Iodine Status of Women of Reproductive Age in Sierra Leone and Its Association with Household Coverage with Adequately Iodized Salt

PubMed Central

Rohner, Fabian; Wirth, James P.; Woodruff, Bradley A.; Chiwile, Faraja; Yankson, Hannah; Sesay, Fatmata; Koroma, Aminata S.; Petry, Nicolai; Pyne-Bailey, Solade; Dominguez, Elisa; Kupka, Roland; Hodges, Mary H.; de Onis, Mercedes

2016-01-01

Salt iodization programs are a public health success in tackling iodine deficiency. Yet, a large proportion of the world’s population remains at risk for iodine deficiency. In a nationally representative cross-sectional survey in Sierra Leone, household salt samples and women’s urine samples were quantitatively analyzed for iodine content. Salt was collected from 1123 households, and urine samples from 817 non-pregnant and 154 pregnant women. Household coverage with adequately iodized salt (≥15 mg/kg iodine) was 80.7%. The median urinary iodine concentration (UIC) of pregnant women was 175.8 µg/L and of non-pregnant women 190.8 µg/L. Women living in households with adequately iodized salt had higher median UIC (for pregnant women: 180.6 µg/L vs. 100.8 µg/L, respectively, p < 0.05; and for non-pregnant women: 211.3 µg/L vs. 97.8 µg/L, p < 0.001). Differences in UIC by residence, region, household wealth, and women’s education were much smaller in women living in households with adequately iodized salt than in households without. Despite the high household coverage of iodized salt in Sierra Leone, it is important to reach the 20% of households not consuming adequately iodized salt. Salt iodization has the potential for increasing equity in iodine status even with the persistence of other risk factors for deficiency. PMID:26848685

Urinary iodine concentration identifies pregnant women as iodine deficient yet school-aged children as iodine sufficient in rural Niger.

PubMed

Hess, Sonja Y; Ouédraogo, Césaire T; Young, Rebecca R; Bamba, Ibrahim F; Stinca, Sara; Zimmermann, Michael B; Wessells, K Ryan

2017-05-01

To assess iodine status among pregnant women in rural Zinder, Niger and to compare their status with the iodine status of school-aged children from the same households. Seventy-three villages in the catchment area of sixteen health centres were randomly selected to participate in the cross-sectional survey. Salt iodization is mandatory in Niger, requiring 20-60 ppm iodine at the retail level. A spot urine sample was collected from randomly selected pregnant women (n 662) and one school-aged child from the same household (n 373). Urinary iodine concentration (UIC) was assessed as an indicator of iodine status in both groups. Dried blood spots (DBS) were collected from venous blood samples of pregnant women and thyroglobulin (Tg), thyroid-stimulating hormone and total thyroxine were measured. Iodine content of household salt samples (n 108) was assessed by titration. Median iodine content of salt samples was 5·5 ppm (range 0-41 ppm), 98 % had an iodine content 40 µg/l. In this region of Niger, most salt is inadequately iodized. UIC in pregnant women indicated iodine deficiency, whereas UIC of school-aged children indicated marginally adequate iodine status. Thus, estimating population iodine status based solely on monitoring of UIC among school-aged children may underestimate the risk of iodine deficiency in pregnant women.

Low Urinary Iodine Concentration among Mothers and Children in Cambodia

PubMed Central

Laillou, Arnaud; Sophonneary, Prak; Kuong, Khov; Hong, Rathavuth; Un, Samoeurn; Chamnan, Chhoun; Poirot, Etienne; Berger, Jacques; Wieringa, Frank

2016-01-01

A 2014 national assessment of salt iodization coverage in Cambodia found that 62% of samples were non-iodized, suggesting a significant decline in daily iodine intakes. The Cambodian Micronutrient Survey conducted in 2014 (CMNS-2014) permitted obtaining national data on urinary iodine concentrations (UIC) to assess iodine status and whether iodized salt use had an impact. Urine samples were collected from mothers (n = 736) and children (n = 950). The median UIC was 63 µg/L and 72 µg/L in mothers and children respectively. More than 60% of mothers and their children had a UIC < 100 µg/L, thereby indicating a serious public health problem. Iodine status was significantly lower among mothers and children living in rural areas, belonging to the poorest socioeconomic category, or living in a household not using iodized salt. The limited enforcement of the legislation for iodized salt has resulted in a major decrease in the prevalence of iodized salt, which in turn has compromised iodine status in Cambodia. It is essential for the government to enhance enforcement of the iodized salt legislation, and implement short term strategies, such as iodine supplementation, to prevent an increase of severe complications due to iodine deficiency in the Cambodian population. PMID:27058551

Perceptions and Impact of Mandatory eLearning for Foundation Trainee Doctors: A Qualitative Evaluation

PubMed Central

Brooks, Hannah L.; Vallance, Hannah K.; Hirsch, Christine A.; Hughes, Elizabeth; Ferner, Robin E.; Marriott, John F.; Coleman, Jamie J.

2016-01-01

Background Junior doctors in the UK must complete various educational components during their two year Foundation training programme. It is important that mandatory learning is informative and engaging. The aim of this study was to evaluate trainee doctors’ perceptions of a Technology Enhanced Learning (TEL) programme developed to improve prescribing competency. Method Focus groups and interviews were conducted at three hospital sites in the West Midlands. Codes, sub-themes and themes were determined using deductive and inductive thematic analysis. Results Data were collected from 38 Foundation trainee doctors. Results revealed major themes relating to prescribing education, the user experience and user engagement. Key findings included the positive impact of preparedness following undergraduate education on the user experience of the TEL programme at the postgraduate level; the impact of content, structure, and individual learning needs and styles on the user experience; and the impact of motivation and time on engagement. Most trainees engaged with the programme owing to its mandatory nature; however, some trainees also used the programme voluntarily, for example, to acquire knowledge prior to starting a new placement. Conclusions It is important to ensure that learners are willing to engage with mandatory TEL, and that they have the time and motivation to do so. It is also important to ensure that learners have a positive user experience and that in designing TEL individual differences in learning styles and needs are taken into account. These findings have implications for educators and system developers in the construction and design of mandatory eLearning programmes. PMID:28005938

Validation of spot-testing kits to determine iodine content in salt.

PubMed Central

Pandav, C. S.; Arora, N. K.; Krishnan, A.; Sankar, R.; Pandav, S.; Karmarkar, M. G.

2000-01-01

Iodine deficiency disorders are a major public health problem, and salt iodization is the most widely practised intervention for their elimination. For the intervention to be successful and sustainable, it is vital to monitor the iodine content of salt regularly. Iodometric titration, the traditional method for measuring iodine content, has problems related to accessibility and cost. The newer spot-testing kits are inexpensive, require minimal training, and provide immediate results. Using data from surveys to assess the availability of iodized salt in two states in India, Madhya Pradesh and the National Capital Territory of Delhi, we tested the suitability of such a kit in field situations. Salt samples from Delhi were collected from 30 schools, chosen using the Expanded Programme on Immunization (EPI) cluster sampling technique. A single observer made the measurement for iodine content using the kit. Salt samples from Madhya Pradesh were from 30 rural and 30 urban clusters, identified by using census data and the EPI cluster sampling technique. In each cluster, salt samples were collected from 10 randomly selected households and all retailers. The 15 investigators performing the survey estimated the iodine content of salt samples in the field using the kit. All the samples were brought to the central laboratory in Delhi, where iodine content was estimated using iodometric titration as a reference method. The agreement between the kit and titration values decreased as the number of observers increased. Although sensitivity was not much affected by the increase in the number of observers (93.3% for a single observer and 93.9% for multiple observers), specificity decreased sharply (90.4% for a single observer and 40.4% for multiple observers). Due to the low specificity and resulting high numbers of false-positives for the kit when used by multiple observers ("real-life situations"), kits were likely to consistently overestimate the availability of iodized salt. This overestimation could result in complacency. Therefore, we conclude that until a valid alternative is available, the titration method should be used for monitoring the iodine content of salt at all levels, from producer to consumer, to ensure effectiveness of the programme. PMID:10994281

saltPAD: A New Analytical Tool for Monitoring Salt Iodization in Low Resource Settings

PubMed Central

Myers, Nicholas M.; Strydom, Emmerentia Elza; Sweet, James; Sweet, Christopher; Spohrer, Rebecca; Dhansay, Muhammad Ali; Lieberman, Marya

2016-01-01

We created a paper test card that measures a common iodizing agent, iodate, in salt. To test the analytical metrics, usability, and robustness of the paper test card when it is used in low resource settings, the South African Medical Research Council and GroundWork performed independent validation studies of the device. The accuracy and precision metrics from both studies were comparable. In the SAMRC study, more than 90% of the test results (n=1704) were correctly classified as corresponding to adequately or inadequately iodized salt. The cards are suitable for market and household surveys to determine whether salt is adequately iodized. Further development of the cards will improve their utility for monitoring salt iodization during production. PMID:29942380

Performance of rapid test kits to assess household coverage of iodized salt.

PubMed

Gorstein, Jonathan; van der Haar, Frits; Codling, Karen; Houston, Robin; Knowles, Jacky; Timmer, Arnold

2016-10-01

The main indicator adopted to track universal salt iodization has been the coverage of adequately iodized salt in households. Rapid test kits (RTK) have been included in household surveys to test the iodine content in salt. However, laboratory studies of their performance have concluded that RTK are reliable only to distinguish between the presence and absence of iodine in salt, but not to determine whether salt is adequately iodized. The aim of the current paper was to examine the performance of RTK under field conditions and to recommend their most appropriate use in household surveys. Standard performance characteristics of the ability of RTK to detect the iodine content in salt at 0 mg/kg (salt with no iodine), 5 mg/kg (salt with any added iodine) and 15 mg/kg ('adequately' iodized salt) were calculated. Our analysis employed the agreement rate (AR) as a preferred metric of RTK performance. Setting/Subjects Twenty-five data sets from eighteen population surveys which assessed household iodized salt by both the RTK and a quantitative method (i.e. titration or WYD Checker) were obtained from Asian (nineteen data sets), African (five) and European (one) countries. In detecting iodine in salt at 0 mg/kg, the RTK had an AR>90 % in eight of twenty-three surveys, while eight surveys had an AR90 %. The RTK is not suited for assessment of adequately iodized salt coverage. Quantitative assessment, such as by titration or WYD Checker, is necessary for estimates of adequately iodized salt coverage.

Post-production losses in iodine concentration of salt hamper the control of iodine deficiency disorders: a case study in northern Ethiopia.

PubMed

Shawel, Dawit; Hagos, Seifu; Lachat, Carl K; Kimanya, Martin E; Kolsteren, Patrick

2010-06-01

Iodine is essential for good function of the thyroid, and its deficiency is of public-health importance in Ethiopia. Iodization of salt is an effective and sustainable strategy to prevent and control iodine deficiency in large populations. The effectiveness of salt-iodization programmes depends on the conservation of iodine concentration in salt at various stages of the supply-chain. The overall objective of the study was to assess the loss of iodine in salt from production to consumption and to estimate the proportion of adults, especially pregnant women, at risk of dietary iodine insufficiency. A cross-sectional study was conducted during February-April 2007 in northern Ethiopia. Iodine concentrations of salt samples from producers (n=41), retailers (n=7), and consumers (n=32) were determined using iodiometric titration. A risk assessment was conducted for dietary iodine insufficiency among adults, including pregnant women, using a semi-probabilistic approach. The concentration of iodine in the sampled salts decreased by 57% from the production site to the consumers. The assessment of exposure showed that adults in 63% (n=20) of the households, including 90% (n=29) with pregnant women, were at risk of insufficient iodine intake. A monitoring and evaluation system needs to be established to ensure adequate supply of iodine along the distribution chain. Special attention is needed for the retailers and consumers. At these levels, dissemination of information regarding proper storage and handling of iodized salt is necessary to address the reported loss of iodine from salt.

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys123

PubMed Central

Knowles, Jacky M; Garrett, Greg S; Gorstein, Jonathan; Kupka, Roland; Situma, Ruth; Yadav, Kapil; Yusufali, Rizwan; Pandav, Chandrakant; Aaron, Grant J

2017-01-01

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI). Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES). Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage. Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively). Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods. PMID:28404840

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys.

PubMed

Knowles, Jacky M; Garrett, Greg S; Gorstein, Jonathan; Kupka, Roland; Situma, Ruth; Yadav, Kapil; Yusufali, Rizwan; Pandav, Chandrakant; Aaron, Grant J

2017-05-01

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI). Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES). Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage. Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively). Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.

[Assessment of individual iodine intake by the adult population in the Potsdam region on the basis of sea fish and iodized salt consumption].

PubMed

Pfaff, G; Georg, T

1995-06-01

Iodized salt has a high acceptance in the Potsdam region: 82% of the interviewed people use iodized salt, 13% do not use it, and only 5% of the probands were not able to make any statements. The current average iodine intake for adults is 76 micrograms/day. Only 5% of the adult population has an iodine intake of more than 100 micrograms/day. An efficient elimination of iodine deficiency in Germany requires a broad usage of iodized salt in the food industry.

