. Considering the necessity of integrating these services into the health system, this study aimed to explore the stakeholders’ perceptions about the provision of a conceptual framework for palliative care services for children with cancer according to the health system in of Iran. Methods: The present qualitative study was conducted through in-depth semi-structured interviews held with 29 participants including palliative care specialists, policy-makers, health care providers, the parents of children with cancer selected through purposive sampling, between August 2016 and February 2017. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed using MAXQDA10 software. Results: The codes extracted from interviews produced the main theme “ classes of palliative care services” with the two main categories “comprehensive care” including, strengthening family shelter, maintaining the child in a familiar environment, achieving stability and “establishing social justice” including, easy access to services, financial relief and quality care. Conclusion: Presenting a framework based on level of palliative care services, the findings of this study paves the way for integrating these services into Iranian health system. Creative Commons Attribution License

The case for planetary sample return missions. 2. History of Mars.

PubMed

Gooding, J L; Carr, M H; McKay, C P

1989-08-01

Principal science goals for exploration of Mars are to establish the chemical, isotopic, and physical state of Martian material, the nature of major surface-forming processes and their time scales, and the past and present biological potential of the planet. Many of those goals can only be met by detailed analyses of atmospheric gases and carefully selected samples of fresh rocks, weathered rocks, soils, sediments, and ices. The high-fidelity mineral separations, complex chemical treatments, and ultrasensitive instrument systems required for key measurements, as well as the need to adapt analytical strategies to unanticipated results, point to Earth-based laboratory analyses on returned Martian samples as the best means for meeting the stated objectives.

Sexual selection favours male parental care, when females can choose

PubMed Central

Alonzo, Suzanne H.

2012-01-01

Explaining the evolution of male care has proved difficult. Recent theory predicts that female promiscuity and sexual selection on males inherently disfavour male care. In sharp contrast to these expectations, male-only care is often found in species with high extra-pair paternity and striking variation in mating success, where current theory predicts female-only care. Using a model that examines the coevolution of male care, female care and female choice; I show that inter-sexual selection can drive the evolution of male care when females are able to bias mating or paternity towards parental males. Surprisingly, female choice for parental males allows male care to evolve despite low relatedness between the male and the offspring in his care. These results imply that predicting how sexual selection affects parental care evolution will require further understanding of why females, in many species, either do not prefer or cannot favour males that provide care. PMID:22171082

The selected reaction monitoring/multiple reaction monitoring-based mass spectrometry approach for the accurate quantitation of proteins: clinical applications in the cardiovascular diseases.

PubMed

Gianazza, Erica; Tremoli, Elena; Banfi, Cristina

2014-12-01

Selected reaction monitoring, also known as multiple reaction monitoring, is a powerful targeted mass spectrometry approach for a confident quantitation of proteins/peptides in complex biological samples. In recent years, its optimization and application have become pivotal and of great interest in clinical research to derive useful outcomes for patient care. Thus, selected reaction monitoring/multiple reaction monitoring is now used as a highly sensitive and selective method for the evaluation of protein abundances and biomarker verification with potential applications in medical screening. This review describes technical aspects for the development of a robust multiplex assay and discussing its recent applications in cardiovascular proteomics: verification of promising disease candidates to select only the highest quality peptides/proteins for a preclinical validation, as well as quantitation of protein isoforms and post-translational modifications.

Patterns of family caregiving and support provided to older psychiatric patients in long-term care.

PubMed

Beeler, J; Rosenthal, A; Cohler, B

1999-09-01

Data on patterns of relationships and caregiving between older, institutionalized chronically mentally ill patients and their families were gathered in brief face-to-face interviews with 109 patients randomly selected from residents age 45 or older in a large intermediate care facility in Chicago. Three-fourths of the sample maintained some form of family contact. One-third had been married or had children. Siblings were the most frequently identified family contact and support. The results suggests that older, institutionalized psychiatric patients continue to have family contact and that siblings and offspring become increasingly important as patients age.

Correlation of neonatal intensive care unit performance across multiple measures of quality of care.

PubMed

Profit, Jochen; Zupancic, John A F; Gould, Jeffrey B; Pietz, Kenneth; Kowalkowski, Marc A; Draper, David; Hysong, Sylvia J; Petersen, Laura A

2013-01-01

To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Twenty-two regional NICUs in California. In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Pneumothorax, growth velocity, health care-associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations, 6 were significant (ρ < .05). Correlations between pairs of measures of quality of care were strong (ρ ≥ .5) for 1 pair, moderate (range, ρ ≥ .3 to ρ < .5) for 8 pairs, weak (range, ρ ≥ .1 to ρ < .3) for 5 pairs, and negligible (ρ < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care-associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

Improving the evidence base in palliative care to inform practice and policy: thinking outside the box.

PubMed

Aoun, Samar M; Nekolaichuk, Cheryl

2014-12-01

The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to (1) describe key myths about palliative care research; (2) highlight substantive challenges of conducting palliative care research, using case illustrations; and (3) propose specific strategies to address some of these challenges. Myths about research in palliative care revolve around evidence hierarchies, sample heterogeneity, random assignment, participant burden, and measurement issues. Challenges arise because of the complex physical, psychological, existential, and spiritual problems faced by patients, families, and service providers. These challenges can be organized according to six general domains: patient, system/organization, context/setting, study design, research team, and ethics. A number of approaches for dealing with challenges in conducting research fall into five separate domains: study design, sampling, conceptual, statistical, and measures and outcomes. Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights "outside the box" approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

PubMed Central

Hall, William J.; Lee, Kent M.; Merino, Yesenia M.; Thomas, Tainayah W.; Payne, B. Keith; Eng, Eugenia; Day, Steven H.; Coyne-Beasley, Tamera

2015-01-01

Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient–provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient–provider interactions and health outcomes than treatment processes. Conclusions. Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color. PMID:26469668

Capturing heterogeneity: The role of a study area's extent for estimating mean throughfall

NASA Astrophysics Data System (ADS)

Zimmermann, Alexander; Voss, Sebastian; Metzger, Johanna Clara; Hildebrandt, Anke; Zimmermann, Beate

2016-11-01

The selection of an appropriate spatial extent of a sampling plot is one among several important decisions involved in planning a throughfall sampling scheme. In fact, the choice of the extent may determine whether or not a study can adequately characterize the hydrological fluxes of the studied ecosystem. Previous attempts to optimize throughfall sampling schemes focused on the selection of an appropriate sample size, support, and sampling design, while comparatively little attention has been given to the role of the extent. In this contribution, we investigated the influence of the extent on the representativeness of mean throughfall estimates for three forest ecosystems of varying stand structure. Our study is based on virtual sampling of simulated throughfall fields. We derived these fields from throughfall data sampled in a simply structured forest (young tropical forest) and two heterogeneous forests (old tropical forest, unmanaged mixed European beech forest). We then sampled the simulated throughfall fields with three common extents and various sample sizes for a range of events and for accumulated data. Our findings suggest that the size of the study area should be carefully adapted to the complexity of the system under study and to the required temporal resolution of the throughfall data (i.e. event-based versus accumulated). Generally, event-based sampling in complex structured forests (conditions that favor comparatively long autocorrelations in throughfall) requires the largest extents. For event-based sampling, the choice of an appropriate extent can be as important as using an adequate sample size.

[Audit of management of arterial hypertension in primary health care in Sousse].

PubMed

Ben Abdelaziz, Ahmed; Ben Othman, Aicha; Mandhouj, Olfa; Gaha, Rafika; Bouabid, Zouhour; Ghannem, Hassen

2006-03-01

A medical audit has been carried out on a representative sample of 456 hypertensive patients followed in the health care facilities of Sousse during 2002, to evaluate the quality of management of hypertension in primary health care. The study yielded the following results: the patients selected for a first line follow-up did not represent more than 79% of the studied population. The minimal recommended balance was achieved in 8% of cases only. Adequate drug therapy was prescribed in 64% of cases. 59% of patients were considered compliant. Controls of blood pressure was achieved in 5,5% of patients. The quality of management of hypertension in primary health care was considered satis factory in 28,7% of patents with a significant difference between urban and rural areas (24,9% versus 40,5%). These results indicate that increased attention should be paid by the national program of Struggle against the Chronic Diseases to the quality of management of hypertension in primary health care institutions.

A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care.

PubMed

Ali, Syed Mustafa; Giordano, Richard; Lakhani, Saima; Walker, Dawn Marie

2016-03-01

A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low. The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow. Copyright © 2016. Published by Elsevier Ireland Ltd.

Nature vs. Nurture: The influence of OB star environments on proto-planetary disk evolution

NASA Astrophysics Data System (ADS)

Bouwman, Jeroen

2006-09-01

We propose a combined IRAC/IRS study of a large, well-defined and unbiased X-ray selected sample of pre-main-sequence stars in three OB associations: Pismis 24 in NGC 6357, NGC 2244 in the Rosette Nebula, and IC 1795 in the W3 complex. The samples are based on recent Chandra X-ray Observatory studies which reliably identify hundreds of cluster members and were carefully chosen to avoid high infrared nebular background. A new Chandra exposure of IC 1795 is requested, and an optical followup to characterise the host stars is planned.

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures.

PubMed

Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J; Aderibigbe, Sunday A; Akande, Tanimola M; Mesnard, Alice

2016-01-01

Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs-particularly women and the poor-forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations.

Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

PubMed

Finlay, V; Phillips, M; Allison, G T; Wood, F M; Ching, D; Wicaksono, D; Plowman, S; Hendrie, D; Edgar, D W

2015-11-01

As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Development of a bar adsorptive micro-extraction-large-volume injection-gas chromatography-mass spectrometric method for pharmaceuticals and personal care products in environmental water matrices.

PubMed

Neng, N R; Nogueira, J M F

2012-01-01

The combination of bar adsorptive micro-extraction using activated carbon (AC) and polystyrene-divinylbenzene copolymer (PS-DVB) sorbent phases, followed by liquid desorption and large-volume injection gas chromatography coupled to mass spectrometry, under selected ion monitoring mode acquisition, was developed for the first time to monitor pharmaceutical and personal care products (PPCPs) in environmental water matrices. Assays performed on 25 mL water samples spiked (100 ng L(-1)) with caffeine, gemfibrozil, triclosan, propranolol, carbamazepine and diazepam, selected as model compounds, yielded recoveries ranging from 74% to 99% under optimised experimental conditions (equilibrium time, 16 h (1,000 rpm); matrix characteristics: pH 5, 5% NaCl for AC phase; LD: methanol/acetonitrile (1:1), 45 min). The analytical performance showed good precision (RSD < 18%), convenient detection limits (5-20 ng L(-1)) and excellent linear dynamic range (20-800 ng L(-1)) with remarkable determination coefficients (r(2) > 0.99), where the PS-DVB sorbent phase showed a much better efficiency. By using the standard addition methodology, the application of the present analytical approach on tap, ground, sea, estuary and wastewater samples allowed very good performance at the trace level. The proposed method proved to be a suitable sorption-based micro-extraction alternative for the analysis of priority pollutants with medium-polar to polar characteristics, showing to be easy to implement, reliable, sensitive and requiring a low sample volume to monitor PPCPs in water matrices.

Effects of enhanced foster care on the long-term physical and mental health of foster care alumni.

PubMed

Kessler, Ronald C; Pecora, Peter J; Williams, Jason; Hiripi, Eva; O'Brien, Kirk; English, Diana; White, James; Zerbe, Richard; Downs, A Chris; Plotnick, Robert; Hwang, Irving; Sampson, Nancy A

2008-06-01

Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.

PubMed

Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Yang, Bo Kyum

2017-01-01

Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality. © 2016 Sigma Theta Tau International.

[Sensitivity of three inmunocromathographic tests in faeces samples for Campylobacter and Salmonella detection in comparison to culture].

PubMed

Liébana-Martos, Ma del Carmen; Gutierrez, José; Riazzo, Cristina; Navarro, José Ma

2014-06-01

Introduction: Campylobacter sp. and Salmonella enterica are two of the main organisms causing gastroenteritis in our environment. Immunochromatographic tests for antigen detection performed directly on stool samples for its simplicity and rapid results may make them useful diagnostic elements in the context of primary care. During October 2012 we selected all feces in which enteropathogenic bacteria are isolated from those received for stool culture in the laboratory of Microbiology of the University Hospital Virgen de las Nieves of Granada. After standard management of faeces samples and isolation of any enteropathogen, the commercial kits: Campy Leti, Ridaquick Campylobacterscreen and Salmonella Leti were tested for simultaneous research of Campylobacter and Salmonella antigens. Sensitivity and specificity were determined. Two hundred and thirty five stool samples were received in which 8 Salmonella enterica (7 B serogroup and 1 D serogroup), 7 Campylobacter jejuni, 4 Aeromonas hydrophila and 1 Yersinia enterocolitica were isolated. Campy Leti, Ridaquick Campylobacterscreen and Salmonella Leti presented a sensitivity of 100%, 100% and 75%, respectively. Specificities corresponded to 46%, 69% and 100%, respectively. Immunocromatographic tests can be useful for a first screening of enteropathogen in primary care.

Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa

PubMed Central

Moshabela, Mosa; Sips, Ilona; Barten, Francoise

2015-01-01

Background Community care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network. Design We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network available to the client, and preferences of the clients remain central to the process of negotiating care. PMID:26689459

Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa.

PubMed

Moshabela, Mosa; Sips, Ilona; Barten, Francoise

2015-01-01

Community care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network. We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter - 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants' references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients' care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network available to the client, and preferences of the clients remain central to the process of negotiating care.

Occurrence of Selected Pharmaceuticals, Personal-Care Products, Organic Wastewater Compounds, and Pesticides in the Lower Tallapoosa River Watershed near Montgomery, Alabama, 2005

USGS Publications Warehouse

Oblinger, Carolyn J.; Gill, Amy C.; McPherson, Ann K.; Meyer, Michael T.; Furlong, Edward T.

2007-01-01

Synthetic and natural organic compounds derived from agricultural operations, residential development, and treated and untreated sanitary and industrial wastewater discharges can contribute contaminants to surface and ground waters. To determine the occurrence of these compounds in the lower Tallapoosa River watershed, Alabama, new laboratory methods were used that can detect human and veterinary antibiotics; pharmaceuticals; and compounds found in personal-care products, food additives, detergents and their metabolites, plasticizers, and other industrial and household products in the environment. Well-established methods for detecting 47 pesticides and 19 pesticide degradates also were used. In all, 186 different compounds were analyzed by using four analytical methods. The lower Tallapoosa River serves as the water-supply source for more than 100,000 customers of the Montgomery Water Works and Sanitary Sewer Board. Source-water protection is a high priority for the Board, which is responsible for providing safe drinking water. The U.S. Geological Survey, in cooperation with the Montgomery Water Works and Sanitary Sewer Board, conducted this study to provide baseline data that could be used to assess the effects of agriculture and residential development on the occurrence of selected organic compounds in the lower Tallapoosa River watershed. Twenty samples were collected at 10 sites on the Tallapoosa River and its tributaries. Ten samples were collected in April 2005 during high base streamflow, and 10 samples were collected in October 2005 when base streamflow was low. Thirty-two of 186 compounds were detected in the lower Tallapoosa River watershed. Thirteen compounds, including atrazine, 2-chloro-4-isopropylamino-6-amino-s-triazine (CIAT), hexazinone, metalaxyl, metolachlor, prometryn, prometon, simazine, azithromycin, oxytetracycline, sulfamethoxazole, trimethoprim, and tylosin, had measurable concentrations above their laboratory reporting levels. Concentrations were estimated for an additional 19 compounds that were detected below their laboratory reporting levels. The two most frequently detected compounds were the pesticides atrazine (19 of 20 samples) and simazine (13 of 20 samples). Tylosin, a veterinary antibiotic, was detected in 8 of 20 samples. Other compounds frequently detected at very low concentrations included CIAT and hexazinone (a degradate of atrazine and a pesticide, respectively); camphor (derived from personal-care products or flavorants), para-cresol (various uses including solvent, wood preservative, and in household cleaning products), and N,N-diethyl-m-toluamide (DEET, an insect repellent).

[The Madrid autonomous community epidemiological bulletin. A survey on its dissemination and opinion thereof on among primary care physicians for the year 2000].

PubMed

Fernández Rodríguez, Silvia; Zorrilla Torras, Belén; Ramírez Fernández, Rosa; Alvarez Castillo, M Carmen; López-Gay Lucio, Dulce; Ibáñez Martín, Cosuelo; Bueno Vallejos, Rafael

2002-01-01

The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers' interests. A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out-by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher's Exact Test method, with Epi-Info v.6. A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System.

Options in human papillomavirus (HPV) detection for cervical cancer screening: comparison between full genotyping and a rapid qualitative HPV-DNA assay in Ghana.

PubMed

Obiri-Yeboah, Dorcas; Adu-Sarkodie, Yaw; Djigma, Florencia; Akakpo, Kafui; Aniakwa-Bonsu, Ebenezer; Amoako-Sakyi, Daniel; Jacques, Simpore; Mayaud, Philippe

2017-01-01

Modern cervical cancer screening increasingly relies on the use of molecular techniques detecting high-risk oncogenic human papillomavirus (hr-HPV). A major challenge for developing countries like Ghana has been the unavailability and costs of HPV DNA-based testing. This study compares the performance of care HPV, a semi-rapid and affordable qualitative detection assay for 14 hr-HPV genotypes, with HPV genotyping, for the detection of cytological cervical squamous intraepithelial lesions (SIL). A study comparing between frequency matched HIV-1 seropositive and HIV-seronegative women was conducted in the Cape Coast Teaching Hospital, Ghana. A systematic sampling method was used to select women attending clinics in the hospital. Cervical samples were tested for HPV by care HPV and Anyplex-II HPV28 genotyping assay, and by conventional cytology. A total of 175 paired results (94 from HIV-1 seropositive and 81 from HIV-seronegative women) were analyzed based on the ability of both tests to detect the 14 hr-HPV types included in the care HPV assay. The inter-assay concordance was 94.3% (95%CI: 89.7-97.2%, kappa = 0.88), similar by HIV serostatus. The care HPV assay was equally sensitive among HIV-1 seropositive and seronegative women (97.3% vs. 95.7%, p  = 0.50) and slightly more specific among HIV-seronegative women (85.0% vs. 93.1%, p  = 0.10). care HPV had good sensitivity (87.5%) but low specificity (52.1%) for the detection of low SIL or greater lesions, but its performance was superior to genotyping (87.5 and 38.8%, respectively). Reproducibility of care HPV, tested on 97 samples by the same individual was 82.5% (95%CI: 73.4-89.4%). The performance characteristics of care HPV compared to genotyping suggest that this simpler and cheaper HPV detection assay could offer a suitable alternative for HPV screening in Ghana.

Perceived Organizational Justice in Care Services: creation and multi-sample validation of a measure.

PubMed

Pérez-Arechaederra, Diana; Briones, Elena; Lind, Allan; García-Ortiz, Luis

2014-02-01

Organizational justice (OJ) perceptions predict attitudes and behaviors of customers and employees across a broad range of services. Although OJ has proven predictive power and relevance, it has rarely been studied in health care settings. This stems partially from the lack of a reliable and valid measure of patients' OJ in health care encounters. The objective here was to create and validate a measure of patients' OJ. With that purpose, a survey study with two sampling contexts - the U.S. and Spain - was carried out in order to provide a cross-national validation of the scale in two versions: English (Perceived Organizational Justice in Care Services, PJustCS) and Spanish (Percepción de Justicia Organizacional en el Ámbito Sanitario, PJustAS). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to select the appropriate items in the final version of the instrument. Reliability and validity of the measure were tested. A total of 406 patients in the U.S. and 473 patients in Spain participated. The measures used were the newly created scale of Perceived Organizational Justice in Care Services (PJustCS/PJustAS) and scales of patients' Satisfaction, Trust and Global Justice. Factor Analyses supported the four dimensional structure of the instrument for each group. Multigroup CFA substantiated invariant factor loadings and invariant structural models across both samples, hence, supporting that the instrument is applicable in its two versions: English and Spanish. Validation results showed expected positive relations of OJ with patients' satisfaction, trust in clinicians and global perceived justice. These results point out the importance of health care customers' perceived organizational justice in the explanation of health care dynamics. The scale has desirable psychometric properties and shows adequate validity, contributing to the potential development of the area. Copyright © 2013 Elsevier Ltd. All rights reserved.

Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study

PubMed Central

2012-01-01

Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-district of Netrokona district, Bangladesh. Methods Using purposive sampling, ten households utilizing a skilled attendant during the birth of the youngest child were selected and matched with ten households utilizing an untrained traditional birth attendant, or dhatri. Households were selected based on a set of inclusion criteria, such as approximate household income, ethnicity, and distance to the nearest hospital. Twenty semi-structured interviews were conducted in Bangla with husbands in these households in June 2010. Interviews were transcribed, translated into English, and analyzed using NVivo 9.0. Results By purposefully selecting households that differed on the type of provider utilized during delivery, common themes--high costs, poor transportation, and long distances to health facilities--were eliminated as sufficient barriers to the utilization of professional delivery care. Divergent themes, namely husbands' social support and perceived social norms, were identified as underlying factors associated with delivery care utilization. We found that husbands whose wives utilized professional delivery care provided emotional, instrumental and informational support to their wives during delivery and believed that medical intervention was necessary. By contrast, husbands whose wives utilized an untrained dhatri at home were uninvolved during delivery and believed childbirth should take place at home according to local traditions. Conclusions This study provides novel evidence about male involvement during childbirth in rural Bangladesh. These findings have important implications for program planners, who should pursue culturally sensitive ways to involve husbands in maternal health interventions and assess the effectiveness of education strategies targeted at husbands. PMID:22494576

Selecting Students for Training in Health Care. A Practical Guide to Improving Selection Procedures. WHO Offset Publication No. 74.

ERIC Educational Resources Information Center

Bennett, Mick; Wakeford, Richard

This guide is intended to help those responsible for choosing health care trainees to develop and improve their selection procedures. Special reference is given to health workers in maternal and child health. Chapter 1 deals with health care policy implications for selection of trainees, the different functions of selection and conflicts that…

Impact of an educational program on knowledge and practice of health care staff toward pharmaceutical waste management in Gaza, Palestine.

PubMed

Tabash, Mohammed I; Hussein, Rim A; Mahmoud, Aleya H; El-Borgy, Mohamed D; Abu-Hamad, Bassam A

2016-04-01

In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. Poor knowledge about their potential downstream impacts may be a primary factor for improper disposal behavior. The objective of this study was to determine the impact of an intervention program on knowledge and practice of health care staff regarding pharmaceutical waste management. The study was designed as a pre/posttest intervention study. Total sample size was 530 in the pre-intervention phase, and then a subsample of 69 individuals was selected for the intervention and the post-intervention phases. Paired-sample t test was used to assess the difference between pretest and follow-up test results. A statistically significant improvement in knowledge and practice was achieved (P<0.001). Poor knowledge and poor practice levels (scores<50%) were found to improve to satisfactory levels (scores≥75%). Therefore, educational programs could be considered as an effective tool for changing health care staff practice in pharmaceutical waste management. In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. A lack of knowledge about the potential impacts of this type of waste may be a leading factor in improper disposal behavior. Following an educational program, statistically significant improvement in knowledge and practice of health care staff as regards to pharmaceutical waste management (PWM) was achieved. It is thus recommended that authorities implement training-of-trainers (TOT) programs to educate health care staff on PWM and organize refreshment workshops regularly.

Annual radiological environmental operating report, Browns Ferry Nuclear Plant, 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-04-01

This report describes the environmental radiological monitoring program conducted by TVA in the vicinity of Browns Ferry Nuclear Plant in 1991. The program includes the collection of samples from the environment and the determination of the concentrations of radioactive materials in the samples. Samples are taken from stations in the general area of the plant and from areas not influenced by plant operations. Station locations are selected after careful consideration of the weather patterns and projected radiation doses to the various areas around the plant. Material sampled includes air, water, milk, foods, vegetation, soil, fish, sediment, and direct radiation levels.more » Results from stations near the plant are compared with concentrations from control stations and with preoperational measurements to determine potential impacts of plant operations.« less

Estimating the applicability of wound care randomized controlled trials to general wound-care populations by estimating the percentage of individuals excluded from a typical wound-care population in such trials.

PubMed

Carter, Marissa J; Fife, Caroline E; Walker, David; Thomson, Brett

2009-07-01

To determine the percentage of individuals that would be excluded from wound care randomized controlled trials (RCTs) as a surrogate for applicability to general populations. A representative sample of wound-care RCTs was selected from the literature in the past 10 years. Exclusion criteria from the trials were evaluated, and prevalence values for each excluded condition were obtained from a large wound-care population, as well as from the literature. The percentage of patients excluded on this basis was calculated. Seventeen RCTs testing "high-technology" wound-care products were evaluated. : Patients in the trials were treated for ulcers (venous, diabetic foot, and pressure ulcers). A percentage of patients in the study population were excluded for each RCT. More than 50% of the study population would have been excluded in 15 of the 17 RCTs. When less clinically relevant exclusion criteria were removed, 14 of 17 RCTs would still have excluded between 25% and 50% of the study population. The results raise serious questions regarding the applicability of these RCTs to wound-care populations.

Diurnal and Reproductive Stage-Dependent Variation of Parental Behaviour in Captive Zebra Finches

PubMed Central

Morvai, Boglárka; Nanuru, Sabine; Mul, Douwe; Kusche, Nina; Milne, Gregory; Székely, Tamás; Komdeur, Jan; Miklósi, Ádám

2016-01-01

Parental care plays a key role in ontogeny, life-history trade-offs, sexual selection and intra-familial conflict. Studies focusing on understanding causes and consequences of variation in parental effort need to quantify parental behaviour accurately. The applied methods are, however, diverse even for a given species and type of parental effort, and rarely validated for accuracy. Here we focus on variability of parental behaviour from a methodological perspective to investigate the effect of different samplings on various estimates of parental effort. We used nest box cameras in a captive breeding population of zebra finches, Taeniopygia guttata, a widely used model system of sexual selection, intra-familial dynamics and parental care. We investigated diurnal and reproductive stage-dependent variation in parental effort (including incubation, brooding, nest attendance and number of feedings) based on 12h and 3h continuous video-recordings taken at various reproductive stages. We then investigated whether shorter (1h) sampling periods provided comparable estimates of overall parental effort and division of labour to those of longer (3h) sampling periods. Our study confirmed female-biased division of labour during incubation, and showed that the difference between female and male effort diminishes with advancing reproductive stage. We found individually consistent parental behaviours within given days of incubation and nestling provisioning. Furthermore, parental behaviour was consistent over the different stages of incubation, however, only female brooding was consistent over nestling provisioning. Parental effort during incubation did not predict parental effort during nestling provisioning. Our analyses revealed that 1h sampling may be influenced heavily by stochastic and diurnal variation. We suggest using a single longer sampling period (3h) may provide a consistent and accurate estimate for overall parental effort during incubation in zebra finches. Due to the large within-individual variation, we suggest repeated longer sampling over the reproductive stage may be necessary for accurate estimates of parental effort post-hatching. PMID:27973549

Sexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context.

PubMed

Lavin, Marie; Hyde, Abbey

2006-02-01

In this article, findings are presented from a study that aimed to explore the perceptions and experiences of a sample of nurses in addressing sexuality as an aspect of care for women receiving chemotherapy for breast cancer. A sample of 10 oncology nurses was selected from oncology units at three hospitals in Ireland, and each participant was interviewed in depth. A qualitative strategy was employed to analyse data. Findings indicated that participants tended to construct sexuality in broad terms, and were well aware of the effects of chemotherapy on a person's sexuality. In addition, they considered sexuality education to be a legitimate and important aspect of their role. However, they also revealed that they avoided addressing sexuality with patients, or encountered structural obstacles in doing so. Some participants expressed anger and frustration when discussing barriers to incorporating sexuality into their practice. A strong theme in data was participants' perceptions that they were not adequately prepared in either pre- or post-registration programmes to incorporate sexuality as a dimension of patient care, although post-registration programmes were more likely to furnish them with knowledge about sexuality. Finally, participants' views on sexuality care are considered in the context of Irish culture which until recently was dominated by Catholic Church teachings.

Comparison of different methods for MP detection: What can we learn from them, and why asking the right question before measurements matters?

PubMed

Elert, Anna M; Becker, Roland; Duemichen, Erik; Eisentraut, Paul; Falkenhagen, Jana; Sturm, Heinz; Braun, Ulrike

2017-12-01

In recent years, an increasing trend towards investigating and monitoring the contamination of the environment by microplastics (MP) (plastic pieces < 5 mm) has been observed worldwide. Nonetheless, a reliable methodology that would facilitate and automate the monitoring of MP is still lacking. With the goal of selecting practical and standardized methods, and considering the challenges in microplastics detection, we present here a critical evaluation of two vibrational spectroscopies, Raman and Fourier transform infrared (FTIR) spectroscopy, and two extraction methods: thermal extraction desorption gas chromatography mass spectrometry (TED-GC-MS) and liquid extraction with subsequent size exclusion chromatography (SEC) using a soil with known contents of PE, PP, PS and PET as reference material. The obtained results were compared in terms of measurement time, technique handling, detection limits and requirements for sample preparation. The results showed that in designing and selecting the right methodology, the scientific question that determines what needs to be understood is significant, and should be considered carefully prior to analysis. Depending on whether the object of interest is quantification of the MP particles in the sample, or merely a quick estimate of sample contamination with plastics, the appropriate method must be selected. To obtain overall information about MP in environmental samples, the combination of several parallel approaches should be considered. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hidden Selection of Bacterial Resistance to Fluoroquinolones In Vivo: The Case of Legionella pneumophila and Humans.

PubMed

Shadoud, Lubana; Almahmoud, Iyad; Jarraud, Sophie; Etienne, Jérôme; Larrat, Sylvie; Schwebel, Carole; Timsit, Jean-François; Schneider, Dominique; Maurin, Max

2015-09-01

Infectious diseases are the leading cause of human morbidity and mortality worldwide. One dramatic issue is the emergence of microbial resistance to antibiotics which is a major public health concern. Surprisingly however, such in vivo adaptive ability has not been reported yet for many intracellular human bacterial pathogens such as Legionella pneumophila. We examined 82 unrelated patients with Legionnaire's disease from which 139 respiratory specimens were sampled during hospitalization and antibiotic therapy. We both developed a real time PCR assay and used deep-sequencing approaches to detect antibiotic resistance mutations in L. pneumophila and follow their selection and fate in these samples. We identified the in vivo selection of fluoroquinolone resistance mutations in L. pneumophila in two infected patients treated with these antibiotics. By investigating the mutational dynamics in patients, we showed that antibiotic resistance occurred during hospitalization most likely after fluoroquinolone treatment. In vivo selection of antibiotic resistances in L. pneumophila may be associated with treatment failures and poor prognosis. This hidden resistance must be carefully considered in the therapeutic management of legionellosis patients and in the control of the gradual loss of effectiveness of antibiotics.

Hidden Selection of Bacterial Resistance to Fluoroquinolones In Vivo: The Case of Legionella pneumophila and Humans

PubMed Central

Shadoud, Lubana; Almahmoud, Iyad; Jarraud, Sophie; Etienne, Jérôme; Larrat, Sylvie; Schwebel, Carole; Timsit, Jean-François; Schneider, Dominique; Maurin, Max

2015-01-01

Background Infectious diseases are the leading cause of human morbidity and mortality worldwide. One dramatic issue is the emergence of microbial resistance to antibiotics which is a major public health concern. Surprisingly however, such in vivo adaptive ability has not been reported yet for many intracellular human bacterial pathogens such as Legionella pneumophila. Methods We examined 82 unrelated patients with Legionnaire's disease from which 139 respiratory specimens were sampled during hospitalization and antibiotic therapy. We both developed a real time PCR assay and used deep-sequencing approaches to detect antibiotic resistance mutations in L. pneumophila and follow their selection and fate in these samples. Findings We identified the in vivo selection of fluoroquinolone resistance mutations in L. pneumophila in two infected patients treated with these antibiotics. By investigating the mutational dynamics in patients, we showed that antibiotic resistance occurred during hospitalization most likely after fluoroquinolone treatment. Interpretation In vivo selection of antibiotic resistances in L. pneumophila may be associated with treatment failures and poor prognosis. This hidden resistance must be carefully considered in the therapeutic management of legionellosis patients and in the control of the gradual loss of effectiveness of antibiotics. PMID:26501115

Improving primary palliative care in Scotland: lessons from a mixed methods study.

PubMed

Mason, Bruce; Buckingham, Susan; Finucane, Anne; Hutchison, Peter; Kendall, Marilyn; McCutcheon, Hazel; Porteous, Lorna; Murray, Scott A

2015-12-10

Since 2012, all GP practices across Scotland have been supported to take a systematic approach to end-of-life care, by helping them to identify more patients for palliative care through a Palliative Care Directed Enhanced Service (DES). We aimed to understand the impact of this initiative. Routine quantitative data from the 2012/13, and 2013/14 DES were collected from regional health boards, analysed and discussed. Qualitative data were collected from a sample of 2012/13 DES returns and analysed using Thematic Analysis. Data were received from 512 practices in nine Scottish Health boards for the 2012-13 DES and 638 practices in 11 Health boards for 2013-14. A sample of 90 of the returns for 2012-13 was selected for qualitative analysis. In 2012-13, 72 % of patients who died of cancer were listed on the palliative care register (PCR) before death while 27 % of patients who died as a result of non-malignant conditions were listed on the PCR. In 2013-14, cancer identification remained the same but identification of people dying with other long-term conditions had improved to 32.5 %. We identified several key issues needed to improve palliative care in the community. The need for training to identify patients with palliative care needs (particularly non-cancer); communication skills training; improvements in sharing information across the NHS; under-resource of and lack of coordination with district nurses; improvements in information technology; and tools for working with enlarged palliative care registers. The DES helped more patients with long-term conditions (LTC) receive generalist palliative care. Approaching generalist palliative care as anticipatory care could facilitate communication between GPs and patients/families and remove some barriers to early identification of palliative care needs. Improvement of information technology and use of identification tools like the SPICT™ may improve professionals' communication with each other and help may make identification and management of patients easier.

Ostomy patients’ perception of the health care received

PubMed Central

Nieves, Candela Bonill-de las; Díaz, Concepción Capilla; Celdrán-Mañas, Miriam; Morales-Asencio, José Miguel; Hernández-Zambrano, Sandra Milena; Hueso-Montoro, César

2017-01-01

ABSTRACT Aim: to describe ostomy patient’s perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion: findings contribute to address the main patients’ needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma. PMID:29236839

Helping the decision maker effectively promote various experts' views into various optimal solutions to China's institutional problem of health care provider selection through the organization of a pilot health care provider research system.

PubMed

Tang, Liyang

2013-04-04

The main aim of China's Health Care System Reform was to help the decision maker find the optimal solution to China's institutional problem of health care provider selection. A pilot health care provider research system was recently organized in China's health care system, and it could efficiently collect the data for determining the optimal solution to China's institutional problem of health care provider selection from various experts, then the purpose of this study was to apply the optimal implementation methodology to help the decision maker effectively promote various experts' views into various optimal solutions to this problem under the support of this pilot system. After the general framework of China's institutional problem of health care provider selection was established, this study collaborated with the National Bureau of Statistics of China to commission a large-scale 2009 to 2010 national expert survey (n = 3,914) through the organization of a pilot health care provider research system for the first time in China, and the analytic network process (ANP) implementation methodology was adopted to analyze the dataset from this survey. The market-oriented health care provider approach was the optimal solution to China's institutional problem of health care provider selection from the doctors' point of view; the traditional government's regulation-oriented health care provider approach was the optimal solution to China's institutional problem of health care provider selection from the pharmacists' point of view, the hospital administrators' point of view, and the point of view of health officials in health administration departments; the public private partnership (PPP) approach was the optimal solution to China's institutional problem of health care provider selection from the nurses' point of view, the point of view of officials in medical insurance agencies, and the health care researchers' point of view. The data collected through a pilot health care provider research system in the 2009 to 2010 national expert survey could help the decision maker effectively promote various experts' views into various optimal solutions to China's institutional problem of health care provider selection.

Health Information Technology Coordination to Support Patient-centered Care Coordination.

PubMed

Steichen, O; Gregg, W

2015-08-13

To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as "best papers". The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement.

Assessing technical performance at diverse ambulatory care sites.

PubMed

Osterweis, M; Bryant, E

1978-01-01

The purpose of the large study reported here was to develop and test methods for assessing the quality of health care that would be broadly applicable to diverse ambulatory care organizations for periodic comparative review. Methodological features included the use of an age-sex stratified random sampling scheme, dependence on medical records as the source of data, a fixed study period year, use of Kessner's tracer methodology (including not only acute and chronic diseases but also screening and immunization rates as indicators), and a fixed tracer matrix at all test sites. This combination of methods proved more efficacious in estimating certain parameters for the total patient populations at each site (including utilization patterns, screening, and immunization rates) and the process of care for acute conditions than it did in examining the process of care for the selected chronic condition. It was found that the actual process of care at all three sites for the three acute conditions (streptococcal pharyngitis, urinary tract infection, and iron deficiency anemia) often differed from the expected process in terms of both diagnostic procedures and treatment. For hypertension, the chronic disease tracer, medical records were frequently a deficient data source from which to draw conclusions about the adequacy of treatment. Several aspects of the study methodology were found to be detrimental to between-site comparisons of the process of care for chronic disease management. The use of an age-sex stratified random sampling scheme resulted in the identification of too few cases of hypertension at some sites for analytic purposes, thereby necessitating supplementary sampling by diagnosis. The use of a fixed study period year resulted in an arbitrary starting point in the course of the disease. Furthermore, in light of the diverse sociodemographic characteristics of the patient populations, the use of a fixed matrix of tracer conditions for all test sites is questionable. The discussion centers on these and other problems encountered in attempting to compare technical performance within diverse ambulatory care organizations and provides some guidelines as to the utility of alternative methods for assessing the quality of health care.

Co-occurring psychiatric symptoms in opioid-dependent women: the prevalence of antenatal and postnatal depression.

PubMed

Holbrook, Amber; Kaltenbach, Karol

2012-11-01

Despite the high prevalence of psychiatric symptoms in substance-dependent women, little evidence is available on postpartum depression in this population. To determine whether demographic variables and prenatal depression predict postpartum depression and select substance abuse treatment outcomes in a sample of pregnant women. A retrospective chart review was conducted on 125 pregnant women enrolled in a comprehensive substance abuse treatment program. Data on demographic variables, prenatal care attendance, urine drug screen (UDS) results, and psychiatric symptoms were abstracted from patient medical and substance abuse treatment charts. The Postpartum Depression Screening Scale (PDSS) was administered 6 weeks post-delivery. Multiple linear regression was conducted to identify predictors of prenatal care attendance and total PDSS scores at 6 weeks postpartum. Multiple logistic regression was used to examine predictors of positive UDS at delivery. Nearly one-third (30.4%) of the sample screened positive for moderate or severe depression at treatment entry. Psychiatric symptoms did not predict either prenatal care compliance or UDS results at delivery. Almost half of the sample (43.7%) exhibited postpartum depression at 6 weeks post-delivery. No demographic variables correlated with incidence of postnatal depression. Only antenatal depression at treatment entry predicted PDSS scores. Prevalence of antenatal psychiatric disorders and postpartum depression was high in this sample of women seeking substance abuse treatment. Results support prior history of depression as a predictor of risk for developing postpartum depression. Routine screening for perinatal and postpartum depression is indicated for women diagnosed with substance abuse disorders.