Successful implementation of the European Resuscitation Council basic life support course as mandatory peer-led training for medical students.

PubMed

Grove, Erik L; Løfgren, Bo

2014-04-01

We aimed to implement the European Resuscitation Council (ERC) basic life support (BLS) and automated external defibrillator (AED) course as a mandatory peer-led training programme for medical students and to evaluate the satisfaction with this course. Medical students certified as ERC BLS/AED instructors were recruited as student trainers and organizers of the course, which was included as a mandatory part of the curriculum for second-year medical students before first clinical rotation. After each course, questionnaires were distributed to evaluate the peer-led training programme. In total, 146 students were trained and assessed. The quality of the course was rated as 9.4±0.8 (10-point scale, 10 being best), and the majority (95%) felt better prepared for their clinical rotation. Implementation of the ERC BLS/AED course as a mandatory peer-led training programme for medical students is feasible. The course has been very well accepted and the students feel better prepared for their first clinical rotation.

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study.

PubMed

Kumma, Wondimagegn Paulos; Haji, Yusuf; Abdurahmen, Junayde; Mehretie Adinew, Yohannes

2018-01-01

Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000) was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD). The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97-7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD.

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study

PubMed Central

Abdurahmen, Junayde

2018-01-01

Background Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. Methods A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000) was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. Result The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD). The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97–7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. Conclusion This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD. PMID:29765978

21 CFR 100.155 - Salt and iodized salt.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Salt and iodized salt. 100.155 Section 100.155 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION GENERAL Specific Administrative Rulings and Decisions § 100.155 Salt and iodized salt. (a) For the purposes of this section, the...

Review of Iodine Nutrition in Iranian Population in the Past Quarter of Century.

PubMed

Delshad, Hossein; Azizi, Fereidoun

2017-10-01

Iodine deficiency is one of the most important health problems worldwide. The overall aim of this study was a narrative review of the past and present status of iodine nutrition in the Iranian population to gather and provide valuable background data in this field for future studies. For this narrative literature review study, published internal (SID, Iran doc, Iran medex) and international (Web of knowledge, Pubmed, SCOPUS) source studies were searched using the following medical subject heading terms: Iodine, IDD (iodine deficiency disorders), UIC (urinary iodine concentration), Goiter, IQ (intelligence quotient), thyroid hormone, Iodine and pregnancy, Iodine and breast feeding, as well as Iodized salt, reporting the prevalence of iodine deficiency and iodine nutrition status of different target populations in Iran over 25 years, between 1988 - 2014, were assessed. We found 185 abstracts by literature search, of which, 161 papers that were as case reports, animal study, with lack of regional or national data were excluded after full text evaluation. Finally 24 full papers covering regional or national data on iodine nutrition of the study population were eligible for our review. Iodine deficiency, as a nutritional problem, had been identified in Iran since 1968. In the years 1987 - 1989, a few studies were done to define the prevalence of iodine deficiency in the country. The first nation-wide survey was performed in 14 provinces. Based on this survey all provinces were suffering of endemic goiter. In 1989, iodine deficiency was recognized as a major problem for community health. In 1990, salt factories began to produce iodized salt and in 1996, the second national survey was performed in 26 provinces. This survey indicated that 40% of boys and 50% of girls have goiter, with a median urinary iodine excretion of 205 µg/L. The 3rd national survey in 2001 showed that the total goiter rate is 9.8% and median UIC of 165 μg/L. In 2007, the 3th national survey was conducted 17 years after iodized salt consumption by Iranian households. In this study the total goiter rate and median urinary iodine was 5.7% and 145 μg/L, respectively. The 5th national survey conducted in 2013, showed household consumption of iodized salt for all provinces was 98% and the median urinary iodine of school children was 161 μg/L. Following the 5th national survey, the 1st national survey of the iodine status and thyroid function of pregnant women, conducted in 10 provinces in the different region of the country, documented a median UIC for pregnant women of 87.3 µg/L, results of this national survey clarified that despite iodine sufficiency of school children in Iran, pregnant women have moderate iodine deficiency and need iodine supplementation. The success of iodine deficiency control program depends on well designed programmatic steps and mandatory iodized salt consumption in certain situations. The iodine intake of school children is sufficient, however, Iranian pregnant women are suffering from moderate iodine deficiency and need iodine supplementation.

Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India.

PubMed

Wirth, James P; Leyvraz, Magali; Sodani, Prahlad R; Aaron, Grant J; Sharma, Narottam D; Woodruff, Bradley A

2016-01-01

Food fortification is a cost-effective approach to prevent and control of micronutrient deficiencies in India. A cross-sectional survey of children 0-35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana was conducted to assess the coverage of adequately iodized salt and the potential for rice fortification. Salt samples were collected and tested for iodine concentration using iodometric titration. Information on demographics, household rice consumption, and Telangana's rice sector was collected and interpreted. In households of selected children, 79% of salt samples were found to be adequately iodized. Salt brand and district were significant predictors of inadequately iodized salt. Daily rice consumption among children and women averaged 122 grams and 321 grams per day, respectively. Approximately 28% of households reported consuming rice produced themselves or purchased from a local farmer, 65% purchased rice from a market or shop, 6% got rice from a public distribution system site, and 2% obtained it from a rice mill. In the catchment areas of Telangana's anganwadi centers, there is significant variation in the coverage of adequately iodized salt by district. Future surveys in Telangana should measure the coverage of salt iodization in the general population using quantitative methods. Nonetheless, increasing the adequacy of iodization of smaller salt manufacturers would help achieve universal salt iodization in Telangana. Despite high consumption of rice, our findings suggest that large-scale market-based rice fortification is not feasible in Telangana due to a large proportion of households producing their own rice and highly fragmented rice distribution. Distributing fortified rice via Telangana's public distribution system may be a viable approach to target low-income households, but would only reach a small proportion of the population in Telangana.

Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India

PubMed Central

Wirth, James P.; Leyvraz, Magali; Sodani, Prahlad R.; Aaron, Grant J.; Sharma, Narottam D.; Woodruff, Bradley A.

2016-01-01

Food fortification is a cost-effective approach to prevent and control of micronutrient deficiencies in India. A cross-sectional survey of children 0–35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana was conducted to assess the coverage of adequately iodized salt and the potential for rice fortification. Salt samples were collected and tested for iodine concentration using iodometric titration. Information on demographics, household rice consumption, and Telangana’s rice sector was collected and interpreted. In households of selected children, 79% of salt samples were found to be adequately iodized. Salt brand and district were significant predictors of inadequately iodized salt. Daily rice consumption among children and women averaged 122 grams and 321 grams per day, respectively. Approximately 28% of households reported consuming rice produced themselves or purchased from a local farmer, 65% purchased rice from a market or shop, 6% got rice from a public distribution system site, and 2% obtained it from a rice mill. In the catchment areas of Telangana’s anganwadi centers, there is significant variation in the coverage of adequately iodized salt by district. Future surveys in Telangana should measure the coverage of salt iodization in the general population using quantitative methods. Nonetheless, increasing the adequacy of iodization of smaller salt manufacturers would help achieve universal salt iodization in Telangana. Despite high consumption of rice, our findings suggest that large-scale market-based rice fortification is not feasible in Telangana due to a large proportion of households producing their own rice and highly fragmented rice distribution. Distributing fortified rice via Telangana’s public distribution system may be a viable approach to target low-income households, but would only reach a small proportion of the population in Telangana. PMID:27447925

Eliminating iodine deficiency disorders--the role of the International Council in the global partnership.

PubMed Central

Hetzel, Basil S.

2002-01-01

Iodine deficiency is the most common preventable cause of brain damage. WHO estimates that some 2.2 billion people are at risk from iodine deficiency in 130 countries. A programme of universal salt iodization was established in 1994 with the aim of eliminating the problem by 2000. This paper reports progress in this field, with particular reference to the primarily scientific role of the International Council for Control of Iodine Deficiency Disorders, a nongovernmental organization founded in 1986. It is now a multidisciplinary network of 600 professionals in 100 countries. PMID:12077619

Knowledge and Perception of Consumption of Iodized Salt Among Food Handlers in Southern Ethiopia.

PubMed

Haji, Yusuf; Abdurahmen, Junayde; Paulos, Wondimagegn

2016-01-01

Iodine deficiency is the world's single most important cause of preventable mental retardation. In Ethiopia, the knowledge and perception of food handlers toward the iodized salt consumption (ISC) was very low. To assess knowledge and perception of food handlers toward consumption of iodized salt in Wolaita Sodo town and Sodo Zuria woreda, 2014. The community-based cross-sectional study design was done from May 10 to May 30, 2014 in Sodo town and Sodo Zuria woreda (district), Wolaita zone, southern Ethiopia. Systematic sampling techniques were used to identify study participants. Data entered into the software Epi Info version 3.5.3 and analyzed using the software SPSS version 16. To assess an association, odds ratio was used at 95% confidence interval, whereas confounding was controlled by employing multivariate logistic regression. Lower knowledge and perception on iodine deficiency was observed. About 239 (44.7%) of the respondents had good knowledge and 228 (42.6%) had positive attitude toward consumption of iodized salt. Most (346, 64.7%) of the participants had heard about goiter, whereas only 170 (31.8%) of them associated it with iodine deficiency. About 46.4% of respondents heard about iodized salt. Respondents' age, education, family income, place of residence, and occupation had significant association with good knowledge and positive attitude toward consumption of iodized salt. The study revealed the existence of knowledge and perception gap in iodine deficiency disorder and ISC. Household income, education of respondents, and place of residence were determinant factors for poor knowledge and perception of iodized salt. Therefore, efforts to scale-up the knowledge and perception toward ISC should focus on households with low income, educational level, and rural residence.

The problem of goitre prevention in India

PubMed Central

Ramalingaswami, V.

1953-01-01

Endemic goitre continues to be prevalent in the entire northern submontane region of the Indian subcontinent. Although its etiology is complex, its prevention can be simply and effectively achieved by increasing the iodine intake of the population. The best way of ensuring a continual supply of iodine is by iodization of salt. Indian salt, however, is obtained mostly by solar evaporation of sea water or inland salt water, and is coarse and moist; it is consequently difficult to iodize uniformly. It is also likely that, under the conditions of storage and climate that prevail in India, the loss of iodine from salt iodized with iodide is considerable. The author recommends the iodization of all cooking salt used in the goitrous areas of India with 1 part of iodide to 100,000 parts of salt. PMID:13094515

Seven deadly sins in confronting endemic iodine deficiency, and how to avoid them.

PubMed

Dunn, J T

1996-04-01

Iodine deficiency is a problem for almost all countries of the world. Goiter is its most obvious consequence, but others do more damage, particularly effects on the developing brain. In 1990, most countries and international agencies pledged the virtual elimination of iodine deficiency by the year 2000. The technology for the assessment and implementation is sufficient to attain this goal, but translating its potential into success requires careful planning. This article reviews seven major errors that frequently occur in iodine supplementation programs and offers suggestions for their avoidance. They are 1) unreliable assessment of iodine deficiency: the best indicators are urinary iodine concentration, thyroid size (preferably by ultrasound), blood spot thyroglobulin levels, and neonatal TSH determinations; the best group for surveys is schoolchildren; 2) poor iodine supplementation plan: iodized salt is the preferred supplement; its effective application frequently requires extensive changes in salt production and marketing, and poor handling of these changes will endanger the iodization program; other measures include iodized oil, iodized water, and iodine drops; all are occasionally useful, but the long range solution should generally be iodized salt; 3) exclusion of relevant stake-holders: the program should include not only health authorities but other arms of the government as well (education, commerce, agriculture, and standards), the salt industry, health professionals, and the iodine-deficient community itself; 4) inadequate education: an understanding of the effects of iodine deficiency and the means for its correction is essential at all levels, from government to affected population; 5) insufficient monitoring: the best instruments are urinary iodine levels, iodized salt use, and thyroid size, measured in representative groups at regular intervals with public reporting of results; 6) inattention to cost: the expense of iodization must be recognized and apportioned fairly; and 7) nonsustainability: for permanent success, an iodization program must be fair to all relevant parties and accompanied by a regular system of appropriate monitoring. Only with careful avoidance of these seven "deadly sins" can the goal of sustainable elimination of iodine deficiency be achieved.

Can even minimal news coverage influence consumer health-related behaviour? A case study of iodized salt sales, Australia.

PubMed

Li, Mu; Chapman, Simon; Agho, Kingsley; Eastman, Creswell J

2008-06-01

Lack of iodine in the diet can cause a spectrum of conditions, known as iodine deficiency disorders (IDD). While iodized salt has been retailed in Australia since the 1960s, sales have remained low, at approximately 10% of total edible salt sales. Salt has never been promoted, advertised or discounted by retailers or manufacturers. Extensive news coverage of health issues has often been shown to influence consumer behaviour. But can even modest news coverage generate changes in consumer health-related behaviour? We report a significant increase (5.2%) in national iodized salt sales after a brief period of television and newspaper reports about IDD and the benefits of using iodized salt during and after the Australian National Iodine Nutrition Study in 2003 and 2004. We conclude that even brief news media exposure can influence health-related decisions.

Identification of Organic Iodine Compounds and Their Transformation Products in Edible Iodized Salt Using Liquid Chromatography-High Resolution Mass Spectrometry.

PubMed

Yun, Lifen; Peng, Yue'e; Chang, Qing; Zhu, Qingxin; Guo, Wei; Wang, Yanxin

2017-07-05

The consumption of edible iodized salt is a key strategy to control and eliminate iodine deficiency disorders worldwide. We herein report the identification of the organic iodine compounds present in different edible iodized salt products using liquid chromatography combined with high resolution mass spectrometry. A total of 38 organic iodine compounds and their transformation products (TPs) were identified in seaweed iodine salt from China. Our experiments confirmed that the TPs were generated by the replacement of I atoms from organic iodine compounds with Cl atoms. Furthermore, the organic iodine compound contents in 4 seaweed iodine salt samples obtained from different manufacturers were measured, with significant differences in content being observed. We expect that the identification of organic iodine compounds in salt will be important for estimating the validity and safety of edible iodized salt products.

Sign language in dental education-A new nexus.

PubMed

Jones, T; Cumberbatch, K

2017-08-14

The introduction of the landmark mandatory teaching of sign language to undergraduate dental students at the University of the West Indies (UWI), Mona Campus in Kingston, Jamaica, to bridge the communication gap between dentists and their patients is reviewed. A review of over 90 Doctor of Dental Surgery and Doctor of Dental Medicine curricula in North America, the United Kingdom, parts of Europe and Australia showed no inclusion of sign language in those curricula as a mandatory component. In Jamaica, the government's training school for dental auxiliaries served as the forerunner to the UWI's introduction of formal training of sign language in 2012. Outside of the UWI, a couple of dental schools have sign language courses, but none have a mandatory programme as the one at the UWI. Dentists the world over have had to rely on interpreters to sign with their deaf patients. The deaf in Jamaica have not appreciated the fact that dentists cannot sign and they have felt insulted and only go to the dentist in emergency situations. The mandatory inclusion of sign language in the Undergraduate Dental Programme curriculum at The University of the West Indies, Mona Campus, sought to establish a direct communication channel to formally bridge this gap. The programme of two sign language courses and a direct clinical competency requirement was developed during the second year of the first cohort of the newly introduced undergraduate dental programme through a collaborating partnership between two faculties on the Mona Campus. The programme was introduced in 2012 in the third year of the 5-year undergraduate dental programme. To date, two cohorts have completed the programme, and the preliminary findings from an ongoing clinical study have shown a positive impact on dental care access and dental treatment for deaf patients at the UWI Mona Dental Polyclinic. The development of a direct communication channel between dental students and the deaf that has led to increased dental access and treatment for the deaf can be extended to dentists and to other dental students globally. The vision is that similar courses will be introduced in other health training programmes at the UWI, and conceivably, in other institutions. The small sample size allows for informative, but not definitive, conclusions to be drawn. The mandatory inclusion of sign language and Deaf culture in the dental curricula has not just removed a communication barrier, but has assisted in the empathetic and ethical development of the dental student. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Variable iodine intake persists in the context of universal salt iodization in China.

PubMed

Wu, Yongning; Li, Xiaowei; Chang, Suying; Liu, Liping; Zou, Shurong; Hipgrave, David Barry

2012-09-01

Iodine deficiency disorders were prevalent in China until the introduction of universal salt iodization in 1995. Concerns have recently arisen about possible excess iodine intake in this context. To document iodine intake and the contribution from iodized salt in China, we surveyed dietary iodine intake during China's nationally representative 2007 total diet study (TDS) and during an additional TDS in 4 coastal provinces and Beijing in 2009. Iodine intake was broken down by age and sex in 2009. Mean daily iodine and salt intake and the contribution from different food and beverage groups (and in 2009, individual items) was measured. The iodine in food cooked with iodized and noniodized salt was also assessed. The mean calculated iodine intake of a standard male in China was 425 μg/d in 2007 and 325 μg/d in coastal areas in 2009, well below the upper limit (UL) in all provinces. In 2009, iodine intake was above the UL in only 1-7% of age-sex groups, except among children (18-19%). A concerning number of individuals consumed less than the WHO-recommended daily allowance, including 31.5% of adult women. Salt contributed 63.5% of food iodine, and 24.6% of salt iodine was lost in cooking. Overall salt consumption declined between the surveys. Salt iodization assures iodine nutrition in China where environmental iodine is widely lacking. The risk of iodine excess is low, but planned decreases in salt iodization levels may increase the existing risk of inadequate intake. Regular monitoring of urinary iodine and more research on the impact of excess iodine intake is recommended.

Processed foods as an integral part of universal salt iodization programs: a review of global experience and analyses of Bangladesh and Pakistan.

PubMed

Spohrer, Rebecca; Garrett, Greg S; Timmer, Arnold; Sankar, Rajan; Kar, Basanta; Rasool, Faiz; Locatelli-Rossi, Lorenzo

2012-12-01

Despite the reference to salt for food processing in the original definition of universal salt iodization (USI), national USI programs often do not explicitly address food industry salt. This may affect program impact and sustainability, given the increasing consumption of processed foods in developing countries. To review experience of the use of iodized salt in the food industry globally, and analyze the market context in Bangladesh and Pakistan to test whether this experience may be applicable to inform improved national USI programming in developing countries. A review of relevant international experience was undertaken. In Bangladesh and Pakistan, local rural market surveys were carried out. In Bangladesh, structured face-to-face interviews with bakers and indepth interviews with processed food wholesalers and retailers were conducted. In Pakistan, face-to-face structured interviews were conducted with food retailers and food labels were checked. Experience from industrialized countries reveals impact resulting from the use of iodized salt in the food industry. In Bangladesh and Pakistan, bread, biscuits, and snacks containing salt are increasingly available in rural areas. In Bangladesh, the majority of bakers surveyed claimed to use iodized salt. In Pakistan, 6 of 362 unique product labels listed iodized salt. Successful experience from developed countries needs to be adapted to the developing country context. The increasing availability of processed foods in rural Bangladesh and Pakistan provides an opportunity to increase iodine intake. However, the impact of this intervention remains to be quantified. To develop better national USI programs, further data are required on processed food consumption across population groups, iodine contents of food products, and the contribution of processed foods to iodine nutrition.

Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

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

Yoshimatsu, Rika; Yamagami, Takuji, E-mail: yamagami@kochi-u.ac.jp; Ishikawa, Masaki

2016-06-15

PurposeTo evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE).MethodsBoth B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated.ResultsAmong 27 tumors, tumormore » enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor.ConclusionsTumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.« less

Adequacy Assessment of a Universal Salt Iodization Program Two Decades after Its Implementation: A National Cross-Sectional Study of Iodine Status among School-Age Children in Tunisia

PubMed Central

Doggui, Radhouene; El Ati-Hellal, Myriam; Traissac, Pierre; Lahmar, Lilia; El Ati, Jalila

2016-01-01

In the framework of a worldwide policy to eliminate iodine deficiency (ID) disorders, universal salt iodization was adopted in Tunisia two decades ago. The present study aims to evaluate this strategy, using both performance and impact indicators. A total of 1560 children, aged 6–12 years, were randomly sampled using a national, two-stage, stratified, cross-sectional cluster survey in 2012. Urinary iodine concentration (UIC) of the subjects, and household salt iodine content, were analyzed. The national median UIC was 220 µg/L (95% confidence interval (CI): 199–241), indicating an acceptable iodine status at the population level. Only 11.4% (95% CI: 8.6–14.9) of the children had UIC <100 µg/L, but with large regional disparities (4.3% to 25.5%, p < 0.01); however, more than a quarter of the subjects were at risk of adverse health consequences due to iodine excess. Children from households of low socio-economic levels were more prone to inadequate UIC. The national median iodine concentration of household salt was 22 mg/kg (95% CI: 21–23). Only half of the households used adequately iodized salt (15–25 ppm), with large regional disparities. National ID rates are now well below the target criteria of WHO (World Health Organization) certification (<20% of children with UIC <50 µg/L and <50% with UIC <100 µg/L). The coverage of adequately iodized salt fell short in meeting the goals of USI (Universal Salt Iodization), i.e., >90% of households. Regular monitoring of iodized salt production lines must be strengthened with involvement by producers. PMID:28029137

Adequacy Assessment of a Universal Salt Iodization Program Two Decades after Its Implementation: A National Cross-Sectional Study of Iodine Status among School-Age Children in Tunisia.

PubMed

Doggui, Radhouene; El Ati-Hellal, Myriam; Traissac, Pierre; Lahmar, Lilia; El Ati, Jalila

2016-12-25

In the framework of a worldwide policy to eliminate iodine deficiency (ID) disorders, universal salt iodization was adopted in Tunisia two decades ago. The present study aims to evaluate this strategy, using both performance and impact indicators. A total of 1560 children, aged 6-12 years, were randomly sampled using a national, two-stage, stratified, cross-sectional cluster survey in 2012. Urinary iodine concentration (UIC) of the subjects, and household salt iodine content, were analyzed. The national median UIC was 220 µg/L (95% confidence interval (CI): 199-241), indicating an acceptable iodine status at the population level. Only 11.4% (95% CI: 8.6-14.9) of the children had UIC <100 µg/L, but with large regional disparities (4.3% to 25.5%, p < 0.01); however, more than a quarter of the subjects were at risk of adverse health consequences due to iodine excess. Children from households of low socio-economic levels were more prone to inadequate UIC. The national median iodine concentration of household salt was 22 mg/kg (95% CI: 21-23). Only half of the households used adequately iodized salt (15-25 ppm), with large regional disparities. National ID rates are now well below the target criteria of WHO (World Health Organization) certification (<20% of children with UIC <50 µg/L and <50% with UIC <100 µg/L). The coverage of adequately iodized salt fell short in meeting the goals of USI (Universal Salt Iodization), i.e., >90% of households. Regular monitoring of iodized salt production lines must be strengthened with involvement by producers.

Stability of iodine in salt fortified with iodine and iron.

PubMed

Ranganathan, Srinivasaiyengar; Karmarkar, Madhu G; Krupadanam, Muddepaka; Brahmam, Ginnela N V; Rao, Mendhu Vishnuvardhana; Vijayaraghavan, Kamasamudram; Sivakumar, Bhattriprolu

2007-03-01

Determining the stability of iodine in fortified salt can be difficult under certain conditions. Current methods are sometimes unreliable in the presence of iron. To test the new method to more accurately estimate iodine content in double-fortified salt (DFS) fortified with iodine and iron by using orthophosphoric acid instead of sulfuric acid in the titration procedure. A double-blind, placebo-controlled study was carried out on DFS and iodized salt produced by the dry-mixing method. DFS and iodized salt were packed and sealed in color-coded, 0.5-kg, low-density polyethylene pouches, and 25 of these pouches were further packed and sealed in color-coded, double-lined, high-density polyethylene bags and transported by road in closed, light-protected containers to the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), Delhi; the National Institute of Nutrition (NIN), Hyderabad; and the Orissa Unit of the National Nutrition Monitoring Bureau (NNMB), Bhubaneswar. The iodine content of DFS and iodized salt stored under normal room conditions in these places was measured by the modified method every month on the same prescribed dates during the first 6 months and also after 15 months. The iodine content of DFS and iodized salt stored under simulated household conditions was also measured in the first 3 months. After the color code was broken at the end of the study, it was found that the DFS and iodized salt stored at Bhubaneswar, Delhi, and Hyderabad retained more or less the same initial iodine content (30-40 ppm) during the first 6 months, and the stability was not affected after 15 months. The proportion of salt samples having more than 30 ppm iodine was 100% in DFS and iodized salt throughout the study period. Daily opening and closing of salt pouches under simulated household conditions did not result in any iodine loss. The DFS and iodized salt prepared by the dry-mixing method and stored at normal room conditions had excellent iodine stability for more than 1 year.

[Influence of removing iodized salt on children's goiter status in areas with high iodine in drinking water].

PubMed

Lu, Shengmin; Xu, Dong; Wang, Yuchun; Du, Yonggui; Jia, Lihui; Liang, Suoli

2015-05-01

To explore the changes of goiter prevalence of children living in areas with high iodine in drinking water after removing iodized salt from their diet. Three towns with median water iodine of 150 - 300 μg/L were selected randomly in Hengshui city of Hebei province of China. A total of 452 and 459 children in the 3 towns were randomly selected to measure thyroid volume by ultrasound before and after removing iodized salt, respectively. Their goiter status was judged using the criteria of age-specific thyroid volume recommended by the WHO. After removing iodized salt, the overall goiter prevalence in the three towns significantly decreased from 24.56% (111/452) to 5.88% (27/459) (P < 0.01). The goiter prevalence in 8, 9 and 10 year-old children decreased respectively from 33.70% (31/92), 23.32% (45/193) and 20.96% (35/167) to 6.10% (10/164), 5.52% (9/163) and 6.06% (8/132). The goiter prevalence in boys and girls decreased from 27.05% (66/244) and 21.63% (45/208 ) to 6.66% (15/226 ) and 5.15% (12/233), respectively. The decreases in children's goiter prevalence across gender and age group were all significant. Children's goiter prevalence decreased significantly after removing iodized salt from their diet for about one and half years in the HIA in Hebei province.