The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation.

PubMed

Ratnayake, Ruwan; Ratto, Jeffrey; Hardy, Colleen; Blanton, Curtis; Miller, Laura; Choi, Mary; Kpaleyea, John; Momoh, Pheabean; Barbera, Yolanda

2017-09-01

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month ( P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] ( P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.

Does caregiver participation in decision making within child welfare agencies influence children's primary and mental health care service use?

PubMed

Jolles, M P; Wells, R

2017-03-01

Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency. In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals (P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non-PDM children (P = 0.004). Group differences were not significant for mental health services. Lower-risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use. © 2016 John Wiley & Sons Ltd.

Deviation from the Standard of Care for Early Breast Cancer in the Elderly: What are the Consequences?

PubMed

Sun, Susie X; Hollenbeak, Christopher S; Leung, Anna M

2015-08-01

For elderly patients with early-stage breast cancer, the standards of care often are not strictly followed due to either clinician biases or patient preferences. The authors hypothesized that forgoing radiation and lymph node (LN) staging for elderly patients with early-stage breast cancer would have a negative impact on survival. From the Surveillance, Epidemiology, and End Results Program database, 53,619 women older than 55 years with stage 1 breast cancer who underwent breast conservation surgery were identified. Analyses were performed to compare the characteristics and outcomes of patients who received the standards of care with LN sampling and radiation and those of patients who did not, with control used for confounders. To account for selection bias from covariate imbalance, propensity score matching was performed. Survival was analyzed using the Kaplan-Meier method. Older patients were less likely to receive radiation and LN sampling. These standards of care were associated with improved overall survival rates of 15.8 and 27.1 % after 10 years, respectively (p ≤ 0.0001). This survival advantage persisted after propensity score matching, with a 7.4 % higher survival rate for patients who received radiation and a 16.8 % higher survival rate for those who underwent LN staging (p < 0.0001). Lymph node sampling and radiation therapy also conferred a statistically significant improvement in breast cancer-specific survival, with 1.3 and 2.6 % lower mortality rates respectively in the radiated and LN biopsy groups (p < 0.0001). As patients age, they are less likely to receive the standard of care for stage 1 breast cancer. Even after controlling for other factors, the study showed that failure to adhere to the standards of LN sampling and radiation therapy may have a negative impact in survival.

Who Cares for Those Who Take Care? Risks and Resources of Work in Care Homes

PubMed Central

Gozzoli, Caterina; Gazzaroli, Diletta; D’Angelo, Chiara

2018-01-01

Over the years – due to the aging population, the process of corporatisation and a demand for a higher quality of services – professionals who work in Care Homes have been exposed to an increasing risk of physical and emotional malaise because of the number of challenges they’ve been asked to manage. Given these factors, there is a growing interest in the study and understanding of professions in geriatric care settings. In the literature there is a prevalence of quantitative studies offering an overview in terms of indicators – at the individual or group or organizational level – concerning the potential development of situations of professional malaise. Conversely, there is a lack of qualitative studies exploring the risk and protection factors. For this reason, in this study we decided to use a qualitative approach to explore “more up close” this kind of organizational context and to keep together the different levels in systemic terms in order to identify – according to professionals’ perceptions – resource factors (in order to leverage these aspects) and fatigue factors (to identify them and treat them). Three Italian Care Homes were involved and the interview’s sample was composed of 45 professionals – 15 nurses, 30 total Patient Care Assistants (PCAs) and Auxiliary Care Assistants (ACAs), of these, 17 males and 28 females, with an average age of 43 years (SD = 0.78) – selected using a sampling of maximum variability. From the analysis of the materials there seem to be four profiles of the professionals involved. Implications to ensure a functional human resource management are discussed for the purpose of promote the well-being of the various professionals, and, as a result, an increasing quality of service. PMID:29593615

Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network.

PubMed

Drummond, Neil; Birtwhistle, Richard; Williamson, Tyler; Khan, Shahriar; Garies, Stephanie; Molnar, Frank

2016-01-01

The proportion of Canadians living with Alzheimer disease and related dementias is projected to rise, with an increased burden on the primary health care system in particular. Our objective was to describe the prevalence and management of dementia in a community-dwelling sample using electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. We used CPCSSN data as of Dec. 31, 2012, for patients 65 years and older with at least 1 clinical encounter in the previous 2 years. A validated case definition for dementia was used to calculate the national and provincial prevalence rates, to examine variations in prevalence according to age, sex, body mass index, rural or urban residence, and select comorbid conditions, and to describe patterns in the pharmacologic management of dementia over time at the provincial level. The age-standardized prevalence of dementia among community-dwelling patients 65 years and older was 7.3%. Prevalence estimates increased with age; they also varied between provinces, and upward trends were observed. Dementia was found to be associated with comorbid diabetes, depression, epilepsy and parkinsonism. Most of the patients with dementia did not have a prescription for a dementia-related medication recorded in their EMR between 2008 and 2012 inclusive. Those who had a prescription were most often prescribed donepezil by their primary care provider. Overall prevalence estimates for dementia based on EMR data in this sample managed in primary care were generally in line with previous estimates based on administrative data, survey results or clinical sources.

Doctors' opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system.

PubMed

Aller, Marta-Beatriz; Vargas, Ingrid; Coderch, Jordi; Vázquez, Maria-Luisa

2017-12-22

Clinical coordination is considered a health policy priority as its absence can lead to poor quality of care and inefficiency. A key challenge is to identify which strategies should be implemented to improve coordination. The aim is to analyse doctors' opinions on the contribution of mechanisms to improving clinical coordination between primary and outpatient secondary care and the factors influencing their use. A qualitative descriptive study in three healthcare networks of the Catalan national health system. A two-stage theoretical sample was designed: in the first stage, networks with different management models were selected; in the second, primary care (n = 26) and secondary care (n = 24) doctors. Data were collected using semi-structured interviews. Final sample size was reached by saturation. A thematic content analysis was conducted, segmented by network and care level. With few differences across networks, doctors identified similar mechanisms contributing to clinical coordination: 1) shared EMR facilitating clinical information transfer and uptake; 2) mechanisms enabling problem-solving communication and agreement on clinical approaches, which varied across networks (joint clinical case conferences, which also promote mutual knowledge and training of primary care doctors; virtual consultations through EMR and email); and 3) referral protocols and use of the telephone facilitating access to secondary care after referrals. Doctors identified organizational (insufficient time, incompatible timetables, design of mechanisms) and professional factors (knowing each other, attitude towards collaboration, concerns over misdiagnosis) that influence the use of mechanisms. Mechanisms that most contribute to clinical coordination are feedback mechanisms, that is those based on mutual adjustment, that allow doctors to exchange information and communicate. Their use might be enhanced by focusing on adequate working conditions, mechanism design and creating conditions that promote mutual knowledge and positive attitudes towards collaboration.

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

PubMed

Goharinezhad, Salime; Maleki, Mohammadreza; Baradaran, Hamid Reza; Ravaghi, Hamid

2016-01-01

With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities' job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

System for selecting relevant information for decision support.

PubMed

Kalina, Jan; Seidl, Libor; Zvára, Karel; Grünfeldová, Hana; Slovák, Dalibor; Zvárová, Jana

2013-01-01

We implemented a prototype of a decision support system called SIR which has a form of a web-based classification service for diagnostic decision support. The system has the ability to select the most relevant variables and to learn a classification rule, which is guaranteed to be suitable also for high-dimensional measurements. The classification system can be useful for clinicians in primary care to support their decision-making tasks with relevant information extracted from any available clinical study. The implemented prototype was tested on a sample of patients in a cardiological study and performs an information extraction from a high-dimensional set containing both clinical and gene expression data.

Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study

PubMed Central

Khalafi, Ali; Elahi, Nasrin; Ahmadi, Fazlollah

2016-01-01

Background Weaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients’ needs by critical care nurses. Objectives The aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses. Methods The study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015. In this qualitative study, 25 ICU staff including nurses, nurse managers, and nurse educators were selected by means of purposive sampling. Semi-structured interviews were used for data collection. The interview transcripts were then analyzed using qualitative content analysis. Results The four main themes that emerged to explain nurses’ experiences of holistic care when weaning patients from mechanical ventilation include continuous care, a holistic overview of the patient, promoting human dignity, and the overall development of well-being. Conclusions It was found that avoiding routine pivotal expertise, increasing consciousness of the nonphysical aspects of patients while providing treatment and presenting exclusive care, utilizing experienced ICU nurses, and placing more emphasis on effective communication with patients in order to honor them as human beings can all enhance the holistic quality of care. PMID:28191345

Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study.

PubMed

Khalafi, Ali; Elahi, Nasrin; Ahmadi, Fazlollah

2016-11-01

Weaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients' needs by critical care nurses. The aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses. The study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015. In this qualitative study, 25 ICU staff including nurses, nurse managers, and nurse educators were selected by means of purposive sampling. Semi-structured interviews were used for data collection. The interview transcripts were then analyzed using qualitative content analysis. The four main themes that emerged to explain nurses' experiences of holistic care when weaning patients from mechanical ventilation include continuous care, a holistic overview of the patient, promoting human dignity, and the overall development of well-being. It was found that avoiding routine pivotal expertise, increasing consciousness of the nonphysical aspects of patients while providing treatment and presenting exclusive care, utilizing experienced ICU nurses, and placing more emphasis on effective communication with patients in order to honor them as human beings can all enhance the holistic quality of care.

The Development and Validation of a Rapid Assessment Tool of Primary Care in China

PubMed Central

Mei, Jie; Liang, Yuan; Shi, LeiYu; Zhao, JingGe; Wang, YuTan; Kuang, Li

2016-01-01

Introduction. With Chinese health care reform increasingly emphasizing the importance of primary care, the need for a tool to evaluate primary care performance and service delivery is clear. This study presents a methodology for a rapid assessment of primary care organizations and service delivery in China. Methods. The study translated and adapted the Primary Care Assessment Tool-Adult Edition (PCAT-AE) into a Chinese version to measure core dimensions of primary care, namely, first contact, continuity, comprehensiveness, and coordination. A cross-sectional survey was conducted to assess the validity and reliability of the Chinese Rapid Primary Care Assessment Tool (CR-PCAT). Eight community health centers in Guangdong province have been selected to participate in the survey. Results. A total of 1465 effective samples were included for data analysis. Eight items were eliminated following principal component analysis and reliability testing. The principal component analysis extracted five multiple-item scales (first contact utilization, first contact accessibility, ongoing care, comprehensiveness, and coordination). The tests of scaling assumptions were basically met. Conclusion. The standard psychometric evaluation indicates that the scales have achieved relatively good reliability and validity. The CR-PCAT provides a rapid and reliable measure of four core dimensions of primary care, which could be applied in various scenarios. PMID:26885509

Group cognitive behavioral therapy to improve the quality of care to opioid-treated patients with chronic noncancer pain: a practice improvement project.

PubMed

Whitten, Stacey K; Stanik-Hutt, Julie

2013-07-01

To enhance outcomes of patients with chronic noncancer pain (CNCP) treated with opioids in a primary care setting by implementing an evidence-based quality improvement project. The project consisted of the implementation of a 6-week cognitive behavioral therapy (CBT) program. Twenty-two patients with CNCP completed the program. Impact of the project was evaluated by comparing pre- and postintervention participant self-reports of mood on the Beck Depression Inventory and functional status on the Brief Pain Inventory and Short Form-36. Patient perception of treatment benefit was also measured using the Patient Global Impression of Change. Qualitative provider perceptions of the program were also collected. Paired t-test statistics were used to analyze the data. Mood (including negative attitude, performance difficulty, and physical complaints), and patient impression of treatment benefit improved significantly after CBT was added. Primary care providers reported that the CBT supported their overall management of these complex patients. The addition of a CBT program improved selected outcomes in this self-selected sample of patients with CNCP treated with opioids. ©2012 The Author(s) ©2012 American Association of Nurse Practitioners.

Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system.

PubMed

Boonen, Lieke H H M; Schut, Frederik T

2011-04-01

We investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers' contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers' attitudes towards insurers' new role. Health insurers' contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers' new role are investigated by surveys among a representative sample of enrollees over the period 2005-2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use 'soft' positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers' reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.

Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care.

PubMed

Boscart, Veronique M; Heckman, George A; Huson, Kelsey; Brohman, Lisa; Harkness, Karen I; Hirdes, John; McKelvie, Robert S; Stolee, Paul

2017-09-01

Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, 'Enhancing Knowledge and Interprofessional Care for Heart Failure', was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention's acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.

Indicators of Family Care for Development for Use in Multicountry Surveys

PubMed Central

Kariger, Patricia; Engle, Patrice; Britto, Pia M. Rebello; Sywulka, Sara M.; Menon, Purnima

2012-01-01

Indicators of family care for development are essential for ascertaining whether families are providing their children with an environment that leads to positive developmental outcomes. This project aimed to develop indicators from a set of items, measuring family care practices and resources important for caregiving, for use in epidemiologic surveys in developing countries. A mixed method (quantitative and qualitative) design was used for item selection and evaluation. Qualitative and quantitative analyses were conducted to examine the validity of candidate items in several country samples. Qualitative methods included the use of global expert panels to identify and evaluate the performance of each candidate item as well as in-country focus groups to test the content validity of the items. The quantitative methods included analyses of item-response distributions, using bivariate techniques. The selected items measured two family care practices (support for learning/stimulating environment and limit-setting techniques) and caregiving resources (adequacy of the alternate caregiver when the mother worked). Six play-activity items, indicative of support for learning/stimulating environment, were included in the core module of UNICEF's Multiple Cluster Indictor Survey 3. The other items were included in optional modules. This project provided, for the first time, a globally-relevant set of items for assessing family care practices and resources in epidemiological surveys. These items have multiple uses, including national monitoring and cross-country comparisons of the status of family care for development used globally. The obtained information will reinforce attention to efforts to improve the support for development of children. PMID:23304914

Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?

PubMed

Bottino, Clement J; Rhodes, Erinn T; Kreatsoulas, Catherine; Cox, Joanne E; Fleegler, Eric W

2017-07-01

To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

PubMed

Majrooh, Muhammad Ashraf; Hasnain, Seema; Akram, Javaid; Siddiqui, Arif; Memon, Zahid Ali

2014-01-01

Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.

Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China.

PubMed

Wang, Qing; Zhang, Donglan; Hou, Zhiyuan

2016-12-01

The private health care sector has become an increasingly important complement to China's health care system. During the health care reform in 2009, China's central government established multiple initiatives to relax constraints on the growth of the private health care sector. However, private health services have not been growing as rapidly as private health care facilities. Using data from the China Health and Retirement Longitudinal Study collected between 2011 and 2013, this study investigated patient choice between private and public providers for outpatient care and estimated its relationship with health insurance and socioeconomic status (SES). The Heckman sample selection model was applied to address the problem of selection bias caused by a lack of awareness of provider ownership. We found that 82.1% of the outpatient care users were aware of their provider's ownership, and 23.8% chose private health care providers. Although patients with health insurance and higher SES were more likely to be aware of their provider's ownership, they preferred public providers over private providers. For example, having Urban Employee Basic Medical Insurance was associated with a 16.5% lower probability of choosing private providers than no health insurance. Respondents with the highest level of household expenditure had a 7.5% lower probability of choosing private providers than those with the lowest level of expenditure. The probability of choosing private providers were significantly lower by 4.0% among respondents with an education level of junior high school and above than those with no formal education. For private providers to play an effective role in the health care system, policies that have constrained the growth of the private sector should be changed, and more effort should be directed toward equalizing health insurance coverage for both types of providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Do emotional intelligence and previous caring experience influence student nurse performance? A comparative analysis.

PubMed

Stenhouse, Rosie; Snowden, Austyn; Young, Jenny; Carver, Fiona; Carver, Hannah; Brown, Norrie

2016-08-01

Reports of poor nursing care have focused attention on values based selection of candidates onto nursing programmes. Values based selection lacks clarity and valid measures. Previous caring experience might lead to better care. Emotional intelligence (EI) might be associated with performance, is conceptualised and measurable. To examine the impact of 1) previous caring experience, 2) emotional intelligence 3) social connection scores on performance and retention in a cohort of first year nursing and midwifery students in Scotland. A longitudinal, quasi experimental design. Adult and mental health nursing, and midwifery programmes in a Scottish University. Adult, mental health and midwifery students (n=598) completed the Trait Emotional Intelligence Questionnaire-short form and Schutte's Emotional Intelligence Scale on entry to their programmes at a Scottish University, alongside demographic and previous caring experience data. Social connection was calculated from a subset of questions identified within the TEIQue-SF in a prior factor and Rasch analysis. Student performance was calculated as the mean mark across the year. Withdrawal data were gathered. 598 students completed baseline measures. 315 students declared previous caring experience, 277 not. An independent-samples t-test identified that those without previous caring experience scored higher on performance (57.33±11.38) than those with previous caring experience (54.87±11.19), a statistically significant difference of 2.47 (95% CI, 0.54 to 4.38), t(533)=2.52, p=.012. Emotional intelligence scores were not associated with performance. Social connection scores for those withdrawing (mean rank=249) and those remaining (mean rank=304.75) were statistically significantly different, U=15,300, z=-2.61, p$_amp_$lt;0.009. Previous caring experience led to worse performance in this cohort. Emotional intelligence was not a useful indicator of performance. Lower scores on the social connection factor were associated with withdrawal from the course. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana's hospitals.

PubMed

Abuosi, Aaron A; Domfeh, Kwame Ameyaw; Abor, Joshua Yindenaba; Nketiah-Amponsah, Edward

2016-05-12

The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest. A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care. Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with. It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of care is a concern of both insured and uninsured patients.

Intimate partner violence during pregnancy and use of antenatal care among rural women in southern Terai of Nepal.

PubMed

Singh, Jitendra Kumar; Evans-Lacko, Sara; Acharya, Dilaram; Kadel, Rajendra; Gautam, Salila

2018-04-01

Underutilisation of antenatal care services due to intimate partner violence during pregnancy has been well documented elsewhere, but it is understudied in Nepal. Our study aimed at exploring the impact of intimate partner violence on antenatal care service utilisation in southern Terai of Nepal. A community-based cross-sectional study was performed in 6 village development committees in Dhanusha district, Nepal. A total of 426 pregnant women in their second trimester were selected using a multistage cluster sampling method. Multivariable regression analyses were used to examine the association between exposure to intimate partner violence and selected antenatal care services, adjusting for covariates. Among 426 pregnant women, almost three out of ten women (28.9%) were exposed to intimate partner violence at some point during their pregnancy. Pregnant women who were exposed to intimate partner violence were less likely to: register for antenatal care (OR 0.31; 95% CI (0.08-0.50)), take iron and folic acid (OR 0.55; 95% CI (0.12-0.90)), report dietary diversity (middle vs low: OR 0.34; 95% CI (0.11-0.58) and high vs low: OR 0.18; 95% CI (0.08-0.37)), have rest and sleep during day time (OR 0.47; 95% CI (0.61-0.58)), and attend mother's group meetings (OR 0.29; 95% CI (0.10-0.83)). Intimate partner violence during pregnancy is associated with low utilisation of antenatal care services. Therefore, effective strategies to prevent or reduce intimate partner violence during pregnancy is needed, which may lead to improved antenatal care service utilization in Nepal with healthier mothers and children's outcome. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal.

PubMed

Acharya, Dilaram; Khanal, Vishnu; Singh, Jitendra Kumar; Adhikari, Mandira; Gautam, Salila

2015-08-12

Antenatal care has several benefits for expecting mothers and birth outcomes; yet many mothers do not utilise this service in Nepal. Mass media may play an important role in increasing the use of antenatal care and other maternal health services. However, the effect of mass media on increasing health service utilisation has remained an under studied area in Nepal. The aim of this study was to investigate the impact of mass media on the utilisation of antenatal care services in rural Nepal. A community-based cross-sectional study was conducted in Sinurjoda Village Development Committee of Dhanusha District, Nepal. A total of 205 mothers of children aged under 1 year were selected using systematic random sampling. Logistic regression was employed to examine the association between selected antenatal care services and mass media exposure after adjusting for other independent variables. A majority of mothers were exposed to mass media. Radio was accessible to most (60.0%) of the participants followed by television (43.41%). Mothers exposed to mass media were more likely to attending antenatal visits [Odds ratio (OR) 6.28; 95% CI (1.01-38.99)], taking rest and sleep during pregnancy [OR 2.65; 95% CI (1.13-6.26)], and receiving TT immunization [OR 5.12; 95% CI (1.23-21.24)] than their non-exposed counterparts. The study reported a positive influence of mass media on the utilisation of antenatal care services in Nepal. Therefore, further emphasis should be given to increase awareness of women of rural Nepal through mass media to improve utilisation of antenatal care services in Nepal.

Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments

PubMed Central

Vrijhoef, Hubertus J. M.; Berbee, Rieneke; Wagner, Edward H.; Steuten, Lotte M. G.

2009-01-01

Abstract Objective  To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care. Background  Health care is becoming more user‐centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care. Methods  Instruments were identified by means of a systematic literature review. Appropriateness of instruments was analysed on seven criteria. The two most promising instruments were translated into Dutch, if necessary, and administered to a convenience sample of 109 people with a chronic illness. Data derived from respondents were analysed statistically. Focus‐group interviews were conducted to assess the semantic and technical equivalence as well as opinions of people about the applicability and relevance of the translated instruments. Results  From 37 instruments identified, the Patients’ Assessment of Care for chronIc Conditions (PACIC) and the short form of the Patient Satisfaction Questionnaire III (PSQ‐18) were selected as most promising instruments. Both instruments produced similar median scores across people with different chronic conditions. The overall PACIC and its subscales and the overall PSQ‐18 were highly internally consistent, but not the PSQ‐18 subscales. Overall, the PACIC demonstrated better psychometric characteristics. PACIC and PSQ‐18 scores were found to be moderately correlated. Whereas more respondents preferred the PSQ‐18, focus‐group participants regarded the PACIC to be more applicable and relevant. The technical and semantic equivalence of both instruments were sufficient. Conclusions  Because of its psychometric characteristics, perceived applicability and relevance, the PACIC is the most appropriate instrument to measure the experience of people receiving integrated chronic care. PMID:19709315

Comparing the quality of preconception care provided in healthcare centers in Mashhad in 2012.

PubMed

Sardasht, Fatemeh Ghaffari; Shourab, Nahid Jahani; Jafarnejad, Farzaneh; Esmaily, Habibollah

2015-01-01

Improving the quality of healthcare services is considered as the main strategy to improve maternal and neonatal health outcomes. Providing appropriate healthcare for mothers and their newborn children is facilitated significantly by considering the mothers' health and welfare before pregnancy occurs. Therefore, the aim of this study was to compare the quality of preconception care provided to women of reproductive age provided by five health centers in Mashhad in 2012 and 2013. Multi-stage sampling was used to select the participants in this descriptive study. As a result, 360 women of reproductive age and 39 healthcare providers from 24 healthcare centers in Mashhad were selected to participate. The data gathering tool was a checklist based on the Donabedian model that includes the three dimensions of structure, process, and outcome. The data were analyzed by SPSS software (version 11.5), Kruskal-Wallis tests, ANOVA, and Spearman rank correlation. The results showed that preconception care at the 24 healthcare centers had essentially the same conditions. But in the process and outcome components, the quality of the preconception care at five of the health centers was significantly different (p=0.008). The highest quality of care processes was identified at health center number 3. The difference in the component of outcomes being followed up by the healthcare providers at five of the health centers was statistically significant (p=0.000); however, there were no significant differences found among the satisfaction and awareness of the women who participated at the five health centers. The results showed that the performance of health personnel in providing preconception care and providing follow-up care was not satisfactory.

Health care seeking behaviour during pregnancy, delivery and the postnatal period in Bangladesh: Assessing the compliance with WHO recommendations.

PubMed

Islam, M Mazharul; Masud, Mohammad Shahed

2018-04-30

The World Health Organization (WHO) recommends four antenatal care (ANC) visits, delivery in a health facility and three postnatal care (PNC) visits for women to optimize the maternal health outcomes. To examine the level and determinants of maternal health care seeking behaviour during pregnancy, delivery and the postnatal period, and assess the compliance with the WHO recommended levels of care in Bangladesh. The study is based on secondary analysis of the data obtained from the 2014 Bangladesh Demographic and Health Survey (BDHS). The 2014 BDHS was a cross-sectional survey of a nationally representative sample of 17,863 ever-married women aged 15-49 years. The sample was selected following a two-stage stratified cluster sampling design. The dataset from a subsample of 4.627 ever-married women who had delivered their last birth within three years before the survey were included in the analysis to meet the objectives of the study. Descriptive statistics and multinomial logistic regression model were used for data analysis. It has been observed that only 31% mothers had recommended four or more ANC visits, 37% births were delivered at health facilities, and 65% mothers received at least one PNC visit. Only 18.0% mothers received the WHO recommended optimal level of four or more ANC visits, births in a health facility and at least one PNC visit. Mothers aged less than 20 years, living in rural area, having no education and media exposure, multiparous, poor wealth status, husband with no education and husband's employment status appeared as significant predictors of optimal level maternal health care after adjusting for other factors. Mothers living in Sylhet, Chittagong and Barisal regions were less likely to receive the optimum level health care. Utilization of maternal health care during pregnancy, delivery and the postnatal period among Bangladeshi women does not reflect the complete compliance with the WHO recommendations. Further studies are needed to identify the reasons for underutilization of optimum level maternal care practice in Bangladesh. The findings underscore the need for targeted intervention for those groups of mothers who were identified as having lowest level of maternal care across the continuum of care. Copyright © 2018 Elsevier Ltd. All rights reserved.

Evolution of the Interstellar Gas Fraction Over Cosmic Time

NASA Astrophysics Data System (ADS)

Wiklind, Tommy; CANDELS

2018-01-01

Galaxies evolve by transforming gas into stars. The gas is acquired through accretion and mergers and is a highly intricate process where feed-back processes play an important role. Directly measuring the gas content in distant galaxies is, however, both complicated and time consuming. A direct observations involves either observing neutral hydrogen using the 21cm line or observing the molecular gas component using tracer molecules such as CO. The former method is impeded by man-made radio interference, and the latter is time consuming even with sensitive instruments such s ALMA. An indirect method is to observe the Raleigh-Jeans part of the dust SED and from this infer the gas mass. Here we present the results from a project using ALMA to measure the RJ part of the dust SED in a carefully selected sample of 70 galaxies at redshifts z=2-5. The galaxies are selected solely based on their redshift and stellar mass and therefore represents an unbiased sample. The stellar masses are selected using the MEAM method and thus the sample corresponds to progenitors of a z=0 galaxy of a particular stellar mass. Preliminary results show that the average gas fraction increases with redshift over the range z=2-3 in accordance with theoretical models, but at z≥4 the observed gas fraction is lower.

The Metallicity of Void Dwarf Galaxies

NASA Astrophysics Data System (ADS)

Kreckel, K.; Croxall, K.; Groves, B.; van de Weygaert, R.; Pogge, R. W.

2015-01-01

The current ΛCDM cosmological model predicts that galaxy evolution proceeds more slowly in lower density environments, suggesting that voids are a prime location to search for relatively pristine galaxies that are representative of the building blocks of early massive galaxies. To test the assumption that void galaxies are more pristine, we compare the evolutionary properties of a sample of dwarf galaxies selected specifically to lie in voids with a sample of similar isolated dwarf galaxies in average density environments. We measure gas-phase oxygen abundances and gas fractions for eight dwarf galaxies (Mr > -16.2), carefully selected to reside within the lowest density environments of seven voids, and apply the same calibrations to existing samples of isolated dwarf galaxies. We find no significant difference between these void dwarf galaxies and the isolated dwarf galaxies, suggesting that dwarf galaxy chemical evolution proceeds independent of the large-scale environment. While this sample is too small to draw strong conclusions, it suggests that external gas accretion is playing a limited role in the chemical evolution of these systems, and that this evolution is instead dominated mainly by the internal secular processes that are linking the simultaneous growth and enrichment of these galaxies.

Corporate buying of health care plans: a framework for marketing theory and practice.

PubMed

Lindenmuth, L J; Burger, P C

1990-06-01

Much of the research in health care plan and provider selection has focused on the patient's selection process. The authors report on the increasing need to understand the corporation's decision process in selecting health care plans and providers. Managed care marketers need to understand this process in order to design and market such plans successfully.

Women's preference for traditional birth attendants and modern health care practitioners in Akpabuyo community of Cross River State, Nigeria.

PubMed

Akpabio, Idongesit I; Edet, Olaide B; Etifit, Rita E; Robinson-Bassey, Grace C

2014-01-01

The proportion of women who patronized traditional birth attendants (TBAs) or modern health care practitioners (MHCPs) was compared, including reasons for their choices. A comparative design was adopted to study 300 respondents selected through a multistage systematic random sampling technique. The instrument for data collection was a validated 21-item structured questionnaire. We observed that 75 (25%) patronized and 80 (27%) preferred TBAs, and 206 (69%) patronized and 220 (75%) preferred MHCPs, while 19 (6%) patronized both. The view that TBAs prayed before conducting deliveries was supported by a majority 75 (94%) of the respondents who preferred them. Factors associated with preference for TBAs should be addressed.

The ATLAS3D project - I. A volume-limited sample of 260 nearby early-type galaxies: science goals and selection criteria

NASA Astrophysics Data System (ADS)

Cappellari, Michele; Emsellem, Eric; Krajnović, Davor; McDermid, Richard M.; Scott, Nicholas; Verdoes Kleijn, G. A.; Young, Lisa M.; Alatalo, Katherine; Bacon, R.; Blitz, Leo; Bois, Maxime; Bournaud, Frédéric; Bureau, M.; Davies, Roger L.; Davis, Timothy A.; de Zeeuw, P. T.; Duc, Pierre-Alain; Khochfar, Sadegh; Kuntschner, Harald; Lablanche, Pierre-Yves; Morganti, Raffaella; Naab, Thorsten; Oosterloo, Tom; Sarzi, Marc; Serra, Paolo; Weijmans, Anne-Marie

2011-05-01

The ATLAS3D project is a multiwavelength survey combined with a theoretical modelling effort. The observations span from the radio to the millimetre and optical, and provide multicolour imaging, two-dimensional kinematics of the atomic (H I), molecular (CO) and ionized gas (Hβ, [O III] and [N I]), together with the kinematics and population of the stars (Hβ, Fe5015 and Mg b), for a carefully selected, volume-limited (1.16 × 105 Mpc3) sample of 260 early-type (elliptical E and lenticular S0) galaxies (ETGs). The models include semi-analytic, N-body binary mergers and cosmological simulations of galaxy formation. Here we present the science goals for the project and introduce the galaxy sample and the selection criteria. The sample consists of nearby (D < 42 Mpc, |δ- 29°| < 35°, |b| > 15°) morphologically selected ETGs extracted from a parent sample of 871 galaxies (8 per cent E, 22 per cent S0 and 70 per cent spirals) brighter than MK < -21.5 mag (stellar mass M★≳ 6 ×109 M⊙). We analyse possible selection biases and we conclude that the parent sample is essentially complete and statistically representative of the nearby galaxy population. We present the size-luminosity relation for the spirals and ETGs and show that the ETGs in the ATLAS3D sample define a tight red sequence in a colour-magnitude diagram, with few objects in the transition from the blue cloud. We describe the strategy of the SAURON integral field observations and the extraction of the stellar kinematics with the pPXF method. We find typical 1σ errors of ΔV≈ 6 km s-1, Δσ≈ 7 km s-1, Δh3≈Δh4≈ 0.03 in the mean velocity, the velocity dispersion and Gauss-Hermite (GH) moments for galaxies with effective dispersion σe≳ 120 km s-1. For galaxies with lower σe (≈40 per cent of the sample) the GH moments are gradually penalized by pPXF towards zero to suppress the noise produced by the spectral undersampling and only V and σ can be measured. We give an overview of the characteristics of the other main data sets already available for our sample and of the ongoing modelling projects.

Applying a feminist analysis model to selected nursing studies of women with HIV.

PubMed

Bunting, S M

1997-01-01

Women's mental health has been linked to oppression and to oppressive practices in health care. Feminist approaches to health care delivery and research have been suggested as a remedy for the subtle and overt oppression faced by women, and many nurses have used feminist principles to conduct and report their research and to critique existing studies. Though nursing authors have identified useful feminist guides for conducting and reporting research, few examples of the practice of feminist critiques of research are available in the nursing literature. This analysis synthesizes and adapts feminist principles from nursing literature and presents a feminist model to review selected nursing research reports of women with human immunodeficiency virus (HIV). A convenience sample of eight articles from nursing journals was examined for statements or implications that the author(s) (a) perceived the purposes of the study as benefiting women, (b) demonstrated an awareness of the structures and policies that oppress women, (c) were sensitive to issues of diversity, (d) were committed to social change, and (e) recognized the female participants' strengths. The selected articles were found to meet many of the feminist criteria, although these principles were not always explicitly addressed in the articles.

Effect of self-care training program based on Orem's model on the behaviors leading to sexually transmitted disease in vulnerable women.

PubMed

Baghersad, Zahra; Alimohammadi, Nasrollah; Boroumandfar, Zahra; Golshiri, Parastoo

2016-01-01

Vulnerable women are prone to sexually transmitted diseases due to their high-risk behaviors. The present study aimed to investigate the effect of self-care training program based on Orem's model on the behaviors leading to sexually transmitted diseases in vulnerable women. This field trial was initially conducted on 100 women covered under health services and welfare organization in Isfahan city, who were selected by rationing ssampling. For needs assessment, they filled the self-care needs assessment questionnaire in three domains of knowledge, attitude, and practice. Then, at the stage of intervention (self-care training), 64 subjects were selected through convenient sampling and were assigned to experimental and control groups by random allocation. Data were analyzed by descriptive and analytical statistical tests through SPSS 18. Results showed that mean scores of knowledge ( P < 0.001), attitude ( P < 0.001), practice ( P = 0.04), and behavior change ( P = 0.01) were significantly higher immediately after and 3 months after intervention, compared to before intervention, but there was no significant difference in mean scores between immediately after and 3 months after intervention. With regard to these results, it can be concluded that if the educational programs are planned based on clients' real needs assessment, the learners follow the educational materials, related to their problems, more seriously and it results in a notable behavior change in them.

Shared Decision Making and Other Variables as Correlates of Satisfaction with Health Care Decisions in a United States National Survey

PubMed Central

Wills, Celia E.; Holloman, Christopher; Olson, Jacklyn; Hechmer, Catherine; Miller, Carla K.; Duchemin, Anne-Marie

2012-01-01

Objective The purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations. Methods A randomly selected age-proportionate national sample of adults (aged 21–70 years) stratified on race, ethnicity, and gender (N = 488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the Shared Decision Making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD. Results After controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R2 = .368, p < .001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD. Conclusion SDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly. Practice Implications By identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes. PMID:22410642

Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey.

PubMed

Glass, Katherine Elizabeth; Wills, Celia E; Holloman, Christopher; Olson, Jacklyn; Hechmer, Catherine; Miller, Carla K; Duchemin, Anne-Marie

2012-07-01

The purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations. A randomly selected age-proportionate national sample of adults (aged 21-70 years) stratified on race, ethnicity, and gender (N=488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the shared decision making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD. After controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R(2)=.368, p<.001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD. SDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly. By identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Marketing midwifery education: findings from a survey.

PubMed

Hunt, S C

1996-03-01

to collect information from a sample of identified customers (midwives and midwifery managers employed by health authorities and trusts) in order to develop a marketing strategy for a Department of Nursing, Midwifery and Health Care. two descriptive and analytical surveys using questionnaires. mid- and west Wales, UK. randomly selected sample of 75 midwives and census sample of eight midwifery managers working within the National Health Service. quantitative and qualitative data collection methods. organisations have to define, and listen carefully, to their customers and offer courses which are appropriate, related to clinical midwifery practice and have titles that accurately reflect the content. Midwives are enthusiastically committed to continuing education despite the current difficulties. Word of mouth and personal recommendation remains the most effective form of advertising. University departments of nursing and midwifery can easily become removed from clinical practice. Education assists practitioners in changing and adapting to a new order; it is also crucial in developing skills in critical thinking and analysis. New skills are needed if practice is to improve. academic departments can easily become remote and out of touch with the needs of clinicians and midwifery managers. Departments must take steps to define the customer, listen carefully to what they want and make every effort to provide continuing education for midwives that is relevant, responsive, accessible and attainable. The benefits of education also must be marketed.

Helping the decision maker effectively promote various experts’ views into various optimal solutions to China’s institutional problem of health care provider selection through the organization of a pilot health care provider research system

PubMed Central

2013-01-01

Background The main aim of China’s Health Care System Reform was to help the decision maker find the optimal solution to China’s institutional problem of health care provider selection. A pilot health care provider research system was recently organized in China’s health care system, and it could efficiently collect the data for determining the optimal solution to China’s institutional problem of health care provider selection from various experts, then the purpose of this study was to apply the optimal implementation methodology to help the decision maker effectively promote various experts’ views into various optimal solutions to this problem under the support of this pilot system. Methods After the general framework of China’s institutional problem of health care provider selection was established, this study collaborated with the National Bureau of Statistics of China to commission a large-scale 2009 to 2010 national expert survey (n = 3,914) through the organization of a pilot health care provider research system for the first time in China, and the analytic network process (ANP) implementation methodology was adopted to analyze the dataset from this survey. Results The market-oriented health care provider approach was the optimal solution to China’s institutional problem of health care provider selection from the doctors’ point of view; the traditional government’s regulation-oriented health care provider approach was the optimal solution to China’s institutional problem of health care provider selection from the pharmacists’ point of view, the hospital administrators’ point of view, and the point of view of health officials in health administration departments; the public private partnership (PPP) approach was the optimal solution to China’s institutional problem of health care provider selection from the nurses’ point of view, the point of view of officials in medical insurance agencies, and the health care researchers’ point of view. Conclusions The data collected through a pilot health care provider research system in the 2009 to 2010 national expert survey could help the decision maker effectively promote various experts’ views into various optimal solutions to China’s institutional problem of health care provider selection. PMID:23557082

[Adjustment of the Andersen's model to the Mexican context: access to prenatal care].

PubMed

Tamez-González, Silvia; Valle-Arcos, Rosa Irene; Eibenschutz-Hartman, Catalina; Méndez-Ramírez, Ignacio

2006-01-01

The aim of this work was to propose an adjustment to the Model of Andersen who answers better to the social inequality of the population in the Mexico City and allows to evaluate the effect of socioeconomic factors in the access to the prenatal care of a sample stratified according to degree of marginalization. The data come from a study of 663 women, randomly selected from a framework sample of 21,421 homes in Mexico City. This work collects information about factors that affect utilization of health services, as well as predisposing factors (age and socioeconomic level), as enabling factors (education, social support, entitlement, pay out of pocket and opinion of health services), and need factors. The sample was ranked according to exclusion variables into three stratums. The data were analyzed through the technique of path analysis. The results indicate that socioeconomic level takes part like predisposed variable for utilization of prenatal care services into three stratums. Otherwise, education and social support were the most important enabling variables for utilization of prenatal care services in the same three groups. In regard to low stratum, the most important enabling variables were education and entitlement. For high stratum the principal enabling variables were pay out of pocket and social support. The medium stratum shows atypical behavior which it was difficult to explain and understand. There was not mediating role with need variable in three models. This indicated absence of equality in all stratums. However, the most correlations in high stratum perhaps indicate less inequitable conditions regarding other stratums.

A descriptive study of access to services in a random sample of Canadian rural emergency departments.

PubMed

Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

2013-11-27

To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Cross-sectional study-mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Canadian rural EDs (rural small town (RST) definition-Statistics Canada). 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands.

Assessing the representativeness of physician and patient respondents to a primary care survey using administrative data.

PubMed

Li, Allanah; Cronin, Shawna; Bai, Yu Qing; Walker, Kevin; Ammi, Mehdi; Hogg, William; Wong, Sabrina T; Wodchis, Walter P

2018-05-30

QUALICOPC is an international survey of primary care performance. QUALICOPC data have been used in several studies, yet the representativeness of the Canadian QUALICOPC survey is unknown, potentially limiting the generalizability of findings. This study examined the representativeness of QUALICOPC physician and patient respondents in Ontario using health administrative data. This representativeness study linked QUALICOPC physician and patient respondents in Ontario to health administrative databases at the Institute for Clinical Evaluative Sciences. Physician respondents were compared to other physicians in their practice group and all Ontario primary care physicians on demographic and practice characteristics. Patient respondents were compared to other patients rostered to their primary care physicians, patients rostered to their physicians' practice groups, and a random sample of Ontario residents on sociodemographic characteristics, morbidity, and health care utilization. Standardized differences were calculated to compare the distribution of characteristics across cohorts. QUALICOPC physician respondents included a higher proportion of younger, female physicians and Canadian medical graduates compared to other Ontario primary care physicians. A higher proportion of physician respondents practiced in Family Health Team models, compared to the provincial proportion for primary care physicians. QUALICOPC patient respondents were more likely to be older and female, with significantly higher levels of morbidity and health care utilization, compared with the other patient groups examined. However, when looking at the QUALICOPC physicians' whole rosters, rather than just the patient survey respondents, the practice profiles were similar to those of the other physicians in their practice groups and Ontario patients in general. Comparisons revealed some differences in responding physicians' demographic and practice characteristics, as well as differences in responding patients' characteristics compared to the other patient groups tested, which may have resulted from the visit-based sampling strategy. Ontario QUALICOPC physicians had similar practice profiles as compared to non-participating physicians, providing some evidence that the participating practices are representative of other non-participating practices, and patients selected by visit-based sampling may also be representative of visiting patients in other practices. Those using QUALICOPC data should understand this limited representativeness when generalizing results, and consider the potential for bias in their analyses.

Nurses' assessments and patients' perceptions: development of the Night Nursing Care Instrument (NNCI), measuring nursing care at night.

PubMed

Johansson, Peter; Oléni, Magnus; Fridlund, Bengt

2005-07-01

Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night. The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night. The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'. Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha. The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items. These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.

Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria.

PubMed

Jooste, Karien; Prinsloo, Carine

2013-03-13

Staffing needs affect the nursing department's budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse) perceive the staffing of agency nurses in intensive care units (ICUs). The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n=124). One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

Measuring equity in household's health care payments (Tehran-Iran 2013): technical points for health policy decision makers.

PubMed

Rezapour, Aziz; Ebadifard Azar, Farbod; Azami Aghdash, Saber; Tanoomand, Asghar; Hosseini Shokouh, Seyed Morteza; Yousefzadeh, Negar; Atefi Manesh, Pezhman; Sarabi Asiabar, Ali

2015-01-01

Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013. This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month. The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system. According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health.

Hippocampus and Basal Forebrain Volumetry for Dementia and Mild Cognitive Impairment Diagnosis: Could It Be Useful in Primary Care?

PubMed

Teipel, Stefan J; Keller, Felix; Thyrian, Jochen R; Strohmaier, Urs; Altiner, Attila; Hoffmann, Wolfgang; Kilimann, Ingo

2017-01-01

Once a patient or a knowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations. To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as a proxy for cerebrovascular comorbidity on diagnostic accuracy. We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from a memory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias. Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only a modest effect on effect size and diagnostic accuracy. Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in a primary care setting.

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities.

PubMed

Babu, Bontha V; Sharma, Yogita; Kusuma, Yadlapalli S; Sivakami, Muthusamy; Lal, Dharmesh K; Marimuthu, Palaniappan; Geddam, Jagjeevan B; Khanna, Anoop; Agarwal, Monika; Sudhakar, Godi; Sengupta, Paramita; Borhade, Anjali; Khan, Zulfia; Kerketta, Anna S; Brogen, Akoijam

2018-05-09

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51 055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2 years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor. Copyright © 2018 John Wiley & Sons, Ltd.

Guide to luminescence dating techniques and their application for paleoseismic research

USGS Publications Warehouse

Gray, Harrison J.; Mahan, Shannon; Rittenour, Tammy M.; Nelson, Michelle Summa; Lund, William R.

2015-01-01

Over the past 25 years, luminescence dating has become a key tool for dating sediments of interest in paleoseismic research. The data obtained from luminescence dating has been used to determine timing of fault displacement, calculate slip rates, and estimate earthquake recurrence intervals. The flexibility of luminescence is a key complement to other chronometers such as radiocarbon or cosmogenic nuclides. Careful sampling and correct selection of sample sites exert two of the strongest controls on obtaining an accurate luminescence age. Factors such as partial bleaching and post-depositional mixing should be avoided during sampling and special measures may be needed to help correct for associated problems. Like all geochronologic techniques, context is necessary for interpreting and calculating luminescence results and this can be achieved by supplying participating labs with associated trench logs, photos, and stratigraphic locations of sample sites.

Continuous flow electrophoresis system experiments on shuttle flights STS-6 and STS-7

NASA Technical Reports Server (NTRS)

Snyder, Robert S.; Rhodes, Percy H.; Miller, Teresa Y.

1988-01-01

The development of a space continuous flow electrophoresis system (CFES) is discussed. The objectives of the experiment were: (1) to use a model sample material at a high concentration to evaluate the continuous flow electrophoresis process in the McDonnell Douglass CFES instrument and compare its separation resolution and sample throughput with related devices on Earth, and (2) to expand the basic knowledge of the limitations imposed by fluid flows and particle concentration effects on the electrophoresis process by careful design and evaluation of the space experiment. Hemoglobin and polysaccharide were selected as samples of concentration effects. The results from space show a large band spread of the high concentration of the single species of hemoglobin that was principally due to the mismatch of electrical conductivity between the sample and buffer.

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

PubMed

Coleman, Christopher Lance; Holzemer, William L; Eller, Lucille Sanzero; Corless, Inge; Reynolds, Nancy; Nokes, Kathleen M; Kemppainen, Jeanne K; Dole, Pam; Kirksey, Kenn; Seficik, Liz; Nicholas, Patrice; Hamilton, Mary Jane

2006-01-01

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

Correlated evolution in parental care in females but not males in response to selection on paternity assurance behaviour.

PubMed

Head, Megan L; Hinde, Camilla A; Moore, Allen J; Royle, Nick J

2014-07-01

According to classical parental care theory males are expected to provide less parental care when offspring in a brood are less likely to be their own, but empirical evidence in support of this relationship is equivocal. Recent work predicts that social interactions between the sexes can modify co-evolution between traits involved in mating and parental care as a result of costs associated with these social interactions (i.e. sexual conflict). In burying beetles (Nicrophorus vespilloides), we use artificial selection on a paternity assurance trait, and crosses within and between selection lines, to show that selection acting on females, not males, can drive the co-evolution of paternity assurance traits and parental care. Males do not care more in response to selection on mating rate. Instead, patterns of parental care change as an indirect response to costs of mating for females. © 2014 The Authors. Ecology Letters published by John Wiley & Sons Ltd and CNRS.

Barrier, weakness and utilization of pre-pregnancy clinic services.

PubMed

Rahman, Mizanur; Rahim, Natazcza Abdul; Arif, Mohd Taha

2017-01-01

Despite being one of the plausible measures towards achieving Sustainable Development Goals (SDGs), various issues pertaining to pre-pregnancy clinic (PPC) services still need to be pondered upon. Based on this view, an attempt was made to identify and understand the barriers and weaknesses of current utilisation of pre-pregnancy care services, since its establishment and implementation in Sarawak from the year 2011. This cross-sectional study was conducted in selected health care facilities throughout Sarawak. A multistage cluster sampling technique was followed to select the health facilities. An unstructured open-ended questionnaire was administered as a part of quantitative data analysis. The open-ended questions were administered to get the in-depth perceived views and current practice of utilisation of pre-pregnancy clinic services. A total of 553 clients from nine selected health care facilities gave their feedback. The results of the study were narrated in textual form and a thematic analysis was done manually. The identified themes for perceived barriers for utilisation of pre-pregnancy care were perception, attitude and acceptance of PPC services, socio-economic issues, services and client factors. The perceived weaknesses of the services are listed under two main themes: working environment and service factors, whereas, the strength of services produced three thematic areas which are preparation for pregnancy, prevention of mortality and morbidity and comprehensive services. Though there is ample evidence that pre-pregnancy services are beneficial for maternal health and wellbeing, various issues still need to be addressed for the improvement of the quality of services. Lack of awareness among clients, socio-economic barriers, lack of resources, organisational barriers and perceptions towards family planning issues are some of the issues which need to be addressed. Nonetheless, promotional and health educational activities are important keys; in ensuring the sustainability of the services.

Tales from the New Frontier: Pioneers' Experiences with Consumer-Driven Health Care

PubMed Central

Lo Sasso, Anthony T; Rice, Thomas; Gabel, Jon R; Whitmore, Heidi

2004-01-01

Objective To conduct site visits to study the early experiences of firms offering consumer-driven health care (CDHC) plans to their employees and firms that provide CDHC products. Data Sources/Study Setting A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers. Study Design We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer-driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC. Principal Findings The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost-savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll. Conclusions Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web-based information and tools actually make patients become better consumers. PMID:15230912

Tales from the new frontier: pioneers' experiences with consumer-driven health care.

PubMed

Lo Sasso, Anthony T; Rice, Thomas; Gabel, Jon R; Whitmore, Heidi

2004-08-01

To conduct site visits to study the early experiences of firms offering consumer-driven health care (CDHC) plans to their employees and firms that provide CDHC products. A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers. We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer-driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC. The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost-savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll. Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web-based information and tools actually make patients become better consumers.

Summary health statistics for U.S. children: National Health Interview Survey, 1998.

PubMed

Blackwell, Debra L; Tonthat, Luong

2002-10-01

This report presents statistics from the 1998 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race/ethnicity, family structure, parent's education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The topics covered are asthma, allergies, learning disabilities, Attention Deficit Disorder, use of medication, respondent-assessed health status, school-loss days, usual place of medical care, time since last contact with a health care professional, selected health care risk factors, and time since last dental contact. The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. In 1998 most U.S. children under 18 years of age enjoyed excellent or very good health (84%). However, 12% of children had no health insurance coverage, and 6% of children had no usual place of medical care. Twelve percent of children had ever been diagnosed with asthma. An estimated 8% of children 3-17 years of age had a learning disability, and an estimated 6% of children had Attention Deficit Disorder (ADD). Lastly, 11% of children in single mother families had two or more visits to an emergency room in the past year compared with 6% of children in two-parent or single-father families.

Summary health statistics for U.S. children: National Health Interview Survey, 2001.

PubMed

Bloom, Barbara; Cohen, Robin A; Vickerie, Jackline L; Wondimu, Ethiopia A

2003-11-01

This report presents statistics from the 2001 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race, Hispanic origin, family structure, parent's education, family income, poverty status, health insurance coverage, residence, region, and health status. The topics covered are asthma, allergies, learning disability, Attention Deficit Hyperactivity Disorder (ADHD), prescription medication, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, unmet dental need, time since last dental contact, and selected measures of health care access. The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention, National Center for Health Statistics, and is representative of the civilian noninstitutionalized population of the United States. Data are collected during face-to-face interviews with adults present at the interview. Information about children is collected for one randomly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child's health. In 2001, most U.S. children under 18 years of age enjoyed excellent or very good health (84%). However, 10% had no health insurance coverage, and 5% had no usual place of health care. Thirteen percent of children had ever been diagnosed with asthma. Eight percent of children 3-17 years of age had a learning disability, and 6% of children had ADHD. Lastly, 11% of children in single-mother families had two or more visits to an emergency room in the past year compared with 6% of children in two-parent families.

The relationship between patients' knowledge of diabetes therapeutic goals and self-management behaviour, including adherence.

PubMed

Waheedi, Mohammad; Awad, Abdelmoneim; Hatoum, Hind T; Enlund, Hannes

2017-02-01

Background The Middle East region has one the highest prevalence rates of diabetes in the world. Little is known about the determinants of adherence and the role of knowledge in diabetes self-management within these populations. Objective To investigate the relationship between patients knowledge of diabetes therapeutic targets with adherence to self-care measures in a sample of patients with type 2 diabetes in Kuwait. Setting Primary care chronic care clinics within the Ministry of Health of Kuwait. Methods A cross sectional survey was carried out with 238 patients from six clinics. A multistage stratified clustered sampling method was used to first randomly select the clinics and the patients. Self-reported adherence to three behaviours: medication taking, diet and physical activity. Results Respondents were able to correctly report a mean (SD) of 1.6 (1.3) out of 5 of the pre-specified treatment targets. Optimal adherence to physical activity, diet and medications was reported in 25, 33 and 47 % of the study cohort, respectively. A structural equation model analysis showed better knowledge of therapeutic goals and own current levels translated into better adherence to medications, diet and physical activity. Conclusion Knowledge of therapeutic goals and own recent levels is associated with adherence to medications, diet, or physical activity in this Kuwaiti cohort of patients with diabetes. Low adherence to self-care management and poor overall knowledge of diabetes is a big challenge to successful diabetes care in Kuwait.

[Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care].

PubMed

Pascual de la Pisa, Beatriz; Márquez Calzada, Cristina; Cuberos Sánchez, Carla; Cruces Jiménez, José Miguel; Fernández Gamaza, Manuel; Martínez Martínez, María Isabel

2015-03-01

Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. Cross-sectional, descriptive, observational study. Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P=.001). The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Economic analysis of the intangible impacts of informal care for people with Alzheimer's disease and other mental disorders.

PubMed

Gervès, Chloé; Bellanger, Martine Marie; Ankri, Joël

2013-01-01

Valuation of the intangible impacts of informal care remains a great challenge for economic evaluation, especially in the framework of care recipients with cognitive impairment. Our main objective was to explore the influence of intangible impacts of caring on both informal caregivers' ability to estimate their willingness to pay (WTP) to be replaced and their WTP value. We mapped characteristics that influence ability or inability to estimate WTP by using a multiple correspondence analysis. We ran a bivariate probit model with sample selection to further analyze the caregivers' WTP value conditional on their ability to estimate their WTP. A distinction exists between the opportunity costs of the caring dimension and those of the intangible costs and benefits of caring. Informal caregivers' ability to estimate WTP is negatively influenced by both intangible benefits from caring (P < 0.001) and negative intangible impacts of caring (P < 0.05). Caregivers' WTP value is negatively associated with positive intangible impacts of informal care (P < 0.01). Informal caregivers' WTP and their ability to estimate WTP are both influenced by intangible burden and benefit of caring. These results call into question the relevance of a hypothetical generalized financial compensation system as the optimal way to motivate caregivers to continue providing care. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Urinary tract infection among pregnant women at a secondary level hospital in Northern India.

PubMed

Kant, Shashi; Lohiya, Ayush; Kapil, Arti; Gupta, Sanjeev Kumar

2017-01-01

Urinary tract infection (UTI) during pregnancy is frequently associated with complications. Currently, in India, there is no regular screening for UTI, and facility for diagnosis of UTI is not available at peripheral government health centers. To estimate the proportion of pregnant women with UTI among antenatal clinic attendees in rural Haryana. Eligible participants were pregnant women attending antenatal clinic of secondary care center of rural Haryana from March to May 2015. Consecutive sampling was done to select pregnant women. Interview schedule was administered to the selected women, and midstream urine sample was collected. Urine sample was plated on MacConkey agar, and colony count was done using standard methods. A total of 1253 pregnant women were included in the study. The proportion of women with symptoms of UTI on the basis of history was 33.3% (95% confidence interval [CI] - 30.7, 35.9), and UTI by colony count was 3.3% (95% CI - 2.4, 4.5). The presence of UTI was found to be significantly associated with the presence of any symptom of UTI on multivariate analysis (odds ratio [95% CI] - 7.35 [1.95, 27.77]). The burden of UTI among pregnant women attending antenatal clinic of a sub-district hospital was considerable, more so among the women that presented with symptoms suggestive of UTI. The study suggested that considering the burden of UTI and its complications, diagnosis of UTI at a resource-constrained setting like a secondary care hospital can be done after screening women for symptoms suggestive of UTI.

Psychotropic medication patterns among youth in foster care.

PubMed

Zito, Julie M; Safer, Daniel J; Sai, Devadatta; Gardner, James F; Thomas, Diane; Coombes, Phyllis; Dubowski, Melissa; Mendez-Lewis, Maria

2008-01-01

Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate > 3 times that of Medicaid-insured youth who qualify by low family income. Systematic data on patterns of medication treatment, particularly concomitant drugs, for youth in foster care are limited. The purpose of this work was to describe and quantify patterns of psychotropic monotherapy and concomitant therapy prescribed to a randomly selected, 1-month sample of youth in foster care who had been receiving psychotropic medication. METHODS. Medicaid data were accessed for a July 2004 random sample of 472 medicated youth in foster care aged 0 through 19 years from a southwestern US state. Psychotropic medication treatment data were identified by concomitant pattern, frequency, medication class, subclass, and drug entity and were analyzed in relation to age group; gender; race or ethnicity; International Classification of Diseases, Ninth Revision, psychiatric diagnosis; and physician specialty. Of the foster children who had been dispensed psychotropic medication, 41.3% received > or = 3 different classes of these drugs during July 2004, and 15.9% received > or = 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The use of specific psychotropic medication classes varied little by diagnostic grouping. Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of > or = 2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly. Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety.

Dysmenorrhoea and self-care behaviours among hospital nurses: a questionnaire survey.

PubMed

Chiu, Min-Hui; Wang, Hsiu-Hung; Hsu, Su-Chen; Liu, I-Ping

2013-11-01

To investigate self-care behaviours and its predictors for dysmenorrhoea among hospital nurses. Dysmenorrhoea is an important issue in hospital nurses for its influence on job performance and quality of patient care. Given the difficulties in reorganising work schedule for taking menstrual leave in Taiwan, it is necessary to improve the comfort level of nurses during menstruation. A cross-sectional correlation study using a structured questionnaire. A convenience sampling method was used to select two hospitals in Southern Taiwan, and participants were recruited by random sampling method. Questionnaire used in the study contained personal information, Dysmenorrheic Knowledge Scale, Menstrual Attitude Scale and Dysmenorrheic Self-Care Behavior Scale (DSCBS). Two hundred and ninety-seven participants had experienced dysmenorrhoea in the last six months, with the prevalence rate of 70·7%. Results showed the average age of the participants was 30·3 years, and 252 participants (82·4%) self-perceived they were bothered by dysmenorrhoea. The score of DSCBS was 29·9 (±5·3). The results of stepwise multiple regression analysis revealed the predictors of DSCBS included whether the participants (1) were married, (2) had irregular menstruation, (3) had received health education on dysmenorrhoea, (4) visited doctor for dysmenorrhoea, (5) knew they may take menstrual leave and (6) were identified with menstruation as a natural event. The r(2) was 18·4%. Hospital nurses' self-care behaviour for dysmenorrhoea is suggested to be improved through enhanced peer support and caring. The prevalence rate of dysmenorrhoea among hospital nurses is high. Most of them take analgesics to reduce pain to return to work. We recommend hospitals to provide women-friendly workplace and empowerment activities to improve the self-care ability and comfort level of nurses during menstruation. © 2013 John Wiley & Sons Ltd.

Patient’s Perception of Nursing Care at a Large Teaching Hospital in India

PubMed Central

Samina, Mufti; GJ, Qadri; Tabish, SA; Samiya, Mufti; Riyaz, R

2008-01-01

Background: As focus has shifted from the healthcare providers to the healthcare consumers; patient satisfaction is being increasingly used worldwide for the assessment of quality of services provided by healthcare institutions. To understand patient satisfaction, “patient’s perception” of care must first be understood. Of all the healthcare workers nurses spend maximum time with the patients. Therefore, the nurse is in a unique position to influence and promote effective consumer relationships. Though patient satisfaction surveys with nursing care are routinely conducted in the developed world to monitor and improve the quality of care, the same is not true for the developing world especially in the Indian subcontinent. Objective: To conduct a study of patient’s perception of nursing care in a large teaching hospital. Methods: A prospective study spread over a period of one year was carried out. Sample size consisted of seven percent of patients each admitted as emergency and routine. All the randomly selected patients were administered questionnaires, thus obtaining a sample size of 2600. Of these 2500 questionnaires were usable for data analysis (valid response rate of 81.6%). Results: The results of the study revealed a relatively higher percentage of patients with poor perception regarding ‘explanation and information’, and ‘caring attitude’ aspects of nursing care (31.6% and 11.5% respectively). However more than 95% patients had good perception of ‘responsiveness’, ‘availability’ and ‘ward organization’ capability of the nurse. Conclusion: Patient satisfaction surveys should become a regular outcome monitoring feature in all the hospitals. Also In-service training programs for nurses, with special emphasis on communication are need of the hour and should become a regular exercise. PMID:21475490

Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study.

PubMed

Poortaghi, Sarieh; Salsali, Mahvash; Ebadi, Abbas; Rahnavard, Zahra; Maleki, Farzaneh

2015-09-01

Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. This study aimed to audit nursing care based on a nursing process model. This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses' compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests. The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses' age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001). Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools.

Predictors of nurse practitioners' autonomy: effects of organizational, ethical, and market characteristics.

PubMed

Ulrich, Connie; Soeken, Karen; Miller, Nancy

2003-07-01

To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed-care systems (e.g., HMOs). A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational characteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state. Although NPs were ethically concerned about their autonomy in a managed-care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethical concern, the lower the perceived autonomy of NPs. Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.

A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I.

PubMed

Rupert, R L

2000-01-01

To investigate the primary care, health promotion activities associated with what has historically been called "maintenance care" (MC) as used in the practice of chiropractic in the United States. This includes issues such as investigating the purpose of MC, what conditions and patient populations it best serves, how frequently it is required, what therapeutic interventions constitute MC, how often it is recommended, and what percent of patient visits are for prevention and health promotion services. It also investigates the economic impact of these services. Postal survey of a randomized sample of practicing US chiropractors. The questionnaire was structured with a 5-point ordinal Likert scale (28 questions) and brief fill-in questionnaire (12 questions). The 40-question survey was mailed to 1500 chiropractors selected at random from a pool of chiropractors with active practices in the United States. The National Directory of Chiropractic database was the source of actively practicing chiropractors from which doctor selection was made. The sample was derived by using the last numbers composing the zip codes assigned by the US Postal Service. This sampling method assured potential inclusion of chiropractors from all 50 states, from rural areas and large cities, and assured a sample weighting based on population density that might not have been afforded by a simple random sample. Six hundred and fifty-eight (44%) of the questionnaires were completed and returned. US chiropractors agreed or strongly agreed that the purpose of MC was to optimize health (90%), prevent conditions from developing (88%), provide palliative care (86%), and minimize recurrence or exacerbations (95%). MC was viewed as helpful in preventing both musculoskeletal and visceral health problems. There was strong agreement that the therapeutic composition of MC placed virtually equal weight on exercise (96%) and adjustments/manipulation (97%) and that other interventions, including dietary recommendations (93%) and patient education about lifestyle changes (84%), shared a high level of importance. Seventy-nine percent of chiropractic patients have MC recommended to them and nearly half of those (34%) comply. The average number of recommended MC visits was 14.4 visits per year, and the total revenue represents an estimated 23% of practice income. Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.

Design and operation of the national home health aide survey: 2007-2008.

PubMed

Bercovitz, Anita; Moss, Abigail J; Sengupta, Manisha; Harris-Kojetin, Lauren D; Squillace, Marie R; Emily, Rosenoff; Branden, Laura

2010-03-01

This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability. METHODS NHHAS, a multistage probability sample survey, was conducted as a supplement to the 2007 National Home and Hospice Care Survey (NHHCS). Agencies providing home health and/or hospice care were sampled, and then aides employed by these agencies were sampled and interviewed by telephone. Survey topics included recruitment, training, job history, family life, client relations, work-related injuries, and demographics. NHHAS was virtually identical to the 2004 National Nursing Assistant Survey of certified nursing assistants employed in sampled nursing homes with minor changes to account for differences in workplace environment and responsibilities. RESULTS From September 2007 to April 2008, interviews were completed with 3,416 aides. A public-use data file that contains the interview responses, sampling weights, and design variables is available. The NHHAS overall response rate weighted by the inverse of the probability of selection was 41 percent. This rate is the product of the weighted first-stage agency response rate of 57 percent (i.e., weighted response rate of 59 percent for agency participation in NHHCS times the weighted response rate of 97 percent for agencies participating in NHHCS that also participated in NHHAS) and the weighted second-stage aide response rate of 72 percent to NHHAS.

Knowledge and perception towards net care and repair practice in Ethiopia.

PubMed

Zewde, Ayele; Irish, Seth; Woyessa, Adugna; Wuletaw, Yonas; Nahusenay, Honelgn; Abdelmenan, Semira; Demissie, Meaza; Gulema, Hanna; Dissanayake, Gunawardena; Chibsa, Sheleme; Solomon, Hiwot; Yenehun, Meseret A; Kebede, Amha; Lorenz, Lena M; Ponce-de-Leon, Gabriel; Keating, Joseph; Worku, Alemayehu; Berhane, Yemane

2017-10-02

Long-lasting insecticidal nets (LLINs) are a key malaria control intervention. Although LLINs are presumed to be effective for 3 years under field or programmatic conditions, net care and repair approaches by users influence the physical and chemical durability. Understanding how knowledge, perception and practices influence net care and repair practices could guide the development of targeted behavioural change communication interventions related to net care and repair in Ethiopia and elsewhere. This population-based, household survey was conducted in four regions of Ethiopia [Amhara, Oromia, Tigray, Southern Nations Nationalities Peoples Region (SNNPR)] in June 2015. A total of 1839 households were selected using multi-stage sampling procedures. The household respondents were the heads of households. A questionnaire was administered and the data were captured electronically. STATA software version 12 was used to analyse the data. Survey commands were used to account for the multi-stage sampling approach. Household descriptive statistics related to characteristics and levels of knowledge and perception on net care and repair are presented. Ordinal logistic regression was used to identify factors associated with net care and repair perceptions. Less than a quarter of the respondents (22.3%: 95% CI 20.4-24.3%) reported adequate knowledge of net care and repair; 24.6% (95% CI 22.7-26.5%) of the respondents reported receiving information on net care and repair in the previous 6 months. Thirty-five per cent of the respondents (35.1%: 95% CI 32.9-37.4%) reported positive perceptions towards net care and repair. Respondents with adequate knowledge on net care and repair (AOR 1.58: 95% CI 1.2-2.02), and those who discussed net care and repair with their family (AOR 1.47: 95% CI 1.14-1.89) had higher odds of having positive perceptions towards net care and repair. The low level of reported knowledge on net care and repair, as well as the low level of reported positive perception towards net repair need to be addressed. Targeted behavioural change communication campaigns could be used to target specific groups; increased net care and repair would lead to longer lasting nets.

Selection to outsmart the germs: The evolution of disease recognition and social cognition.

PubMed

Kessler, Sharon E; Bonnell, Tyler R; Byrne, Richard W; Chapman, Colin A

2017-07-01

The emergence of providing care to diseased conspecifics must have been a turning point during the evolution of hominin sociality. On a population level, care may have minimized the costs of socially transmitted diseases at a time of increasing social complexity, although individual care-givers probably incurred increased transmission risks. We propose that care-giving likely originated within kin networks, where the costs may have been balanced by fitness increases obtained through caring for ill kin. We test a novel hypothesis of hominin cognitive evolution in which disease may have selected for the cognitive ability to recognize when a conspecific is infected. Because diseases may produce symptoms that are likely detectable via the perceptual-cognitive pathways integral to social cognition, we suggest that disease recognition and social cognition may have evolved together. Using agent-based modeling, we test 1) under what conditions disease can select for increasing disease recognition and care-giving among kin, 2) whether providing care produces greater selection for cognition than an avoidance strategy, and 3) whether care-giving alters the progression of the disease through the population. The greatest selection was produced by diseases with lower risks to the care-giver and prevalences low enough not to disrupt the kin networks. When care-giving and avoidance strategies were compared, only care-giving reduced the severity of the disease outbreaks and subsequent population crashes. The greatest selection for increased cognitive abilities occurred early in the model runs when the outbreaks and population crashes were most severe. Therefore, over the course of human evolution, repeated introductions of novel diseases into naïve populations could have produced sustained selection for increased disease recognition and care-giving behavior, leading to the evolution of increased cognition, social complexity, and, eventually, medical care in humans. Finally, we lay out predictions derived from our disease recognition hypothesis that we encourage paleoanthropologists, bioarchaeologists, primatologists, and paleogeneticists to test. Copyright © 2017 Elsevier Ltd. All rights reserved.

Is personality a driving force for socioeconomic differences in young adults' health care use? A prospective cohort study.

PubMed

Kraft, Maren; Arts, Koos; Traag, Tanja; Otten, Ferdy; Bosma, Hans

2017-09-01

To relate personality characteristics at the age of 12 to socioeconomic differences in health care use in young adulthood. And thereby examining the extent to which socioeconomic differences in the use of health care in young adulthood are based on differences in personality characteristics, independent of the (parental) socioeconomic background. Personality of more than 13,000 Dutch 12-year old participants was related to their health and socioeconomic position after a follow-up of 13 years (when the participants had become young adults). In young adulthood, low socioeconomic status was related to high health care use (e.g. low education -hospital admission: OR = 2.21; low income -GP costs: OR = 1.25). Odds ratios (for the socioeconomic health differences) did not decrease when controlled for personality. In this Dutch sample of younger people, personality appeared not to be a driving force for socioeconomic differences in health care use. Findings thus do not support the personality-related, indirect selection perspective on the explanation of socioeconomic differences in health.

Universal health insurance and health care access for homeless persons.

PubMed

Hwang, Stephen W; Ueng, Joanna J M; Chiu, Shirley; Kiss, Alex; Tolomiczenko, George; Cowan, Laura; Levinson, Wendy; Redelmeier, Donald A

2010-08-01

We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system. We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with unmet needs. Unmet health care needs were reported by 17% of participants. Compared with Toronto's general population, unmet needs were significantly more common among homeless individuals, particularly among homeless women with dependent children. Factors independently associated with a greater likelihood of unmet needs were younger age, having been a victim of physical assault in the past 12 months, and lower mental and physical health scores on the 12-Item Short Form Health Survey. Within a system of universal health insurance, homeless people still encounter barriers to obtaining health care. Strategies to reduce nonfinancial barriers faced by homeless women with children, younger adults, and recent victims of physical assault should be explored.

Universal Health Insurance and Health Care Access for Homeless Persons

PubMed Central

Ueng, Joanna J. M.; Chiu, Shirley; Kiss, Alex; Tolomiczenko, George; Cowan, Laura; Levinson, Wendy; Redelmeier, Donald A.

2010-01-01

Objectives. We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system. Methods. We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with unmet needs. Results. Unmet health care needs were reported by 17% of participants. Compared with Toronto's general population, unmet needs were significantly more common among homeless individuals, particularly among homeless women with dependent children. Factors independently associated with a greater likelihood of unmet needs were younger age, having been a victim of physical assault in the past 12 months, and lower mental and physical health scores on the 12-Item Short Form Health Survey. Conclusions. Within a system of universal health insurance, homeless people still encounter barriers to obtaining health care. Strategies to reduce nonfinancial barriers faced by homeless women with children, younger adults, and recent victims of physical assault should be explored. PMID:20558789

Perceptions of family caregivers of cancer patients about the challenges of caregiving: a qualitative study.

PubMed

Nemati, Shahnaz; Rassouli, Maryam; Ilkhani, Mahnaz; Baghestani, Ahmad Reza

2018-03-01

The experience of caring for a family member with cancer is associated with several care-related problems and challenges for the caregiver. The comprehensive and in-depth understanding of the trials and tribulations of caregiving can be a step towards resolving the problems faced by family caregivers of these patients. The present study aimed to explore challenges faced by Iranian family caregivers of cancer patients. The present qualitative study was conducted through in-depth semi-structured interviews held with 21 family caregivers of cancer patients selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analysed through conventional content analysis. The codes extracted from interviews produced four main themes, including 'confusion', 'uncertainty', 'disintegration' and 'setback', which collectively caused suffering for family caregivers. Care provided in an atmosphere of suffering and discontent diminishes caregiver's quality of life and quality of patient care. Health planners should therefore consider the challenges and sufferings faced by family caregivers and should seek to obviate them through appropriate plans. © 2017 Nordic College of Caring Science.

Adjusting for outcome misclassification: the importance of accounting for case-control sampling and other forms of outcome-related selection.

PubMed

Jurek, Anne M; Maldonado, George; Greenland, Sander

2013-03-01

Special care must be taken when adjusting for outcome misclassification in case-control data. Basic adjustment formulas using either sensitivity and specificity or predictive values (as with external validation data) do not account for the fact that controls are sampled from a much larger pool of potential controls. A parallel problem arises in surveys and cohort studies in which participation or loss is outcome related. We review this problem and provide simple methods to adjust for outcome misclassification in case-control studies, and illustrate the methods in a case-control birth certificate study of cleft lip/palate and maternal cigarette smoking during pregnancy. Adjustment formulas for outcome misclassification that ignore case-control sampling can yield severely biased results. In the data we examined, the magnitude of error caused by not accounting for sampling is small when population sensitivity and specificity are high, but increases as (1) population sensitivity decreases, (2) population specificity decreases, and (3) the magnitude of the differentiality increases. Failing to account for case-control sampling can result in an odds ratio adjusted for outcome misclassification that is either too high or too low. One needs to account for outcome-related selection (such as case-control sampling) when adjusting for outcome misclassification using external information. Copyright © 2013 Elsevier Inc. All rights reserved.

Prevalence and correlates of acute respiratory infections in children less than two years of age.

PubMed

Saeed, A A; Bani, I A

2000-12-01

To study acute respiratory infections of children less than 2 years of age in Riyadh City and their sociodemographic and anthropometric correlates. Study subjects included 250 mothers selected by systematic random sampling from mothers attending 5 Primary Health Care Centers selected by simple random sampling from the 5 geographical zones (one from each zone) in Riyadh during a one month period. Data was collected via a structured pilot tested modified questionnaire filled in by trained research assistants who interviewed mothers regarding acute respiratory infections during the past 2 weeks in their children aged less than 2 years. Heights and weights of both children and mothers were measured and the necessary sociodemographic characteristics of the mothers, and children were collected by the research assistants in addition to mothers' practices concerning their child's acute respiratory infections. The prevalence of acute respiratory infection in children was 24%, mostly in children whose mothers are less educated, aged 35 years or more, married at age 25 years or more and whose relatives take care of their children while working outside the home. The children affected were mostly 7 - 12 months of age, lighter in weight, not vaccinated, with no follow up cards and not weighed during the last 4 months. About 3 quarters of the mothers consulted somebody about acute respiratory infections, mostly at modern health facilities particularly government Primary Health Care Centers. Tachypnea, or diarrhea or both were the most important symptoms urging mothers to seek medical advice. Working mothers whose children are taken care of by relatives is the only significant predictor of acute respiratory infections, and children with a follow up card is the only significant predictor for consulting somebody about acute respiratory infections. Intervention strategies to control acute respiratory infections in children less than 2 years of age should target working mothers, less educated mothers, malnourished unvaccinated children and encourage periodic follow up visits for children.

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures

PubMed Central

Janssens, Wendy; de Bree, Godelieve J.; Aderibigbe, Sunday A.; Akande, Tanimola M.; Mesnard, Alice

2016-01-01

Objectives Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. Methods A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. Results The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Conclusions Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs—particularly women and the poor—forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations. PMID:27832107

Urban public attitudes to the treatment of psychological problems and depression in general practice.

PubMed

Gavigan, P; Carr, A; McKeon, P

2000-10-01

A previous national study of public attitudes to depression indicated that only 17% spontaneously mentioned their general practitioner as someone who could help with depression, in contrast to 79% of respondents being willing to consult their G.P. in a similar U.K. survey. The present study undertook to examine the public perception of an urban sample to the treatment of depression in general practice and the factors associated with expressed unwillingness to consult. A random sample from the electoral register was drawn and 54 (89%) of 61 subjects selected were interviewed. While 85% of respondents were satisfied with their general practice care, only 24% to 52%, depending on the context and wording of the question, said that they would seek help from their general practitioner for depression. Factors associated with an expressed reluctance to consult were being male, dissatisfied with general practitioner care and believing that general practitioners were not qualified to treat depression.

Maternal and child health in urban Sabah, Malaysia: a comparison of citizens and migrants.

PubMed

Zulkifli, S N; U, K M; Yusof, K; Lin, W Y

1994-01-01

This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored.

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

PubMed

Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

2013-12-01

The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

[A comparison of convenience sampling and purposive sampling].

PubMed

Suen, Lee-Jen Wu; Huang, Hui-Man; Lee, Hao-Hsien

2014-06-01

Convenience sampling and purposive sampling are two different sampling methods. This article first explains sampling terms such as target population, accessible population, simple random sampling, intended sample, actual sample, and statistical power analysis. These terms are then used to explain the difference between "convenience sampling" and purposive sampling." Convenience sampling is a non-probabilistic sampling technique applicable to qualitative or quantitative studies, although it is most frequently used in quantitative studies. In convenience samples, subjects more readily accessible to the researcher are more likely to be included. Thus, in quantitative studies, opportunity to participate is not equal for all qualified individuals in the target population and study results are not necessarily generalizable to this population. As in all quantitative studies, increasing the sample size increases the statistical power of the convenience sample. In contrast, purposive sampling is typically used in qualitative studies. Researchers who use this technique carefully select subjects based on study purpose with the expectation that each participant will provide unique and rich information of value to the study. As a result, members of the accessible population are not interchangeable and sample size is determined by data saturation not by statistical power analysis.