Nutritional disparities among women in urban India.

PubMed

Agarwal, Siddharth; Sethi, Vani

2013-12-01

The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/ severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days.

Nutritional Disparities among Women in Urban India

PubMed Central

Sethi, Vani

2013-01-01

The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days. PMID:24592595

Impact of removing iodized salt on the iodine nutrition of children living in areas with variable iodine content in drinking water.

PubMed

Lv, Shengmin; Zhao, Yinglu; Li, Yanxia; Wang, Yuchun; Liu, Hua; Li, Yang; Zhao, Jun; Rutherford, Shannon

2015-09-01

Excess iodine in drinking water has emerged as a public health issue in China. This study assesses the effectiveness of removing iodized salt on reducing the iodine excess in populations living in high-iodine areas and also to identify the threshold value for safe levels of iodine in water. Twelve villages from 5 cities of Hebei Province with iodine content in drinking water ranging from 39 to 313 µg/l were selected to compare the urinary iodine content of children aged 8-10 years before and after removing iodized salt from their diet. For 3 villages where median water iodine content (MWIC) was below 110 µg/l, following the removal of iodized salt (the intervention), the median urinary iodine content (MUIC) reduced to under 300 µg/l decreasing from 365, 380, 351 to 247, 240, 281 µg/l, respectively. However, the MUIC in the 9 villages with MWIC above 110 µg/l remained higher than 300 µg/l. The children's MUIC correlated positively with the MWIC in the 12 villages (p ≤ 0.001). The linear regression equation after removing iodized salt was MUIC = 0.6761MWIC + 225.67, indicating that to keep the MUIC below 300 µg/l (the iodine excess threshold recommended by the WHO) requires the MWIC to be under 110 µg/l. Removing iodized salt could only correct the iodine excess in the population living in the areas with MWIC below 110 µg/l. In the areas with water iodine above 110 µg/l, interventions should be focused on seeking water with lower iodine content. This study suggests a threshold value of 110 µg/l of iodine in drinking water to maintain a safe level of dietary iodine.

Implementing large-scale food fortification in Ghana: lessons learned.

PubMed

Nyumuah, Richard Odum; Hoang, Thuy-Co Caroline; Amoaful, Esi Foriwa; Agble, Rosanna; Meyer, Marc; Wirth, James P; Locatelli-Rossi, Lorenzo; Panagides, Dora

2012-12-01

Food fortification began in Ghana in 1996 when legislation was passed to enforce the iodization of salt. This paper describes the development of the Ghanaian fortification program and identifies lessons learned in implementing fortification initiatives (universal salt iodization, fortification of vegetable oil and wheat flour) from 1996 to date. This paper identifies achievements, challenges, and lessons learned in implementing large scale food fortification in Ghana. Primary data was collected through interviews with key members of the National Food Fortification Alliance (NFFA), implementation staff of the Food Fortification Project, and staff of GAIN. Secondary data was collected through desk review of documentation from the project offices of the National Food Fortification Project and the National Secretariat for the Implementation of the National Salt Iodization in Ghana. Reduction of the prevalence of goiter has been observed, and coverage of households with adequately iodized salt increased between 1996 and 2006. Two models were designed to increase production of adequately iodized salt: one to procure and distribute potassium iodate (KIO3) locally, and the second, the salt bank cooperative (SBC) model, specifically designed for small-scale artisanal salt farmers. This resulted in the establishment of a centralized potassium iodate procurement and distribution system, tailored to local needs and ensuring competitive and stable prices. The SBC model allowed for nearly 157 MT of adequately iodized salt to be produced in 2011 in a region where adequately iodized salt was initially not available. For vegetable oil fortification, implementing quantitative analysis methods for accurate control of added fortificant proved challenging but was overcome with the use of a rapid test device, confirming that 95% of vegetable oil is adequately fortified in Ghana. However, appropriate compliance with national standards on wheat flour continues to pose challenges due to adverse sensory effects, which have led producers to reduce the dosage of premix in wheat flour. Challenges to access to premix experienced by small producers can be overcome with a central procurement model in which the distributor leverages the overall volume by tendering for a consolidated order. The SBC model has the potential to be expanded and to considerably increase the coverage of the population consuming iodized salt in Ghana. Successful implementation of the cost-effective iCheck CHROMA rapid test device should be replicated in other countries where quality control of fortified vegetable oil is a challenge, and extended to additional food vehicles, such as wheat flour and salt. Only a reduced impact on iron deficiency in Ghana can be expected, given the low level of fortificant added to the wheat flour. An integrated approach, with complementary programs including additional iron-fortified food vehicles, should be explored to maximize health impact.

Impact of Deterrents on Effectiveness of Mandatory Continuing Professional Education for Company Secretaries in India

ERIC Educational Resources Information Center

Walawalkar, Rajesh

2015-01-01

This study is about the perceptions of Company Secretaries about effectiveness of their formal and mandatory Continuing Professional Education (CPE) programme run by the Institute of Company Secretaries of India. The objectives were to ascertain: (1) to what extent do Company Secretaries perceive their CPE as effective, (2) what are the various…

[Field study on the change of urinary iodine levels among family members with iodine content of 5 - 150 microg/L in drinking water before and after non-iodized salt intervention].

PubMed

Li, Su-mei; Zhang, Gen-hong; Sun, Fan; Wang, Pei-hua; Zhang, Zhi-zhong; Li, Xiu-wei; Li, Shu-hua

2008-08-01

To compare the changes of urinary iodine levels among the family members with iodine content of 5 - 150 microg/L in drinking water, before and after non-iodized salt intervention through a field trail study. Family members who routinely drank water with iodine content 5 - 150 microg/L were chosen to substitute non-iodized salt for their current iodized salt for 2 months, and urine samples of the family members were collected for determination of iodine change before and after intervention was carried out. Median urinary iodine of school children, women with productive age and male adults exceeding 370 microg/L before intervention and the frequency distribution of urinary iodine were all above 70%. Our results revealed that iodine excess exited in three groups of family members. After intervention, all median urinary iodine level seemed to have decreased significantly, and groups with drinking water iodine 5.0 - 99.9 microg/L reduced to adequate or close to adequate while the group that drinking water iodine was 100 - 150 microg/L reached the cut-off point of excessive iodine level (300 microg/L). Results from your study posed the idea that the iodine adequate areas should be defined as the areas with iodine content of 5.0 - 100 microg/L in drinking water, and edible salt not be iodized in these areas. Areas with iodine content of 100 - 150 microg/L in drinking water should be classified as iodine excessive.

Assessment of the iodine concentration in table salt at the production stage in South Africa.

PubMed Central

Jooste, Pieter L.

2003-01-01

OBJECTIVE: To determine the iodine content of iodized salt at the production stage, to assess the perceptions and knowledge of salt producers about the prevention and control of iodine deficiency, and to examine the internal quality control procedures used during iodization in South Africa. METHOD: Salt samples were collected for iodine analysis by titration from the 12 producers iodizing salt in South Africa. Information on the producers' knowledge of iodine deficiency disorders and on internal quality control was obtained by means of questionnaires. FINDINGS: The legal requirement of 40-60 ppm iodine was met in 30.9% of salt samples; 57.9% contained more than 30 ppm iodine; 34.8% contained under 20 ppm iodine. There were shortcomings in perceptions and knowledge about iodine deficiency disorders and in the internal quality control procedures of a substantial proportion of the producers. CONCLUSION: In order to encourage and support salt producers to achieve optimal iodization there should be an information, education and communication strategy aimed at improving knowledge of iodine deficiency disorders and at raising the standard of internal quality control procedures. External monitoring should continue. PMID:12973644

NRL Radar Division C++ Coding Standard

DTIC Science & Technology

2016-12-05

The coding standard provides tools aimed at helping C++ programmers develop programs that are free of common types of errors, maintainable by...different programmers , portable to other operating systems, easy to read and understand, and have a consistent style. Questions of design, such as how to...mandatory for any organization with quality goals. The purpose of this standard is to provide tools aimed at helping C++ programmers develop programs that

Considering consumer choice in the economic evaluation of mandatory health programmes: a review.

PubMed

Parkinson, Bonny; Goodall, Stephen

2011-08-01

Governments are increasing their focus on mandatory public health programmes following positive economic evaluations of their impact. This review aims to examine whether loss of consumer choice should be included in economic evaluations of mandatory health programmes (MHP). A systematic literature review was conducted to identify economic evaluations of MHP, whether they discuss the impact on consumer choice and any methodological limitations. Overall 39 economic evaluations were identified, of which 10 discussed the loss of consumer choice and 6 attempted to place a value on the loss of consumer choice. Methodological limitations included: measuring the marginal cost of compliance, unavailability of price elasticity estimates, the impact of income effects, double counting health impacts, biased willingness-to-pay responses, and "protest" responses. Overall it was found that the inclusion of the loss of consumer choice rarely impacted on the final outcome of the study. The impact of MHP on the loss of consumer choice has largely been ignored in economic evaluations. Its importance remains uncertain due to its infrequent inclusion and significant methodological limitations. Further research regarding which methodology is best for valuing the loss of consumer choice and whether it is important to the final implementation decision is warranted. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Fortification of bread with iodized salt corrected iodine deficiency in school-aged children, but not in their mothers: a national cross-sectional survey in Belgium.

PubMed

Vandevijvere, Stefanie; Mourri, Ahmed Bensouda; Amsalkhir, Sihame; Avni, Freddy; Van Oyen, Herman; Moreno-Reyes, Rodrigo

2012-10-01

In the years 1985-1998, it was noted that mild iodine deficiency (MID) was a public health problem in Belgium. Therefore, an agreement was signed in 2009 between the bakery sector and the Ministry of Health, to fortify bread with iodized salt. We tested the hypothesis that the iodine status of Belgian children improved after the introduction of bread fortified with iodized salt. Since the dietary habits of children and adults may differ, we also investigated whether the median urinary iodine concentration (UIC) among the children in this study reflected the iodine status of their mothers. The study was cross-sectional. In a van, equipped with an ultrasound device, the thyroid volumes (Tvol) of children were measured and household salt samples and urine samples were collected from the children and their mothers. From across Belgium, 60 schools were selected and 1541 children participated in the study. The median UIC in children was 113.1 and 84.4 μg/L among their mothers. The median UIC among children was substantially greater compared to more than 10 years ago (80 μg/L; p<0.001). The median UIC in school-aged children was lower in Wallonia than in Flanders (p<0.001) and was higher in boys than in girls (p<0.001). The percentage of children with goiter was 7.2%. Of the 904 salt samples received, 63.2% did not contain iodine. Fortification of bread with iodized salt corrected iodine deficiency in Belgian children, but not in their mothers. To provide these women with an adequate iodine intake, the use of both iodized salt in bread and iodized instead of noniodized household salt needs to increase. Our findings suggest that the median UIC in children may not be an adequate surrogate of adults' iodine status. Therefore, monitoring iodine status should not be limited to children, but should be extended to women of child-bearing age.

Breast-Milk Iodine Concentrations, Iodine Status, and Thyroid Function of Breastfed Infants Aged 2-4 Months and Their Mothers Residing in a South African Township.

PubMed

Osei, Jennifer; Andersson, Maria; Reijden, Olivia van der; Dold, Susanne; Smuts, Cornelius M; Baumgartner, Jeannine

2016-12-01

Lactating women and their infants are susceptible to iodine deficiency and iodine excess. In South Africa, no data exist on the iodine status and thyroid function of these vulnerable groups. In a cross-sectional study, urinary iodine concentrations (UIC), thyroid function, and breast-milk iodine concentrations (BMIC) were assessed in 100 lactating women from a South African township and their 2-4-month-old breastfed infants. Potential predictors of UIC, thyroid function, and BMIC, including household salt iodine concentrations (SIC) and maternal sodium excretion, were also investigated. The median (25th-75th percentile) UIC was 373 (202-627) μg/L in infants and 118 (67-179) μg/L in mothers. Median household SIC was 44 (27-63) ppm. Household SIC and maternal urinary sodium excretion predicted UIC of lactating mothers. Median BMIC was 179 (126-269) μg/L. Age of infants, SIC, and maternal UIC predicted BMIC. In turn, infant age and BMIC predicted UIC of infants. Forty-two percent of SIC values were within the South African recommended salt iodine fortification level at production of 35-65 ppm, whilst 21% of SIC were >65 ppm. Thyroid-stimulating hormone, total thyroxine, and thyroglobulin concentrations in the dried whole blood spot specimens from the infants were 1.3 (0.8-1.9) mU/L, 128±33 mmol/L, and 77.1 (56.3-105.7) μg/L, respectively, and did not correlate with infant UIC or BMIC. Our results suggest that the salt fortification program in South Africa provides adequate iodine to lactating women and indirectly to their infants via breast milk. However, monitoring of salt iodine content of the mandatory salt iodization program in South Africa is important to avoid over-iodization of salt.