The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm.

PubMed

Gustafsson, Lars L; Wettermark, Björn; Godman, Brian; Andersén-Karlsson, Eva; Bergman, Ulf; Hasselström, Jan; Hensjö, Lars-Olof; Hjemdahl, Paul; Jägre, Ingrid; Julander, Margaretha; Ringertz, Bo; Schmidt, Daniel; Sjöberg, Susan; Sjöqvist, Folke; Stiller, Carl-Olav; Törnqvist, Elisabeth; Tryselius, Rolf; Vitols, Sigurd; von Bahr, Christer

2011-04-01

The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.

A Uniformly Selected Sample of Low-mass Black Holes in Seyfert 1 Galaxies. II. The SDSS DR7 Sample

NASA Astrophysics Data System (ADS)

Liu, He-Yang; Yuan, Weimin; Dong, Xiao-Bo; Zhou, Hongyan; Liu, Wen-Juan

2018-04-01

A new sample of 204 low-mass black holes (LMBHs) in active galactic nuclei (AGNs) is presented with black hole masses in the range of (1–20) × 105 M ⊙. The AGNs are selected through a systematic search among galaxies in the Seventh Data Release (DR7) of the Sloan Digital Sky Survey (SDSS), and careful analyses of their optical spectra and precise measurement of spectral parameters. Combining them with our previous sample selected from SDSS DR4 makes it the largest LMBH sample so far, totaling over 500 objects. Some of the statistical properties of the combined LMBH AGN sample are briefly discussed in the context of exploring the low-mass end of the AGN population. Their X-ray luminosities follow the extension of the previously known correlation with the [O III] luminosity. The effective optical-to-X-ray spectral indices α OX, albeit with a large scatter, are broadly consistent with the extension of the relation with the near-UV luminosity L 2500 Å. Interestingly, a correlation of α OX with black hole mass is also found, with α OX being statistically flatter (stronger X-ray relative to optical) for lower black hole masses. Only 26 objects, mostly radio loud, were detected in radio at 20 cm in the FIRST survey, giving a radio-loud fraction of 4%. The host galaxies of LMBHs have stellar masses in the range of 108.8–1012.4 M ⊙ and optical colors typical of Sbc spirals. They are dominated by young stellar populations that seem to have undergone continuous star formation history.

ASSOCIATION BETWEEN SELF-CARE BEHAVIORS AND SELF-ESTEEM OF RURAL ELDERLIES; NECESSITY OF HEALTH PROMOTION.

PubMed

Bagheri-Nesami, Masoumeh; Goudarzian, Amir Hossein; Mirani, Hesam; Jouybari, Sina Sabourian; Nasiri, Davoud

2016-02-01

Changes in the modern medical science caused significant reduction of mortality and every day increase of the elderly in the world. According to prevalence of physical and mental problems in elderly, it is necessary to take some actions. Self care in one of the best way to improve elderly health and life satisfaction that seems have a relation to self-esteem. This descriptive and analytical study was performed on 180 elderly in rural areas of the Sari city. Elderly selected by multi-stage randomize sampling method. Data were gathered by using standard questionnaires of self-care and Rosenberg self-esteem. Data were analyzed by Spearman and Pearson's correlation using SPSS software (V16). The mean±SD of the ages of the elderly were 66.85±7.661. The score of self-care varies between 99 to 155 and most of them (66.7%) had good level of self-care. Also, most of elderly (52.2%) had high level of self-esteem. Also there was a significant relationship, between self-care and self-esteem (P<0.001, r=0.426). According to significant relationship between self-care and self-esteem of elderly, by the planning for improving the self care of elderly, can increase their health and significantly reduce from physical and mental complications.

Determination of personal care products -benzophenones and parabens- in human menstrual blood.

PubMed

Jiménez-Díaz, I; Iribarne-Durán, L M; Ocón, O; Salamanca, E; Fernández, M F; Olea, N; Barranco, E

2016-11-01

Benzophenones and parabens are synthetic chemicals used in many personal care products, foods and pharmaceuticals. Benzophenones are used to protect the skin and materials from the adverse effects of UV-radiation, and parabens are used as preservatives. Despite their widespread occurrence and proven endocrine disrupting activity, relatively little is known about human exposure to these compounds. In the present work, an analytical method based on sample treatment using dispersive liquid-liquid microextraction (DLLME) for the extraction of six benzophenones (benzophenone-1, -2, -3, -6, -8 and 4-hydroxybenzophenone) and four parabens (methyl-, ethyl-, propyl- and butyl- paraben) from human menstrual blood samples, followed by ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) analysis, is proposed and validated. The method was validated using matrix-matched standard calibration followed by a recovery assay with spiked samples. The limits of detection ranged from 0.1 to 0.3ngmL -1 , with recoveries of 93.8% to 108.9%, and precision (evaluated as relative standard deviation) lower than 14% for all selected compounds. This method was successfully applied for the determination of the target compounds in 25 samples of human menstrual blood. Methylparaben and benzophenone-3 were the most frequently detected compounds (96%). Copyright © 2016 Elsevier B.V. All rights reserved.

Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011

PubMed Central

2013-01-01

Background Healthcare waste management options are varying in Ethiopia. One of the first critical steps in the process of developing a reliable waste management plan requires a widespread understanding of the amount and the management system. This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Methods Six hospitals in Addis Ababa, (three private and three public), were selected using simple random sampling method for this work. Data was recorded by using an appropriately designed questionnaire, which was completed for the period of two months. The calculations were based on the weights of the health care wastes that were regularly generated in the selected hospitals over a one week period during the year 2011. Average generation indexes were determined in relation to certain important factors, like the type of hospitals (public vs private). Results The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, comprised of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased (rs=1). Public hospitals generated high proportion of total health care wastes (59.22%) in comparison with private hospitals (40.48%). The median waste generation rate was significantly vary between hospitals with Kruskal-Wallis test (X2=30.65, p=0.0001). The amount of waste was positively correlated with the number of patients (p < 0.05). The waste separation and treatment practices were very poor. Other alternatives for waste treatment rather than incineration such as a locally made autoclave should be evaluated and implemented. Conclusion These findings revealed that the management of health care waste at hospitals in Addis Ababa city was poor. PMID:23311573

A neural algorithm for the non-uniform and adaptive sampling of biomedical data.

PubMed

Mesin, Luca

2016-04-01

Body sensors are finding increasing applications in the self-monitoring for health-care and in the remote surveillance of sensitive people. The physiological data to be sampled can be non-stationary, with bursts of high amplitude and frequency content providing most information. Such data could be sampled efficiently with a non-uniform schedule that increases the sampling rate only during activity bursts. A real time and adaptive algorithm is proposed to select the sampling rate, in order to reduce the number of measured samples, but still recording the main information. The algorithm is based on a neural network which predicts the subsequent samples and their uncertainties, requiring a measurement only when the risk of the prediction is larger than a selectable threshold. Four examples of application to biomedical data are discussed: electromyogram, electrocardiogram, electroencephalogram, and body acceleration. Sampling rates are reduced under the Nyquist limit, still preserving an accurate representation of the data and of their power spectral densities (PSD). For example, sampling at 60% of the Nyquist frequency, the percentage average rectified errors in estimating the signals are on the order of 10% and the PSD is fairly represented, until the highest frequencies. The method outperforms both uniform sampling and compressive sensing applied to the same data. The discussed method allows to go beyond Nyquist limit, still preserving the information content of non-stationary biomedical signals. It could find applications in body sensor networks to lower the number of wireless communications (saving sensor power) and to reduce the occupation of memory. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Detection and Statistics of Giant Arcs behind CLASH Clusters

NASA Astrophysics Data System (ADS)

Xu, Bingxiao; Postman, Marc; Meneghetti, Massimo; Seitz, Stella; Zitrin, Adi; Merten, Julian; Maoz, Dani; Frye, Brenda; Umetsu, Keiichi; Zheng, Wei; Bradley, Larry; Vega, Jesus; Koekemoer, Anton

2016-02-01

We developed an algorithm to find and characterize gravitationally lensed galaxies (arcs) to perform a comparison of the observed and simulated arc abundance. Observations are from the Cluster Lensing And Supernova survey with Hubble (CLASH). Simulated CLASH images are created using the MOKA package and also clusters selected from the high-resolution, hydrodynamical simulations, MUSIC, over the same mass and redshift range as the CLASH sample. The algorithm's arc elongation accuracy, completeness, and false positive rate are determined and used to compute an estimate of the true arc abundance. We derive a lensing efficiency of 4 ± 1 arcs (with length ≥6″ and length-to-width ratio ≥7) per cluster for the X-ray-selected CLASH sample, 4 ± 1 arcs per cluster for the MOKA-simulated sample, and 3 ± 1 arcs per cluster for the MUSIC-simulated sample. The observed and simulated arc statistics are in full agreement. We measure the photometric redshifts of all detected arcs and find a median redshift zs = 1.9 with 33% of the detected arcs having zs > 3. We find that the arc abundance does not depend strongly on the source redshift distribution but is sensitive to the mass distribution of the dark matter halos (e.g., the c-M relation). Our results show that consistency between the observed and simulated distributions of lensed arc sizes and axial ratios can be achieved by using cluster-lensing simulations that are carefully matched to the selection criteria used in the observations.

Surveillance for cancer recurrence in long-term young breast cancer survivors randomly selected from a statewide cancer registry.

PubMed

Jones, Tarsha; Duquette, Debra; Underhill, Meghan; Ming, Chang; Mendelsohn-Victor, Kari E; Anderson, Beth; Milliron, Kara J; Copeland, Glenn; Janz, Nancy K; Northouse, Laurel L; Duffy, Sonia M; Merajver, Sofia D; Katapodi, Maria C

2018-05-01

This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices. Data collected with a self-administered survey from a statewide, randomly selected sample of YBCS diagnosed with invasive breast cancer or ductal carcinoma in situ younger than 45 years old, stratified by race (Black vs. White/Other). Multivariate logistic regression models identified predictors of annual CBEs and mammograms. Among 859 YBCS (n = 340 Black; n = 519 White/Other; mean age = 51.0 ± 5.9; diagnosed 11.0 ± 4.0 years ago), the majority (> 85%) reported an annual CBE and a mammogram. Black YBCS in the study were more likely to report lower rates of annual mammography and more barriers accessing care compared to White/Other YBCS. Having a routine source of care, confidence to use healthcare services, perceived expectations from family members and healthcare providers to engage in cancer surveillance, and motivation to comply with these expectations were significant predictors of having annual CBEs and annual mammograms. Cost-related lack of access to care was a significant barrier to annual mammograms. Routine source of post-treatment care facilitated breast cancer surveillance above national average rates. Persistent disparities regarding access to mammography surveillance were identified for Black YBCS, primarily due to lack of access to routine source of care and high out-of-pocket costs. Public health action targeting cancer surveillance in YBCS should ensure routine source of post-treatment care and address cost-related barriers. Clinical Trials Registration Number: NCT01612338.

Disparities in Regular Source of Dental Care among Mothers of Medicaid-Enrolled Preschool Children

PubMed Central

Grembowski, David; Spiekerman, Charles; Milgrom, Peter

2008-01-01

For mothers of Medicaid children aged 3 to 6 years, we examined whether mothers’ characteristics and local supply of dentists and public dental clinics are associated with having a regular source of dental care. Disproportionate stratified sampling by racial/ethnic group selected 11,305 children aged 3 to 6 in Medicaid in Washington state. Mothers (N=4,373) completed a mixed-mode survey that was combined with dental supply measures. Results reveal 38% of mothers had a regular dental place and 27% had a regular dentist. Dental insurance, greater education, income, and length of residence and better mental health were associated with having a regular place or dentist for Black, Hispanic and White mothers, along with increased supply of private dentists and safety net clinics for White and Hispanic mothers. Mothers lacking a regular source of dental care may increase oral health disparities in their children. PMID:17982208

Oral health status of New Hampshire Head Start children, 2007-2008.

PubMed

Anderson, Ludmila; Martin, Nancy R; Burdick, Arnie; Flynn, Regina T; Blaney, David D

2010-01-01

We report on the baseline prevalence and severity of dental caries of children enrolled in the New Hampshire Head Start program during the 2007-2008 school year. We selected a random cluster sample of 607 children aged 3-5 years attending 27 Head Start centers across the state. Four volunteer dentists provided oral examinations and determined the presence of untreated dental caries, caries experience, and treatment urgency. Overall, 40 percent of the participating children had experienced dental caries, and 31 percent had at least one untreated decayed tooth. Approximately 22 percent of the children had evidence of maxillary anterior caries, 23 percent were in need of dental care, and < 1 percent needed urgent care. The prevalence of dental caries is comparable with that reported by Head Start programs elsewhere. The prevalence of caries affecting maxillary anterior teeth is higher. Further studies should examine state-specific barriers to dental care among this population.

Being a good nurse and doing the right thing: a replication study.

PubMed

Catlett, Shelia; Lovan, Sherry R

2011-01-01

This qualitative research study, a replication of a study published in 2002, investigated the qualities of a good nurse and the role ethics plays in decision making. After reviewing the limitations of the published work, the current study implemented modifications related to the research questions, sample selection, data collection, and use of software for data analysis. The original study identified seven categories that related to being a good nurse and doing the right thing. In the present study, the use of relational analysis led to the recognition of four categories: (1) personal traits and attributes; (2) technical skills and management of care; (3) work environment and co-workers; and (4) caring and caring behaviors. To understand what it means to be a good nurse and do the right thing is a complex task; however, this research adds to the small amount of empirical data that exists to describe those characteristics.

Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study.

PubMed

Tountas, Yannis; Oikonomou, Nikolaos; Pallikarona, Georgia; Dimitrakaki, Christine; Tzavara, Chara; Souliotis, Kyriakos; Mariolis, Anargiros; Pappa, Evelina; Kontodimopoulos, Nick; Niakas, Dimitris

2011-02-01

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34-44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.

Women's participation in rural credit programmes in Bangladesh and their demand for formal health care: is there a positive impact?

PubMed

Nanda, P

1999-08-01

Within the overall aim of poverty alleviation, development efforts have included credit and self-employment programmes. In Bangladesh, the major beneficiaries of such group-based credit programmes are rural women who use the loans to initiate small informal income-generating activities. This paper explores the benefits of women's participation in credit programmes on their own health seeking. Using data from a sample of 1798 households from rural Bangladesh, conducted in 1991-1992 through repeated random sampling of 87 districts covered by Grameen Bank, Bangladesh Rural Advancement Committee (BRAC) and Bangladesh Rural Development Board (BRDB), this paper addresses the question: does women's participation in credit programmes significantly affect their use of formal health care? A non-unitary household preference model is suggested to test the hypothesis that women's empowerment through participation in these programmes results in greater control of resources for their own demand for formal health care. The analysis controls for endogeneity due to self-selection and other unobserved village level factors through the use of a weighted two stage instrumental variable approach with village level fixed effects. The findings indicate a positive impact of women's participation in credit programmes on their demand for formal health care. The policy simulations on the results of this study highlight the importance of credit programmes as a health intervention in addition to being a mechanism for women's economic empowerment.

The influence of the mass media on the selection of physicians.

PubMed

Trandel-Korenchuk, D M

1998-01-01

The purpose of this study was to examine now media sources influence an individual's reported choice of a physician as compared to personal referral sources and how consumers use the Yellow Pages to search for health care information. A random sample of 762 residents was systematically selected from the Charlotte, North Carolina White Pages and was asked to participate in a 20-item descriptive phone survey designed and tested by the investigator. Five hundred and seventy-eight individuals completed the survey, with a response rate of 75.9%. This study supports previous research suggesting that personal referrals are the most influential sources in selecting health care services. Therefore, satisfying and delighting the physician's/practice's existing client base may be one of the most potent advertising resources at hand. Mass media sources played a relatively minor role in influencing provider selection in this study. Nevertheless, it should not be dismissed in as much as the media may be an important way for physicians to promote "brand recognition," a problem not considered in this study. Finally, approximately 28% of the participants were "Yellow Pages users"; that is, individuals who tended to be heavy users of the Yellow Pages and used it for multiple information-seeking tasks. The findings related to the Yellow Pages suggest that while it may be useful to advertise in the Yellow Pages, a more modest financial allocation to this source may be considered.

76 FR 51038 - Draft Guidance for Industry: Cell Selection Devices for Point of Care Production of Minimally...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

...; formerly Docket No. 2007D-0290] Draft Guidance for Industry: Cell Selection Devices for Point of Care Production of Minimally Manipulated Autologous Peripheral Blood Stem Cells; Withdrawal of Draft Guidance...: Cell Selection Devices for Point of Care Production of Minimally Manipulated Autologous Peripheral...

Case-mix groups for VA hospital-based home care.

PubMed

Smith, M E; Baker, C R; Branch, L G; Walls, R C; Grimes, R M; Karklins, J M; Kashner, M; Burrage, R; Parks, A; Rogers, P

1992-01-01

The purpose of this study is to group hospital-based home care (HBHC) patients homogeneously by their characteristics with respect to cost of care to develop alternative case mix methods for management and reimbursement (allocation) purposes. Six Veterans Affairs (VA) HBHC programs in Fiscal Year (FY) 1986 that maximized patient, program, and regional variation were selected, all of which agreed to participate. All HBHC patients active in each program on October 1, 1987, in addition to all new admissions through September 30, 1988 (FY88), comprised the sample of 874 unique patients. Statistical methods include the use of classification and regression trees (CART software: Statistical Software; Lafayette, CA), analysis of variance, and multiple linear regression techniques. The resulting algorithm is a three-factor model that explains 20% of the cost variance (R2 = 20%, with a cross validation R2 of 12%). Similar classifications such as the RUG-II, which is utilized for VA nursing home and intermediate care, the VA outpatient resource allocation model, and the RUG-HHC, utilized in some states for reimbursing home health care in the private sector, explained less of the cost variance and, therefore, are less adequate for VA home care resource allocation.

An aging population and growing disease burden will require a large and specialized health care workforce by 2025.

PubMed

Dall, Timothy M; Gallo, Paul D; Chakrabarti, Ritasree; West, Terry; Semilla, April P; Storm, Michael V

2013-11-01

As the US population ages, the increasing prevalence of chronic disease and complex medical conditions will have profound implications for the future health care system. We projected future prevalence of selected diseases and health risk factors to model future demand for health care services for each person in a representative sample of the current and projected future population. Based on changing demographic characteristics and expanded medical coverage under the Affordable Care Act, we project that the demand for adult primary care services will grow by approximately 14 percent between 2013 and 2025. Vascular surgery has the highest projected demand growth (31 percent), followed by cardiology (20 percent) and neurological surgery, radiology, and general surgery (each 18 percent). Market indicators such as long wait times to obtain appointments suggest that the current supply of many specialists throughout the United States is inadequate to meet the current demand. Failure to train sufficient numbers and the correct mix of specialists could exacerbate already long wait times for appointments, reduce access to care for some of the nation's most vulnerable patients, and reduce patients' quality of life.

Factor structure of the geriatric care environment scale.

PubMed

Kim, Hongsoo; Capezuti, Elizabeth; Boltz, Marie; Fairchild, Susan; Fulmer, Terry; Mezey, Mathy

2007-01-01

Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery. To explore the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP, test its validity with a sample of staff registered nurses (RNs), and evaluate its invariance across 4 groups of RNs who worked at 4 different types of hospitals. Staff RNs (N = 9,400) at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, were split randomly into 2 groups for cross-validation. A 3-step data analysis was completed. The a priori factor structure was developed using exploratory factor analysis. The obtained factor model was validated, and its invariance by types of hospitals was examined by confirmatory factor analyses. The GCES is internally consistent (Cronbach's alpha = .93) and accounts for approximately 55% of the total variance. The 4 factors extracted from the exploratory factor analysis are Aging-Sensitive Care Delivery, Resource Availability, Institutional Values Regarding Older Adults and Staff, and Capacity for Collaboration. The 4-factor structured model is validated in a half-randomly selected sample (normed fit index [NFI] = .931, nonnormed fit index [NNFI] = .933, comparative fit index [CFI] = .939, root-mean-square error of approximation [RMSEA] = .058) and does not vary significantly across the 4 groups of RNs who worked at the 4 different types of hospitals (NFI = .969, NNFI = .975, CFI = .976, RMSEA = .027). The GCES is a reliable measure of RN perception of how care provided to older adults reflects age-sensitive principles and the organizational practice environment that supports or hinders care delivery.

Review of concepts useful for maintaining quality of male reproductive field samples for laboratory study

USGS Publications Warehouse

Jenkins, Jill A.

2011-01-01

Investigations into cellular and molecular characteristics of male gametes obtained from fish in natural ecosystems require careful sample handling and shipping in order to minimize artifacts. Maintaining sample integrity engenders confident assessments of ecosystem health, whereby animal condition is often reflected by gamete biomarkers - indicators that respond in measurable ways to changes. A number of our investigations have addressed the hypothesis that biomarkers from fish along a pollution gradient are reflective of site location. Species biology and the selected biological endpoints direct choice of parameters such as: temperature, buffer osmolality, time in transit, fixation, cryoprotectants, protease inhibition, and antibiotic inclusion in extender. This paper will highlight case studies, and outline parameters and thoughts on approaches for use by field and laboratory researchers.

Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care.

PubMed

Picardi, Angelo; Adler, D A; Rogers, W H; Lega, I; Zerella, M P; Matteucci, G; Tarsitani, L; Caredda, M; Gigantesco, A; Biondi, M

2013-01-01

Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a 'gold standard' diagnostic interview in primary care. A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available.

The role of community mental health nurses caring for people with schizophrenia in Taiwan: a substantive grounded theory.

PubMed

Huang, Xuan-Yi; Yen, Wen-Jiuan; Liu, Shwu-Jiuan; Lin, Chouh-Jiuan

2008-03-01

The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi-structured one-to-one in-depth interviews and unstructured non-participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers.

New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis.

PubMed

Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet

2018-03-24

To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.

Personal characteristics associated with resident physicians' self perceptions of preparedness to deliver cross-cultural care.

PubMed

Lopez, Lenny; Vranceanu, Ana-Maria; Cohen, Amy P; Betancourt, Joseph; Weissman, Joel S

2008-12-01

Recent reports from the Institute of Medicine emphasize patient-centered care and cross-cultural training as a means of improving the quality of medical care and eliminating racial and ethnic disparities. To determine whether, controlling for training received in medical school or during residency, resident physician socio-cultural characteristics influence self-perceived preparedness and skill in delivering cross-cultural care. National survey of resident physicians. A probability sample of residents in seven specialties in their final year of training at US academic health centers. Nine resident characteristics were analyzed. Differences in preparedness and skill were assessed using the chi(2) statistic and multivariate logistic regression. Fifty-eight percent (2047/3500) of residents responded. The most important factor associated with improved perceived skill level in performing selected tasks or services believed to be useful in treating culturally diverse patients was having received cross-cultural skills training during residency (OR range 1.71-4.22). Compared with white residents, African American physicians felt more prepared to deal with patients with distrust in the US healthcare system (OR 1.63) and with racial or ethnic minorities (OR 1.61), Latinos reported feeling more prepared to deal with new immigrants (OR 1.88) and Asians reported feeling more prepared to deal with patients with health beliefs at odds with Western medicine (1.43). Cross-cultural care skills training is associated with increased self-perceived preparedness to care for diverse patient populations providing support for the importance of such training in graduate medical education. In addition, selected resident characteristics are associated with being more or less prepared for different aspects of cross-cultural care. This underscores the need to both include medical residents from diverse backgrounds in all training programs and tailor such programs to individual resident needs in order to maximize the chances that such training is likely to have an impact on the quality of care.

Sparsely-sampled hyperspectral stimulated Raman scattering microscopy: a theoretical investigation

NASA Astrophysics Data System (ADS)

Lin, Haonan; Liao, Chien-Sheng; Wang, Pu; Huang, Kai-Chih; Bouman, Charles A.; Kong, Nan; Cheng, Ji-Xin

2017-02-01

A hyperspectral image corresponds to a data cube with two spatial dimensions and one spectral dimension. Through linear un-mixing, hyperspectral images can be decomposed into spectral signatures of pure components as well as their concentration maps. Due to this distinct advantage on component identification, hyperspectral imaging becomes a rapidly emerging platform for engineering better medicine and expediting scientific discovery. Among various hyperspectral imaging techniques, hyperspectral stimulated Raman scattering (HSRS) microscopy acquires data in a pixel-by-pixel scanning manner. Nevertheless, current image acquisition speed for HSRS is insufficient to capture the dynamics of freely moving subjects. Instead of reducing the pixel dwell time to achieve speed-up, which would inevitably decrease signal-to-noise ratio (SNR), we propose to reduce the total number of sampled pixels. Location of sampled pixels are carefully engineered with triangular wave Lissajous trajectory. Followed by a model-based image in-painting algorithm, the complete data is recovered for linear unmixing. Simulation results show that by careful selection of trajectory, a fill rate as low as 10% is sufficient to generate accurate linear unmixing results. The proposed framework applies to any hyperspectral beam-scanning imaging platform which demands high acquisition speed.

Comparability on knowledge, attitudes, and behaviors between STD clinic clients and high-risk individuals in community.

PubMed

Du, Ping; Thomas, Rosalind; McNutt, Louise-Anne; Bruce Coles, F

2008-01-01

To assess the feasibility and generalizability of STD clinic samples for studying STD-related knowledge, attitudes, and behaviors (KAB), and healthcare preferences among individuals at high risk for STDs in the same community. An STD clinic and a community sample were selected from each of two urban areas in New York State. At each STD clinic, 100 individuals were interviewed. In each community, about 400 individuals were selected by random-digit-dialing telephone survey during the same period. Community sample participants were defined as having high-risk profiles on the basis of five items related to their sexual behaviors. The STD clinic samples were younger and had a larger proportion of men and nonwhite people compared with the high-risk community samples. Although the majority of STD clinic clients would seek healthcare at the STD clinics, high-risk community participants were more likely to prefer private doctors for STDs care (P < .0001 for both areas). Overall STD-related KAB were similar between STD clinic and high-risk community samples; however, STD clinic clients may be more knowledgeable about specific STDs and more likely to feel embarrassment about getting an STD. The findings comparing KAB between high-risk community subjects and STD clinic attendees also varied by geographic location. STD clinic samples may not be sufficiently representative of community STD-related KAB collected by telephone surveys, even for that subset of community respondents with high-risk behaviors associated with STDs.

Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile.

PubMed

Araya, Ricardo; Flynn, Terry; Rojas, Graciela; Fritsch, Rosemarie; Simon, Greg

2006-08-01

The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile. A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars). The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

Family Socioeconomic Status and Consistent Environmental Stimulation in Early Childhood

PubMed Central

Crosnoe, Robert; Leventhal, Tama; Wirth, R. J.; Pierce, Kim M.; Pianta, Robert

2010-01-01

The transition into school occurs at the intersection of multiple environmental settings. This study applied growth curve modeling to a sample of 1,364 American children, followed from birth through age six, who had been categorized by their exposure to cognitive stimulation at home and in preschool child care and first grade classrooms. Of special interest was the unique and combined contribution to early learning of these three settings. Net of socioeconomic selection into different settings, children had higher math achievement when they were consistently stimulated in all three, and they had higher reading achievement when consistently stimulated at home and in child care. The observed benefits of consistent environmental stimulation tended to be more pronounced for low-income children. PMID:20573117

Pulmonary infections in critical/intensive care - rapid diagnosis and optimizing antimicrobial usage.

PubMed

Douglas, Ivor S

2017-05-01

Diagnosis of pulmonary infection, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the critically ill patient remains a common and therapeutically challenging diagnosis with significant attributable morbidity, mortality, and cost. Current clinical approaches to surveillance, early detection and, conventional culture-based microbiology are inadequate for optimal targeted antibiotic treatment and stewardship. Efforts to enhance diagnosis of HAP and VAP and the impact of these novel approaches on rational antimicrobial selection and stewardship are the focus of recent studies reviewed here. Recent consensus guidelines for diagnosis and management of HAP and VAP are relatively silent on the potential role of novel rapid microbiological techniques and reply heavily on conventional culture strategies of noninvasively obtained (including endotracheal aspirate samples). Novel rapid microbiological diagnostics, including nucleic acid amplification, mass spectrometry, and fluorescence microscopy-based technologies are promising approaches for the future. Exhaled breath biomarkers, including measurement of VOC represent a future approach. Further validation of novel diagnostic technology platforms will be required to evaluate their utility for enhancing diagnosis and guiding treatment of pulmonary infections in the critically ill. However, the integration of novel diagnostics for rapid microbial identification, resistance phenotyping, and antibiotic sensitivity testing into usual care practice could significantly transform the care of patients and potentially inform improved targeted antimicrobial selection, de-escalation, and stewardship.

Nine centuries waiting: The experiences of Iranians surrogacy commissioning mothers.

PubMed

Zandi, Mitra; Vanaki, Zohreh; Shiva, Marziyeh; Mohammadi, Eesa

2014-05-01

There are a few studies about commissioning mothers' understanding from the surrogacy during 9 months of waiting for delivery in Iran and other countries. This study was conducted with an aim to explore and explain the nature of concerns (experiences) of commissioning mothers. A qualitative design with a conventional content analysis approach was used to gather and analyze the experiences of commissioning mothers. They were selected from Royan Research Centre and other infertility centers in Iran. After purposive sampling for the selection of the participants, unstructured interviews were held for data collection. Twenty-four unstructured interviews were conducted with 12 commissioning mothers, 2 surrogate mothers, and 2 infertility center social workers who directly and continuously dealt with these mothers. TWO MAIN THEMES EMERGED FROM THE DATA ANALYSIS: 1. cultural dilemma (consisting of three subthemes: Social taboo, concerns about disclosure to others and the child, concerns about altering maternal and child's identity, and 2. uncertain waiting (consisting of three subthemes: Concerns about health of fetus and surrogate, concerns about an unfamiliar surrogate, and concerns about lack of preparation for maternal role). The study reveals the importance of maternal emotional care in this group and introduces a new arena for nurses' activity. These findings help the mothers by nurses' activities in health care clinics and anywhere they deliver nursing care.

Health Care Waste Management Practice in Health Care Institutions of Nepal.

PubMed

Joshi, H D; Acharya, T; Ayer, R; Dhakal, P; Karki, K B; Dhimal, M

2017-01-01

Medical waste is considered as a major public health hazard. In a developing country like Nepal, there is much concern about the management practice of medical waste. This study aimed to assess Health Care Waste Management practice among Health Care Institutions in Nepal. A cross sectional study was carried out between July 2012 to June 2013 in 62 different Health Care Institutions, selected from stratified proportionate random sampling technique from all administrative regions of Nepal. A structured questionnaire and observation checklist were used for data collection. The waste generation rate is found significantly correlated with bed capacity, patient flow rate and annual budget spent in the hospital. It is found significantly higher in Teaching hospital than other Health Care Institutions of Nepal. An average of 3.3 kg/day/patient of medical waste (2.0 kg/day/patient non-hazardous and 1.0 kg/day/patient hazardous waste) was generated during the study period. Further, it was found that most of the Health care wastes were not disinfected before transportation to waste disposal sites. Very limited number of Health Care Institutions had conducted Environmental Assessment. Similarly, some of the Health Care Institutions had not followed Health care waste management guideline 2009 of Nepal Government. We found poor compliance of medical waste management practice as per existing legislation of Government of Nepal. Hence, additional effort is needed for improvement of Health care waste management practice at Health Care Institutions of Nepal.

Assessing health care in Canada's North: what can we learn from national and regional surveys?

PubMed Central

Young, T. Kue; Ng, Carmina; Chatwood, Susan

2015-01-01

Background Health surveys are a rich source of information on a variety of health issues, including health care. Objectives This article compares various national and regional surveys in terms of their geographical coverage with respect to the Canadian North, especially their Aboriginal population, and the comparability of the survey contents relating to health care. Methods Three surveys were selected as providing some information on health care, with separate estimates for the North and its Aboriginal populations. They are the Canadian Community Health Survey (CCHS), Aboriginal Peoples Survey (APS) and the First Nations Regional Health Survey (RHS). Results Different surveys focus on different categories of Aboriginal people, and no single survey has covered all categories of Aboriginal people in the North consistently. RHS is targeted at the on-reserve First Nations population only. APS and CCHS sample the off-reserve First Nations population as well as Métis and Inuit. To achieve adequate sample size for North–South comparisons and comparisons among Aboriginal groups within the North, several cycles of the biennial/annual CCHS can be merged, producing a large data set with consistent coverage of topics using comparable questions. The content areas of the 3 surveys can be broadly categorized as health status, health determinants and health care. Substantial variation exists across surveys in the domains covered. There are also changes over time in terms of definitions, questions and even basic concepts. The available health care content of the 3 surveys focus on access to different types of health services, contact with different categories of health professionals, unmet health needs and the use of preventive services. Many important dimensions of health care are not covered. Not all these basic indicators are available for the North or its Aboriginal populations. Conclusions A comprehensive survey of health care in the North with sufficient sample size to provide reliable estimates for its subpopulations – urban and remote, Aboriginal and non-Aboriginal, and First Nations, Inuit and Métis – would provide useful information to decision-makers and service providers. Analytical studies can also be conducted to investigate the correlations and interactions among health status, health determinants and health care and assess whether such relationships differ among the different population groups. PMID:26214103

48 CFR 873.109 - General requirements for acquisition of health-care resources.

Code of Federal Regulations, 2011 CFR

2011-10-01

... acquisition of health-care resources. 873.109 Section 873.109 Federal Acquisition Regulations System... HEALTH-CARE RESOURCES 873.109 General requirements for acquisition of health-care resources. (a) Source selection authority. Contracting officers shall be the source selection authority for acquisitions of health...

48 CFR 873.109 - General requirements for acquisition of health-care resources.

Code of Federal Regulations, 2010 CFR

2010-10-01

... acquisition of health-care resources. 873.109 Section 873.109 Federal Acquisition Regulations System... HEALTH-CARE RESOURCES 873.109 General requirements for acquisition of health-care resources. (a) Source selection authority. Contracting officers shall be the source selection authority for acquisitions of health...

Getting right to the point: identifying Australian outpatients' priorities and preferences for patient-centred quality improvement in chronic disease care.

PubMed

Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Oldmeadow, Christopher

2016-09-01

To identify specific actions for patient-centred quality improvement in chronic disease outpatient settings, this study identified patients' general and specific preferences among a comprehensive suite of initiatives for change. A cross-sectional survey was conducted in three hospital-based clinics specializing in oncology, neurology and cardiology care located in New South Wales, Australia. Adult English-speaking outpatients completed the touch-screen Consumer Preferences Survey in waiting rooms or treatment areas. Participants selected up to 23 general initiatives that would improve their experience. Using adaptive branching, participants could select an additional 110 detailed initiatives and complete a relative prioritization exercise. A total of 541 individuals completed the survey (71.1% consent, 73.1% completion). Commonly selected general initiatives, presented in order of decreasing priority (along with sample proportion), included: improved parking (60.3%), up-to-date information provision (15.0%), ease of clinic contact (12.9%), access to information at home (12.8%), convenient appointment scheduling (14.2%), reduced wait-times (19.8%) and information on medical emergencies (11.1%). To address these general initiatives, 40 detailed initiatives were selected by respondents. Initiatives targeting service accessibility and information provision, such as parking and up-to-date information on patient prognoses and progress, were commonly selected and perceived to be of relatively greater priority. Specific preferences included the need for clinics to provide patient-designated parking in close proximity to the clinic, information on treatment progress and test results (potentially in the form of designated brief appointments or via telehealth) and comprehensive and trustworthy lists of information sources to access at home. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Major tire fragment contributions to PM{sub 10} non-attainment in Anchorage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Draftz, R.G.; Cowherd, C. Jr.; Grelinger, M.A.

1999-07-01

Anchorage exceeded the 24-hour National Ambient Air Quality Standard for PM{sub 10} a total of thirty-one times in the period from 1987 to 1997. About half of these exceedances were due to natural events. The remaining exceedances could not be linked to natural events. Moreover, these exceedances occurred predominantly at one PM{sub 10} site near one of the major thoroughfares in Anchorage. The apportionment of sources producing these unexplained violations was one of the major goals of a 1996--98 study sponsored and directed by the Air Quality Program of the Municipality of Anchorage. Two suites of PM{sub 10} samples weremore » utilized for source apportionment of exceedances. The first consisted of historical samples selected from sampling periods unaffected by natural events. These samples were carefully selected to avoid the high values during and following volcanic eruptions when there were likely to be considerable accumulations of volcanic ejecta on roads. Dust storms were excluded by simple inspection of data for days that showed that all sites in the Anchorage basin had high PM{sub 10} loadings. The second group of samples were selected from a special springtime road dust tagging experiment used to measure emission and depletion rates of the taggant and accumulated road dust particles, mainly road aggregate wear and anti-skid minerals. Quantitative microscopical analysis of the first suite of historical samples showed that rubber tire concentrations contributed from approximately 12 to 42{micro}g/m{sup 3} of the PM{sub 10} for samples near or exceeding the 24 hour limit. Road dust samples from the road tagging experiment showed that the PM{sub 10}-sized tire fragments were not present in the road dust and therefore, had to have become immediately airborne rather than re-entrained from road dust deposits. Rubber tire fragments are one of the three dominant components that collectively account for more than 95% of the PM{sub 10} non-attainment in Anchorage.« less

The relationship between hypochondriasis and medical illness.

PubMed

Barsky, A J; Wyshak, G; Latham, K S; Klerman, G L

1991-01-01

Forty-one Diagnostic and Statistical Manual of Mental Disorders-III-Revised hypochondriacs were accrued from a primary care practice. Seventy-five control subjects were selected at random from among the remainder of the patients in the same clinic. All subjects completed a structured diagnostic interview and standardized self-report questionnaires. Medical morbidity was assessed with a medical record audit and with primary physicians' ratings. The hypochondriacal and comparison samples did not differ in aggregate medical morbidity, although the hypochondriacal sample had more undiagnosed complaints and nonspecific findings in their medical records. Within the comparison sample, higher levels of medical morbidity were associated with higher levels of hypochondriacal symptoms. This occurred primarily because the most serious medical disorders were associated with more bodily preoccupation, disease conviction, and somatization. Within the hypochondriacal sample, no correlation was found between the degree of hypochondriasis and the extent of medical morbidity.

In vitro bacterial isolate susceptibility to empirically selected antimicrobials in 111 dogs with bacterial pneumonia.

PubMed

Proulx, Alexandre; Hume, Daniel Z; Drobatz, Kenneth J; Reineke, Erica L

2014-01-01

To determine the proportion of airway bacterial isolates resistant to both empirically selected and recently administered antimicrobials, and to assess the impact of inappropriate initial empiric antimicrobials selection on length of hospital stay and survival to discharge in dogs with bacterial pneumonia. Retrospective study. University veterinary teaching hospital. One hundred and eleven dogs with a clinical diagnosis of bacterial pneumonia that had aerobic bacterial culture and susceptibility testing performed from a tracheal wash sample. None. Overall, 26% (29/111) of the dogs had at least 1 bacterial isolate that was resistant to empirically selected antimicrobials. In dogs with a history of antimicrobial administration within the preceding 4 weeks, a high incidence (57.4%, 31/54) of in vitro bacterial resistance to those antimicrobials was found: 64.7% (11/17) in the community-acquired pneumonia group, 55.2% (16/29) in the aspiration pneumonia group, and 50.0% (4/8) in the other causes of bacterial pneumonia group. No statistically significant association was found between bacterial isolate resistance to empirically selected antimicrobials and length of hospital stay or mortality. The high proportion of in vitro airway bacterial resistance to empiric antimicrobials would suggest that airway sampling for bacterial culture and susceptibility testing may be helpful in guiding antimicrobial therapy and recently administered antimicrobials should be avoided when empirically selecting antimicrobials. Although no relationship was found between inappropriate initial empiric antimicrobial selection and length of hospital stay or mortality, future prospective studies using standardized airway-sampling techniques, treatment modalities, and stratification of disease severity based on objective values, such as arterial blood gas analysis in all dogs with pneumonia, would be needed to determine if a clinical effect of in vitro bacterial resistance to empirically administered antimicrobials truly exists or not. © Veterinary Emergency and Critical Care Society 2013.

The accuracy of home glucose meters in hypoglycemia.

PubMed

Sonmez, Alper; Yilmaz, Zeynep; Uckaya, Gokhan; Kilic, Selim; Tapan, Serkan; Taslipinar, Abdullah; Aydogdu, Aydogan; Yazici, Mahmut; Yilmaz, Mahmut Ilker; Serdar, Muhittin; Erbil, M Kemal; Kutlu, Mustafa

2010-08-01

Home glucose meters (HGMs) may not be accurate enough to sense hypoglycemia. We evaluated the accuracy and the capillary and venous comparability of five different HGMs (Optium Xceed [Abbott Diabetes Care, Alameda, CA, USA], Contour TS [Bayer Diabetes Care, Basel, Switzerland], Accu-Chek Go [Roche Ltd., Basel, Switzerland], OneTouch Select [Lifescan, Milpitas, CA, USA], and EZ Smart [Tyson Bioresearch Inc., Chu-Nan, Taiwan]) in an adult population. The insulin hypoglycemia test was performed to 59 subjects (56 males; 23.6 +/- 3.2 years old). Glucose was measured from forearm venous blood and finger capillary samples both before and after regular insulin (0.1 U/kg) was injected. Venous samples were analyzed in the reference laboratory by the hexokinase method. In vitro tests for method comparison and precision analyses were also performed by spiking the glucose-depleted venous blood. All HGMs failed to sense hypoglycemia to some extend. EZ Smart was significantly inferior in critical error Zone D, and OneTouch Select was significantly inferior in the clinically unimportant error Zone B. Accu-Chek Go, Optium Xceed, and Contour TS had similar performances and were significantly better than the other two HGMs according to error grid analysis or International Organization for Standardization criteria. The in vitro tests were consistent with the above clinical data. The capillary and venous consistencies of Accu-Chek Go and OneTouch Select were better than the other HGMs. The present results show that not all the HGMs are accurate enough in low blood glucose levels. The patients and the caregivers should be aware of these restrictions of the HGMs and give more credit to the symptoms of hypoglycemia than the values obtained by the HGMs. Finally, these results indicate that there is a need for the revision of the accuracy standards of HGMs in low blood glucose levels.

Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

PubMed Central

Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

2015-01-01

Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

[Effects of Home Care Services Use by Older Adults on Family Caregiver Distress].

PubMed

Kim, Jiyeon; Kim, Hongsoo

2016-12-01

The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress. A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3. Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult. The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

A descriptive study of access to services in a random sample of Canadian rural emergency departments

PubMed Central

Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

2013-01-01

Objective To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Design Cross-sectional study—mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Setting Canadian rural EDs (rural small town (RST) definition—Statistics Canada). Participants 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. Main outcome measures General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Results Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. Conclusions This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands. PMID:24285633

Genetic Structure and Antimicrobial Resistance of Escherichia coli and Cryptic Clades in Birds with Diverse Human Associations.

PubMed

Blyton, Michaela D J; Pi, Hongfei; Vangchhia, Belinda; Abraham, Sam; Trott, Darren J; Johnson, James R; Gordon, David M

2015-08-01

The manner and extent to which birds associate with humans may influence the genetic attributes and antimicrobial resistance of their commensal Escherichia communities through strain transmission and altered selection pressures. In this study, we determined whether the distribution of the different Escherichia coli phylogenetic groups and cryptic clades, the occurrence of 49 virulence associated genes, and/or the prevalence of resistance to 12 antimicrobials differed between four groups of birds from Australia with contrasting types of human association. We found that birds sampled in suburban and wilderness areas had similar Escherichia communities. The Escherichia communities of backyard domestic poultry were phylogenetically distinct from the Escherichia communities sourced from all other birds, with a large proportion (46%) of poultry strains belonging to phylogenetic group A and a significant minority (17%) belonging to the cryptic clades. Wild birds sampled from veterinary and wildlife rehabilitation centers (in-care birds) carried Escherichia isolates that possessed particular virulence-associated genes more often than Escherichia isolates from birds sampled in suburban and wilderness areas. The Escherichia isolates from both the backyard poultry and in-care birds were more likely to be multidrug resistant than the Escherichia isolates from wild birds. We also detected a multidrug-resistant E. coli strain circulating in a wildlife rehabilitation center, reinforcing the importance of adequate hygiene practices when handling and caring for wildlife. We suggest that the relatively high frequency of antimicrobial resistance in the in-care birds and backyard poultry is due primarily to the use of antimicrobials in these animals, and we recommend that the treatment protocols used for these birds be reviewed. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Genetic Structure and Antimicrobial Resistance of Escherichia coli and Cryptic Clades in Birds with Diverse Human Associations

PubMed Central

Blyton, Michaela D. J.; Pi, Hongfei; Vangchhia, Belinda; Abraham, Sam; Trott, Darren J.; Johnson, James R.

2015-01-01

The manner and extent to which birds associate with humans may influence the genetic attributes and antimicrobial resistance of their commensal Escherichia communities through strain transmission and altered selection pressures. In this study, we determined whether the distribution of the different Escherichia coli phylogenetic groups and cryptic clades, the occurrence of 49 virulence associated genes, and/or the prevalence of resistance to 12 antimicrobials differed between four groups of birds from Australia with contrasting types of human association. We found that birds sampled in suburban and wilderness areas had similar Escherichia communities. The Escherichia communities of backyard domestic poultry were phylogenetically distinct from the Escherichia communities sourced from all other birds, with a large proportion (46%) of poultry strains belonging to phylogenetic group A and a significant minority (17%) belonging to the cryptic clades. Wild birds sampled from veterinary and wildlife rehabilitation centers (in-care birds) carried Escherichia isolates that possessed particular virulence-associated genes more often than Escherichia isolates from birds sampled in suburban and wilderness areas. The Escherichia isolates from both the backyard poultry and in-care birds were more likely to be multidrug resistant than the Escherichia isolates from wild birds. We also detected a multidrug-resistant E. coli strain circulating in a wildlife rehabilitation center, reinforcing the importance of adequate hygiene practices when handling and caring for wildlife. We suggest that the relatively high frequency of antimicrobial resistance in the in-care birds and backyard poultry is due primarily to the use of antimicrobials in these animals, and we recommend that the treatment protocols used for these birds be reviewed. PMID:26002899

A critical analysis of high-redshift, massive, galaxy clusters. Part I

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoyle, Ben; Jimenez, Raul; Verde, Licia

2012-02-01

We critically investigate current statistical tests applied to high redshift clusters of galaxies in order to test the standard cosmological model and describe their range of validity. We carefully compare a sample of high-redshift, massive, galaxy clusters with realistic Poisson sample simulations of the theoretical mass function, which include the effect of Eddington bias. We compare the observations and simulations using the following statistical tests: the distributions of ensemble and individual existence probabilities (in the > M, > z sense), the redshift distributions, and the 2d Kolmogorov-Smirnov test. Using seemingly rare clusters from Hoyle et al. (2011), and Jee etmore » al. (2011) and assuming the same survey geometry as in Jee et al. (2011, which is less conservative than Hoyle et al. 2011), we find that the ( > M, > z) existence probabilities of all clusters are fully consistent with ΛCDM. However assuming the same survey geometry, we use the 2d K-S test probability to show that the observed clusters are not consistent with being the least probable clusters from simulations at > 95% confidence, and are also not consistent with being a random selection of clusters, which may be caused by the non-trivial selection function and survey geometry. Tension can be removed if we examine only a X-ray selected sub sample, with simulations performed assuming a modified survey geometry.« less

Demand for health care in Denmark: results of a national sample survey using contingent valuation.

PubMed

Gyldmark, M; Morrison, G C

2001-10-01

In this paper we use willingness to pay (WTP) to elicit values for private insurance covering treatment for four different health problems. By way of obtaining these values, we test the viability of the contingent valuation method (CVM) and econometric techniques, respectively, as means of eliciting and analysing values from the general public. WTP responses from a Danish national sample survey, which was designed in accordance with existing guidelines, are analysed in terms of consistency and validity checks. Large numbers of zero responses are common in WTP studies, and are found here; therefore, the Heckman selectivity model and log-transformed OLS are employed. The selectivity model is rejected, but test results indicate that the lognormal model yields efficient and unbiased estimates. The results give confidence in the WTP estimates obtained and, more generally, in CVM as a means of valuing publicly provided goods and in econometrics as a tool for analysing WTP results containing many zero responses.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

PubMed

Cho, Eunhee; Lee, Nam-Ju; Kim, Eun-Young; Kim, Sinhye; Lee, Kyongeun; Park, Kwang-Ok; Sung, Young Hee

2016-08-01

The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. A cross-sectional survey. A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals. Copyright © 2016 Elsevier Ltd. All rights reserved.

How Sensor, Signal, and Imaging Informatics May Impact Patient Centered Care and Care Coordination

PubMed Central

Moreau-Gaudry, A.

2015-01-01

Summary Objective This synopsis presents a selection for the IMIA (International Medical Informatics Association) Yearbook 2015 of excellent research in the broad field of Sensor, Signal, and Imaging Informatics published in the year 2014, with a focus on patient centered care coordination. Methods The two section editors performed a systematic initial selection and a double blind peer review process to select a list of candidate best papers in the domain published in 2014, from the PubMed and Web of Science databases. A set of MeSH keywords provided by experts was used. This selection was peer-reviewed by external reviewers. Results The review process highlighted articles illustrating two current trends related to care coordination and patient centered care: the enhanced capacity to predict the evolution of a disease based on patient-specific information can impact care coordination; similarly, better perception of the patient and his treatment could lead to enhanced personalized care with a potential impact on care coordination. Conclusions This review shows the multiplicity of angles from which the question of patient-centered care can be addressed, with consequences on care coordination that will need to be confirmed and demonstrated in the future. PMID:26293856

Patients' experiences of cold exposure during ambulance care.

PubMed

Aléx, Jonas; Karlsson, Stig; Saveman, Britt-Inger

2013-06-06

Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors. During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C. Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

PubMed Central

Profit, J; Zupancic, JAF; Gould, JB; Pietz, K; Kowalkowski, MA; Draper, D; Hysong, SJ; Petersen, LA

2014-01-01

Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P < .05). Correlations between pairs of quality measures were strong (ρ > .5) for 1 pair, moderate (.3 < |ρ| < .5) for 8 pairs, weak (.1 < |ρ| < .3) for 5 pairs and negligible (|ρ| < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest. PMID:23403539

Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.

PubMed

Zlotnick, Cheryl; Tam, Tammy; Zerger, Suzanne

2012-09-01

Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition. © 2012 Blackwell Publishing Ltd.

Rethinking presence: a grounded theory of nurses and teleconsultation.

PubMed

Barrett, David

2017-10-01

To develop a theory that offered an evidence-based insight into the use of teleconsultation by nurses. Teleconsultation is the use of video to facilitate real-time, remote interaction between healthcare practitioners and patients. Although its popularity is growing, there is little understanding of how teleconsultation impacts on the role of nurses. The study adopted a constructivist grounded theory method, supplemented by the use of Straussian analytical approaches. Using selective and theoretical approaches, registered nurses with experience of using video in health care were sampled. Data were collected using semi-structured interviews exploring experiences, knowledge and feelings surrounding teleconsultation. Interviews were recorded, transcribed and subjected to three-stage, nonlinear manual analysis (open, axial and selective coding). Theoretical saturation occurred after 17 interviews. The core category identified from the data was 'nursing presence' Four subcategories of nursing presence were identified: operational, clinical, therapeutic and social. The degree to which presence could be achieved was dependent upon three influencing factors - enablers, constraints and compensation. Nurses provide different types of presence during teleconsultation, with the degree of presence dependent on specific characteristics of video-mediated communication. Where the use of video constrains the delivery of presence, nurses use a range of compensatory mechanisms to enhance patient care. Teleconsultation provides an innovative approach to enhancing the delivery of health care. This study provides nurses with insight into the impact of teleconsultation on their professional role, and an understanding of how best to use video-mediated communication to support patient care. © 2016 John Wiley & Sons Ltd.

Nursing intellectual capital theory: testing selected propositions.

PubMed

Covell, Christine L; Sidani, Souraya

2013-11-01

To test the selected propositions of the middle-range theory of nursing intellectual capital. The nursing intellectual capital theory conceptualizes nursing knowledge's influence on patient and organizational outcomes. The theory proposes nursing human capital, nurses' knowledge, skills and experience, is related to the quality of patient care and nurse recruitment and retention of an inpatient care unit. Two factors in the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital's association with patient and organizational outcomes. A cross-sectional survey design. The study took place in 2008 in six Canadian acute care hospitals. Financial, human resource and risk data were collected from hospital departments and unit managers. Clearly specified empirical indicators quantified the study variables. The propositions of the theory were tested with data from 91 inpatient care units using structural equation modelling. The propositions associated with the nursing human capital concept were supported. The propositions associated with the employer support for nurse continuing professional development concept were not. The proposition that nurse staffing's influences on patient outcomes was mediated by the nursing human capital of an inpatient unit, was partially supported. Some of the theory's propositions were empirically validated. Additional theoretical work is needed to refine the operationalization and measurement of some of the theory's concepts. Further research with larger samples of data from different geographical settings and types of hospitals is required to determine if the theory can withstand empirical scrutiny. © 2013 Blackwell Publishing Ltd.

Assessing sample representativeness in randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network.

PubMed

Susukida, Ryoko; Crum, Rosa M; Stuart, Elizabeth A; Ebnesajjad, Cyrus; Mojtabai, Ramin

2016-07-01

To compare the characteristics of individuals participating in randomized controlled trials (RCTs) of treatments of substance use disorder (SUD) with individuals receiving treatment in usual care settings, and to provide a summary quantitative measure of differences between characteristics of these two groups of individuals using propensity score methods. Design Analyses using data from RCT samples from the National Institute of Drug Abuse Clinical Trials Network (CTN) and target populations of patients drawn from the Treatment Episodes Data Set-Admissions (TEDS-A). Settings Multiple clinical trial sites and nation-wide usual SUD treatment settings in the United States. A total of 3592 individuals from 10 CTN samples and 1 602 226 individuals selected from TEDS-A between 2001 and 2009. Measurements The propensity scores for enrolling in the RCTs were computed based on the following nine observable characteristics: sex, race/ethnicity, age, education, employment status, marital status, admission to treatment through criminal justice, intravenous drug use and the number of prior treatments. Findings The proportion of those with ≥ 12 years of education and the proportion of those who had full-time jobs were significantly higher among RCT samples than among target populations (in seven and nine trials, respectively, at P < 0.001). The pooled difference in the mean propensity scores between the RCTs and the target population was 1.54 standard deviations and was statistically significant at P < 0.001. In the United States, individuals recruited into randomized controlled trials of substance use disorder treatments appear to be very different from individuals receiving treatment in usual care settings. Notably, RCT participants tend to have more years of education and a greater likelihood of full-time work compared with people receiving care in usual care settings. © 2016 Society for the Study of Addiction.

Bivariate mass-size relation as a function of morphology as determined by Galaxy Zoo 2 crowdsourced visual classifications

NASA Astrophysics Data System (ADS)

Beck, Melanie; Scarlata, Claudia; Fortson, Lucy; Willett, Kyle; Galloway, Melanie

2016-01-01

It is well known that the mass-size distribution evolves as a function of cosmic time and that this evolution is different between passive and star-forming galaxy populations. However, the devil is in the details and the precise evolution is still a matter of debate since this requires careful comparison between similar galaxy populations over cosmic time while simultaneously taking into account changes in image resolution, rest-frame wavelength, and surface brightness dimming in addition to properly selecting representative morphological samples.Here we present the first step in an ambitious undertaking to calculate the bivariate mass-size distribution as a function of time and morphology. We begin with a large sample (~3 x 105) of SDSS galaxies at z ~ 0.1. Morphologies for this sample have been determined by Galaxy Zoo crowdsourced visual classifications and we split the sample not only by disk- and bulge-dominated galaxies but also in finer morphology bins such as bulge strength. Bivariate distribution functions are the only way to properly account for biases and selection effects. In particular, we quantify the mass-size distribution with a version of the parametric Maximum Likelihood estimator which has been modified to account for measurement errors as well as upper limits on galaxy sizes.

Recognizing ancient papyri by a combination of spectroscopic, diffractional and chromatographic analytical tools

PubMed Central

Łojewska, J.; Rabin, I.; Pawcenis, D.; Bagniuk, J.; Aksamit-Koperska, M. A.; Sitarz, M.; Missori, M.; Krutzsch, M.

2017-01-01

Ancient papyri are a written heritage of culture that flourished more than 3000 years ago in Egypt. One of the most significant collections in the world is housed in the Egyptian Museum and Papyrus Collection in Berlin, from where the samples for our investigation come. The papyrologists, curators and conservators of such collections search intensely for the analytical detail that would allow ancient papyri to be distinguished from modern fabrications, in order to detect possible forgeries, assess papyrus deterioration state, and improve the design of storage conditions and conservation methods. This has become the aim of our investigation. The samples were studied by a number of methods, including spectroscopic (FTIR, fluorescent-FS, Raman) diffractional (XRD) and chromatographic (size exclusion chromatography-SEC), selected in order to determine degradation parameters: overall oxidation of lignocellulosic material, degree of polymerization and crystallinity of cellulose. The results were correlated with those obtained from carefully selected model samples including modern papyri and paper of different composition aged at elevated temperature in humid air. The methods were classified in the order SEC > FS > FTIR > XRD, based on their effectiveness in discriminating the state of papyri degradation. However, the most trustworthy evaluation of the age of papyri samples should rely on several methods. PMID:28382971

Recognizing ancient papyri by a combination of spectroscopic, diffractional and chromatographic analytical tools.

PubMed

Łojewska, J; Rabin, I; Pawcenis, D; Bagniuk, J; Aksamit-Koperska, M A; Sitarz, M; Missori, M; Krutzsch, M

2017-04-06

Ancient papyri are a written heritage of culture that flourished more than 3000 years ago in Egypt. One of the most significant collections in the world is housed in the Egyptian Museum and Papyrus Collection in Berlin, from where the samples for our investigation come. The papyrologists, curators and conservators of such collections search intensely for the analytical detail that would allow ancient papyri to be distinguished from modern fabrications, in order to detect possible forgeries, assess papyrus deterioration state, and improve the design of storage conditions and conservation methods. This has become the aim of our investigation. The samples were studied by a number of methods, including spectroscopic (FTIR, fluorescent-FS, Raman) diffractional (XRD) and chromatographic (size exclusion chromatography-SEC), selected in order to determine degradation parameters: overall oxidation of lignocellulosic material, degree of polymerization and crystallinity of cellulose. The results were correlated with those obtained from carefully selected model samples including modern papyri and paper of different composition aged at elevated temperature in humid air. The methods were classified in the order SEC > FS > FTIR > XRD, based on their effectiveness in discriminating the state of papyri degradation. However, the most trustworthy evaluation of the age of papyri samples should rely on several methods.

Infrared Extinction and the Initial Conditions For Star and Planet Formation

NASA Technical Reports Server (NTRS)

Lada, Charles J.

2003-01-01

This grant funds a research program to use infrared extinction measurements to probe the detailed structure of dark molecular clouds and investigate the physical conditions which give rise to star and planet formation. The goals of the this program are to: 1) acquire deep infrared and molecular-line observations of a carefully selected sample of nearby dark clouds, 2) reduce and analyze the data obtained in order to produce detailed extinction maps of the clouds, 3) prepare results, where appropriate, for publication.

Infrared Extinction and the Initial Conditions for Star and Planet Formation

NASA Technical Reports Server (NTRS)

Lada, Charles J.

2002-01-01

This grant funds a research program to use infrared extinction measurements to probe the detailed structure of dark molecular clouds and investigate the physical conditions which give rise to star and planet formation. The goals of the this program are to: (1) acquire deep infrared and molecular-line observations of a carefully selected sample of nearby dark clouds; (2) reduce and analyze the data obtained in order to produce detailed extinction maps of the clouds; and (3) prepare results, where appropriate, for publication.

Long-term care information systems: an overview of the selection process.

PubMed

Nahm, Eun-Shim; Mills, Mary Etta; Feege, Barbara

2006-06-01

Under the current Medicare Prospective Payment System method and the ever-changing managed care environment, the long-term care information system is vital to providing quality care and to surviving in business. system selection process should be an interdisciplinary effort involving all necessary stakeholders for the proposed system. The system selection process can be modeled following the Systems Developmental Life Cycle: identifying problems, opportunities, and objectives; determining information requirements; analyzing system needs; designing the recommended system; and developing and documenting software.

[Access to health care for an induced abortion: qualitative and quantitative approaches].

PubMed

Bajos, N; Moreau, C; Ferrand, M; Bouyer, J

2003-12-01

Despite recent studies showing evidence that the organisation of the French health care system raises some problems concerning access to abortion, far little is known on the reality of access conditions and the views of women on the difficulties they experience when they attend an abortion clinic. In this article, we discuss the complementarity of materials from two surveys one qualitative, the other quantitative in the study of patterns of care for an abortion. The qualitative survey included 51 women who reported a history of induced abortion, selected from a qualitative study on unintended pregnancy in France. The quantitative survey included 480 women, who had an abortion in the past 10 years. These women were selected from a representative sample of 2863 women aged 18 to 44, who participated in a study on contraception and abortion. The variety of patterns of care for an abortion, the rareness of dysfunctions in the health care system and the importance of the first professional women contacted, demonstrated in the qualitative survey, were confirmed in the quantitative survey. The quantitative survey enabled quantifying the distribution of the different patterns of care. It also permitted to identify factors associated with the choice of first professional contacted and with the type of subsequent patterns of care. The qualitative survey permitted to explore these patterns of care and to highlight the interaction between the women's request and the representation of the legitimacy of their request. Difficulties of access seemed to be linked to the lack of support women experienced in the process of finding an abortion clinic. Results suggest that general practitioners are less well informed of the procedures required for an abortion than other professionals. However, the qualitative survey also shows that problems of access cannot be reduced to the lack of information of professionals, as their practice was also linked to their own representation of abortion, and their perception of the legitimacy of the women's request. Our results underline the need for the definition of a clear health policy that should include two priorities: the improvement of the visibility of health care supply for an abortion and the promotion of information delivered to health care professionals.

Perceived needs of pharmaceutical care services among healthcare professionals in South Korea: a qualitative study.

PubMed

Lee, Iyn-Hyang; Rhie, Sandy Jeong; Je, Nam Kyung; Rhew, Ki Yon; Ji, Eunhee; Oh, Jung Mi; Lee, Euni; Yoon, Jeong-Hyun

2016-10-01

Purpose To explore the need for pharmaceutical care services, key features of desirable pharmacy services, and perceived barriers for advancing the services in hospital environments with doctors and nurses who are key co-workers of the interdisciplinary team care services.Methods Semi-structured, in-depth interviews with eighteen doctors and fifteen nurses employing purposive and snowballing sampling strategies were conducted in ten hospitals in South Korea. Results The level of pharmaceutical care was varied across regions or institutions in South Korea. The concept of pharmaceutical care was insufficiently defined, and tended to be limited to some parts of medication counseling. Through pharmaceutical care services, doctors desired to acquire comprehensive drug information from and to share clinical responsibilities with pharmacists. Nurses wished to lower their burdens of medication counseling services from their daily practices. Doctors and nurses asked for pharmacists providing essential and carefully selected medication information to their patients in a patient-centered manner. The listed barriers to pharmaceutical care included the lack of appropriate systems for reward, insufficient accessibility to patient records by pharmacists, ambiguous role descriptions of pharmacist, and absence of effective communication among professionals. Conclusion A successful pharmaceutical care service model should allow efficient exchange of information among healthcare professionals to build inter-professional trust and to provide a continuity of care both in terms of time and setting. As prerequisites of such system, it was warranted to develop clinical evidence and an appropriate reward system for pharmaceutical care services.

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study.

PubMed

Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa

2016-01-01

Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

A Model of Consumer Decision Making in the Selection of a Long-Term Care Facility.

ERIC Educational Resources Information Center

Neugroschel, William J.; Notzon, Linda R.

Since nursing home placement is frequently the last choice for families of elderly people who need long-term care, little literature exists which delineates a model for consumer decision making in the selection of a specific long-term care facility. Critical issues include the following: (1) who actually makes the selection; (2) what other…

Risk factors for death in patients with severe asthma*

PubMed Central

Fernandes, Andréia Guedes Oliva; Souza-Machado, Carolina; Coelho, Renata Conceição Pereira; Franco, Priscila Abreu; Esquivel, Renata Miranda; Souza-Machado, Adelmir; Cruz, Álvaro Augusto

2014-01-01

OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality. PMID:25210958

The Addiction Benefits Scorecard: A Framework to Promote Health Insurer Accountability and Support Consumer Engagement.

PubMed

Danovitch, Itai; Kan, David

2017-01-01

Health care insurance plans covering treatment for substance use disorders (SUD) offer a wide range of benefits. Distinctions between health plan benefits are confusing, and consumers making selections may not adequately understand the characteristics or significance of the choices they have. The California Society of Addiction Medicine sought to help consumers make informed decisions about plan selections by providing education on the standard of care for SUD and presenting findings from an expert analysis of selected health plans. We developed an assessment framework, based on criteria endorsed by the American Society of Addiction Medicine, to rate the quality of SUD treatment benefits offered by a sample of insurance plans. We convened an expert panel of physicians to rate 16 policies of 10 insurance providers across seven categories. Data from published resources for 2014 insurance plans were extracted, categorized, and rated. The framework and ratings were summarized in a consumer-facing white paper. We found significant heterogeneity in benefits across comparable plans, as well as variation in the characterization and clarity of published services. This article presents findings and implications of the project. There is a pressing need to define requirements for SUD benefits and to hold health plans accountable for offering quality services in accordance with those benefits.

High prevalence of skin and wound care of hospitalized elderly in Brazil: a prospective observational study.

PubMed

da Rosa Silva, Carleara Ferreira; Santana, Rosimere Ferreira; de Oliveira, Beatriz Guitton Renaud Baptista; do Carmo, Thalita Gomes

2017-02-02

Skin changes caused by aging increase the risk of skin damages, such as pressure ulcers, during hospitalization of elderly patients. There is few information about the cost of wound treatment in Brazil. Conversely, skin and wound problems are highly reported among hospitalized elderly patients and caregivers. The purpose is to analyze the socio-demographic and clinical profile associated with skin and wound care in hospitalized elderly. This is a prospective observational study. The sample consisted of 75 patients, aged 60 years or more, randomly selected in three hospitals in Rio de Janeiro, Brazil. Data extraction from nursing records of the sample, using cross mapping with Nursing Interventions Classification. Data Synthesis supported by SAS 6.11 (SAS Institute, Inc. Cary North Carolina) in association with SPSS version 14.0 and statistics analysis. The findings were: age standard deviation 7.8, with minimum as 60, and maximum as 91 years old. Prevalence of women and married seniors. High prevalence of long-term hospitalization. There were 21 Nursing Interventions in the nursing records and seventeen of them related to skin and wound care. They were described in 57 nursing activities, present during 376 evaluations and repeated 1756 times. A significant difference was obtained between age and the presence of the nursing interventions "Positioning" (p-0.004), Eye Care/Hygiene (p- < 0.0001) and Oral Health Maintenance (p-0.0003). The skin care to prevention and treatment of skin damages represented the major demand of nursing interventions in different clinical conditions of hospitalized elderly.

Husbandry, working practices and field performance when using draught oxen in land preparation in Shambat, Nile Valley, Sudan.

PubMed

Makki, Elsamawal Khalil

2014-01-01

Little quantitative information is available on animal power in the Nile Valley in Sudan, despite that it is being used in the area for centuries and playing an important role in agriculture in the present day. A survey was conducted to assess draught oxen management and its association with field capacity and efficiency at the farm level and to identify potential areas for intervention. A sample of 50 farmers was selected for this purpose using the systematic random sampling technique. The main management parameters discussed were animal health, feeding, housing, work strategy and care for yoke and plough. The results showed that most of the farmers poorly manage their animals, and this was reflected in low working speeds and field efficiencies. The main dimensions of poor management were in veterinary care (78 % did not take their animals to the veterinary centre), feeding (66 % feed their animals shortly before work) and care for yoke (80 % did not follow daily care measures for their yokes) and plough (74 % did not follow plough care measure before and after work). Low working speeds (0.90–2.0 km/h) were recorded by the majority of the farmers (64 %). The majority of the farmers (70 %) recorded field capacities between 0.06 and 0.10 ha/h, while all of them worked at high field efficiencies of >86 %. The only parameter that significantly affected field capacity was the yoke-related wounds (p = 0.019). Extension advice and capacity building in husbandry and working practices were identified as principal entry points for intervention.

Experiences and Preferences for End-of-Life Care for Young Adults with Cancer and Their Informal Carers: A Narrative Synthesis.

PubMed

Ngwenya, Nothando; Kenten, Charlotte; Jones, Louise; Gibson, Faith; Pearce, Susie; Flatley, Mary; Hough, Rachael; Stirling, L Caroline; Taylor, Rachel M; Wong, Geoff; Whelan, Jeremy

2017-06-01

To review the qualitative literature on experiences of and preferences for end-of-life care of people with cancer aged 16-40 years (young adults) and their informal carers. A systematic review using narrative synthesis of qualitative studies using the 2006 UK Economic and Social Research Council research methods program guidance. Seven electronic bibliographic databases, two clinical trials databases, and three relevant theses databases were searched from January 2004 to October 2015. Eighteen articles were included from twelve countries. The selected studies included at least 5% of their patient sample within the age range 16-40 years. The studies were heterogeneous in their aims, focus, and sample, but described different aspects of end-of-life care for people with cancer. Positive experiences included facilitating adaptive coping and receiving palliative home care, while negative experiences were loss of "self" and nonfacilitative services and environment. Preferences included a family-centered approach to care, honest conversations about end of life, and facilitating normality. There is little evidence focused on the end-of-life needs of young adults. Analysis of reports including some young adults does not explore experience or preferences by age; therefore, it is difficult to identify age-specific issues clearly. From this review, we suggest that supportive interventions and education are needed to facilitate open and honest communication at an appropriate level with young people. Future research should focus on age-specific evidence about the end-of-life experiences and preferences for young adults with cancer and their informal carers.

Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives

PubMed Central

Garrido, Melissa M.; Balboni, Tracy A.; Maciejewski, Paul K.; Bao, Yuhua; Prigerson, Holly G.

2014-01-01

Context Advance directives (ADs) are expected to improve patients’ end-of-life outcomes, but retrospective analyses, surrogate recall of patients’ preferences, and selection bias have hampered efforts to determine ADs’ effects on patient outcomes. Objectives To examine associations among ADs, quality of life, and estimated costs of care in the week before death. Methods We used prospective data from interviews of 336 patients with advanced cancer and their caregivers, and analyzed patient baseline interview and caregiver and provider post-mortem evaluation data from the Coping with Cancer study. Cost estimates were from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and published Medicare payment rates and cost estimates. Outcomes were quality of life (range 0-10) and estimated costs of care received in the week before death. Because patient end-of-life care preferences influence both AD completion and care use, analyses were stratified by preferences regarding heroic endof-life measures (everything possible to remain alive). Results Most patients did not want heroic measures (76%). Do-not-resuscitate (DNR) orders were associated with higher quality of life (β=0.75, standard error=0.30, P=0.01) across the entire sample. There were no statistically significant relationships between DNR orders and outcomes among patients when we stratified by patient preference, or between living wills/durable powers of attorney and outcomes in any of the patient groups. Conclusion The associations between DNR orders and better quality of life in the week before death indicate that documenting preferences against resuscitation in medical orders may be beneficial to many patients. PMID:25498855

Sexual selection of male parental care in giant water bugs

PubMed Central

Ohba, Shin-ya; Okuda, Noboru; Kudo, Shin-ichi

2016-01-01

Paternal care can be maintained under sexual selection, if it helps in attracting more mates. We tested the hypothesis in two giant water bug species, Appasus major and Appasus japonicus, that male parental care is sexually selected through female preference for caring males. Females were given an opportunity to choose between two males. In the first test of female mate choice, one male carried eggs on its back, while the other did not. The egg status was switched between these two males in the second test. The experiment revealed that females of both species preferred caring males (i.e. egg-bearing) to non-caring males. Nonetheless, the female mate preference for egg-bearing males was stronger in A. major than in A. japonicus. Our results suggest that sexual selection plays an important role in maintaining elaborate paternal care in giant water bugs, but the importance of egg-bearing by males in female mate choice varies among species. PMID:27293778

Health insurance and care-seeking behaviours of female migrants in Accra, Ghana.

PubMed

Lattof, Samantha R

2018-05-01

People working in Ghana's informal sector have low rates of enrolment in the publicly funded National Health Insurance Scheme. Informal sector workers, including migrant girls and women from northern Ghana working as head porters (kayayei), report challenges obtaining insurance and seeking formal health care. This article analyses how health insurance status affects kayayei migrants' care-seeking behaviours. This mixed-methods study involved surveying 625 migrants using respondent-driven sampling and conducting in-depth interviews with a sub-sample of 48 migrants. Analyses explore health status and health seeking behaviours for recent illness/injury. Binary logistic regression modelled the effects of selected independent variables on whether or not a recently ill/injured participant (n = 239) sought health care. Although recently ill/injured participants (38.4%) desired health care, less than half (43.5%) sought care. Financial barriers overwhelmingly limit kayayei migrants from seeking health care, preventing them from registering with the National Health Insurance Scheme, renewing their expired health insurance policies, or taking time away from work. Both insured and uninsured migrants did not seek formal health services due to the unpredictable nature of out-of-pocket expenses. Catastrophic and impoverishing medical expenses also drove participants' migration in search of work to repay loans and hospital bills. Health insurance can help minimize these expenditures, but only 17.4% of currently insured participants (58.2%) reported holding a valid health insurance card in Accra. The others lost their cards or forgot them when migrating. Access to formal health care in Accra remains largely inaccessible to kayayei migrants who suffer from greater illness/injury than the general female population in Accra and who are hindered in their ability to receive insurance exemptions. With internal migration on the rise in many settings, health systems must recognize the varied needs of populations in multi-ethnic and multilingual countries to ensure that internal migrants can access affordable, quality health services across domestic borders.

Evaluation of the diagnostic accuracy of CareStart G6PD deficiency Rapid Diagnostic Test (RDT) in a malaria endemic area in Ghana, Africa.

PubMed

Adu-Gyasi, Dennis; Asante, Kwaku Poku; Newton, Sam; Dosoo, David; Amoako, Sabastina; Adjei, George; Amoako, Nicholas; Ankrah, Love; Tchum, Samuel Kofi; Mahama, Emmanuel; Agyemang, Veronica; Kayan, Kingsley; Owusu-Agyei, Seth

2015-01-01

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most widespread enzyme defect that can result in red cell breakdown under oxidative stress when exposed to certain medicines including antimalarials. We evaluated the diagnostic accuracy of CareStart G6PD deficiency Rapid Diagnostic Test (RDT) as a point-of-care tool for screening G6PD deficiency. A cross-sectional study was conducted among 206 randomly selected and consented participants from a group with known G6PD deficiency status between February 2013 and June 2013. A maximum of 1.6ml of capillary blood samples were used for G6PD deficiency screening using CareStart G6PD RDT and Trinity qualitative with Trinity quantitative methods as the "gold standard". Samples were also screened for the presence of malaria parasites. Data entry and analysis were done using Microsoft Access 2010 and Stata Software version 12. Kintampo Health Research Centre Institutional Ethics Committee granted ethical approval. The sensitivity (SE) and specificity (SP) of CareStart G6PD deficiency RDT was 100% and 72.1% compared to Trinity quantitative method respectively and was 98.9% and 96.2% compared to Trinity qualitative method. Malaria infection status had no significant (P=0.199) change on the performance of the G6PD RDT test kit compared to the "gold standard". The outcome of this study suggests that the diagnostic performance of the CareStart G6PD deficiency RDT kit was high and it is acceptable at determining the G6PD deficiency status in a high malaria endemic area in Ghana. The RDT kit presents as an attractive tool for point-of-care G6PD deficiency for rapid testing in areas with high temperatures and less expertise. The CareStart G6PD deficiency RDT kit could be used to screen malaria patients before administration of the fixed dose primaquine with artemisinin-based combination therapy.

Health insurance and care-seeking behaviours of female migrants in Accra, Ghana

PubMed Central

Lattof, Samantha R

2018-01-01

Abstract People working in Ghana’s informal sector have low rates of enrolment in the publicly funded National Health Insurance Scheme. Informal sector workers, including migrant girls and women from northern Ghana working as head porters (kayayei), report challenges obtaining insurance and seeking formal health care. This article analyses how health insurance status affects kayayei migrants’ care-seeking behaviours. This mixed-methods study involved surveying 625 migrants using respondent-driven sampling and conducting in-depth interviews with a sub-sample of 48 migrants. Analyses explore health status and health seeking behaviours for recent illness/injury. Binary logistic regression modelled the effects of selected independent variables on whether or not a recently ill/injured participant (n = 239) sought health care. Although recently ill/injured participants (38.4%) desired health care, less than half (43.5%) sought care. Financial barriers overwhelmingly limit kayayei migrants from seeking health care, preventing them from registering with the National Health Insurance Scheme, renewing their expired health insurance policies, or taking time away from work. Both insured and uninsured migrants did not seek formal health services due to the unpredictable nature of out-of-pocket expenses. Catastrophic and impoverishing medical expenses also drove participants’ migration in search of work to repay loans and hospital bills. Health insurance can help minimize these expenditures, but only 17.4% of currently insured participants (58.2%) reported holding a valid health insurance card in Accra. The others lost their cards or forgot them when migrating. Access to formal health care in Accra remains largely inaccessible to kayayei migrants who suffer from greater illness/injury than the general female population in Accra and who are hindered in their ability to receive insurance exemptions. With internal migration on the rise in many settings, health systems must recognize the varied needs of populations in multi-ethnic and multilingual countries to ensure that internal migrants can access affordable, quality health services across domestic borders. PMID:29462305

Determination of geostatistically representative sampling locations in Porsuk Dam Reservoir (Turkey)

NASA Astrophysics Data System (ADS)

Aksoy, A.; Yenilmez, F.; Duzgun, S.