Iodine nutritional status in Asturian schoolchildren.

PubMed

Riestra Fernández, María; Menéndez Torre, Edelmiro; Díaz Cadórniga, Francisco; Fernández Fernández, Juan Carlos; Delgado Álvarez, Elías

2017-11-01

Iodine deficiency is a public health problem, and iodine nutritional status should therefore be regularly measured. To ascertain iodine nutritional status in Asturias and its relation to use of iodized salt and to other sociodemographic and nutritional parameters. A descriptive, observational study was conducted in a random sample of schoolchildren aged 5 to 14 years, in whom urinary iodine levels were measured by high-performance liquid chromatography. Families completed a survey on use of iodized salt, consumption of dairy products and fish, and sociodemographic data. The study sample consisted of 705 schoolchildren (51.1% females) with a mean age of 9.9 years (SD 2.6). In a total of 620 valid measurements, mean urinary iodine level was 204.1 μg/L (SD 120.6), while the median value was 180.7 μg/L (P 25 -P 75 : 124-252.3 μg/L, interquartile range 128.3 μg/L). Urinary iodine levels were <100 μg/L in 16.6% of children, and very low (<20 μg/L) in 0.2%. Iodized salt was used in 69.3% of all households, and in all school canteens. Consumption of dairy products was significantly associated to urinary iodine levels (P<.0005). Iodine nutrition of Asturian schoolchildren is adequate, although the target of use of iodized salt in 90% of households is still far away. Adequate iodine nutrition may be due to other sources, such as dairy products. Public health campaigns are required to promote iodized salt consumption. Regular assessment of iodine nutritional status is also needed. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

An Increase in Consuming Adequately Iodized Salt May Not Be Enough to Rectify Iodine Deficiency in Pregnancy in an Iodine-Sufficient Area of China

PubMed Central

Wang, Zhifang; Zhu, Wenming; Mo, Zhe; Wang, Yuanyang; Mao, Guangming; Wang, Xiaofeng; Lou, Xiaoming

2017-01-01

Universal salt iodization (USI) has been implemented for two decades in China. It is crucial to periodically monitor iodine status in the most vulnerable population, such as pregnant women. A cross-sectional study was carried out in an evidence-proved iodine-sufficient province to evaluate iodine intake in pregnancy. According to the WHO/UNICEF/ICCIDD recommendation criteria of adequate iodine intake in pregnancy (150–249 µg/L), the median urinary iodine concentration (UIC) of the total 8159 recruited pregnant women was 147.5 µg/L, which indicated pregnant women had iodine deficiency at the province level. Overall, 51.0% of the total study participants had iodine deficiency with a UIC < 150 µg/L and only 32.9% of them had adequate iodine. Participants living in coastal areas had iodine deficiency with a median UIC of 130.1 µg/L, while those in inland areas had marginally adequate iodine intake with a median UIC of 158.1 µg/L (p < 0.001). Among the total study participants, 450 pregnant women consuming non-iodized salt had mild-moderate iodine deficiency with a median UIC of 99.6 µg/L; 7363 pregnant women consuming adequately iodized salt had a lightly statistically higher median UIC of 151.9 µg/L, compared with the recommended adequate level by the WHO/UNICEF/ICCIDD (p < 0.001). Consuming adequately iodized salt seemed to lightly increase the median UIC level, but it may not be enough to correct iodine nutrition status to an optimum level as recommended by the WHO/UNICEF/ICCIDD. We therefore suggest that, besides strengthening USI policy, additional interventive measure may be needed to improve iodine intake in pregnancy. PMID:28230748

An Increase in Consuming Adequately Iodized Salt May Not Be Enough to Rectify Iodine Deficiency in Pregnancy in an Iodine-Sufficient Area of China.

PubMed

Wang, Zhifang; Zhu, Wenming; Mo, Zhe; Wang, Yuanyang; Mao, Guangming; Wang, Xiaofeng; Lou, Xiaoming

2017-02-20

Universal salt iodization (USI) has been implemented for two decades in China. It is crucial to periodically monitor iodine status in the most vulnerable population, such as pregnant women. A cross-sectional study was carried out in an evidence-proved iodine-sufficient province to evaluate iodine intake in pregnancy. According to the WHO/UNICEF/ICCIDD recommendation criteria of adequate iodine intake in pregnancy (150-249 µg/L), the median urinary iodine concentration (UIC) of the total 8159 recruited pregnant women was 147.5 µg/L, which indicated pregnant women had iodine deficiency at the province level. Overall, 51.0% of the total study participants had iodine deficiency with a UIC < 150 µg/L and only 32.9% of them had adequate iodine. Participants living in coastal areas had iodine deficiency with a median UIC of 130.1 µg/L, while those in inland areas had marginally adequate iodine intake with a median UIC of 158.1 µg/L ( p < 0.001). Among the total study participants, 450 pregnant women consuming non-iodized salt had mild-moderate iodine deficiency with a median UIC of 99.6 µg/L; 7363 pregnant women consuming adequately iodized salt had a lightly statistically higher median UIC of 151.9 µg/L, compared with the recommended adequate level by the WHO/UNICEF/ICCIDD ( p < 0.001). Consuming adequately iodized salt seemed to lightly increase the median UIC level, but it may not be enough to correct iodine nutrition status to an optimum level as recommended by the WHO/UNICEF/ICCIDD. We therefore suggest that, besides strengthening USI policy, additional interventive measure may be needed to improve iodine intake in pregnancy.

ESL Student Teachers' Perceptions of a Short-Term Overseas Immersion Programme

ERIC Educational Resources Information Center

Lee, Jackie F. K.

2009-01-01

In recent years there has been an increasing demand for teachers to develop the international knowledge and skills necessary to help promote their students' global perspectives. The Hong Kong Special Administrative Region Government has seized the initiative to provide mandatory overseas immersion programmes for pre-service English teachers to…

Maternal iodine status and neonatal thyroid-stimulating hormone concentration: a community survey in Songkhla, southern Thailand.

PubMed

Jaruratanasirikul, Somchit; Sangsupawanich, Pasuree; Koranantakul, Ounjai; Chanvitan, Prasin; Ruaengrairatanaroj, Prasit; Sriplung, Hutcha; Patanasin, Thanomjit; Sukmee, Siriporn

2009-12-01

To determine iodine intake and urinary iodine excretion (UIE) in a group of pregnant Thai women and the concentration of thyroid-stimulating hormone (TSH) in their neonates. A prospective cohort study. Three districts of Songkhla, southern Thailand. Two hundred and thirty-six pregnant women. A quarter of the participants lacked knowledge of iodine and the prevention of iodine deficiency, although 70 % used iodized salt. Those who did not use iodized salt stated that they had no knowledge about iodine (57 %) and no iodized salt was sold in their village (36 %). The median iodine intake in the three districts was 205-240 microg/d, with 53-74 % of pregnant women having iodine intake <250 microg/d. The median UIE in the three districts was 51-106 microg/l, with 24-35 % having UIE < 50 microg/l. The mean neonatal TSH was 2.40 (sd 1.56) mU/l, with 8.9 % of neonates having TSH > 5 mU/l. The studied women and their fetuses were at risk of mild iodine deficiency. About a quarter of the participants lacked knowledge of the importance of iodine. Education regarding the importance of iodine supplements and the promotion of iodized salt should be added to national health-care policies in order to prevent iodine-deficiency disorders, diseases that are subclinical but have long-term sequelae.

Mandatory coursework assignments can be, and should be, eliminated!

NASA Astrophysics Data System (ADS)

Haugan, John; Lysebo, Marius; Lauvas, Per

2017-11-01

Formative assessment can serve as a catalyst for increased student effort and student learning. Yet, many engineering degree programmes are dominated by summative assessment and make limited use of formative assessment. The present case study serves as an example on how formative assessment can be used strategically to increase student effort and improve student learning. Within five courses of an engineering bachelor degree programme in Norway, the mandatory coursework assignments were removed and replaced by formative-only assessment. To facilitate the formative assessment, weekly student peer-assessment sessions were introduced. The main findings include an increase in student study hours and improved student performance on the examinations. Finally, interviews were conducted by an external consultant in an effort to identify key factors that attributed to the positive outcome.

Identifying hospital-onset Escherichia coli bacteraemia cases from English mandatory surveillance: the case for applying a two-day post-admission rule.

PubMed

Davies, J; Johnson, A P; Hope, R

2017-11-01

A national voluntary surveillance programme has shown year-on-year increases in the number of bacteraemias caused by Escherichia coli. Mandatory surveillance of E. coli bacteraemia was introduced in 2011 with the aim of improving the quantity and quality of data collected. In contrast to the other national mandatory surveillance programmes, cases are not currently categorized based upon time of onset in relation to hospital admission. To assess the case for applying time-of-onset categorization to cases of E. coli bacteraemia in England. Data for all cases of E. coli bacteraemia reported to Public Health England between April 2012 and March 2016 were extracted from the national mandatory surveillance database. Cases were categorized as hospital-onset if positive blood cultures were obtained two or more days after admission. Approximately 21% of cases were categorized as hospital-onset. However, the proportion of hospital-onset cases decreased by 1% in each successive 12-month period, from 23% in 2012/13 to 20% in 2015/16 (P<0.001). Approximately one-fifth of E. coli bacteraemia cases reported via mandatory surveillance were identified as hospital-onset. Given that prevention and control strategies will vary by setting, the routine feedback of this information will prove important in informing infection prevention and control efforts. The categorization of this subset of cases represents an important step towards better understanding of the epidemiology of E. coli bacteraemia. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Exploring the Effectiveness of Mandatory Premarital Screening and Genetic Counselling Programmes for β-Thalassaemia in the Middle East: A Scoping Review.

PubMed

Saffi, Marwa; Howard, Natasha

2015-01-01

β-Thalassaemia is a common genetic blood disorder in the Middle Eastern region. Mandatory premarital screening and genetic counselling (PMSGC) programmes are implemented in 8 Middle East countries to reduce at-risk marriages and thus disease prevalence. A scoping review was conducted to explore the effectiveness of these programmes. The 6-stage scoping framework of Arksey and O'Malley [Int J Soc Res Methodol 2005;8:19-32] was used. Reported outcomes were analysed per country, with success defined as achieving a 65% reduction in at-risk marriages and/or thalassaemia-affected births. Emergent enablers and barriers were analysed thematically. Twenty-one sources were included from the 1,348 identified, discussing 7 country programmes, with 95% (20/21) published during 2003-2013. Five publications each were included for Iran and Saudi Arabia, 3 for Turkey, 2 each for Bahrain and Iraq (Kurdistan), and 1 for the United Arab Emirates, plus 2 multi-country evaluations. No programme achieved a 65% at-risk marriage cancellation rate. Though data on thalassaemia-affected birth reductions were minimal, programmes in Iran, Turkey and Iraq reported at least 65% reductions. A thematic analysis found that screening timing, access to prenatal detection and abortion, socio-religious issues, awareness and counselling affected decisions. This review found that PMSGC programmes were unsuccessful in discouraging at-risk marriages but successful in reducing the prevalence of affected births in countries providing prenatal detection and therapeutic abortion. A life cycle approach to prevention, incorporation of school screening, awareness campaigns, reconsideration of therapeutic abortion, and screening and counselling of couples married prior to programme inception are likely to improve the effectiveness of such programmes in the Middle Eastern region. © 2015 S. Karger AG, Basel.

Global iodine nutrition: Where do we stand in 2013?

PubMed

Pearce, Elizabeth N; Andersson, Maria; Zimmermann, Michael B

2013-05-01

Dietary iodine intake is required for the production of thyroid hormone. Consequences of iodine deficiency include goiter, intellectual impairments, growth retardation, neonatal hypothyroidism, and increased pregnancy loss and infant mortality. In 1990, the United Nations World Summit for Children established the goal of eliminating iodine deficiency worldwide. Considerable progress has since been achieved, largely through programs of universal salt iodization. Approximately 70% of all households worldwide currently have access to adequately iodized salt. In 2013, as defined by a national or subnational median urinary iodine concentration of 100-299 μg/L in school-aged children, 111 countries have sufficient iodine intake. Thirty countries remain iodine-deficient; 9 are moderately deficient, 21 are mildly deficient, and none are currently considered severely iodine-deficient. Ten countries have excessive iodine intake. In North America, both the United States and Canada are generally iodine-sufficient, although recent data suggest pregnant U.S. women are mildly iodine-deficient. Emerging issues include discrepancies between urinary iodine status in pregnant women compared to school-aged children in some populations, the problem of re-emerging iodine deficiency in parts of the developed world, the importance of food industry use of iodized salt, regions of iodine excess, and the potential effects of initiatives to lower population sodium consumption on iodine intake. Although substantial progress has been made over the last several decades, iodine deficiency remains a significant health problem worldwide and affects both industrialized and developing nations. The ongoing monitoring of population iodine status remains crucially important, and particular attention may need to be paid to monitoring the status of vulnerable populations, such as pregnant women and infants. There is also need for ongoing monitoring of iodized salt and other dietary iodine sources in order to prevent excess as well as insufficient iodine nutrition. Finally, it will be essential to coordinate interventions designed to reduce population sodium intake with salt iodization programs in order to maintain adequate levels of iodine nutrition as salt intake declines.