2013-12-01

Several factors such as wind action, bathymetry and shape of a lake/reservoir, inflows, outflows, point and diffuse pollution sources result in spatial and temporal variations in water quality of lakes and reservoirs. The guides by the United Nations Environment Programme and the World Health Organization to design and implement water quality monitoring programs suggest that even a single monitoring station near the center or at the deepest part of a lake will be sufficient to observe long-term trends if there is good horizontal mixing. In stratified water bodies, several samples can be required. According to the guide of sampling and analysis under the Turkish Water Pollution Control Regulation, a minimum of five sampling locations should be employed to characterize the water quality in a reservoir or a lake. The European Union Water Framework Directive (2000/60/EC) states to select a sufficient number of monitoring sites to assess the magnitude and impact of point and diffuse sources and hydromorphological pressures in designing a monitoring program. Although existing regulations and guidelines include frameworks for the determination of sampling locations in surface waters, most of them do not specify a procedure in establishment of monitoring aims with representative sampling locations in lakes and reservoirs. In this study, geostatistical tools are used to determine the representative sampling locations in the Porsuk Dam Reservoir (PDR). Kernel density estimation and kriging were used in combination to select the representative sampling locations. Dissolved oxygen and specific conductivity were measured at 81 points. Sixteen of them were used for validation. In selection of the representative sampling locations, care was given to keep similar spatial structure in distributions of measured parameters. A procedure was proposed for that purpose. Results indicated that spatial structure was lost under 30 sampling points. This was as a result of varying water quality in the reservoir due to inflows, point and diffuse inputs, and reservoir hydromorphology. Moreover, hot spots were determined based on kriging and standard error maps. Locations of minimum number of sampling points that represent the actual spatial structure of DO distribution in the Porsuk Dam Reservoir

Systemic tobramycin concentrations during selective decontamination of the digestive tract in intensive care unit patients on continuous venovenous hemofiltration.

PubMed

Mol, Meriel; van Kan, Hendrikus J M; Schultz, Marcus J; de Jonge, Evert

2008-05-01

To study whether selective decontamination of the digestive tract (SDD) results in detectable serum tobramycin concentrations in intensive care unit (ICU) patients with acute renal failure treated with continuous venovenous hemofiltration (CVVH). Prospective, observational, single-center study in a mixed medical-surgical ICU. Adult ICU patients receiving SDD for at least 3 days and being treated with CVVH because of acute renal failure. Tobramycin serum concentrations were measured at the 3rd day after start of CVVH and every 3 days thereafter. Detectable serum concentrations of tobramycin were found in 12 (63%) of 19 patients and in 15 (58%) of the 26 samples. With a toxic tobramycin concentration defined as more than 2.0 mg/l, we found one patient with a toxic concentration of 3.0 mg/l. In three other patients tobramycin concentrations of >or=1.0 mg/l were found. In patients with acute renal failure treated with CVVH, administration of SDD with tobramycin can lead to detectable and potentially toxic serum tobramycin concentrations.

Blue emitting copper nanoclusters as colorimetric and fluorescent probe for the selective detection of bilirubin

NASA Astrophysics Data System (ADS)

R. S., Aparna; J. S., Anjali Devi; John, Nebu; Abha, K.; S. S., Syamchand; George, Sony

2018-06-01

Hurdles to develop point of care diagnostic methods restrict the translation of progress in the health care sector from bench side to bedside. In this article a simple, cost effective fluorescent as well as colorimetric nanosensor was developed for the early and easy detection of hyperbilirubinemia. A stable, water soluble bovine serum albumin stabilised copper nanocluster (BSA CuNC) was used as the fluorescent probe which exhibited strong blue emission (404 nm) upon 330 nm excitation. The fluorescence of the BSA CuNC can be effectively quenched by the addition of bilirubin by the formation of copper-bilirubin complex. Meanwhile the copper-bilirubin complex resulted in an observable colour change from pale violet to green facilitating colorimetric detection. The prepared sensor displayed good selectivity and sensitivity over other co-existing molecules, and can be used for quantifying bilirubin with a detection limit down to 257 fM. Additionally, the as-prepared probe was coated on a paper strip to develop a portable paper strip sensor of bilirubin. Moreover, the method was successfully applied in real sample analysis and obtained promising result.

A Survey of Nurses' Compliance with Hand Hygiene Guidelines in Caring for Patients with Cancer in a Selected Center of Isfahan, Iran, in 2016

PubMed Central

Mostafazadeh-Bora, Mostafa; Bahrami, Masoud; Hosseini, Abbas

2018-01-01

Background: Hand hygiene is one of the key ways of preventing healthcare-associated infections (HCAI), especially in patients with cancer. The aim of this study was to determine nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center in Isfahan, Iran, in 2016. Materials and Methods: The present observational study was conducted on nurses in a cancer center in Isfahan in 2016. The participants were selected via convenience sampling method. Nurses serving at bedsides and willing to participate were entered into the study. Data were collected through the direct observation of nurses during delivering routine care, using the standard checklist for direct observation of the “five moments for hand hygiene” approach. Results: In the present study, 94 nurses were studied at 500 clinical moments. The overall hand hygiene compliance rate was 12.80%. The highest hand hygiene compliance rate was observed in the after body fluid exposure moment (72.70%). In addition, hand hygiene compliance rate in preprocedure indications (before patient contact and before aseptic procedure) and postprocedure indications (after patient contact, after body fluid exposure, and after patient surrounding contact) were 3.40 and 21%, respectively, which had a significant correlation (p = 0.001). Conclusions: The findings indicate that the hand hygiene compliance rate among nurses was low. Further research in this regard is recommended in order to find the causes of low compliance with hand hygiene and design interventions for improvement in hand hygiene compliance rate among nurses. PMID:29628959

Accounting for length-bias and selection effects in estimating the distribution of menstrual cycle length

PubMed Central

Lum, Kirsten J.; Sundaram, Rajeshwari; Louis, Thomas A.

2015-01-01

Prospective pregnancy studies are a valuable source of longitudinal data on menstrual cycle length. However, care is needed when making inferences of such renewal processes. For example, accounting for the sampling plan is necessary for unbiased estimation of the menstrual cycle length distribution for the study population. If couples can enroll when they learn of the study as opposed to waiting for the start of a new menstrual cycle, then due to length-bias, the enrollment cycle will be stochastically larger than the general run of cycles, a typical property of prevalent cohort studies. Furthermore, the probability of enrollment can depend on the length of time since a woman’s last menstrual period (a backward recurrence time), resulting in selection effects. We focus on accounting for length-bias and selection effects in the likelihood for enrollment menstrual cycle length, using a recursive two-stage approach wherein we first estimate the probability of enrollment as a function of the backward recurrence time and then use it in a likelihood with sampling weights that account for length-bias and selection effects. To broaden the applicability of our methods, we augment our model to incorporate a couple-specific random effect and time-independent covariate. A simulation study quantifies performance for two scenarios of enrollment probability when proper account is taken of sampling plan features. In addition, we estimate the probability of enrollment and the distribution of menstrual cycle length for the study population of the Longitudinal Investigation of Fertility and the Environment Study. PMID:25027273

Summary of Selected State Licensing Requirements: Day Care Centers, Family Day Care Homes. Day Care Survey--1970. Preliminary Edition.

ERIC Educational Resources Information Center

Office of Economic Opportunity, Washington, DC. Evaluation Div.

This volume of abstracts of child day care facility licensing requirements is intended to serve as an introduction to selected aspects of the licensing process within the several states by reviewing (1) the various definitions of day care facilities in the jurisdictions covered, and (2) the prescribed regulations established by the states to…

The experience of adverse childhood experiences and dental care in childhood.

PubMed

Crouch, Elizabeth; Radcliff, Elizabeth; Nelson, Joni; Strompolis, Melissa; Martin, Amy

2018-06-06

Routine preventive dental care is important to overall child health and well-being. However, the experience of adversity in childhood may prevent children from getting adequate preventive care. This study seeks to explore how the prevalence of adverse childhood experiences (ACEs) and the role of a protective adult may be associated with dental care utilization in childhood. Data from the 2016 South Carolina Behavioral Risk Factor Surveillance System (SC BRFSS), which interviews adults eighteen year of age and older, were used in this study. Dental care utilization in childhood was measured as the adult retrospectively reported frequency of dental care in childhood: at least once every 2 years (adequate dental care) or less often than every 2 years (inadequate dental care). ACEs were determined by asking about each of respondent's childhood exposure to eleven childhood experiences, including divorce, parental incarceration, domestic violence, drug and alcohol abuse, mental illness and emotional, physical or sexual abuse. The presence of a protective adult in childhood included respondents who had an adult who made them feel safe and protected during childhood. Descriptive and bivariate statistics explored differences in the adequacy of child dental care by ACE exposure, the presence of a protective adult and selected demographic characteristics. Multivariate regression models were used to examine the impact of counts and types of ACEs and the presence of a protective adult with inadequate childhood dental care. The unweighted study sample included 7079 respondents ageing from 18 to 79 years of age Sampling weights were used for all analyses. Among all respondents, 71.7% reported receiving adequate dental care during childhood; 28.3% responded that they received inadequate dental care. Adjusting for sociodemographic characteristics, respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs (aOR 2.79; 95% CI 2.77-2.82). The odds of reporting inadequate dental care were lower among those grew up with an adult who made them feel safe and protected (aOR 0.38; 95% CI 0.37-0.39). The presence of protective factors may mitigate the effects of ACEs on paediatric dental care. This research contributes to the literature through the further identification of the role of dentists in identifying signs of abuse and neglect. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

An estimation of dental treatment needs in two groups of refugees in Sweden.

PubMed

Zimmerman, M; Bornstein, R; Martinsson, T

1990-06-01

The aim of this study was to estimate dental treatment need in groups of Chilean and Polish refugees in Sweden. Of the Nordic countries, Sweden accepts the greatest number of refugees. An average of 5000 refugees arrived annually in 1981-85, increasing to 15,000 during 1986-87. Refugees and their families now comprise 93% of non-Nordic immigration. In 1981-83 a sample of 193 Chilean and 92 Polish refugees in the county of Stockholm was selected for this study. Dental treatment needs were calculated in accordance with CPITN and the working study of Swedish dentistry, which formed the basis for the Swedish scale of dental fees for the National Dental Insurance Scheme. The estimated mean treatment time (+/- SD) in the Chilean sample was 6.9 +/- 2.3 h and in the Polish group 8.4 +/- 3.0; in comparison with estimated treatment needs in a Swedish material, both would be classified as extreme risk groups. There was no correlation between the number of months in Sweden and the estimated treatment needs. The results indicate a cumulative, unmet need for dental care in these groups. Barriers to ensuring adequate health care for immigrants persist; special outreach programmes, conducted by dental health personnel, may be an effective means of introducing immigrants to the Swedish dental care system.

A Randomized Trial Comparing Mail versus In-Office Distribution of the CAHPS Clinician and Group Survey

PubMed Central

Anastario, Michael P; Rodriguez, Hector P; Gallagher, Patricia M; Cleary, Paul D; Shaller, Dale; Rogers, William H; Bogen, Karen; Safran, Dana Gelb

2010-01-01

Objective To assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences. Data Sources/Study Setting Multisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State. Data Collection/Extraction Methods Mail and handout distribution modes were alternated weekly at each site for 6 weeks. Principal Findings Handout protocols yielded an incomplete distribution rate (74 percent) and lower overall response rates (40 percent versus 58 percent) compared with mail. Handout distribution rates decreased over time and resulted in more favorable survey scores compared with mailed surveys. There were significant mode–physician interaction effects, indicating that data cannot simply be pooled and adjusted for mode. Conclusions In-office survey distribution has the potential to bias measurement and comparison of physicians and sites on patient care experiences. Incomplete distribution rates observed in-office, together with between-office differences in distribution rates and declining rates over time suggest staff may be burdened by the process and selective in their choice of patients. Further testing with a larger physician and site sample is important to definitively establish the potential role for in-office distribution in obtaining reliable, valid assessment of patient care experiences. PMID:20579126

[Claim and reality of selective contact options : experiences in finalizing selective contracts in urological care].

PubMed

Ex, P; Schroeder, A

2014-08-01

Selective contracts are an important component in addition to the total healthcare concept in order to introduce process-related innovations into the healthcare system. Since 2011 the Berufsverband der Deutschen Urologen (BDU, Professional Association of German Urologists) has held negotiations with individual health insurance companies and care providers in order to view selective contracts as collective contracts, not only as pilot projects but also as additional forms of care.This article illustrates the experiences of the BDU in the initiation and finalizing of selective contracts as well as existing weak points in the framework conditions.

The Costs of Decedents in the Medicare Program: Implications for Payments to Medicare+Choice Plans

PubMed Central

Buntin, Melinda Beeuwkes; Garber, Alan M; McClellan, Mark; Newhouse, Joseph P

2004-01-01

Objective To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life—a group that accounts for more than one-quarter of Medicare's annual expenditures. Data Source Medicare administrative claims for 1994 and 1995. Study Design We calculated the payment a plan would have received under three risk-adjustment systems for each beneficiary in our 1995 sample based on his or her age, gender, county of residence, original reason for Medicare entitlement, and principal inpatient diagnoses received during any hospital stays in 1994. We compared these amounts to the actual costs incurred by those beneficiaries. We then looked for clinical categories that were predictive of costs, including costs in a beneficiary's last year of life, not accounted for by the risk adjusters. Data Extraction Methods The analyses were conducted using claims for a 5 percent random sample of Medicare beneficiaries who died in 1995 and a matched group of survivors. Principal Findings Medicare is currently implementing the Principal Inpatient Diagnostic Cost Groups (PIP-DCG) risk adjustment payment system to address the problem of risk selection in the Medicare+Choice program. We quantify the strong financial disincentives to enroll terminally ill beneficiaries that plans still have under this risk adjustment system. We also show that up to one-third of the selection observed between Medicare HMOs and the traditional fee-for-service system could be due to differential enrollment of decedents. A risk adjustment system that incorporated more of the available diagnostic information would attenuate this disincentive; however, plans could still use clinical information (not included in the risk adjustment scheme) to identify beneficiaries whose expected costs exceed expected payments. Conclusions More disaggregated prospective risk adjustment methods and alternative payment systems that compensate plans for delivering care to certain classes of patients should be considered to ensure access to high-quality managed care for all beneficiaries. PMID:14965080

Characterization of the selection of medicines for the Brazilian primary health care.

PubMed

Karnikowski, Margô Gomes de Oliveira; Galato, Dayani; Meiners, Micheline Marie Milward de Azevedo; Silva, Emília Vitória da; Gerlack, Letícia Farias; Bós, Ângelo José Gonçalves; Leite, Silvana Nair; Álvares, Juliana; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-11-13

To characterize the process of selection of medicines for primary health care in the Brazilian regions. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Monitoring pharmaceuticals and personal care products in reservoir water used for drinking water supply.

PubMed

Aristizabal-Ciro, Carolina; Botero-Coy, Ana María; López, Francisco J; Peñuela, Gustavo A

2017-03-01

In this work, the presence of selected emerging contaminants has been investigated in two reservoirs, La Fe (LF) and Rio Grande (RG), which supply water to two drinking water treatment plants (DWTPs) of Medellin, one of the most populated cities of Colombia. An analytical method based on solid-phase extraction (SPE) of the sample followed by measurement by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) was developed and validated for this purpose. Five monitoring campaigns were performed in each reservoir, collecting samples from 7 sites (LF) and 10 sites (RG) at 3 different depths of the water column. In addition, water samples entering in the DWTPs and treated water samples from these plans were also analysed for the selected compounds. Data from this work showed that parabens, UV filters and the pharmaceutical ibuprofen were commonly present in most of the reservoir samples. Thus, methyl paraben was detected in around 90% of the samples collected, while ibuprofen was found in around 60% of the samples. Water samples feeding the DWTPs also contained these two compounds, as well as benzophenone at low concentrations, which was in general agreement with the results from the reservoir samples. After treatment in the DWTPs, these three compounds were still present in the samples although at low concentrations (<40 ng/L), which evidenced that they were not completely removed after the conventional treatment applied. The potential effects of the presence of these compounds at the ppt levels in drinking water are still unknown. Further research is needed to evaluate the effect of chronic exposure to these compounds via consumption of drinking water.

Prevalence and causes of low vision and blindness in Baotou

PubMed Central

Zhang, Guisen; Li, Yan; Teng, Xuelong; Wu, Qiang; Gong, Hui; Ren, Fengmei; Guo, Yuxia; Liu, Lei; Zhang, Han

2016-01-01

Abstract The aim of this study was to investigate the prevalence and causes of low vision and blindness in Baotou, Inner Mongolia. A cross-sectional study was carried out. Multistage sampling was used to select samples. The visual acuity was estimated using LogMAR and corrected by pinhole as best-corrected visual acuity. There were 7000 samples selected and 5770 subjects included in this investigation. The overall bilateral prevalence rates of low vision and blindness were 3.66% (95% CI: 3.17–4.14) and 0.99% (95% CI: 0.73–1.24), respectively. The prevalence of bilateral low vision, blindness, and visual impairment increased with age and decreased with education level. The main leading cause of low vision and blindness was cataract. Diabetic retinopathy and age-related macular degeneration were found to be the second leading causes of blindness in Baotou. The low vision and blindness were more prevalent in elderly people and subjects with low education level in Baotou. Cataract was the main cause for visual impairment and more attention should be paid to fundus diseases. In order to prevent blindness, much more eye care programs should be established. PMID:27631267

Prevalence and causes of low vision and blindness in Baotou: A cross-sectional study.

PubMed

Zhang, Guisen; Li, Yan; Teng, Xuelong; Wu, Qiang; Gong, Hui; Ren, Fengmei; Guo, Yuxia; Liu, Lei; Zhang, Han

2016-09-01

The aim of this study was to investigate the prevalence and causes of low vision and blindness in Baotou, Inner Mongolia.A cross-sectional study was carried out. Multistage sampling was used to select samples. The visual acuity was estimated using LogMAR and corrected by pinhole as best-corrected visual acuity.There were 7000 samples selected and 5770 subjects included in this investigation. The overall bilateral prevalence rates of low vision and blindness were 3.66% (95% CI: 3.17-4.14) and 0.99% (95% CI: 0.73-1.24), respectively. The prevalence of bilateral low vision, blindness, and visual impairment increased with age and decreased with education level. The main leading cause of low vision and blindness was cataract. Diabetic retinopathy and age-related macular degeneration were found to be the second leading causes of blindness in Baotou.The low vision and blindness were more prevalent in elderly people and subjects with low education level in Baotou. Cataract was the main cause for visual impairment and more attention should be paid to fundus diseases. In order to prevent blindness, much more eye care programs should be established.

Composition and Source Identification of Chemical Species in Dust from Selected Indoor Environments in Ile-Ife, Nigeria

NASA Astrophysics Data System (ADS)

Ogundele, Lasun T.; Olasinde, Roseline T.; Owoade, Oyediran K.; Olise, Felix S.

2018-05-01

This study presents the elemental compositions and concentrations of indoor dust and identifies the major sources in some selected indoor environments in Ile-Ife, Nigeria. The dust samples were collected from 16 indoor environments comprising offices, churches, residential and staff quarters using a cyclonic high power vacuum cleaner. The dust samples were analyzed for elemental concentrations using x-ray fluorescences. The data sets were analyzed for the possible sources and their contributions using Principal Component Factor Analysis (PCFA). The result showed that dust samples contained several elements: K, Ca, Ti, Mn, Fe, Ni, Cu, Zn, Ga, As, Rb, Sr, Se, Zr, V, and Sc. The PCFA identified three factors with the percentage variance of 92, 77, 71 and 68%, for the office, church, residential, and staff quarters, respectively, for the combined elemental data of each of the site classes. The identified sources were track-in-soil, road and windblown soil dust, paint debris, household dust from personal care materials, cooking, and cleaning activities. The unintentional track-in-soil due to mobility of the occupants, structural materials, and outdoor air was the major sources contributing to the indoor dust.

Effects of ageing on different binders for retouching and on some binder-pigment combinations used for restoration of wall paintings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ropret, P.; Zoubek, R.; Skapin, A. Sever

2007-11-15

In restoration of colour layers, the selection of the most appropriate retouching binder is a very important step that may have a crucial impact on materials durability. As different weather conditions can have versatile influence on stability of colour layers, we determined the effect of ageing on carefully selected samples of binders (Tylose, Klucel, ammonium caseinate, gum arabicum, fish and skin glues and some other synthetic binders) as well as on several binder-pigment combinations (the pigments in combinations being cinnabar, green earth and smalt). The samples were subjected to accelerated ageing tests in climatic chambers. In these tests the temperaturemore » and the relative humidity were daily oscillating between - 20 deg. C and 50 deg. C and 50% to 90%, respectively, for a period of one month. Then the samples were exposed to UV and visible light generated by a metal halide lamp for a month. The differences in microstructure before and after ageing were determined by optical and scanning electron microscopy, while the ageing of the organic structures in binders was investigated by Fourier transform infrared (FTIR) microscopy.« less

Biomonitoring of 21 endocrine disrupting chemicals in human hair samples using ultra-high performance liquid chromatography-tandem mass spectrometry.

PubMed

Rodríguez-Gómez, R; Martín, J; Zafra-Gómez, A; Alonso, E; Vílchez, J L; Navalón, A

2017-02-01

Rapid industrial growth has increased human exposure to a large variety of chemicals with adverse health effects. These industrial chemicals are usually present in the environment, foods, beverages, clothes and personal care products. Among these compounds, endocrine disrupting chemicals (EDCs) have raised concern over the last years. In the present work, the determination of 21 EDCs in human hair samples is proposed. An analytical method based on the digestion of the samples with a mixture of acetic acid/methanol (20:80, v/v) followed by a solid-liquid microextraction and analysis by ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was developed and validated. The most influential parameters affecting the extraction method were optimized. The method was validated using matrix-matched calibration and recovery assays. Limits of detection ranged from 0.2 to 4 ng g -1 , limits of quantification from 0.5 to 12 ng g -1 , and inter- and intra-day variability was under 15% in all cases. Recovery rates for spiked samples ranged from 92.1 to 113.8%. The method was applied for the determination of the selected compounds in human hair. Samples were collected weekly from six randomly selected volunteers (three men and three women) over a three-month period. All the analyzed samples tested positive for at least one of the analyzed compounds. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bacterial clonal diagnostics as a tool for evidence-based empiric antibiotic selection

PubMed Central

Tchesnokova, Veronika; Avagyan, Hovhannes; Rechkina, Elena; Chan, Diana; Muradova, Mariya; Haile, Helen Ghirmai; Radey, Matthew; Weissman, Scott; Riddell, Kim; Scholes, Delia; Johnson, James R.

2017-01-01

Despite the known clonal distribution of antibiotic resistance in many bacteria, empiric (pre-culture) antibiotic selection still relies heavily on species-level cumulative antibiograms, resulting in overuse of broad-spectrum agents and excessive antibiotic/pathogen mismatch. Urinary tract infections (UTIs), which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E. coli clonal-level antibiograms to improve empiric antibiotic selection. A novel PCR-based clonotyping assay was applied to fresh urine samples to rapidly detect E. coli and the urine strain's clonotype. Based on a database of clonotype-specific antibiograms, the acceptability of various antibiotics for empiric therapy was inferred using a 20%, 10%, and 30% allowed resistance threshold. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. coli clonotypes directly in patients’ urine within 25–35 minutes, with high specificity and sensitivity compared to culture. Antibiotic selection based on a clonotype-specific antibiogram could reduce the relative likelihood of antibiotic/pathogen mismatch by ≥ 60%. Compared to observed prescribing patterns, clonal diagnostics-guided antibiotic selection could safely double the use of trimethoprim/sulfamethoxazole and minimize fluoroquinolone use. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E. coli UTI, including reversing preferential use of fluoroquinolones over trimethoprim/sulfamethoxazole. The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence-based medicine directly to the point of care. PMID:28350870

Bacterial clonal diagnostics as a tool for evidence-based empiric antibiotic selection.

PubMed

Tchesnokova, Veronika; Avagyan, Hovhannes; Rechkina, Elena; Chan, Diana; Muradova, Mariya; Haile, Helen Ghirmai; Radey, Matthew; Weissman, Scott; Riddell, Kim; Scholes, Delia; Johnson, James R; Sokurenko, Evgeni V

2017-01-01

Despite the known clonal distribution of antibiotic resistance in many bacteria, empiric (pre-culture) antibiotic selection still relies heavily on species-level cumulative antibiograms, resulting in overuse of broad-spectrum agents and excessive antibiotic/pathogen mismatch. Urinary tract infections (UTIs), which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E. coli clonal-level antibiograms to improve empiric antibiotic selection. A novel PCR-based clonotyping assay was applied to fresh urine samples to rapidly detect E. coli and the urine strain's clonotype. Based on a database of clonotype-specific antibiograms, the acceptability of various antibiotics for empiric therapy was inferred using a 20%, 10%, and 30% allowed resistance threshold. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. coli clonotypes directly in patients' urine within 25-35 minutes, with high specificity and sensitivity compared to culture. Antibiotic selection based on a clonotype-specific antibiogram could reduce the relative likelihood of antibiotic/pathogen mismatch by ≥ 60%. Compared to observed prescribing patterns, clonal diagnostics-guided antibiotic selection could safely double the use of trimethoprim/sulfamethoxazole and minimize fluoroquinolone use. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E. coli UTI, including reversing preferential use of fluoroquinolones over trimethoprim/sulfamethoxazole. The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence-based medicine directly to the point of care.

Annual radiological environmental operating report: Browns Ferry Nuclear Plant, 1992. Operations Services/Technical Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1993-04-01

This report describes the environmental radiological monitoring program conducted by TVA in the vicinity of Browns Ferry Nuclear Plant (BFN) in 1992. The program includes the collection of samples from the environment and the determination of the concentrations of radioactive materials in the samples. Samples are taken from stations in the general area of the plant and from areas not influenced by plant operations. Station locations are selected after careful consideration of the weather patterns and projected radiation doses to the various areas around the plant. Material sampled includes air, water, milk, foods, vegetation, soil, fish, sediment, and direct radiationmore » levels. Results from stations near the plant are compared with concentrations from control stations and with preoperational measurements to determine potential impacts of plant operations. Small amounts of Co-60 and Cs-134 were found in sediment samples downstream from the plant. This activity in stream sediment would result in no measurable increase over background in the dose to the general public.« less

Key elements of successful care process of patients with heart symptoms in an emergency care - could an ERP system help?

PubMed

Kontio, Elina; Korvenranta, Heikki; Lundgren-Laine, Heljä; Salanterä, Sanna

2009-01-01

The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.

Effects of Spiritual Group Therapy on Caregiver Strain in Home Caregivers of the Elderly with Alzheimer's Disease.

PubMed

Mahdavi, Behrouz; Fallahi-Khoshknab, Masoud; Mohammadi, Farahnaz; Hosseini, Mohammad Ali; Haghi, Marjan

2017-06-01

Care of patients with Alzheimer's disease is one of the most difficult types of care that exposes the caregiver to a high level of care strain. The present research aimed at determining the effect of spiritual care on caregiver strain of the elderly with Alzheimer's disease. An experimental study was carried out on 100 caregivers who were selected by convenience sampling and randomly divided into intervention, control one and control two groups. Group spiritual therapy was performed on the intervention group for five weeks, Control one participate in the group sessions without any particular interventions, and control two received no interventions. Data was collected through a demographic questionnaire and Robinson's (1983) Caregiver Strain Index, and analyzed using the Chi-square, Fisher's Exact test, one-way analysis of variance and paired t-test. Statistical significance level was considered as 0.05. In the intervention group mean of the posttest care strain score 32.43±2.73 was significantly lower than pretest 37.16±1.26 (P<0.001). The mean posttest score of care strain was significantly lower in the intervention group compared to the two other groups (P<0.001). Spiritual care can reduce care strain in home caregivers of the elderly with Alzheimer's disease. Copyright © 2016 Elsevier Inc. All rights reserved.

Predictors of health care seeking for irritable bowel syndrome: a population based study.

PubMed

Talley, N J; Boyce, P M; Jones, M

1997-09-01

It has been suggested that psychological factors rather than symptoms drive subjects with irritable bowel syndrome (IBS) to seek medical care, but this issue has not been tackled in a population based study. To identify whether psychological factors or abuse explain health care seeking for IBS. A sample of residents of Penrith (a Sydney suburb representative of the Australian population) selected randomly from the electoral rolls (that by law include the entire population > or = 18 years) was mailed a validated self-report questionnaire. Measured were gastrointestinal symptoms including the Manning (and Rome) criteria for IBS, health care seeking, neuroticism (Eysenck Personality Questionnaire), psychological morbidity (General Health Questionnaire: GHQ) and sexual, physical and emotional abuse (including the standardised Drossman questions). Among 730 subjects, 96 (13%, 95% confidence interval (CI) 11-16%) had IBS by the Manning criteria. Of those with IBS, 73% (95% CI 63-81%) had sought medical care for abdominal pain or discomfort. Only increasing pain severity (odds ratio (OR) = 2.10, 95% CI 1.11-3.95) and duration of pain (OR = 1.53, 95% CI 1.10-2.13) were independently associated with seeking health care for IBS. Pain severity was also predictive of recent care seeking (OR = 1.74, 95% CI 1.12-1.96). Neuroticism, psychological morbidity and abuse history were not significant predictors. Psychological factors do not seem to explain health care seeking among community subjects with IBS.

ASSOCIATION BETWEEN SELF-CARE BEHAVIORS AND SELF-ESTEEM OF RURAL ELDERLIES; NECESSITY OF HEALTH PROMOTION

PubMed Central

Bagheri-Nesami, Masoumeh; Goudarzian, Amir Hossein; Mirani, Hesam; Jouybari, Sina Sabourian; Nasiri, Davoud

2016-01-01

Introduction: Changes in the modern medical science caused significant reduction of mortality and every day increase of the elderly in the world. According to prevalence of physical and mental problems in elderly, it is necessary to take some actions. Self care in one of the best way to improve elderly health and life satisfaction that seems have a relation to self-esteem. Methods: This descriptive and analytical study was performed on 180 elderly in rural areas of the Sari city. Elderly selected by multi-stage randomize sampling method. Data were gathered by using standard questionnaires of self-care and Rosenberg self-esteem. Data were analyzed by Spearman and Pearson’s correlation using SPSS software (V16). Findings: The mean±SD of the ages of the elderly were 66.85±7.661. The score of self-care varies between 99 to 155 and most of them (66.7%) had good level of self-care. Also, most of elderly (52.2%) had high level of self-esteem. Also there was a significant relationship, between self-care and self-esteem (P<0.001, r=0.426). Conclusion: According to significant relationship between self-care and self-esteem of elderly, by the planning for improving the self care of elderly, can increase their health and significantly reduce from physical and mental complications. PMID:27047266

Birth outcomes associated with receipt of group prenatal care among low-income Hispanic women.

PubMed

Tandon, S Darius; Colon, Lucinda; Vega, Patricia; Murphy, Jeanne; Alonso, Alina

2012-01-01

Although Hispanic women in the United States have preterm birth and low-birth-weight rates comparable to non-Hispanic white women, their rates fall short of 2010 Healthy People goals, with variability found across states. This study examined the effectiveness of the CenteringPregnancy group prenatal care model in reducing preterm birth and low-birth-weight rates for Hispanic women. Pregnant Hispanic women at less than or equal to 20 weeks, gestation initiating prenatal care between January 2008 to July 2009 at 2 Palm Beach County, Florida, public health clinics selected either group or traditional prenatal care. Data on neonatal birth weight and gestational age were obtained through abstraction of Palm Beach County Health Department medical records. Records were abstracted for 97% of CenteringPregnancy (n = 150) and 94% of traditional care (n = 66) participants. A statistically significant difference was found in the percentage of women giving birth to preterm neonates (5% group prenatal care vs 13% traditional care; P= .04). There were no statistically significant differences in the percentage of women having a low-birth-weight neonate when group and traditional care participants were compared. The CenteringPregnancy model holds promise for improving the birth outcomes of Hispanic women. Future research should be conducted with larger sample sizes to replicate study findings using experimental designs and incorporating formal cost-effectiveness analyses. © 2012 by the American College of Nurse-Midwives.

[Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality].

PubMed

Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E

2016-01-01

To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Identifying a Robust and Practical Quasar Accretion-Rate Indicator Using the Chandra Archive

NASA Astrophysics Data System (ADS)

Shemmer, Ohad

2017-09-01

Understanding the rapid growth of supermassive black holes and the assembly of their host galaxies is severely limited by the lack of reliable estimates of black-hole mass and accretion rate in distant quasars. We propose to utilize the Chandra archive to identify the most reliable and practical Eddington-ratio indicator by investigating diagnostics of quasar accretion power in the hard-X-ray, C IV, and Hbeta spectral bands of a carefully-selected sample of optically-selected sources. We will perform a ``stress test'' to each of these diagnostics, relying critically on the hard-X-ray observable properties, and deliver a prescription for the most robust Eddington-ratio estimate that can be utilized economically at the highest accessible redshifts.

Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness.

PubMed

Zaragoza, M; Sallés, M; Gomez, J; Bayas, J M; Trilla, A

1999-06-01

The effectiveness of an alcoholic solution compared with the standard hygienic handwashing procedure during regular work in clinical wards and intensive care units of a large public university hospital in Barcelona was assessed. A prospective, randomized clinical trial with crossover design, paired data, and blind evaluation was done. Eligible health care workers (HCWs) included permanent and temporary HCWs of wards and intensive care units. From each category, a random sample of persons was selected. HCWs were randomly assigned to regular handwashing (liquid soap and water) or handwashing with the alcoholic solution by using a crossover design. The number of colony-forming units on agar plates from hands printing in 3 different samples was counted. A total of 47 HCWs were included. The average reduction in the number of colony-forming units from samples before handwashing to samples after handwashing was 49.6% for soap and water and 88.2% for the alcoholic solution. When both methods were compared, the average number of colony-forming units recovered after the procedure showed a statistically significant difference in favor of the alcoholic solution (P <.001). The alcoholic solution was well tolerated by HCWs. Overall acceptance rate was classified as "good" by 72% of HCWs after 2 weeks use. Of all HCWs included, 9.3% stated that the use of the alcoholic solution worsened minor pre-existing skin conditions. Although the regular use of hygienic soap and water handwashing procedures is the gold standard, the use of alcoholic solutions is effective and safe and deserves more attention, especially in situations in which the handwashing compliance rate is hampered by architectural problems (lack of sinks) or nursing work overload.

Variability in the performance of preventive services and in the degree of control of identified health problems: A primary care study protocol

PubMed Central

Bolíbar, Bonaventura; Pareja, Clara; Astier-Peña, M Pilar; Morán, Julio; Rodríguez-Blanco, Teresa; Rosell-Murphy, Magdalena; Iglesias, Manuel; Juncosa, Sebastián; Mascort, Juanjo; Violan, Concepció; Magallón, Rosa; Apezteguia, Javier

2008-01-01

Background Preventive activities carried out in primary care have important variability that makes necessary to know which factors have an impact in order to establish future strategies for improvement. The present study has three objectives: 1) To describe the variability in the implementation of 7 preventive services (screening for smoking status, alcohol abuse, hypertension, hypercholesterolemia, obesity, influenza and tetanus immunization) and to determine their related factors; 2) To describe the degree of control of 5 identified health problems (smoking, alcohol abuse, hypertension, hypercholesterolemia and obesity); 3) To calculate intraclass correlation coefficients. Design Multi-centered cross-sectional study of a randomised sample of primary health care teams from 3 regions of Spain designed to analyse variability and related factors of 7 selected preventive services in years 2006 and 2007. At the end of 2008, we will perform a cross-sectional study of a cohort of patients attended in 2006 or 2007 to asses the degree of control of 5 identified health problems. All subjects older than16 years assigned to a randomised sample of 22 computerized primary health care teams and attended during the study period are included in each region providing a sample with more than 850.000 subjects. The main outcome measures will be implementation of 7 preventive services and control of 5 identified health problems. Furthermore, there will be 3 levels of data collection: 1) Patient level (age, gender, morbidity, preventive services, attendance); 2) Health-care professional level (professional characteristics, years working at the team, workload); 3) Team level (characteristics, electronic clinical record system). Data will be transferred from electronic clinical records to a central database with prior encryption and dissociation of subject, professional and team identity. Global and regional analysis will be performed including standard analysis for primary health care teams and health-care professional level. Linear and logistic regression multilevel analysis adjusted for individual and cluster variables will also be performed. Variability in the number of preventive services implemented will be calculated with Poisson multilevel models. Team and health-care professional will be considered random effects. Intraclass correlation coefficients, standard error and variance components for the different outcome measures will be calculated. PMID:18691407

Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure.

PubMed

Ali, Shehzad; Cookson, Richard; Dusheiko, Mark

2017-03-01

Health Insurance (HI) programmes in low-income countries aim to reduce the burden of out-of-pocket (OOP) health care expenditure. However, if the decisions to purchase insurance and to seek care when ill are correlated with the expected health care expenditure, the use of naïve regression models may produce biased estimates of the impact of insurance membership on OOP expenditure. Whilst many studies in the literature have accounted for the endogeneity of the insurance decision, the potential selection bias due to the care-seeking decision has not been taken into account. We extend the Heckman selection model to account simultaneously for both care-seeking and insurance-seeking selection biases in the health care expenditure regression model. The proposed model is illustrated in the context of a Vietnamese HI programme using data from a household survey of 1,192 individuals conducted in 1999. Results were compared with those of alternative econometric models making no or partial allowance for selection bias. In this illustrative example, the impact of insurance membership on reducing OOP expenditures was underestimated by 21 percentage points when selection biases were not taken into account. We believe this is an important methodological contribution that will be relevant to future empirical work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Attitudes Toward Spirituality and Spiritual Care among Iranian Nurses and Nursing Students: A Cross-Sectional Study.