Assessment of iodine concentration in dietary salt at household level in Morocco.

PubMed

Zahidi, Ahmed; Zahidi, Meriem; Taoufik, Jamal

2016-05-20

Following WHO recommendations, Morocco adopted in 1995 the universal salt iodization (USI) as a strategy to prevent and control iodine deficiency disorders. In 2009, the standard salt iodine concentration was adjusted to 15-40 mg/kg. The success of USI for the control of iodine deficiency disorders requires an evaluation of iodine concentration in salt prior to assessing the iodine nutritional status of a population. In our study we refer to the anterior studies that were made in Morocco in 1993 and 1998. 178 salt samples from households were tested for iodine using spot-testing kits. The iodometric titration method was used to analyze accurately the concentration of iodine in the 178 household salt samples. An empiric polling method was adopted, using a non-probability sampling method; across the different twelve regions in the country. The median and interquartile range iodine concentration in salt was 2.9 mg/kg (IQR: 2.4-3.7). The results show that only 25 % of households use iodized salt. The recommended iodine concentration in salt of 15-40 mg/kg was met only in 4.5 % of salt samples. The bulk salt is used by 8 % of households. All samples of this bulk salt were found in rural areas. According to nonparametric appropriate tests used, there is no significant difference in iodine concentrations between regions, between urban and rural areas and between packaged and bulk salt. Two decades since introducing legislation on Universal Salt Iodization, our survey shows that generalization of iodized salt is far from being reached. In 2015, only a quarter of Moroccan households use the iodized salt and only 4.5 % of salt is in conformity with regulations. The use of bulk salt by households in rural areas constitutes a major obstacle to the success of USI. The National Iodine Deficiency Disorders Control Program can only be achieved if an internal follow-up and a control of external quality of program is put in place.

A status update on EUMETSAT programmes and plans

NASA Astrophysics Data System (ADS)

Klaes, K. Dieter

2017-09-01

The mandate of EUMETSAT is providing space observations for operational meteorology and climate monitoring. EUMETSAT operates geostationary and sun-synchronous polar orbiting satellites through mandatory programmes. Optional programmes provide further observations for altimetry and oceanography. EUMETSAT makes available data from partner agencies' satellites to the user community through third party programmes. The current fleet of operational geostationary spacecraft comprises Meteosat-7, which is the last satellite of the first generation and the four satellites of the Second Generation of Meteosat (MSG), Meteosat-8, Meteosat-9, Meteosat-10 and Meteosat-11. The EUMETSAT Polar System (EPS) provides data from sun-synchronous polar orbit with currently two satellites: Metop-B, the second of a series of three satellites, launched in September 2012 and currently the prime satellite, and Metop-A, the first of the series, in orbit since October 2006. These satellites are part of the Initial Joint Polar System (IJPS) together with the US. EUMETSAT's first optional programme continues to provide data from the Jason-2 satellite since summer 2008. The follow on satellite Jason-3 was successfully launched and commissioned in 2016 and is now providing the reference altimetry mission. To assure continuity in the mandatory missions the development of Meteosat Third Generation (MTG) is ongoing. The EPS-SG EPS Second generation) programme is now under full development. In the frame of the Copernicus Programme EUMETSAT operates the Sentinel-3A satellite, which was launched in February 2016. EUMETSAT is providing operational marine products from the Sentinel-3A satellite. Sentinel-3B, is scheduled to be launched early 2018.

Iodine deficiency disorders: contemporary scientific issues.

PubMed

Maberly, G F

1994-08-01

Iodine deficiency is the leading cause of preventable intellectual impairment and is associated with a spectrum of neurologic and developmental pathology. More than one billion people are at risk. The developing fetus, newborn, and young child are the most susceptible to the effects of an iodine-deficient diet. If intervention is not initiated in a timely fashion, the pathophysiologic abnormalities become resistant to treatment and permanent intellectual, neurologic, and somatic deficits result. The technology of iodine deficiency intervention is well established. Iodized salt, the preferred method, is easy to produce, administer in physiologic doses, and is cost effective. The distribution of iodized salt and social marketing are key to a successful iodine deficiency elimination program. In remote regions, iodized oil is a useful interim intervention. However, it is clear that technology is not enough. Any national effort to eliminate iodine deficiency must extend far beyond the Ministry of Health. The program will require the full participation of a range of national government ministries and agencies and the full support and participation of local or regional governments.

Simulation model based on non-newtonian fluid mechanics applied to the evaluation of the embolic effect of emulsions of iodized oil and anticancer drug.

PubMed

Demachi, H; Matsui, O; Abo, H; Tatsu, H

2000-01-01

To verify the difference in embolic effect between oil-in-water (O-W) and water-in-oil (W-O) emulsions composed of iodized oil and an anticancer drug, epirubicin, using a simulation model based on non-Newtonian fluid mechanics. Flow curves of pure iodized oil and two types of O-W and W-O emulsions immediately and 1 hr after preparation were examined with a viscometer. Using the yield stress data obtained, we simulated the stagnation of each fluid with steady flow in a rigid tube. The W-O emulsions were observed to stagnate in the thin tube at a low pressure gradient. However, the embolic effect of the W-O emulsions decreased 1 hr after preparation. The O-W emulsions were stable and did not stagnate under the conditions in which the W-O emulsions stagnated. The simulation model showed that the embolic effect of the W-O emulsions was superior to that of the O-W emulsions.

Chernobyl and iodine deficiency in the Russian Federation: an environmental disaster leading to a public health opportunity.

PubMed

Jackson, Richard J; DeLozier, David M; Gerasimov, Gregory; Borisova, Olga; Garbe, Paul L; Goultchenko, Lioudmila; Shakarishvili, George; Hollowell, Joseph G; Miller, Dayton T

2002-01-01

The Chernobyl nuclear disaster of April 26, 1986, triggered a chain of devastating events that later included an unexpected increase in childhood thyroid cancer and evidence of iodine deficiency (ID) in Russia. For the Russian people the Chernobyl event had profound psychological impacts, provoking anxiety about nuclear technology and mistrust of governmental control efforts. Frequently in public health a crisis is required to create the political will to manage longstanding problems, and public health officials must rapidly mobilize to take advantage of the opportunity. In this case, ID, previously not seen as a problem in Russia, was recognized to be potentially serious, and the Russian Federation, assisted by the catalytic bi-national effort of the U.S.-Russian Joint Commission on Economic and Technological Cooperation (Gore-Chernomyrdin Commission (GCC)) established a model salt iodization policy, developed a planning process, and implemented a program to prevent ID through a systematic approach that included the people, government, and private groups using open communication, dissemination of the findings, and action plans. By 1999, political will had been mobilized and over 20% of the nation's salt was being iodized, up from about 1% in 1996. Universal iodization of salt was not a specific objective of the GCC; however, the increasing availability of iodized salt is leading to the elimination of ID, which is now a political goal in Russia. The full realization of this goal will require more time for education, marketing, and possibly legislative action.

Acceptability of Parental Financial Incentives and Quasi-Mandatory Interventions for Preschool Vaccinations: Triangulation of Findings from Three Linked Studies.

PubMed

Adams, Jean; McNaughton, Rebekah J; Wigham, Sarah; Flynn, Darren; Ternent, Laura; Shucksmith, Janet

2016-01-01

Childhood vaccinations are a core component of public health programmes globally. Recent measles outbreaks in the UK and USA have prompted debates about new ways to increase uptake of childhood vaccinations. Parental financial incentives and quasi-mandatory interventions (e.g. restricting entry to educational settings to fully vaccinated children) have been successfully used to increase uptake of childhood vaccinations in developing countries, but there is limited evidence of effectiveness in developed countries. Even if confirmed to be effective, widespread implementation of these interventions is dependent on acceptability to parents, professionals and other stakeholders. We conducted a systematic review (n = 11 studies included), a qualitative study with parents (n = 91) and relevant professionals (n = 24), and an on-line survey with embedded discrete choice experiment with parents (n = 521) exploring acceptability of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Here we use Triangulation Protocol to synthesise findings from the three studies. There was a consistent recognition that incentives and quasi-mandatory interventions could be effective, particularly in more disadvantaged groups. Universal incentives were consistently preferred to targeted ones, but relative preferences for quasi-mandatory interventions and universal incentives varied between studies. The qualitative work revealed a consistent belief that financial incentives were not considered an appropriate motivation for vaccinating children. The costs of financial incentive interventions appeared particularly salient and there were consistent concerns in the qualitative work that incentives did not represent the best use of resources for promoting preschool vaccinations. Various suggestions for improving delivery of the current UK vaccination programme as an alternative to incentives and quasi-mandates were made. Parental financial incentives and quasi-mandatory interventions for increasing uptake of preschool vaccinations do not currently attract widespread enthusiastic support in the UK; but some potential benefits of these approaches are recognised.

Acceptability of Parental Financial Incentives and Quasi-Mandatory Interventions for Preschool Vaccinations: Triangulation of Findings from Three Linked Studies

PubMed Central

McNaughton, Rebekah J.; Wigham, Sarah; Flynn, Darren; Ternent, Laura; Shucksmith, Janet

2016-01-01

Background Childhood vaccinations are a core component of public health programmes globally. Recent measles outbreaks in the UK and USA have prompted debates about new ways to increase uptake of childhood vaccinations. Parental financial incentives and quasi-mandatory interventions (e.g. restricting entry to educational settings to fully vaccinated children) have been successfully used to increase uptake of childhood vaccinations in developing countries, but there is limited evidence of effectiveness in developed countries. Even if confirmed to be effective, widespread implementation of these interventions is dependent on acceptability to parents, professionals and other stakeholders. Methods We conducted a systematic review (n = 11 studies included), a qualitative study with parents (n = 91) and relevant professionals (n = 24), and an on-line survey with embedded discrete choice experiment with parents (n = 521) exploring acceptability of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Here we use Triangulation Protocol to synthesise findings from the three studies. Results There was a consistent recognition that incentives and quasi-mandatory interventions could be effective, particularly in more disadvantaged groups. Universal incentives were consistently preferred to targeted ones, but relative preferences for quasi-mandatory interventions and universal incentives varied between studies. The qualitative work revealed a consistent belief that financial incentives were not considered an appropriate motivation for vaccinating children. The costs of financial incentive interventions appeared particularly salient and there were consistent concerns in the qualitative work that incentives did not represent the best use of resources for promoting preschool vaccinations. Various suggestions for improving delivery of the current UK vaccination programme as an alternative to incentives and quasi-mandates were made. Conclusions Parental financial incentives and quasi-mandatory interventions for increasing uptake of preschool vaccinations do not currently attract widespread enthusiastic support in the UK; but some potential benefits of these approaches are recognised. PMID:27253196

Nursing students' attendance at learning activities in relation to attainment and passing courses: A prospective quantitative study.

PubMed

Rejnö, Åsa; Nordin, Per; Forsgren, Susanne; Sundell, Yvonne; Rudolfsson, Gudrun

2017-03-01

Students' motivation and ways of engaging in their schoolwork are important for their performance, including passing exams. Attendance at learning activities has also been argued to be of major importance, although no causal relationship with passing exams has been established in nursing education. The aim of this study was to describe the impact of attendance at nonmandatory learning activities on attainment, in terms of passing or failing of exams, in nursing education courses including both mandatory and non-mandatory activities. A prospective quantitative design. The nursing education programme at a Swedish university. Nursing students (n=361) from two courses and four classes within the nursing programme. Attendance was registered at every non-mandatory teaching activity by asking the students to note their attendance on a list. Data such as sex, age, and whether the students had passed the exam were also collected for each course and each semester separately. Increased participation was associated with an increasing proportion of students passing the exam. The chance of passing the exam increased by 13% for every additional learning occasion attended. Logistic regression showed an OR of 5.4 for an attendance of 100%. An increase in attendance gave a higher proportion of exam passes. Encouraging students to attend non-mandatory learning activities could be of value, and potentially contribute to an increased graduation rate for nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.

Iodine insufficiency: a global health problem?

PubMed

Swanson, Christine A; Pearce, Elizabeth N

2013-09-01

As a result of collaborative efforts with international organizations and the salt industry, many developing and developed countries practice universal salt iodization (USI) or have mandatory salt fortification programs. As a consequence, the prevalence of iodine deficiency decreased dramatically. The United States and Canada are among the few developed countries that do not practice USI. Such an undertaking would require evidence of deficiency among vulnerable population groups, including pregnant women, newborns, and developing infants. Government agencies in the United States rely heavily on data from NHANES to assess the iodine status of the general population and pregnant women in particular. NHANES data suggest that pregnant women in the United States remain mildly deficient. This is important, because the developing fetus is dependent on maternal iodine intake for normal brain development throughout pregnancy. Professional societies have recommended that pregnant and lactating women, or those considering pregnancy, consume a supplement providing 150 μg iodine daily. The United States and Canada collaborate on the daily recommended intake and are also confronted with the challenge of identifying the studies needed to determine if USI is likely to be beneficial to vulnerable population groups without exposing them to harm.