PubMed

Babamohamadi, Hassan; Ahmadpanah, Mahsa-Sadat; Ghorbani, Raheb

2017-08-22

Addressing spiritual needs is taken into account as an integral part of holistic health care and also an important component of nursing practice. The aim of present study is to evaluate attitudes toward spirituality and spiritual care among nurses and nursing students at Semnan University of Medical Sciences in Iran. In this cross-sectional study, all nurses (n = 180) working in the teaching hospitals affiliated to Semnan University of Medical Sciences as well as senior nursing students (n = 50) selected by the census method. Finally, 168 individuals meeting the inclusion criteria were evaluated as the study sample. The data collection instrument was the Spirituality and Spiritual Care Rating Scale. The mean and standard deviation scores of attitudes toward spirituality and spiritual care among nurses and nursing students were 59 ± 10.9, and the scores obtained by the majority of study population (64.3%) ranged between 32 and 62 which were at a moderate and relatively desirable level. Nurses and nursing students working in aforementioned hospitals reported positive attitudes to spirituality and spiritual care. Given the importance of spiritual care and also the moderate level of spirituality and spiritual care among nurses and nursing students in this study, institutionalization of the concept of spirituality, provision of an appropriate context to deliver such care, and also implementation of interventions in order to improve spiritual care along with other nursing skills were assumed of utmost importance.

Role of the Internet in Care Initiation by People Living With HIV.

PubMed

Perazzo, Joseph; Haas, Stephen; Webel, Allison; Voss, Joachim

2017-02-01

People frequently use the internet to obtain information, including information about health, but we lack understanding of how people living with HIV (PLHIV) use the internet in their care and treatment decisions. In this secondary analysis, interviews with 23 individuals who initiated HIV care at an urban, Midwestern medical center and mentioned internet use were analyzed using qualitative content analysis to explore how they used the internet during the process of initiating HIV care. HIV care had been initiated by this sample from less than one month to three years post-diagnosis. Participants discussed the internet as a source of information about their diagnosis that influenced their care and treatment decisions. Five themes were predominant: (i) The internet alerted me to the possibility of HIV, (ii) the internet showed me a solution is available, (iii) the internet influenced my decisions about care, (iv) the internet empowered me to participate in my treatment decisions, and (v) the internet gave me hope for my future. The results suggest that the internet has the potential to provide information that can profoundly influence PLHIVs' acceptance of care and treatment decisions. Clinicians face a new reality in which patients use internet resources to obtain information and shape opinions about HIV treatment and care initiation decision-making. Guiding PLHIV in their selection of online resources is one approach to educating and empowering individuals as they cope with their diagnosis and contemplate decisions regarding HIV care and treatment. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Assessing the quality of reproductive health services in Egypt via exit interviews.

PubMed

Zaky, Hassan H M; Khattab, Hind A S; Galal, Dina

2007-05-01

This study assesses the quality of reproductive health services using client satisfaction exit interviews among three groups of primary health care units run by the Ministry of Health and Population of Egypt. Each group applied a different model of intervention. The Ministry will use the results in assessing its reproductive health component in the health sector reform program, and benefits from the strengths of other models of intervention. The sample was selected in two stages. First, a stratified random sampling procedure was used to select the health units. Then the sample of female clients in each health unit was selected using the systematic random approach, whereby one in every two women visiting the unit was approached. All women in the sample coming for reproductive health services were included in the analysis. The results showed that reproductive health beneficiaries at the units implementing the new health sector reform program were more satisfied with the quality of services. Still there were various areas where clients showed significant dissatisfaction, such as waiting time, interior furnishings, cleanliness of the units and consultation time. The study showed that the staff of these units did not provide a conductive social environment as other interventions did. A significant proportion of women expressed their intention to go to private physicians owing to their flexible working hours and variety specializations. Beneficiaries were generally more satisfied with the quality of health services after attending the reformed units than the other types of units, but the generalization did not fully apply. Areas of weakness are identified.

THE DETECTION AND STATISTICS OF GIANT ARCS BEHIND CLASH CLUSTERS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, Bingxiao; Zheng, Wei; Postman, Marc

We developed an algorithm to find and characterize gravitationally lensed galaxies (arcs) to perform a comparison of the observed and simulated arc abundance. Observations are from the Cluster Lensing And Supernova survey with Hubble (CLASH). Simulated CLASH images are created using the MOKA package and also clusters selected from the high-resolution, hydrodynamical simulations, MUSIC, over the same mass and redshift range as the CLASH sample. The algorithm's arc elongation accuracy, completeness, and false positive rate are determined and used to compute an estimate of the true arc abundance. We derive a lensing efficiency of 4 ± 1 arcs (with length ≥6″ andmore » length-to-width ratio ≥7) per cluster for the X-ray-selected CLASH sample, 4 ± 1 arcs per cluster for the MOKA-simulated sample, and 3 ± 1 arcs per cluster for the MUSIC-simulated sample. The observed and simulated arc statistics are in full agreement. We measure the photometric redshifts of all detected arcs and find a median redshift z{sub s} = 1.9 with 33% of the detected arcs having z{sub s} > 3. We find that the arc abundance does not depend strongly on the source redshift distribution but is sensitive to the mass distribution of the dark matter halos (e.g., the c–M relation). Our results show that consistency between the observed and simulated distributions of lensed arc sizes and axial ratios can be achieved by using cluster-lensing simulations that are carefully matched to the selection criteria used in the observations.« less

Five years' experience of classical swine fever polymerase chain reaction ring trials in France.

PubMed

Po, F; Le Dimna, M; Le Potier, M F

2011-12-01

Since 2004, the French National Reference Laboratory for classical swine fever (CSF) has conducted an annual proficiency test (PT) to evaluate the ability of local veterinary laboratories to perform real-time polymerase chain reaction (PCR) for CSF virus. The results of five years of testing (2004-2008) are described here. The PT was conducted under blind conditions on 20 samples. The same batch of samples was used for all five years. The number of laboratories that analysed the samples increased from four in 2004 to 13 in 2008. The results of the PT showed the following: cross-contamination between samples and deficiencies in RNA preparation can occur even in experienced laboratories; sample homogeneity should be checked carefully before selection; samples stored at-80 degrees C for several years remain stable; and poor shipment conditions do not damage the samples with regard to detection of CSF virus genome. These results will enable redesign of the panel to improve the overall quality of the PT, which will encourage laboratories to check and improve their PCR procedures and expertise. This is an excellent way to determine laboratory performance.

Unstable and Multiple Child Care Arrangements and Young Children’s Behavior

PubMed Central

Pilarz, Alejandra Ros; Hill, Heather D.

2015-01-01

Growing evidence suggests that child care instability is associated with child behavior problems, but existing studies confound different types of instability; use small, convenience samples; and/or control insufficiently for selection into child care arrangements. This study uses survey and calendar data from the Fragile Families and Child Well-Being Study to estimate the associations between three different types of child care instability—long-term instability, multiplicity, and the use of back-up arrangements—and children’s internalizing, externalizing, and prosocial behaviors at age 3, controlling for a large number of child and family background characteristics. Long-term instability between birth and age 3, as measured in both the survey and calendar data, is associated with higher levels of externalizing behavior problems. Current multiplicity at age 3 (as measured by survey data) is associated with higher levels of both externalizing and internalizing behavior problems, but stable multiplicity over time (as measured using calendar data) is not. Finally, the use of back-up arrangements at age 3 is associated with higher levels of internalizing behaviors. We find no consistent differences in these results by the timing of instability, child gender, family income, or type of care. PMID:25635158

Relationship of nurses' intrapersonal characteristics with work performance and caring behaviors: A cross-sectional study.

PubMed

Geyer, Nelouise-Marié; Coetzee, Siedine K; Ellis, Suria M; Uys, Leana R

2018-02-28

This study aimed to describe intrapersonal characteristics (professional values, personality, empathy, and job involvement), work performance as perceived by nurses, and caring behaviors as perceived by patients, and to examine the relationships among these variables. A cross-sectional design was employed. A sample was recruited of 218 nurses and 116 patients in four private hospitals and four public hospitals. Data were collected using self-report measures. Data analysis included descriptive statistics, exploratory and confirmatory factor analyses, hierarchical linear modelling, correlations, and structural equation modeling. Nurses perceived their work performance to be of high quality. Among the intrapersonal characteristics, nurses had high scores for professional values, and moderately high scores for personality, empathy and job involvement. Patients perceived nurses' caring behaviors as moderately high. Professional values of nurses were the only selected intrapersonal characteristic with a statistically significant positive relationship, of practical importance, with work performance as perceived by nurses and with caring behaviors as perceived by patients at ward level. Managers can enhance nurses' work performance and caring behaviors through provision of in-service training that focuses on development of professional values. © 2018 John Wiley & Sons Australia, Ltd.

Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment.

PubMed

Boamah, Sheila

2018-03-01

Background While improving patient safety requires strong nursing leadership, there has been little empirical research that has examined the mechanisms by which leadership influences patient safety outcomes. Aim To test a model examining relationships among transformational leadership, structural empowerment, staff nurse clinical leadership, and nurse-assessed adverse patient outcomes. Methods A cross-sectional survey was conducted with a randomly selected sample of 378 registered nurses working in direct patient care in acute care hospitals across Ontario, Canada. Structural equation modeling was used to test the hypothesized model. Results The model had an acceptable fit, and all paths were significant. Transformational leadership was significantly associated with decreased adverse patient outcomes through structural empowerment and staff nurse clinical leadership. Discussion This study highlights the importance of transformational leadership in creating empowering practice environments that foster high-quality care. The findings indicate that a more complete understanding of what drives desired patient outcomes warrants the need to focus on how to empower nurses and foster clinical leadership practices at the point of care. Conclusion In planning safety strategies, managers must demonstrate transformational leadership behaviors in order to modify the work environment to create better defenses for averting adverse events.

Leukodepletion as a Point-of-Care Method for Monitoring HIV-1 Viral Load in Whole Blood

PubMed Central

Titchmarsh, Logan; Zeh, Clement; Verpoort, Thierry; Allain, Jean-Pierre

2014-01-01

In order to limit the interference of HIV-1 cellular nucleic acids in estimating viral load (VL), the feasibility of leukodepletion of a small whole-blood (WB) volume to eliminate only leukocyte cell content was investigated, using a selection of filters. The efficacy of leukocyte filtration was evaluated by counting, CD45 quantitative PCR, and HIV-1 DNA quantification. Plasma HIV-1 was tested by real-time reverse transcription (RT)-PCR. A specific, miniaturized filter was developed and tested for leukocyte and plasma virus retention, WB sample dilution, and filtration parameters in HIV-1-spiked WB samples. This device proved effective to retain >99.9% of white blood cells in 100 μl of WB without affecting plasma VL. The Samba sample preparation chemistry was adapted to use a leukodepleted WB sample for VL monitoring using the point-of-care Samba-1 semiautomated system. The clinical performance of the assay was evaluated by testing 207 consecutive venous EDTA WB samples from HIV-1-infected patients attending a CD4 testing clinic. Most patients were on antiretroviral treatment (ART), but their VL status was unknown. Compared to the Roche Cobas AmpliPrep/Cobas TaqMan HIV-1 test, the new Samba assay had a concordance of 96.5%. The use of the Samba system with a VL test for WB might contribute to HIV-1 ART management and reduce loss-to-follow-up rates in resource-limited settings. PMID:25428162

Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

PubMed Central

Poortaghi, Sarieh; Salsali, Mahvash; Ebadi, Abbas; Rahnavard, Zahra; Maleki, Farzaneh

2015-01-01

Background: Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives: This study aimed to audit nursing care based on a nursing process model. Patients and Methods: This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses’ compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests. Results: The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses’ age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001). Conclusions: Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools. PMID:26576448

Influence knowledge and behavior of TB medical personnels’ concordance principle based communications skill at primary healthcare, Medan, Indonesia

NASA Astrophysics Data System (ADS)

Wahyuni, A. S.; Soeroso, N. N.; Alona, I.; Yunanda, Y.; Siregar, I.

2018-03-01

Concordance behavior of TB management is a form of collaboration among doctors, personnel, and patients in treating TB. Approvalamong them could be achieved if credibility and policy occur. This study is aimed to analyze the influence of TB medical personnel’s concordance behaviour principle to patient obedience at primary health care in Medan.The design of this study was quasi experimental, focusing on interventional primary health care, which is those who applied concordance behaviour principle to non-interventionalprimary health care. The population is TB patients, starting from 18 years old, TB category I with positive Acid Fast Bacilli Smear Test (AFBST), and taking TB regimens at Medan. Seventy- four patients were selected to be samples. They had undergone interview based on validated concordance principle, knowledge, behavior, and treatment. Data were analyzed using chi- square. The percentage of knowledge, behavior of TB patient to the treatment is higher on interventional primary health care than noninterventional ones. Treatment awareness based on concordance principle is expected to planish DOTS-based TB programs.

[Factor analysis and internal consistency of pedagogical practices questionnaire among health care teachers].

PubMed

Pérez V, Cristhian; Vaccarezza G, Giulietta; Aguilar A, César; Coloma N, Katherine; Salgado F, Horacio; Baquedano R, Marjorie; Chavarría R, Carla; Bastías V, Nancy

2016-06-01

Teaching practice is one of the most complex topics of the training process in medicine and other health care careers. The Teaching Practices Questionnaire (TPQ) evaluates teaching skills. To assess the factor structure and internal consistency of the Spanish version of the TPP among health care teachers. The TPQ was answered by 315 university teachers from 13 of the 15 administrative Chilean regions, who were selected through a non-probabilistic volunteer sampling. The internal consistency of TPP factors was calculated and the correlation between them was analyzed. Six factors were identified: Student-centered teaching, Teaching planning, Assessment process, Dialogue relationship, Teacher-centered teaching and Use of technological resources. They had Cronbach alphas ranging from 0.60 to 0.85. The factorial structure of TPQ differentiates the most important functions of teaching. It also shows a theoretical consistency and a practical relevance to perform a diagnosis and continuous evaluation of teaching practices. Additionally, it has an adequate internal consistency. Thus, TPQ is valid and reliable to evaluate pedagogical practices in health care careers.

The life-world of mothers who care for mentally retarded children: the Katutura township experience.

PubMed

Ntswane, A M; van Rhyn, L

2007-03-01

This article reports on a research study done in Katutura Township, near Windhoek. A qualitative, exploratory, descriptive and contextual design was followed to answer the research question investigating experiences of mothers caring for mentally retarded children at home. Phenomenological interviews were conducted with a purposefully selected sample of twelve mothers. The meaning of their experiences was analysed by using Teschxs method (1990 in Creswell, 1994:155) of analysing qualitative data. The results indicated various emotions and challenges experienced by these mothers during the care of their children. Feelings of shock, despondency and sadness dominated the early stages when the retarded children were still young. During later years, as the children were growing up, the mothers felt shame, fear, frustration, anger, disappointment and worry. However, acceptance followed, as the children grew older. Stigma seemed to affect all the respondents. Support in any form or lack thereof seemed to be the decisive factor-positioning mothers along a continuum of two extremes, namely despairing isolation and integrated happiness. Recommendations were made regarding the improvement of heath care services and education of the mothers and their families.

Impact of emerging health insurance arrangements on diabetes outcomes and disparities: rationale and study design.

PubMed

Wharam, J Frank; Soumerai, Steve; Trinacty, Connie; Eggleston, Emma; Zhang, Fang; LeCates, Robert; Canning, Claire; Ross-Degnan, Dennis

2013-01-01

Consumer-directed health plans combine lower premiums with high annual deductibles, Internet-based quality-of-care information, and health savings mechanisms. These plans may encourage members to seek better value for health expenditures but may also decrease essential care. The expansion of high-deductible health plans (HDHPs) represents a natural experiment of tremendous proportion. We designed a pre-post, longitudinal, quasi-experimental study to determine the effect of HDHPs on diabetes quality of care, outcomes, and disparities. We will use a 13-year rolling sample (2001-2013) of members of an HDHP and members of a control group. To reduce selection bias, we will limit participants to those whose employers mandate a single health insurance type. The study will measure rates of monthly hemoglobin A1c, lipid, and albuminuria testing; availability of blood glucose test strips; and rates of retinal examinations, high-severity emergency department visits, and preventable hospitalizations. Results could be used to design health plan features that promote high-quality care and better outcomes among people who have diabetes.

Acceptance of selective contracting: the role of trust in the health insurer

PubMed Central

2013-01-01

Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting. Methods An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Results Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. Conclusion This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop. PMID:24083663

Acceptance of selective contracting: the role of trust in the health insurer.

PubMed

Bes, Romy E; Wendel, Sonja; Curfs, Emile C; Groenewegen, Peter P; de Jong, Judith D

2013-10-02

In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees' trust in the health insurer on their acceptance of selective contracting. An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. This study provides insight into factors that influence people's acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.

Prevalence of Unmet Health Care needs and description of health care-seeking behavior among displaced people after the 2007 California wildfires.

PubMed

Jenkins, J Lee; Hsu, Edbert B; Sauer, Lauren M; Hsieh, Yu-Hsiang; Kirsch, Thomas D

2009-06-01

The southern California wildfires in autumn 2007 resulted in widespread disruption and one of the largest evacuations in the state's history. This study aims to identify unmet medical needs and health care-seeking patterns as well as prevalence of acute and chronic disease among displaced people following the southern California wildfires. These data can be used to increase the accuracy, and therefore capacity, of the medical response. A team of emergency physicians, nurses, and epidemiologists conducted surveys of heads of households at shelters and local assistance centers in San Diego and Riverside counties for 3 days beginning 10 days postdisaster. All households present in shelters on the day of the survey were interviewed, and at the local assistance centers, a 2-stage sampling method was used that included selecting a sample size proportionate to the number of registered visits to that site compared with all sites followed by a convenience sampling of people who were not actively being aided by local assistance center personnel. The survey covered demographics; needs following the wildfires (shelter, food, water, and health care); acute health symptoms; chronic health conditions; access to health care; and access to prescription medications. Among the 175 households eligible, 161 (92.0%) households participated. Within the 47 households that reported a health care need since evacuation, 13 (27.7%) did not receive care that met their perceived need. Need for prescription medication was reported by 47 (29.2%) households, and 20 (42.6%) of those households did not feel that their need for prescription medication had been met. Mental health needs were reported by 14 (8.7%) households with 7 of these (50.0%) reporting unmet needs. At least 1 family member per household left prescription medication behind during evacuation in 46 households (28.6%), and 1 family member in 48 households (29.8%) saw a health care provider since their evacuation. Most people sought care at a clinic (24, 50.0%) or private doctor (11, 22.9%) as opposed to an emergency department (6, 12.5%). A significant portion of the households reported unmet health care needs during the evacuations of the southern California wildfires. The provision of prescription medication and mental health services were the most common unmet need. In addition, postdisaster disease surveillance should include outpatient and community clinics, given that these were the most common treatment centers for the displaced population.

Knowledge of Vaccination Needs of HIV-Infected Men Who Have Sex with Men in a National Sample of "Gay Friendly" Health care Providers.

PubMed

Blackwell, Christopher W

2016-09-01

The purpose of this study was to assess knowledge levels regarding vaccination needs of healthy, HIV-infected (with CD4 counts >200 cells/mm(3) ) men who have sex with men (MSM) in a national sample of "gay friendly" health providers. Participants (n = 92) were sent a demographic questionnaire and case vignette asking for correct identification of vaccine needs of an HIV-infected MSM with a CD4 count >200 cells/mm(3) . Participants were recruited from the Gay and Lesbian Medical Association's Health Provider Index. Descriptive statistics and Fisher's exact test were used to answer the research questions and define the sample. The vast majority of the sample (n = 83; 90%) misidentified correct vaccine needs of and/or selected inappropriate vaccines for the HIV-infected MSM. Greater familiarity with the CDC Adult Vaccination Schedule (p = .027), practice specialization (p = .004), and administration of vaccinations within location of practice (p = .009) were associated with greater knowledge of the patient's vaccine needs. Health care providers who prescribe vaccines to HIV-infected MSM need more education regarding their vaccine needs. Nurses can reduce disparities in HIV-infected MSM by advocating for vaccination and augmenting providers' comprehension of vaccine needs of this population. © 2016 Wiley Periodicals, Inc.

Galaxy And Mass Assembly (GAMA): the mass-metallicity relationship

NASA Astrophysics Data System (ADS)

Foster, C.; Hopkins, A. M.; Gunawardhana, M.; Lara-López, M. A.; Sharp, R. G.; Steele, O.; Taylor, E. N.; Driver, S. P.; Baldry, I. K.; Bamford, S. P.; Liske, J.; Loveday, J.; Norberg, P.; Peacock, J. A.; Alpaslan, M.; Bauer, A. E.; Bland-Hawthorn, J.; Brough, S.; Cameron, E.; Colless, M.; Conselice, C. J.; Croom, S. M.; Frenk, C. S.; Hill, D. T.; Jones, D. H.; Kelvin, L. S.; Kuijken, K.; Nichol, R. C.; Owers, M. S.; Parkinson, H. R.; Pimbblet, K. A.; Popescu, C. C.; Prescott, M.; Robotham, A. S. G.; Lopez-Sanchez, A. R.; Sutherland, W. J.; Thomas, D.; Tuffs, R. J.; van Kampen, E.; Wijesinghe, D.

2012-11-01

Context. The mass-metallicity relationship (MMR) of star-forming galaxies is well-established, however there is still some disagreement with respect to its exact shape and its possible dependence on other observables. Aims: We measure the MMR in the Galaxy And Mass Assembly (GAMA) survey. We compare our measured MMR to that measured in the Sloan Digital Sky Survey (SDSS) and study the dependence of the MMR on various selection criteria to identify potential causes for disparities seen in the literature. Methods: We use strong emission line ratio diagnostics to derive oxygen abundances. We then apply a range of selection criteria for the minimum signal-to-noise in various emission lines, as well as the apparent and absolute magnitude to study variations in the inferred MMR. Results: The shape and position of the MMR can differ significantly depending on the metallicity calibration and selection used. After selecting a robust metallicity calibration amongst those tested, we find that the mass-metallicity relation for redshifts 0.061 ≲ z ≲ 0.35 in GAMA is in reasonable agreement with that found in the SDSS despite the difference in the luminosity range probed. Conclusions: In view of the significant variations of the MMR brought about by reasonable changes in the sample selection criteria and method, we recommend that care be taken when comparing the MMR from different surveys and studies directly. We also conclude that there could be a modest level of evolution over 0.06 ≤ z ≤ 0.35 within the GAMA sample.

Predictors of Public Early Care and Education Use among Children of Low-Income Immigrants

PubMed Central

Johnson, Anna D.; Padilla, Christina; Votruba-Drzal, Elizabeth

2017-01-01

Little is known about predictors of publicly funded early care and education (ECE) use among low-income children of immigrants. Without this knowledge, it is difficult to effectively increase participation in these public programs, which promote school readiness but are underused by children of immigrants. Using nationally representative data from the Early Childhood Longitudinal Study -Birth Cohort (ECLS-B), this study attempts to identify pertinent family, child, maternal ECE preference, broader contextual, and immigrant specific characteristics predictive of ECE use among 4-year old children in a sample of low-income children of immigrants (N ≈ 1,050). Specifically, we estimate multinomial logistic regression models predicting type of ECE (Head Start, public pre-k, subsidized ECE, unsubsidized ECE, parental care) from these characteristics. Findings suggest that even in a low-income sample, correlates of disadvantage such as low maternal education and prior receipt of public benefits are important predictors of public ECE use, as are maternal preferences for certain features of care and supply-side factors such as ECE availability. Immigrant-specific factors such as English proficiency, citizenship status, availability of non-English speaking caregivers, and generosity of state policies toward immigrants emerged as particularly salient for explaining the public ECE selection patterns of low-income immigrants. Results point to future research areas and potential policy solutions aimed at increasing public ECE use for children who may stand to benefit the most. PMID:28966423

A mixed-methods analysis of patient reviews of hospital care in England: implications for public reporting of health care quality data in the United States.

PubMed

Lagu, Tara; Goff, Sarah L; Hannon, Nicholas S; Shatz, Amy; Lindenauer, Peter K

2013-01-01

In the United States patients have limited opportunities to read and write narrative reviews about hospitals. In contrast, the National Health Service (NHS) in England encourages patients to provide feedback to hospitals on their quality-reporting website, NHS Choices. The scope and content of the narrative feedback was studied. All NHS hospitals with more than 10 reviews posted on NHS Choices were included in a cross-sectional mixed-methods (qualitative and quantitative) analysis of patients' reviews of 20 randomly selected hospitals. The final sample consisted of 264 hospitals and 2,640 patient responses to structured questions. All 200 reviews from the 20 hospitals randomly selected were subjected to further quantitative and qualitative analysis. Comments about clinicians and staff were common (179 [90%]) and overwhelmingly positive, with 149 (83%) favorable to workers. In 124 (62%) of the 200 reviews, patients commented on technical aspects of hospital care, including quality of care, injuries, errors, and incorrect medical record or discharge documentation. Perceived medical errors were described in 51 (26%) hospital reviews. Comments about the hospital facility appeared in half (52%) of reviews, describing hospital cleanliness, food, parking, and amenities. Hospitals replied to 56% of the patient reviews. NHS Choices represents the first government-run initiative that enables any patient to provide narrative feedback about hospital care. Reviews appear to have similar domains to those covered in existing satisfaction surveys but also include detailed feedback that would be unlikely to be revealed by such surveys. Online narrative reviews can therefore provide useful and complementary information to consumers (patients) and hospitals, particularly when combined with systematically collected patient experience data.

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme

PubMed Central

Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU

2013-01-01

Background: The increasing importance of the concept of patients’ satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. Aim: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. Subject and Methods: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient–staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. Results: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient–staff relationship (3.9), patient–staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). Conclusion: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status. PMID:23634326

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme.

PubMed

Iloh, Gup; Ofoedu, Jn; Njoku, Pu; Okafor, Goc; Amadi, An; Godswill-Uko, Eu

2013-01-01

The increasing importance of the concept of patients' satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient-staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient-staff relationship (3.9), patient-staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.

Mental health care treatment initiation when mental health services are incorporated into primary care practice.

PubMed

Kessler, Rodger

2012-01-01

Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice. Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem. In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment. When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the findings persist across the different offices suggests that this model of care may contain elements that improve the longstanding problem of poor treatment initiation rates when primary care physicians refer patients for outpatient behavioral health services.

Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi, Kenya.

PubMed

Cohen, Jessica; Golub, Ginger; Kruk, Margaret E; McConnell, Margaret

2016-11-01

Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these "active" patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the "slums" of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Development and validation of a questionnaire assessing the perceived control in health care among older adults with care needs in the Netherlands.

PubMed

Claassens, L; Terwee, C B; Deeg, D J H; Broese van Groenou, M I; Widdershoven, G A M; Huisman, M

2016-04-01

In response to the increased emphasis placed on older people's self-reliance in many welfare societies, we aimed to develop and validate a measurement instrument, assessing perceived control in health care among older adults with care needs. The target group consists of older people who live (semi-)independently and use professional health care, with or without informal care. Phase I (development) of the study consisted of the construction of the instrument based on the input from a variety of stakeholders. Phase II (validation) entailed a quantitative study in a sample of 247 respondents selected from the Longitudinal Aging Study Amsterdam, to assess the instrument's construct validity (structural validity and hypotheses testing) and reliability (internal consistency). The questionnaire consists of 29 items, related to organizing professional care, communication with care professionals, health management in the home situation, planning (more) complex care in the future, and perceived support from the social network. Based on a factor analysis, we identified three subscales: (I.) 'perceived personal control in health care'; (II.) 'anticipated personal control regarding future health care'; and (III.) 'perceived support from the social network,' with internal consistencies varying from Cronbach's α = .71 to .90. Factor I was associated with mastery, self-efficacy, self-esteem (r = .31-.35) and factor III with social loneliness (r = -.42). Factor II correlated less strongly with mastery, self-efficacy, and self-esteem (r < .30). Our questionnaire revealed sufficient construct validity and internal consistency. The instrument provides a basis for further quantitative research regarding control, especially in relation to health care-related outcomes.

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

PubMed

Weiner, B J; Alexander, J A

1993-08-01

We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.

Phenotyping of subjects for large scale studies on patients with IBS.

PubMed

Boeckxstaens, G E; Drug, V; Dumitrascu, D; Farmer, A D; Hammer, J; Hausken, T; Niesler, B; Pohl, D; Pojskic, L; Polster, A; Simren, M; Goebel-Stengel, M; Van Oudenhove, L; Vassallo, M; Wensaas, K-A; Aziz, Q; Houghton, L A

2016-08-01

Irritable bowel syndrome (IBS) is a complex condition with multiple factors contributing to its aetiology and pathophysiology. Aetiologically these include genetics, life-time events and environment, and physiologically, changes in motility, central processing, visceral sensitivity, immunity, epithelial permeability and gastrointestinal microflora. Such complexity means there is currently no specific reliable biomarker for IBS, and thus IBS continues to be diagnosed and classified according to symptom based criteria, the Rome Criteria. Carefully phenotyping and characterisation of a 'large' pool of IBS patients across Europe and even the world however, might help identify sub-populations with accuracy and consistency. This will not only aid future research but improve tailoring of treatment and health care of IBS patients. The aim of this position paper is to discuss the requirements necessary to standardize the process of selecting and phenotyping IBS patients and how to organise the collection and storage of patient information/samples in such a large multi-centre pan European/global study. We include information on general demographics, gastrointestinal symptom assessment, psychological factors, quality of life, physiological evaluation, genetic/epigenetic and microbiota analysis, biopsy/blood sampling, together with discussion on the organisational, ethical and language issues associated with implementing such a study. The proposed approach and documents selected to be used in such a study was the result of a thoughtful and thorough four-year dialogue amongst experts associated with the European COST action BM1106 GENIEUR (www.GENIEUR.eu). © 2016 John Wiley & Sons Ltd.

Early Discharge and Home Care After Unplanned Cesarean Birth: Nursing Care Time

PubMed Central

Brooten, Dorothy; Knapp, Helen; Borucki, Lynne; Jacobsen, Barbara; Finkler, Steven; Arnold, Lauren; Mennuti, Michael

2013-01-01

Objective This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. Design A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. Setting An urban tertiary-care hospital. Patients The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborns was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Interventions Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Outcome Measure Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. Results More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Conclusions Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group. PMID:8892128

Veterans Affairs Geriatric Scholars Program: Enhancing Existing Primary Care Clinician Skills in Caring for Older Veterans.

PubMed

Kramer, B Josea; Creekmur, Beth; Howe, Judith L; Trudeau, Scott; Douglas, Joseph R; Garner, Kimberly; Bales, Connie; Callaway-Lane, Carol; Barczi, Steven

2016-11-01

The Veterans Affairs Geriatric Scholars Program (GSP) is a continuing professional development program to integrate geriatrics into the clinical practices of primary care providers and select associated health professions that support primary care teams. GSP uses a blended program educational format, and the minimal requirements are to attend an intensive course in geriatrics, participate in an interactive workshop on quality improvement (QI), and initiate a local QI project to demonstrate application of new knowledge to benefit older veterans. Using a retrospective post/pre survey design, the effect of GSP on clinical practices and behaviors and variation of that effect on clinicians working in rural and nonrural settings were evaluated. Significant improvement was found in the frequency of using evidence-based brief standardized assessments, clinical decision-making, and standards of care. Significant subgroup differences were observed in peer-to-peer information sharing between rural and nonrural clinicians. Overall, 77% of the sample reported greater job satisfaction after participating in GSP. The program is a successful model for advancing postgraduate education in geriatrics and a model that might be replicated to increase access to quality health care, particularly in rural areas. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention.

PubMed

Benjamin, Sara E; Ammerman, Alice; Sommers, Janice; Dodds, Janice; Neelon, Brian; Ward, Dianne S

2007-01-01

To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care. Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers. Child care centers in 8 counties across North Carolina. A convenience sample of 19 child care centers (15 intervention and 4 comparison). Intervention centers completed the self-assessment instrument at baseline and then selected 3 environmental improvements to make over the 6-month intervention period with assistance from a trained NAP SACC Consultant. Changes in pre- and post-intervention self-assesment of the nutrition and physical activity child care environment with additional process measures to evaluate project implementation, feasibility and acceptability. Comparison of pre- and post-test scores for the intervention group using a Wilcoxon signed-rank test and descriptions of environmental changes. Intervention centers rated themselves higher at follow-up than at baseline, and relative to comparison centers, reported a variety of environmental nutrition and physical activity improvements confirmed by research staff. The NAP SACC pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings. Additional evaluation of the project is needed using a greater number of centers and a more objective outcome measure.

Effect of the essentials of critical care orientation (ECCO) program on the development of nurses' critical thinking skills.

PubMed

Kaddoura, Mahmoud A

2010-09-01

It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe and effective care to patients with complex and variable needs in ever-changing clinical environments. To date, very few studies have been conducted to examine how nursing orientation programs develop the critical thinking skills of novice critical care nurses. Strikingly, no research studies could be found about the American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO) program and specifically its effect on the development of nurses' critical thinking skills. This study explored the perceptions of new graduate nurses regarding factors that helped to develop their critical thinking skills throughout their 6-month orientation program in the intensive care unit. A convenient non-probability sample of eight new graduates was selected from a hospital that used the ECCO program. Data were collected with demographic questionnaires and semi-structured interviews. An exploratory qualitative research method with content analysis was used to analyze the data. The study findings showed that new graduate nurses perceived that they developed critical thinking skills that improved throughout the orientation period, although there were some challenges in the ECCO program. This study provides data that could influence the development and implementation of future nursing orientation programs. Copyright 2010, SLACK Incorporated.

Novel capsule phase microextraction in combination with liquid chromatography-tandem mass spectrometry for determining personal care products in environmental water.

PubMed

Lakade, Sameer S; Borrull, Francesc; Furton, Kenneth G; Kabir, Abuzar; Marcé, Rosa Maria; Fontanals, Núria

2018-05-01

A novel sample preparation technique named capsule phase microextraction (CPME) is presented here. The technique utilizes a miniaturized microextraction capsule (MEC) as the extraction medium. The MEC consists of two conjoined porous tubular polypropylene membranes, one of which encapsulates the sorbent through sol-gel technology, while the other encapsulates a magnetic metal rod. As such, MEC integrates both the extraction and stirring mechanisms into a single device. The aim of this article is to demonstrate the application potential of CPME as sample preparation technique for the extraction of a group of personal care products (PCPs) from water matrices. Among the different sol-gel sorbent materials (UCON ® , poly(caprolactone-dimethylsiloxane-caprolactone) (PCAP-DMS-CAP) and Carbowax 20M (CW-20M)) evaluated, CW-20M MEC demonstrated the best extraction performance for the selected PCPs. The extraction conditions for sol-gel CW-20M MEC were optimized, including sample pH, stirring speed, addition of salt, extraction time, sample volume, liquid desorption solvent, and time. Under the optimal conditions, sol-gel CW-20M MEC provided recoveries, ranging between 47 and 90% for all analytes, except for ethylparaben, which showed a recovery of 26%. The method based on CPME with sol-gel CW-20M followed by liquid chromatography-tandem mass spectrometry was developed and validated for the extraction of PCPs from river water and effluent wastewater samples. When analyzing different environmental samples, some analytes such as 2,4-dihydroxybenzophenone, 2,2-dihydroxy-4-4 methoxybenzophenone and 3-benzophenone were found at low ng L -1 .

Costs of health care across primary care models in Ontario.

PubMed

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the traditional FFS model, despite higher primary care costs in some models.

Patterns of antibacterials use in intensive care units.

PubMed

Santos, Edilson Floriano Dos; Lauria-Pires, Liana

2010-06-01

To know and compare the patterns of antimicrobials use in intensive care units (ICUs) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system. a prospective cohort study was conducted in three medical-surgical intensive care units, two of them in public hospitals and one in a private hospital. Simple random, independent samples of patients admitted from 10/2004 to 09/2005 to the selected intensive care units were used. The antibiotics use was assessed using the ATC/DDD system. The amount of antibacterials used in each intensive care unit, in grams, was transformed in daily defined dose (DDD). The number of DDDs was divided by the number of patient-days, multiplied by one thousand, to obtain the average density of consumption (DC) per thousand patient-days (DDD1000). 1,728 patients-days and 2,918.6 DDDs were examined in the three intensive care units, corresponding to an average density of consumption of 1,689.0 DDD1000. The median number of DDDs of antibiotics use in the public hospitals’ intensive care units was significantly higher (p=0.002) versus the private hospital’s intensive care unit. The consumption of antibiotics in the private hospital’s intensive care unit (DC=2,191.7 DDD1000) was significantly higher (p<0.001) versus the intensive care units of public hospitals (1,499.5 DDD1000). The most used antibiotics groups in the three intensive care units were 3rd generation cephalosporins, penicillins/betalactamases inhibitors, carbapenems and fluorquinolones. The pattern of antibiotics use in the three examined intensive care units was not uniform. The private hospital’s intensive care unit used a significantly larger amount versus the public hospitals’ intensive care units. Nevertheless, the most used antibiotics groups were similar in the three intensive care units.

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China.

PubMed

Wang, Hong; Zhang, Licheng; Yip, Winnie; Hsiao, William

2006-09-01

This study examines adverse selection in a subsidized voluntary health insurance scheme, the Rural Mutual Health Care (RMHC) scheme, in a poor rural area of China. The study was made possible by a unique longitudinal data set: the total sample includes 3492 rural residents from 1020 households. Logistic regression was employed for the data analysis. The results show that although this subsidized scheme achieved a considerable high enrollment rate of 71% of rural residents, adverse selection still exists. In general, individuals with worse health status are more likely to enroll in RMHC than individuals with better health status. Although the household is set as the enrollment unit for the RMHC for the purpose of reducing adverse selection, nearly 1/3 of enrolled households are actually only partially enrolled. Furthermore, we found that adverse selection mainly occurs in partially enrolled households. The non-enrolled individuals in partially enrolled households have the best health status, while the enrolled individuals in partially enrolled households have the worst health status. Pre-RMHC, medical expenditure for enrolled individuals in partially enrolled households was 206.6 yuan per capita per year, which is 1.7 times as much as the pre-RMHC medical expenditure for non-enrolled individuals in partially enrolled households. The study also reveals that the pre-enrolled medical expenditure per capita per year of enrolled individuals was 9.6% higher than the pre-enrolled medical expenditure of all residents, including both enrolled and non-enrolled individuals. In conclusion, although the subsidized RMHC scheme reached a very high enrollment rate and the household is set as the enrollment unit for the purpose of reducing adverse selection, adverse selection still exists, especially within partially enrolled households. Voluntary RMHC will not be financially sustainable if the adverse selection is not fully taken into account.

Midwives' experiences of managing women in labour in the Limpopo Province of South Africa.