Components of Effective Diversity Training Programmes.

ERIC Educational Resources Information Center

Wentling, Rose Mary; Palma-Rivas, Nilda

1999-01-01

Interviews with 12 diversity experts uncovered components of effective diversity training programs: management commitment and support, inclusion in strategic planning, attention to specific organizational needs, qualified trainers, mandatory attendance, inclusiveness, trust and confidentiality, accountability, and clearly focused evaluation. (SK)

Geographic distribution and socio-economic determinants of women's nutritional status in Mali households.

PubMed

Gewa, Constance A; Leslie, Timothy F; Pawloski, Lisa R

2013-09-01

Mali is one of the poorest countries in Africa, with 72% of its population surviving on less than $US 1.00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women’s anthropometric status and use of adequately iodized salt among households in Mali. Demographic and Health Survey data, multistage-stratified cluster sampling methodology. Rural and urban areas of Mali. Non-pregnant women (n 6015) between the ages of 19 and 44 years. Nineteen per cent of the women were overweight or obese while 11% were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women’s BMI or households’ use of adequately iodized salt. The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.

Iodine intake in Somalia is excessive and associated with the source of household drinking water.

PubMed

Kassim, Ismail A R; Moloney, Grainne; Busili, Ahono; Nur, Abukar Yusuf; Paron, Paolo; Jooste, Pieter; Gadain, Hussein; Seal, Andrew J

2014-03-01

Few data on iodine status in Somalia are available, but it is assumed that deficiency is a public health problem due to the limited access to iodized salt. We aimed to describe the iodine status of the population of Somalia and to investigate possible determinants of iodine status. A national 2-stage, stratified household cluster survey was conducted in 2009 in the Northwest, Northeast, and South Central Zones of Somalia. Urinary iodine concentration (UIC) was determined in samples from women (aged 15-45 y) and children (aged 6-11 y), and examination for visible goiter was performed in the Northwest and South Central strata. A 24-h household food-frequency questionnaire was conducted, and salt samples were tested for iodization. The median UICs for nonpregnant women and children were 329 and 416 μg/L, respectively, indicating excessive iodine intake (>300 μg/L). The prevalence of visible goiter was <4%. The coverage of salt iodization was low, with a national average of 7.7% (95% CI: 3.2%, 17.4%). Spatial analysis revealed localized areas of relatively high and low iodine status. Variations could not be explained by food consumption or salt iodization but were associated with the main source of household drinking water, with consumers of borehole water having a higher UIC (569 vs. 385 μg/L; P < 0.001). Iodine intake in Somalia is among the highest in the world and excessive according to WHO criteria. Further work is required to investigate the geochemistry and safety of groundwater sources in Somalia and the impact on human nutrition and health.

Effect of iodine status and other nutritional factors on psychomotor and cognitive performance of Filipino schoolchildren.

PubMed

Amarra, Ma Sofia V; Bongga, Demetria C; Peñano-Ho, Leticia; Cruz, Federico B; Solis, José S; Barrios, Erniel B

2007-03-01

Until 1998, iodine deficiency was a public health problem in the Philippines. A law entitled "An Act Promoting Salt Iodization Nationwide" (ASIN) has been passed and implemented by the government to eliminate iodine deficiency. The contribution of salt iodization, as well as dietary, health, and environmental factors, to improving the intellectual performance of Filipino schoolchildren remains to be determined. The objectives of the study were to determine the relationship between iodine status and levels of psychomotor and cognitive performance in first-grade children aged 6 to 10 years, and to examine the extent to which dietary, biochemical, health, and environmental factors contribute to children's mental performance. Two hundred ninety children in six classroom sections from a public school in Manila were examined by measurement of urinary iodine excretion (UIE) and thyroid palpation. The median UIE level for each section was determined. Sixty-five children classified as iodine deficient (UIE < 90 microg/L with grade 1 goiter, n = 34) and non-iodine deficient (UIE > 100 microg/L without goiter, n = 31) were given psychomotor and cognitive function tests (Bender-Gestalt and Raven's Colored Progressive Matrices). Scores from the two tests were used to determine each child's general ability percentile rank. Other variables examined were dietary intake (% RDA of nutrients ingested based on two nonconsecutive 24-hour recalls); deficiencies in iron, vitamin A, and selenium; parasitic infection; coliform contamination of drinking water; household use of iodized salt; illness in the past 2 weeks; and wasting and stunting. Children whose general ability scores were at or above the 50th percentile had higher UIE levels, but the relationship was not significant. Children from sections with higher median UIE levels had higher percentile ranks for general ability (p = .002). Backward logistic regression showed that the variance in deficient and adequate mental performance was explained by dietary intakes that met > or = 80% of the RDA for energy, protein, thiamin, and riboflavin; the use of iodized salt; child's iodine status; and stunting (R2 = .520, p = .0016). Higher class median UIE was associated with better psychomotor and cognitive performance in children who were tested. Factors that contributed to better performance include higher intakes of energy, protein, thiamin, and riboflavin; household use of iodized salt; normal iodine status; and absence of stunting or chronic malnutrition. Salt iodization, accompanied by adequate intakes of energy, protein, and foods rich in thiamin and riboflavin, can contribute to improved mental performance in Filipino schoolchildren. Longer-term factors that can contribute to improved performance are achievement of normal iodine status and elimination of protein-energy malnutrition.

Iodine nutritional status in pregnant women of two historically different iodine-deficient areas of Catalonia, Spain.

PubMed

Vila, Lluis; Serra-Prat, Mateu; de Castro, Alfonso; Palomera, Elisabet; Casamitjana, Roser; Legaz, Gustavo; Barrionuevo, Celia; Muñoz, José A; García, Ana J; Lal-Trehan, Sanjay; García, Amparo; Durán, Josep; Puig-Domingo, Manel

2011-10-01

Catalonia (Spain) has a historically worse situation of mild iodine deficiency in the Pyrenees Mountains compared with the coastal region. The aim of this study was to evaluate the current iodine status in pregnant women living in these two areas. An epidemiologic prospective survey included 267 consecutive pregnancies in the Catalan mountains (n = 139) and coast (n = 128) studied during the first trimester; an additional subset of 135 women from the initial cohort was available for evaluation in the third trimester. Urinary iodine (UI) was measured, and questionnaires to determine iodized salt and sea fish consumption and potassium iodide supplementation were administered. The median UI in the first trimester was 163 μg/L for the entire cohort, with differences between mountain and coastal regions (209 versus 142 μg/L, P = 0.007). The highest prevalence of iodized salt consumption was in the mountain area (58% versus 36.4%, P < 0.001). For the entire group, a higher median UI was found in iodized salt consumers compared with non-consumers (193 versus 134 μg/L, P < 0.001). In the third trimester, an increase of median UI was seen in those to whom iodine supplements were given during pregnancy (190 versus 154 μg/L, P = 0.015). A reversal in the historically iodine-deficient situation was observed in the Catalan Pyrenees compared with the coastal area, with a globally acceptable iodine status in pregnant women of the two geographic locations. Iodized salt consumption seems to have contributed to maintaining an acceptable iodine status in this population. Copyright © 2011 Elsevier Inc. All rights reserved.

Comparative Validation of Five Quantitative Rapid Test Kits for the Analysis of Salt Iodine Content: Laboratory Performance, User- and Field-Friendliness

PubMed Central

Rohner, Fabian; Kangambèga, Marcelline O.; Khan, Noor; Kargougou, Robert; Garnier, Denis; Sanou, Ibrahima; Ouaro, Bertine D.; Petry, Nicolai; Wirth, James P.; Jooste, Pieter

2015-01-01

Background Iodine deficiency has important health and development consequences and the introduction of iodized salt as national programs has been a great public health success in the past decades. To render national salt iodization programs sustainable and ensure adequate iodization levels, simple methods to quantitatively assess whether salt is adequately iodized are required. Several methods claim to be simple and reliable, and are available on the market or are in development. Objective This work has validated the currently available quantitative rapid test kits (quantRTK) in a comparative manner for both their laboratory performance and ease of use in field settings. Methods Laboratory performance parameters (linearity, detection and quantification limit, intra- and inter-assay imprecision) were conducted on 5 quantRTK. We assessed inter-operator imprecision using salt of different quality along with the comparison of 59 salt samples from across the globe; measurements were made both in a laboratory and a field setting by technicians and non-technicians. Results from the quantRTK were compared against iodometric titration for validity. An ‘ease-of-use’ rating system was developed to identify the most suitable quantRTK for a given task. Results Most of the devices showed acceptable laboratory performance, but for some of the devices, use by non-technicians revealed poorer performance when working in a routine manner. Of the quantRTK tested, the iCheck® and I-Reader® showed most consistent performance and ease of use, and a newly developed paper-based method (saltPAD) holds promise if further developed. Conclusions User- and field-friendly devices are now available and the most appropriate quantRTK can be selected depending on the number of samples and the budget available. PMID:26401655

Iodine Intake in Somalia Is Excessive and Associated with the Source of Household Drinking Water123

PubMed Central

Kassim, Ismail A. R.; Moloney, Grainne; Busili, Ahono; Nur, Abukar Yusuf; Paron, Paolo; Jooste, Pieter; Gadain, Hussein; Seal, Andrew J.

2014-01-01

Few data on iodine status in Somalia are available, but it is assumed that deficiency is a public health problem due to the limited access to iodized salt. We aimed to describe the iodine status of the population of Somalia and to investigate possible determinants of iodine status. A national 2-stage, stratified household cluster survey was conducted in 2009 in the Northwest, Northeast, and South Central Zones of Somalia. Urinary iodine concentration (UIC) was determined in samples from women (aged 15–45 y) and children (aged 6–11 y), and examination for visible goiter was performed in the Northwest and South Central strata. A 24-h household food-frequency questionnaire was conducted, and salt samples were tested for iodization. The median UICs for nonpregnant women and children were 329 and 416 μg/L, respectively, indicating excessive iodine intake (>300 μg/L). The prevalence of visible goiter was <4%. The coverage of salt iodization was low, with a national average of 7.7% (95% CI: 3.2%, 17.4%). Spatial analysis revealed localized areas of relatively high and low iodine status. Variations could not be explained by food consumption or salt iodization but were associated with the main source of household drinking water, with consumers of borehole water having a higher UIC (569 vs. 385 μg/L; P < 0.001). Iodine intake in Somalia is among the highest in the world and excessive according to WHO criteria. Further work is required to investigate the geochemistry and safety of groundwater sources in Somalia and the impact on human nutrition and health. PMID:24500936

Transcatheter Arterial Embolization with a Mixture of Absolute Ethanol and Iodized Oil for Poorly Visualized Endophytic Renal Masses Prior to CT-Guided Percutaneous Cryoablation

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

Michimoto, Kenkichi, E-mail: michikoo@jikei.ac.jp; Shimizu, Kanichiro; Kameoka, Yoshihiko

PurposeTo retrospectively evaluate the feasibility of transcatheter arterial embolization (TAE) using a mixture of absolute ethanol and iodized oil to improve localization of endophytic renal masses on unenhanced computed tomography (CT) prior to CT-guided percutaneous cryoablation (PCA).Materials and MethodsOur institutional review board approved this retrospective study. From September 2011 to June 2015, 17 patients (mean age, 66.8 years) with stage T1a endophytic renal masses (mean diameter, 26.5 mm) underwent TAE using a mixture of absolute ethanol and iodized oil to improve visualization of small and endophytic renal masses on unenhanced CT prior to CT-guided PCA. TAE was considered successful that accumulated iodizedmore » oil depicted whole of the tumor edge on CT. PCA was considered successful when the iceball covered the entire tumor with over a 5 mm margin. Oncological and renal functional outcomes and complications were also evaluated.ResultsTAE was successfully performed in 16 of 17 endophytic tumors. The 16 tumors were performed under CT-guided PCA with their distinct visualization of localization and safe ablated margin. During the mean follow-up period of 15.4 ± 5.1 months, one patient developed local recurrence. Estimated glomerular filtration rate declined by 8 % with statistical significance (P = 0.01). There was no procedure-related significant complication.ConclusionTAE using a mixture of absolute ethanol and iodized oil to improve visualization of endophytic renal masses facilitated tumor localization on unenhanced CT, permitting depiction of the tumor edge as well as a safe margin for ablation during CT-guided PCA, with an acceptable decline in renal function.« less

A community continuity programme: volunteer faculty mentors and continuity learning.