PubMed

Maputle, S M; Hiss, D C

2010-09-01

The objective of this study was to explore and describe the experiences of midwives managing women during labour at a tertiary care hospital in the Limpopo Province. An exploratory, descriptive, contextual and inductive design was applied to this qualitative research study. Purposive sampling was used to select midwives who were working in the childbirth unit and had managed women during labour. A sample of 12 midwives participated in this study. Data were collected by means of unstructured individual interviews and analysed through an open coding method by the researchers and the independent co-coder. Categories identified were lack of mutual participation and responsibility sharing, dependency and lack of decision-making, lack of information-sharing, empowering autonomy and informed choices opportunities, lack of open communication and listening, non-accommodative midwifery actions, and lack of human and material infrastructure. To ensure the validity of the results, criteria to measure trustworthiness were utilized. This study has implications for woman-centered care by midwives managing women in labour and provides appropriate guidelines that should be integrated into the Batho-Pele Principles.

Comparison of rapid diagnostic tests for the detection of Plasmodium vivax malaria in South Korea.

PubMed

Kim, Jung-Yeon; Ji, So-Young; Goo, Youn-Kyoung; Na, Byoung-Kuk; Pyo, Hyo-Joo; Lee, Han-Na; Lee, Juyoung; Kim, Nam Hee; von Seidlein, Lorenz; Cheng, Qin; Cho, Shin-Hyung; Lee, Won-Ja

2013-01-01

South Korea is one of many countries with endemic Plasmodium vivax malaria. Here we report the evaluation of four rapid diagnostic tests (RDTs) for diagnosis of this disease. A total of 253 subjects were enrolled in the study. The sensitivities, specificities and agreement frequencies were estimated by comparing the four RDTs against the standard of nested-PCR and microscopic examination. The CareStart(TM) and SD Bioline had higher test sensitivities (99.4 and 98.8%, respectively) compared with the NanoSign and Asan Easy tests (93.0 and 94.7%, respectively). The CareStart(TM) and SD Bioline tests could detect P. vivax in samples with parasite densities <150/μl, which was a slightly better performance than the other two RDTs. The quantitative accuracy of the four RDTs was also estimated by comparing results with P. vivax counts from blood samples. Lower test price would result in increased use of these RDTs in the field. The results of this study contribute valuable information that will aid in the selection of a diagnostic method for the detection of malaria.

Comparison of Rapid Diagnostic Tests for the Detection of Plasmodium vivax Malaria in South Korea

PubMed Central

Goo, Youn-Kyoung; Na, Byoung-Kuk; Pyo, Hyo-Joo; Lee, Han-Na; Lee, Juyoung; Kim, Nam Hee; von Seidlein, Lorenz; Cheng, Qin; Cho, Shin-Hyung; Lee, Won-Ja

2013-01-01

South Korea is one of many countries with endemic Plasmodium vivax malaria. Here we report the evaluation of four rapid diagnostic tests (RDTs) for diagnosis of this disease. A total of 253 subjects were enrolled in the study. The sensitivities, specificities and agreement frequencies were estimated by comparing the four RDTs against the standard of nested-PCR and microscopic examination. The CareStartTM and SD Bioline had higher test sensitivities (99.4 and 98.8%, respectively) compared with the NanoSign and Asan Easy tests (93.0 and 94.7%, respectively). The CareStartTM and SD Bioline tests could detect P. vivax in samples with parasite densities <150/μl, which was a slightly better performance than the other two RDTs. The quantitative accuracy of the four RDTs was also estimated by comparing results with P. vivax counts from blood samples. Lower test price would result in increased use of these RDTs in the field. The results of this study contribute valuable information that will aid in the selection of a diagnostic method for the detection of malaria. PMID:23667710

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

PubMed

Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

2018-04-06

Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

Cost-effectiveness implications based on a comparison of nursing home and home health case mix.

PubMed Central

Kramer, A M; Shaughnessy, P W; Pettigrew, M L

1985-01-01

Case-mix differences between 653 home health care patients and 650 nursing home patients, and between 455 Medicare home health patients and 447 Medicare nursing home patients were assessed using random samples selected from 20 home health agencies and 46 nursing homes in 12 states in 1982 and 1983. Home health patients were younger, had shorter lengths of stay, and were less functionally disabled than nursing home patients. Traditional long-term care problems requiring personal care were more common among nursing home patients, whereas problems requiring skilled nursing services were more prevalent among home health patients. Considering Medicare patients only, nursing home patients were much more likely to be dependent in activities of daily living (ADLs) than home health patients. Medicare nursing home and home health patients were relatively similar in terms of long-term care problems, and differences in medical problems were less pronounced than between all nursing home and all home health patients. From the standpoint of cost-effectiveness, it would appear that home health care might provide a substitute for acute care hospital use at the end of a hospital stay, and appears to be a more viable option in the care of patients who are not severely disabled and do not have profound functional problems. The Medicare skilled nursing facility, however, is likely to continue to have a crucial role in posthospital care as the treatment modality of choice for individuals who require both highly skilled care and functional assistance. PMID:3932258

Association between prenatal care utilization and risk of preterm birth among Chinese women.

PubMed

Zhang, Bin; Yang, Rong; Liang, Sheng-Wen; Wang, Jing; Chang, Jen Jen; Hu, Ke; Dong, Guang-Hui; Hu, Rong-Hua; Flick, Louise H; Zhang, Yi-Ming; Zhang, Dan; Li, Qing-Jie; Zheng, Tong-Zhang; Xu, Shun-Qing; Yang, Shao-Ping; Qian, Zheng-Min

2017-08-01

It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization (PCU) and preterm birth (PTB), and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System (EPHCIS) and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization (APNCU) index. Logistic regression models were used to estimate odds ratios (OR) and the 95% confidence interval (95% CI). Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695 (10.5%) women experienced inadequate prenatal care, and 5131 (77.1%) received adequate plus prenatal care. Inadequate PCU was associated with PTB (adjusted OR: 1.41, 95% CI: 1.32-1.84); the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.

[Introduction of rapid syphilis and HIV testing in prenatal care in Colombia: qualitative analysis].

PubMed

Ochoa-Manjarrés, María Teresa; Gaitán-Duarte, Hernando Guillermo; Caicedo, Sidia; Gómez, Berta; Pérez, Freddy

2016-12-01

Interpret perceptions of Colombian health professionals concerning factors that obstruct and facilitate the introduction of rapid syphilis and HIV testing in prenatal care services. A qualitative study based on semi-structured interviews was carried out. A convenience sample was selected with 37 participants, who included health professionals involved in prenatal care services, programs for pregnant women, clinical laboratories, and directors of health care units or centers, as well as representatives from regional departments and the Ministry of Health. Colombia does not do widespread screening with rapid syphilis and HIV tests in prenatal care. The professionals interviewed stated they did not have prior experience in the use of rapid tests-except for laboratory staff-or in the course of action in response to a positive result. The insurance system hinders access to timely diagnosis and treatment. Health authorities perceive a need to review existing standards, strengthen the first level of care, and promote comprehensive prenatal care starting with contracts between insurers and health service institutional providers. Participants recommended staff training and integration between health-policymaking and academic entities for updating training programs. The market approach and the characteristics of the Colombian health system constitute the main barriers to implementation of rapid testing as a strategy for elimination of mother-to-child transmission of syphilis and HIV. Measures identified include making changes in contracts between insurers and health service institutional providers, adapting the timing and duration of prenatal care procedures, and training physicians and nurses involved in prenatal care.

Quantifying the demand for hospital care services: a time and motion study.

PubMed

van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T

2015-01-22

The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.

Stress and Burnout in Health-Care Workers after the 2009 L’Aquila Earthquake: A Cross-Sectional Observational Study

PubMed Central

Mattei, Antonella; Fiasca, Fabiana; Mazzei, Mariachiara; Necozione, Stefano; Bianchini, Valeria

2017-01-01

Burnout is a work-related mental health impairment, which is now recognized as a real problem in the context of the helping professions due to its adverse health outcomes on efficiency. To our knowledge, the literature on the postdisaster scenario in Italy is limited by a focus on mental health professionals rather than other health-care workers. Our cross-sectional study aims to evaluate the prevalence of burnout and psychopathological distress in different categories of health-care workers, i.e., physicians, nurses, and health-care assistants, working in different departments of L’Aquila St. Salvatore General Hospital 6 years after the 2009 earthquake in order to prevent and reduce work-related burnout. With a two-stage cluster sampling, a total of 8 departments out of a total of 28 departments were selected and the total sample included 300 health-care workers. All the participants completed the following self-reporting questionnaires: a sociodemographic data form, a Maslach Burnout Inventory and a General Health Questionnaire 12 Items (GHQ-12). Statistically significant differences emerged between the total scores of the GHQ-12: post hoc analysis showed that the total average scores of the GHQ-12 were significantly higher in doctors than in health-care assistants. A high prevalence of burnout among doctors (25.97%) emerged. Using multivariate analysis, we identified a hostile relationship with colleagues, direct exposure to the L’Aquila earthquake and moderate to high levels of distress as being burnout predictors. Investigating the prevalence of burnout and distress in health-care staff in a postdisaster setting and identifying predictors of burnout development such as stress levels, time-management skills and work-life balance will contribute to the development of preventative strategies and better organization at work with a view to improving public health efficacy and reducing public health costs, given that these workers live in the disaster-affected community as survivors and serve as disaster relief workers at the same time. PMID:28659831

Stress and Burnout in Health-Care Workers after the 2009 L'Aquila Earthquake: A Cross-Sectional Observational Study.

PubMed

Mattei, Antonella; Fiasca, Fabiana; Mazzei, Mariachiara; Necozione, Stefano; Bianchini, Valeria

2017-01-01

Burnout is a work-related mental health impairment, which is now recognized as a real problem in the context of the helping professions due to its adverse health outcomes on efficiency. To our knowledge, the literature on the postdisaster scenario in Italy is limited by a focus on mental health professionals rather than other health-care workers. Our cross-sectional study aims to evaluate the prevalence of burnout and psychopathological distress in different categories of health-care workers, i.e., physicians, nurses, and health-care assistants, working in different departments of L'Aquila St. Salvatore General Hospital 6 years after the 2009 earthquake in order to prevent and reduce work-related burnout. With a two-stage cluster sampling, a total of 8 departments out of a total of 28 departments were selected and the total sample included 300 health-care workers. All the participants completed the following self-reporting questionnaires: a sociodemographic data form, a Maslach Burnout Inventory and a General Health Questionnaire 12 Items (GHQ-12). Statistically significant differences emerged between the total scores of the GHQ-12: post hoc analysis showed that the total average scores of the GHQ-12 were significantly higher in doctors than in health-care assistants. A high prevalence of burnout among doctors (25.97%) emerged. Using multivariate analysis, we identified a hostile relationship with colleagues, direct exposure to the L'Aquila earthquake and moderate to high levels of distress as being burnout predictors. Investigating the prevalence of burnout and distress in health-care staff in a postdisaster setting and identifying predictors of burnout development such as stress levels, time-management skills and work-life balance will contribute to the development of preventative strategies and better organization at work with a view to improving public health efficacy and reducing public health costs, given that these workers live in the disaster-affected community as survivors and serve as disaster relief workers at the same time.

A tale of two audits: statistical process control for improving diabetes care in primary care settings.

PubMed

Al-Hussein, Fahad Abdullah

2008-01-01

Diabetes constitutes a major burden of disease globally. Both primary and secondary prevention need to improve in order to face this challenge. Improving management of diabetes in primary care is therefore of fundamental importance. The objective of these series of audits was to find means of improving diabetes management in chronic disease mini-clinics in primary health care. In the process, we were able to study the effect and practical usefulness of different audit designs - those measuring clinical outcomes, process of care, or both. King Saud City Family and Community Medicine Centre, Saudi National Guard Health Affairs in Riyadh city, Saudi Arabia. Simple random samples of 30 files were selected every two weeks from a sampling frame of file numbers for all diabetes clients seen over the period. Information was transferred to a form, entered on the computer and an automated response was generated regarding the appropriateness of management, a criterion mutually agreed upon by care providers. The results were plotted on statistical process control charts, p charts, displayed for all employees. Data extraction, archiving, entry, analysis, plotting and design and preparation of p charts were managed by nursing staff specially trained for the purpose by physicians with relevant previous experience. Audit series with mixed outcome and process measures failed to detect any changes in the proportion of non-conforming cases over a period of one year. The process measures series, on the other hand, showed improvement in care corresponding to a reduction in the proportion non-conforming by 10% within a period of 3 months. Non-conformities dropped from a mean of 5.0 to 1.4 over the year (P < 0.001). It is possible to improve providers' behaviour regarding implementation of given guidelines through periodic process audits and feedbacks. Frequent process audits in the context of statistical process control should be supplemented with concurrent outcome audits, once or twice a year.

“I Wasted 3 Years, Thinking It’s Not a Problem”: Patient and Health System Delays in Diagnosis of Leprosy in India: A Mixed-Methods Study

PubMed Central

Govindarajulu, Srinivas; Isaakidis, Petros; Shewade, Hemant Deepak; Rokade, Vasudev; Singh, Rajbir; Kamble, Sanjeev

2017-01-01

Background Worldwide, leprosy is one of the major causes of preventable disability. India contributes to 60% of global leprosy burden. With increasing numbers of leprosy with grade 2 disability (visible disability) at diagnosis, we aimed to determine risk factors associated with grade 2 disability among new cases and explore patients and providers’ perspectives into reasons for late presentation. Methodology/Principal Findings This was an explanatory mixed-methods study where the quantitative component, a matched case-control design, was followed by a qualitative component. A total of 70 cases (grade 2 disability) and 140 controls (grade 0) matched for age and sex were randomly sampled from new patients registered between January 2013-January 2015 in three districts of Maharashtra (Mumbai, Thane and Amaravati) and interviewed using a structured close ended questionnaire. Eight public health care providers involved in leprosy care and 7 leprosy patients were purposively selected (maximum variation sampling) and interviewed using a structured open-ended interview schedule. Among cases, overall median (IQR) diagnosis delay in months was 17.9(7–30); patient and health system delay was 7(4–16.5) and 5.5(0.9–12.5) respectively; this was significantly higher than the delay in controls. Reasons for delayed presentation identified by the quantitative and qualitative data were: poor awareness of leprosy symptoms, first health care provider visited being private practitioners who were not aware about provision of free leprosy treatment at public health care facilities, reduced engagement and capacity of the general health care system in leprosy control. Conclusions Raising awareness in communities and health care providers regarding early leprosy symptoms, engagement of private health care provider in early leprosy diagnosis and increasing capacity of general health system staff, especially targeting high endemic areas that are hotspots for leprosy transmission may help in reducing diagnosis delays. PMID:28081131

"I Wasted 3 Years, Thinking It's Not a Problem": Patient and Health System Delays in Diagnosis of Leprosy in India: A Mixed-Methods Study.

PubMed

Muthuvel, Thirumugam; Govindarajulu, Srinivas; Isaakidis, Petros; Shewade, Hemant Deepak; Rokade, Vasudev; Singh, Rajbir; Kamble, Sanjeev

2017-01-01

Worldwide, leprosy is one of the major causes of preventable disability. India contributes to 60% of global leprosy burden. With increasing numbers of leprosy with grade 2 disability (visible disability) at diagnosis, we aimed to determine risk factors associated with grade 2 disability among new cases and explore patients and providers' perspectives into reasons for late presentation. This was an explanatory mixed-methods study where the quantitative component, a matched case-control design, was followed by a qualitative component. A total of 70 cases (grade 2 disability) and 140 controls (grade 0) matched for age and sex were randomly sampled from new patients registered between January 2013-January 2015 in three districts of Maharashtra (Mumbai, Thane and Amaravati) and interviewed using a structured close ended questionnaire. Eight public health care providers involved in leprosy care and 7 leprosy patients were purposively selected (maximum variation sampling) and interviewed using a structured open-ended interview schedule. Among cases, overall median (IQR) diagnosis delay in months was 17.9(7-30); patient and health system delay was 7(4-16.5) and 5.5(0.9-12.5) respectively; this was significantly higher than the delay in controls. Reasons for delayed presentation identified by the quantitative and qualitative data were: poor awareness of leprosy symptoms, first health care provider visited being private practitioners who were not aware about provision of free leprosy treatment at public health care facilities, reduced engagement and capacity of the general health care system in leprosy control. Raising awareness in communities and health care providers regarding early leprosy symptoms, engagement of private health care provider in early leprosy diagnosis and increasing capacity of general health system staff, especially targeting high endemic areas that are hotspots for leprosy transmission may help in reducing diagnosis delays.

Some Insights into Analytical Bias Involved in the Application of Grab Sampling for Volatile Organic Compounds: A Case Study against Used Tedlar Bags

PubMed Central

Ghosh, Samik; Kim, Ki-Hyun; Sohn, Jong Ryeul

2011-01-01

In this study, we have examined the patterns of VOCs released from used Tedlar bags that were once used for the collection under strong source activities. In this way, we attempted to account for the possible bias associated with the repetitive use of Tedlar bags. To this end, we selected the bags that were never heated. All of these target bags were used in ambient temperature (typically at or below 30°C). These bags were also dealt carefully to avoid any mechanical abrasion. This study will provide the essential information regarding the interaction between VOCs and Tedlar bag materials as a potential source of bias in bag sampling approaches. PMID:22235175

Some insights into analytical bias involved in the application of grab sampling for volatile organic compounds: a case study against used Tedlar bags.

PubMed

Ghosh, Samik; Kim, Ki-Hyun; Sohn, Jong Ryeul

2011-01-01

In this study, we have examined the patterns of VOCs released from used Tedlar bags that were once used for the collection under strong source activities. In this way, we attempted to account for the possible bias associated with the repetitive use of Tedlar bags. To this end, we selected the bags that were never heated. All of these target bags were used in ambient temperature (typically at or below 30°C). These bags were also dealt carefully to avoid any mechanical abrasion. This study will provide the essential information regarding the interaction between VOCs and Tedlar bag materials as a potential source of bias in bag sampling approaches.

Solutions to health care waste: life-cycle thinking and "green" purchasing.

PubMed

Kaiser, B; Eagan, P D; Shaner, H

2001-03-01

Health care waste treatment is linked to bioaccumulative toxic substances, such as mercury and dioxins, which suggests the need for a new approach to product selection. To address environmental issues proactively, all stages of the product life cycle should be considered during material selection. The purchasing mechanism is a promising channel for action that can be used to promote the use of environmentally preferable products in the health care industry; health care facilities can improve environmental performance and still decrease costs. Tools that focus on environmentally preferable purchasing are now emerging for the health care industry. These tools can help hospitals select products that create the least amount of environmental pollution. Environmental performance should be incorporated into the evolving definition of quality for health care.

Towards linking patients and clinical information: detecting UMLS concepts in e-mail.

PubMed

Brennan, Patricia Flatley; Aronson, Alan R

2003-01-01

The purpose of this project is to explore the feasibility of detecting terms within the electronic messages of patients that could be used to effectively search electronic knowledge resources and bring health information resources into the hands of patients. Our team is exploring the application of the natural language processing (NLP) tools built within the Lister Hill Center at the National Library of Medicine (NLM) to the challenge of detecting relevant concepts from the Unified Medical Language System (UMLS) within the free text of lay people's electronic messages (e-mail). We obtained a sample of electronic messages sent by patients participating in a randomized field evaluation of an internet-based home care support service to the project nurse, and we subjected elements of these messages to a series of analyses using several vocabularies from the UMLS Metathesaurus and the selected NLP tools. The nursing vocabularies provide an excellent starting point for this exercise because their domain encompasses patient's responses to health challenges. In successive runs we augmented six nursing vocabularies (NANDA Nursing Diagnosis, Nursing Interventions Classification, Nursing Outcomes Classification, Home Health Classification, Omaha System, and the Patient Care Data Set) with selected sets of clinical terminologies (International Classification of Primary Care; International Classification of Primary Care- American English; Micromedex DRUGDEX; National Drug Data File; Thesaurus of Psychological Terms; WHO Adverse Drug Reaction Terminology) and then additionally with either Medical Subject Heading (MeSH) or SNOMED International terms. The best performance was obtained when the nursing vocabularies were complemented with selected clinical terminologies. These findings have implications not only for facilitating lay people's access to electronic knowledge resources but may also be of assistance in developing new tools to aid in linking free text (e.g., clinical notes) to lexically complex knowledge resources such as those emerging from the Human Genome Project.

[Gender analysis of primary care professionals' perceptions and attitudes to informal care].

PubMed

del Mar García-Calvente, María; del Río Lozano, María; Castaño López, Esther; Mateo Rodríguez, Inmaculada; Maroto Navarro, Gracia; Hidalgo Ruzzante, Natalia

2010-01-01

To analyze primary care professionals' perceptions and attitudes to informal care from a gender perspective. We performed a qualitative study using interviews and a discussion group. Eighteen primary care professionals were selected in the Health District of Grenada (Spain) by means of intentional sampling. Content analysis was performed with the following categories: a) perceptions: concepts of dependency and informal care, gender differences and impact on health, b) attitudes: not in favor of change, in favor of change and the right not to provide informal care. The health professionals emphasized the non-professional, free and strong emotional component of informal care. These professionals assigned the family (especially women) the main responsibility for caregiving and used stereotypes to differentiate between care provided by men and by women. The professionals agreed that women had a greater psychological burden associated with care, mainly because they more frequently provide caregiving on their own than men. Three major attitudes emerged among health professionals about informal care: those who did not question the current situation and idealized the family as the most appropriate framework for caregiving; those who proposed changes toward a more universal dependency system that would relieve families; and those who adopted an intermediate position, favoring education to achieve wellbeing in caregivers and prevent them from ceasing to provide care. We identified perceptions and attitudes that showed little sensitivity to gender equality, such as a conservative attitude that assigned the family the primary responsibility for informal care and some sexist stereotypes that attributed a greater ability for caregiving to women. Specific training in gender equality is required among health professionals to reduce inequalities in informal care. Copyright © 2009 SESPAS. Published by Elsevier Espana. All rights reserved.

The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

PubMed

Makhele, M F; Mulaudzi, F M

2012-01-01

The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.

Impact of long-term care insurance on institutional dementia care in Japan.

PubMed

Ito, Hiroto; Miyamoto, Yuki

2003-06-01

Japan started long-term care insurance for nursing and home help services in April 2000 to cope with growing medical expenditures for the population aged over 65. To study the impact of the new insurance on utilization of dementia care, we compared demographic and clinical characteristics including diagnosis, degree of disability and behavioral disturbance before and after the launch among people with dementia covered by either long-term care or medical insurance. The subjects of the study were randomly selected patients/residents of specialized dementia care units in both psychiatric hospitals and geriatric care facilities before (1145 patients/residents in early 2000) and after (262 for medical insurance and 205 for long-term care insurance in 2001) the new system was launched. Although patients/residents in 2000 and 2001 were similar as a whole, the 2001 sample showed differences between patients in each of the types of insurance systems. Logistic regression analysis revealed that patients/residents covered by long-term care insurance were significantly more likely to be females and require higher levels of care. Patients covered by long-term care insurance were significantly less likely to be transferred from a psychiatric department nor did they display behavioral disturbance or an inability to put out or deal with fire. These results suggest that health care facilities have shifted to the new insurance system for patients requiring higher levels of care but without behavioral disturbances as it was intended. On the other hand, there were policy concerns of that demented persons with moderate activities of daily living impairments and behavioral disturbances would be at risk being excluded from the long-term care scheme.

Quality geriatric care as perceived by nurses in long-term and acute care settings.

PubMed

Barba, Beth Ellen; Hu, Jie; Efird, Jimmy

2012-03-01

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings. Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide. Descriptive design. The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings. Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities. Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities. Modification of hospital geriatric practice environments and leadership commitment to evidence-based practice guidelines that promote autonomy and independence of patients and staff could improve acute care nurses' perceptions of quality of geriatric care. © 2011 Blackwell Publishing Ltd.

Nine centuries waiting: The experiences of Iranians surrogacy commissioning mothers

PubMed Central

Zandi, Mitra; Vanaki, Zohreh; Shiva, Marziyeh; Mohammadi, Eesa

2014-01-01

Background: There are a few studies about commissioning mothers’ understanding from the surrogacy during 9 months of waiting for delivery in Iran and other countries. This study was conducted with an aim to explore and explain the nature of concerns (experiences) of commissioning mothers. Materials and Methods: A qualitative design with a conventional content analysis approach was used to gather and analyze the experiences of commissioning mothers. They were selected from Royan Research Centre and other infertility centers in Iran. After purposive sampling for the selection of the participants, unstructured interviews were held for data collection. Twenty-four unstructured interviews were conducted with 12 commissioning mothers, 2 surrogate mothers, and 2 infertility center social workers who directly and continuously dealt with these mothers. Results: Two main themes emerged from the data analysis: 1. cultural dilemma (consisting of three subthemes: Social taboo, concerns about disclosure to others and the child, concerns about altering maternal and child's identity, and 2. uncertain waiting (consisting of three subthemes: Concerns about health of fetus and surrogate, concerns about an unfamiliar surrogate, and concerns about lack of preparation for maternal role). Conclusions: The study reveals the importance of maternal emotional care in this group and introduces a new arena for nurses’ activity. These findings help the mothers by nurses’ activities in health care clinics and anywhere they deliver nursing care. PMID:24949058

Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations.

PubMed

Fields, Dail; Riesenmy, Kelly; Blum, Terry C; Roman, Paul M

2015-11-01

This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act.

Beliefs about the causes of obesity in a national sample of 4th year medical students.

PubMed

Phelan, Sean M; Burgess, Diana J; Burke, Sara E; Przedworski, Julia M; Dovidio, John F; Hardeman, Rachel; Morris, Megan; van Ryn, Michelle

2015-11-01

Physician knowledge of the complex contributors to obesity varies. We do not know whether today's medical students are graduating with deep understanding of the causes of obesity. Our objective was to assess beliefs about causes of obesity in a national sample of 4th year medical students. We randomly selected 2000 4th year students from a random sample of 50 U.S. medical schools and asked them to rate the importance of several factors as causes of obesity. Of those invited, 1244 (62%) responded. We conducted latent class analysis to identify groups with similar response patterns. Most students demonstrated knowledge that obesity has multiple contributors. Students fell into 1 of 4 classes: (1) more likely to endorse all contributors (28%), (2) more likely to endorse physiological contributors (27%), (3) more likely to endorse behavioral or social contributors (24%), and (4) unlikely to endorse contributors outside of overeating and physical activity (22%). Though students were generally aware of multiple causes, there were 4 distinct patterns of beliefs, with implications for patient care. Targeted interventions may help to improve depth of knowledge about the causes of obesity and lead to more effective care for obese patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations

PubMed Central

Fields, Dail; Riesenmy, Kelly; Blum, Terry C.; Roman, Paul M.

2015-01-01

Objective: This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). Method: A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. Results: After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. Conclusions: From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act. PMID:26562603

Paying for Primary Care: The Factors Associated with Physician Self-selection into Payment Models.

PubMed

Rudoler, David; Deber, Raisa; Barnsley, Janet; Glazier, Richard H; Dass, Adrian Rohit; Laporte, Audrey

2015-09-01

To determine the factors associated with primary care physician self-selection into different payment models, we used a panel of eight waves of administrative data for all primary care physicians who practiced in Ontario between 2003/2004 and 2010/2011. We used a mixed effects logistic regression model to estimate physicians' choice of three alternative payment models: fee for service, enhanced fee for service, and blended capitation. We found that primary care physicians self-selected into payment models based on existing practice characteristics. Physicians with more complex patient populations were less likely to switch into capitation-based payment models where higher levels of effort were not financially rewarded. These findings suggested that investigations aimed at assessing the impact of different primary care reimbursement models on outcomes, including costs and access, should first account for potential selection effects. Copyright © 2015 John Wiley & Sons, Ltd.

Psychometric Properties of the Persian Version of Care Dependency Scale in Nursing Homes.

PubMed

Rajabi, Gholamreza; Namadmalan, Masoume; Dijkstra, Ate; Ghasemzade, Roya; Foroughan, Mahshid; Zahednejad, Shahla

The purpose of the study was to examine the psychometric properties of the Persian version of the Care Dependency Scale (CDS) in nursing homes. Instrument development. The English version of the CDS was translated into Persian. A convenience sample of 140 (100 older people without dementia and 40 patients with dementia) Persian-speaking people were selected from the nursing homes in Ahvaz, Iran. Cronbach's alpha, discriminant validity, and construct validity (exploratory factor analysis) were examined. Exploratory factor analysis indicated that the CDS has two factors, including psychosocial and somatic factors. Discriminant validity showed that the CDS can differentiate patients with dementia from the older adults without dementia. The results of the study showed that the Persian CDS is a reliable and valid scale when used in nursing homes. The Persian version of the CDS can help clinicians and nurses to assess patients' need and the degree of care dependency among older adults in Persian-speaking areas.

Predicting risk for medical malpractice claims using quality-of-care characteristics.

PubMed Central

Charles, S C; Gibbons, R D; Frisch, P R; Pyskoty, C E; Hedeker, D; Singha, N K

1992-01-01

The current fault-based tort system assumes that claims made against physicians are inversely related to the quality of care they provide. In this study we identified physician characteristics associated with elements of medical care that make physicians vulnerable to malpractice claims. A sample of physicians (n = 248) thought to be at high or low risk for claims was surveyed on various personal and professional characteristics. Statistical analysis showed that 9 characteristics predicted risk group. High risk was associated with increased age, surgical specialty, emergency department coverage, increased days away from practice, and the feeling that the litigation climate was "unfair." Low risk was associated with scheduling enough time to talk with patients, answering patients' telephone calls directly, feeling "satisfied" with practice arrangements, and acknowledging greater emotional distress. Prediction was more accurate for physicians in practice 15 years or less. We conclude that a relationship exists between a history of malpractice claims and selected physician characteristics. PMID:1462538

Mental Health and Migration: Depression, Alcohol Abuse, and Access to Health Care among Migrants in Central Asia

PubMed Central

Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

2014-01-01

Background One fifth of Kazakhstan’s population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Methods Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N=450). We used survey logistic regression adjusted for clustering of workers within stalls. Results Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. Conclusions This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia. PMID:24186359

Influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria.

PubMed

Ajao, K O; Ojofeitimi, E O; Adebayo, A A; Fatusi, A O; Afolabi, O T

2010-12-01

Fertility pattern and reproductive behaviours affect infant death in Nigeria. Household food insecurity and poor care practices also place children at risk of morbidity and mortality. The objectives of this study were to assess the influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 423 mothers of under-five children and their children in the households selected through multistage sampling methods. Food-insecure households were five times more likely than secure households to have wasted children (crude OR = 5.707, 95 percent CI = 1.31-24.85). Children with less educated mothers were significantly more likely to be stunted. The prevalence of food insecurity among households in Ile-Ife was high. Households with food insecurity and less educated mothers were more likely to have malnourished children.

Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia.

PubMed

Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

2014-12-01

One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia.

Factors Affecting the Communication Competence in Iranian Nursing Students: A Qualitative Study

PubMed Central

Jouzi, Mina; Vanaki, Zohreh; Mohammadi, Easa

2015-01-01

Background: Communication competence in nursing students is one of the nursing education requirements, especially during the internship period, the final stage of the bachelor nursing education in Iran. Several factors can influence this competence and identifying them could help provide safe care by nursing students in the future. Objectives: This study aimed to investigate factors that influence nursing students' communication competence. Patients and Methods: A purposeful sampling technique was used to select 18 nursing students who had completed their internship. Semi-structured interviews were conducted and data were analyzed by the conventional qualitative content analysis method. Results: After data analysis, three main categories were achieved: organizational factors, humanistic factors and socio-cultural factors. The main and latent theme that affected the students' communication competence was not being accepted as a caregiver in the clinical environment. Conclusions: With regards to students not being accepted in health care environments, it is recommended to plan special programs for empowering students to acquire better social state and acceptance by the health care team. PMID:26019902

Professional responsibility and decision-making in the context of a disease-focused model of nursing care: The difficulties experienced by Spanish nurses.

PubMed

Rodrigo, Olga; Caïs, Jordi; Monforte-Royo, Cristina

2017-10-01

When, in 1977, nurse education in Spain was transferred to universities a more patient-centred, the Anglo-American philosophy of care was introduced into a context in which nurses had traditionally prioritised their technical skills. This paper examines the characteristics of the nurse's professional role in Spain, where the model of nursing practice has historically placed them in a position akin to that of physician assistants. The study design was qualitative and used the method of analytic induction. Participants were selected by means of theoretical sampling and then underwent in-depth interviews. The resulting material was analysed using an approach based on the principles of grounded theory. Strategies were applied to ensure the credibility, transferability, dependability and confirmability of the findings. The main conclusion is that nurses in Spain continue to work within a disease-focused model of care, making it difficult for them to take responsibility for decision-making. © 2017 John Wiley & Sons Ltd.

Strategies of organization and service for the critical-care laboratory.

PubMed

Fleisher, M; Schwartz, M K

1990-08-01

Critical-care medicine requires rapidity of treatment decisions and clinical management. To meet the objectives of critical-care medicine, the critical-care laboratory must consider four major aspects of laboratory organization in addition to analytical responsibilities: specimen collection and delivery, training of technologists, selection of reliable instrumentation, and efficient data dissemination. One must also consider the advantages and disadvantages of centralization vs decentralization, the influence of such a laboratory on patient care and personnel needs, and the space required for optimal operation. Centralization may lead to workflow interruption and increased turnaround time (TAT); decentralization requires redundancy of instrumentation and staff but may shorten TAT. Minimal TAT is the hallmark of efficient laboratory service. We surveyed 55 laboratories in 33 hospitals and found that virtually all hospitals with 200 or more beds had a critical-care laboratory operating as a satellite of the main laboratory. We present data on actual TAT, although these were available in only eight of the 15 routine laboratories that provided emergency service and in eight of the 40 critical-care laboratories. In meeting the challenges of an increasing workload, a reduced clinical laboratory work force, and the need to reduce TAT, changes in traditional laboratory practice are mandatory. An increased reliance on whole-blood analysis, for example, should eliminate delays associated with sample preparation, reduce the potential hazards associated with centrifugation, and eliminate excess specimen handling.

Intensity of interprofessional collaboration among intensive care nurses at a tertiary hospital.

PubMed

Serrano-Gemes, G; Rich-Ruiz, M

To measure the intensity of interprofessional collaboration (IPC) in nurses of an intensive care unit (ICU) at a tertiary hospital, to check differences between the dimensions of the Intensity of Interprofessional Collaboration Questionnaire, and to identify the influence of personal variables. A cross-sectional descriptive study was conducted with 63 intensive care nurses selected by simple random sampling. Explanatory variables: age, sex, years of experience in nursing, years of experience in critical care, workday type and work shift type; variable of outcome: IPC. The IPC was measured by: Intensity of Interprofessional Collaboration Questionnaire. Descriptive and bivariate statistical analysis (IPC and its dimensions with explanatory variables). 73.8% were women, with a mean age of 46.54 (±6.076) years. The average years experience in nursing and critical care was 23.03 (±6.24) and 14.25 (±8.532), respectively. 77% had a full time and 95.1% had a rotating shift. 62.3% obtained average IPC values. Statistically significant differences were found (P<.05) between IPC (overall score) and overall assessment with years of experience in critical care. This study shows average levels of IPC; the nurses with less experience in critical care obtained higher IPC and overall assessment scores. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Modeling efficiency at the process level: an examination of the care planning process in nursing homes.

PubMed

Lee, Robert H; Bott, Marjorie J; Gajewski, Byron; Taunton, Roma Lee

2009-02-01

To examine the efficiency of the care planning process in nursing homes. We collected detailed primary data about the care planning process for a stratified random sample of 107 nursing homes from Kansas and Missouri. We used these data to calculate the average direct cost per care plan and used data on selected deficiencies from the Online Survey Certification and Reporting System to measure the quality of care planning. We then analyzed the efficiency of the assessment process using corrected ordinary least squares (COLS) and data envelopment analysis (DEA). Both approaches suggested that there was considerable inefficiency in the care planning process. The average COLS score was 0.43; the average DEA score was 0.48. The correlation between the two sets of scores was quite high, and there was no indication that lower costs resulted in lower quality. For-profit facilities were significantly more efficient than not-for-profit facilities. Multiple studies of nursing homes have found evidence of inefficiency, but virtually all have had measurement problems that raise questions about the results. This analysis, which focuses on a process with much simpler measurement issues, finds evidence of inefficiency that is largely consistent with earlier studies. Making nursing homes more efficient merits closer attention as a strategy for improving care. Increasing efficiency by adopting well-designed, reliable processes can simultaneously reduce costs and improve quality.

Assessment of the quality of hospital care for children in Indonesia.

PubMed

Sidik, Nurul A; Lazuardi, Lilliana; Agung, Fransisca H; Pritasari, Kirana; Roespandi, Hanny; Setiawan, Tini; Pawitro, Udjiani; Nurhamzah, Waldi; Weber, Martin W

2013-04-01

To obtain an overview of the quality of care for children in Indonesia, by assessing hospitals with a view to proceed to a quality improvement mechanism for child care. Stratified two-stage random sampling in six regions identified 18 hospitals (provinces Jambi, East Java, Central Kalimantan, South-East Sulawesi, East Nusa Tenggara, North Maluku). Three randomly selected hospitals in each province were visited by trained assessors who scored each assessed service (expressed as a percentage of achievement) and grouped into good (≥ 80%), requiring improvement (60-79%) and urgently requiring improvement (< 60%). The overall median result score across all areas was 43% (IQR 28%-53%). Case management for common childhood illnesses had a median score of 37% (IQR18-43%), neonatal care 46% (IQR 26-57%) and patient monitoring 40% (IQR 30-50%), all indicating an urgent need for improvement. Qualitative data showed as main problems inadequate use of standard treatment guidelines, irrational prescribing of antibiotics, poor progress monitoring and poor supportive care. We found serious shortcomings in the quality of hospital care for children. Finding and documenting those is the first step in a quality improvement process. Work is needed to start an improvement cycle for hospital care. © 2013 Blackwell Publishing Ltd. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Assessing primary care data quality.

PubMed

Lim, Yvonne Mei Fong; Yusof, Maryati; Sivasampu, Sheamini

2018-04-16

Purpose The purpose of this paper is to assess National Medical Care Survey data quality. Design/methodology/approach Data completeness and representativeness were computed for all observations while other data quality measures were assessed using a 10 per cent sample from the National Medical Care Survey database; i.e., 12,569 primary care records from 189 public and private practices were included in the analysis. Findings Data field completion ranged from 69 to 100 per cent. Error rates for data transfer from paper to web-based application varied between 0.5 and 6.1 per cent. Error rates arising from diagnosis and clinical process coding were higher than medication coding. Data fields that involved free text entry were more prone to errors than those involving selection from menus. The authors found that completeness, accuracy, coding reliability and representativeness were generally good, while data timeliness needs to be improved. Research limitations/implications Only data entered into a web-based application were examined. Data omissions and errors in the original questionnaires were not covered. Practical implications Results from this study provided informative and practicable approaches to improve primary health care data completeness and accuracy especially in developing nations where resources are limited. Originality/value Primary care data quality studies in developing nations are limited. Understanding errors and missing data enables researchers and health service administrators to prevent quality-related problems in primary care data.