PubMed

McGeehan, John; English, Richard; Shenberger, Keith; Tracy, Gerald; Smego, Raymond

2013-02-01

Longitudinal generalist preceptorship experiences early in medical education can have beneficial effects on how students practise the art and science of medicine, regardless of their eventual career choices. We evaluated the first 2 years of implementation of an integrated, regional campus-based, early clinical experience programme, the Community Continuity Program, at our new community-based medical school that is under the supervision of volunteer primary care faculty members acting as continuity mentors (CMs). Curricular components for years 1 and 2 consisted of three annual 1-week community-based experiences with CMs, extensive physical diagnosis practice, interprofessional learning activities, a multigenerational family care experience, a mandatory Community Health Research Project (CHRP) in year 1 and a mandatory Quality Improvement Project in year 2. Outcome measures included student, faculty member and programme evaluations, student reflective narratives in portal-based e-journals, a Liaison Committee on Medical Education (LCME) self-study student survey and serial level-of-empathy surveys.   Students found all elements of this integrated community experience programme beneficial and worthwhile, especially the CMs and the use of standardised and real-life patients. CMs noted effective and professional student-patient interactions. The number of reflective e-journal postings per student during year1 ranged from 14 to 81 (mean, 47). Serial empathy questionnaires administered over 2 years demonstrated preservation of student empathy, and students believed that the programme had a positive effect on their personal level of empathy.   An integrative, longitudinal, community-based, early clinical experience programme driven by volunteer CMs provides patient-centered instruction for preclinical students in the clinical, social, behavioural, ethical and research foundations of medicine. © Blackwell Publishing Ltd 2013.

Use of web based systems to support postgraduate medical education.

PubMed

Tochel, C; Beggs, K; Haig, A; Roberts, J; Scott, H; Walker, K; Watson, M

2011-12-01

BACKGROUND To meet the demands of delivering the Foundation programme across a geographically diverse country, two web based systems (ePortfolio and eLearning) were developed to promote accessibility to training material and assessment tools on standardised platforms. This study evaluated the use of both tools throughout an entire academic year. METHODS All Scottish Foundation trainees' online learning and assessment data in 2007/08 were analysed, providing a national breakdown of post specialty, completion rates of mandatory assessments (including summary analysis of anonymised scores), and trainees' use of non-mandatory learning tools. Independent verification of competence data was sought from Deaneries. RESULTS There were high levels of engagement with both the ePortfolio (75-97% assessment completion) and eLearning systems (89-98% induction course completion), and the majority of trainees completed all required elements. There was extensive use of ePortfolio beyond mandatory levels for recording of learning events, including almost 20 000 personal learning records submitted by second year trainees. There was evidence that ePortfolio was used to record achievement of clinical competence rather than to track improvements towards competence (median workplace based assessment scores were 'high' or 'very high'). Online learning modules received positive feedback and its flexible format suited the trainees' working environment. External verification of formal assessment data revealed good correlation with locally stored outcomes, both indicating approximately 99% programme completion rates. CONCLUSIONS Core components of the Foundation programme have been delivered successfully to thousands of trainees across Scotland using web based systems to deliver and support education and assessment. There is great potential for further exploration of this carefully managed, rich dataset at individual, regional, and national levels to inform the future of medical education.

Short report: documentation of iodine deficiency in Haitian schoolchildren: implication for lymphatic filariasis elimination in Haiti.

PubMed

Beach, M J; Streit, T G; Houston, R; May, W A; Addiss, D G; Lammie, P J

2001-01-01

In this study we documented unexpected moderate-to-severe iodine deficiency in Haitian schoolchildren although they live in a coastal community where presumably they have access to iodine-containing seafood. This fact combined with the lack of an iodized salt supply and endemic lymphatic filariasis makes community distribution of diethylcarbamazine-fortified, iodized salt an attractive strategy for elimination of lymphatic filariasis and iodine deficiency disorders in this area of Haiti. Combining lymphatic filariasis elimination with other public health interventions is one strategy to increase its public health benefit and maximize the impact of limited public health resources.

Iodine Nutritional Status of School Children in Nauru 2015

PubMed Central

Huang, Chun-Jui; Tseng, Chi-Lung; Chen, Harn-Shen; Garabwan, Chanda; Korovo, Samuela; Tang, Kam-Tsun; Won, Justin Ging-Shing; Hsieh, Chang-Hsun; Wang, Fan-Fen

2016-01-01

Little is known about iodine nutritional status in island countries in the Pacific Ocean. The primary objective of this study was to report for the first time the iodine nutritional status of people in Nauru. In addition, sources of iodine nutrition (i.e., water and salt) were investigated. A school-based cross-sectional survey of children aged 6–12 years was conducted in three primary schools of Nauru. Urinary iodine concentration (UIC) was determined by spot urine samples. Available water and salt samples in Nauru were collected for the measurement of iodine content. A food frequency questionnaire was conducted. The median UIC was 142 μg/L, and 25.2% and 7.4% of the population had median UIC below 100 μg/L and 50 μg/L, respectively. Natural iodine-containing foods such as seaweeds and agar were rare. Iodine was undetectable in Nauruan tank water, filtered tap water, and raindrops. Of the analyzed salt products, five kinds were non-iodized, and three were iodized (iodine content: 15 ppm, 65 ppm, and 68 ppm, respectively). The results indicate that the iodine status in Nauruan school children is adequate. Iodized salt may serve as an important source of iodine nutrition in Nauru. PMID:27563920

[Factors related to urinary iodine in adults from Shanghai].

PubMed

Ren, Tian-hong; Yu, Xiao-dan

2013-12-01

The objective of this study was to analyze the related factors that influencing the level of urinary iodine(UI). 994 adult cases were selected from medical centers. Morning urine was collected and questionnaire including age, sex, family medical history of thyroid disease administered. Information on previous 24-hour consumption of iodine-containing foods was collected. Data was analyzed by Empower(®) software with logistic model. The median UI level was 193.0 µg/L. After adjusting for potential confounders, gender (P = 0.000), family monthly income per capita (P = 0.000), the amount of iodized salt intake (P = 0.041), and eating kelps (P = 0.000)appeared to be associated with the level of UI. Risk regarding the prevalence of excess UI (>300 µg/L)increased with the increasing amount of salt and kelp consumption:salt consumption > 165 g/m (OR = 24.3, 95%CI:1.1-523.8, P < 0.05); kelp consumption (OR = 9.6, 95%CI:2.6 -35.1, P < 0.001). UI was associated with factors as:gender, family monthly income per capita, intake of iodized salt and the amount of kelp consumption. Excessive intake of iodine might be associated with high intake of iodized salt and kelp.

Implications of online learning for nurse managers.

PubMed

McCarthy, Jillian

2014-10-30

Online learning for nurses is growing in popularity, with programmes ranging from mandatory update training to part-time master's degrees. E-learning, as it is known, offers flexibility in access to learning, study time and learning styles. In busy clinical areas, where guidance is provided on minimum nurse staffing levels, e-learning provides solutions for managers who wish to encourage professional development while maintaining adequate nursing cover. Caution must be taken, however, when choosing e-learning programmes, as quality and efficacy differ across the range. This article highlights the properties of good e-learning pedagogy to prepare nurse managers for successful assessment of these programmes.

Prison rights: mandatory drugs tests and performance indicators for prisons.

PubMed Central

Gore, S. M.; Bird, A. G.; Ross, A. J.

1996-01-01

Mandatory drugs testing of prisoners applies throughout England and Wales. Data from the 1995 pilot study in eight prisons show that the proportion testing positive for opiates or benzodiazepines rose from 4.1% to 7.4% between the first and second phase of random testing and that there was a 20% increase over 1993-4 in the provisional total of assaults for 1995. Interpretation of these data is difficult, but this is no excuse for prevarication over the danger that this policy may induce inmates to switch from cannabis (which has a negligible public health risk) to injectable class A drugs (a serious public health risk) in prison. The performance indicators for misuse of drugs that are based on the random mandatory drugs testing programme lack relevant covariate information about the individuals tested and are not reliable or timely for individual prisons. PMID:8646103

School Leadership Preparation in Malaysia: Aims, Content and Impact

ERIC Educational Resources Information Center

Ng, Ashley Yoon-Mooi

2017-01-01

This paper examines the preparation of school principals in Malaysia, and the aspiration of the Malaysian Education Blueprint 2013-2025 to ensure high-performing school leaders in every school. It reports on the principal preparatory programme, the National Professional Qualification for Educational Leaders, which is mandatory to those who aspire…

Testing iodized activated carbon filters with non-radioactive methyl iodide. Final report

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

Deitz, V.R.; Romans, J.B.

1980-05-30

Iodized carbons, impregnated with KIx(KI + xI2), were evaluated for trapping methyl iodide-127. In this method the complete effluent of the carbon is sampled and analyzed continuously. In contrast, the RDT-M16 test procedure counts the carbon and the back-up beds for the accumulated 131 species and no information is obtained for the interaction of the large amount of carrier methyl iodide-127 with the iodized charcoal. The test apparatus to measure the penetration of methyl iodide-127 is described and the calibration procedures are detailed. Results are given for the penetration of methyl iodide-127 through new activated carbons, carbons in service, andmore » exhausted carbons withdrawn from service. The reduction in trapping efficiency with service is accompanied by the development of a maximum in the concentration of methyl iodide-127 during the air purge after the dose period. This behavior has escaped notice with methyl iodide-131 due to the way that test is made. The chromatographic holdup of methyl iodide-127 by carbons in service, together with the subsequent slow desorption step, could result in a dilution of the penetration iodine to acceptable levels under some conditions encountered in plant filter operations.« less

Sustainability of a well-monitored salt iodization program in Iran: marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations without alteration in iodine content of salt.

PubMed

Azizi, F; Mehran, L; Sheikholeslam, R; Ordookhani, A; Naghavi, M; Hedayati, M; Padyab, M; Mirmiran, P

2008-05-01

Two yr after legislation of salt iodization of 40 parts per million (ppm) in 1994, goiter was still endemic and urinary iodine concentration (UIC) remained elevated in many provinces of Iran. Goiter prevalence and UIC were compared 2 and 7 yr after sustained consumption of uniformly iodized salt by Iranian households. Schoolchildren (7-10 yr) of all provinces were randomly selected by cluster sampling from December 2000 to June 2001. Goiter rate, UIC, and household salt iodine values were compared to those in 1996. Factory salt iodine was also compared in 2001 vs 1996. Ultrasonographically determined thyroid volumes of 7-10 yr old children were compared in 2001 vs 1999. In 2001 (no.=33600) vs 1996 (no.=36178), total, grade 1, and grade 2 goiter rates were 13.9 vs 53.8%, 11.0 vs 44.8%, and 2.9 vs 9.0%, respectively (p<0.0001). Weighted total goiter rate was 9.8% in 2001. Median (range) UIC in 2001 (no.=3329) was 165 (18-499) microg/l and in 1996 (no.=2917) was 205 (10-2300) microg/l (p<0.0001). In 2001 vs 1996, mean+/-SD for iodine salt content was 32.7+/-10.1 vs 33.0+/-10.2 ppm (p=0.68) in households and was 33.2+/-13.4 and 33.8+/-13.2 ppm (p=0.57) in factories, respectively. Among 7-10 yr old children in 2001 (no.=400) vs 1999 (no.=396), only 7-yr-old children in 2001 (the only group with probably no history of iodine deficiency) showed significant smaller thyroid volumes by ultrasonography compared to those in 1999. After 7 yr of optimized iodized-salt supplementation in Iran, adequate UIC values and marked reduction in goiter rate have been achieved.

Risk factors for goiter in primary school girls in Qom city of Iran.

PubMed

Mousavi, S M; Tavakoli, N; Mardan, F

2006-03-01

Goiter is endemic in Iran. The iodine deficiency disorders program was begun a few years ago in Iran, and the coverage of iodized salt is sufficient now. But, in a periodic yearly medical examination of primary school girls in Qom, the prevalence of goiter was above 30% in 2002. This survey was designed to study the risk factors of goiter in those students. The study was a randomized (multistage, proportional simple random sampling) case-control study. We selected and performed thyroid examinations in 1050 girl students in primary schools in Qom city of Iran in 2002. We found 284 cases: girls in primary schools had goiter in accordance with the clinical exam of World Health Organization classification. Among students who did not present with goiter in the clinical exam, we randomly selected 288 students as the control group. We used a questionnaire to evaluate them for the risk factors of goiter. The mean+/-s.d. ages of cases and controls were 8.7+/-1.3 and 8.9+/-1.3 years, respectively. There is no significant difference between the two groups regarding history of soya, kale, turnip, fish, daily iodized salt usage, education and job of mothers, monthly family income, nationality, immigration and residential situation. By using multinomial logistic regression, we found that storage of iodized salt in open containers, odds ratio (OR): 2.201 (1.412-3.428); P-value <0.0001, medium socioeconomic situation (SES) of family, OR: 2.099 (1.029-4.282), P-value=0.041, district 2 of Qom city, OR: 2.880 (1.376-6.027), P-value=0.005, and district 3 of Qom city, OR: 2.051(1.032-4.078), P-value=0.041, were the major risk factors for goiter in this population. In this study, the main risk factors for goiter were storage of iodized salt in open containers, medium SES and also living in specific districts of Qom city. As the coverage of iodinized salt is over 95% in Iran, we advise the education of the family about storage of iodized salt in closed containers. We also recommend the study of the other risk factors of goiter in the different geographical areas of Iran, because of differences in the SES and nutritional habits. This study was supported by issuing permission letters for our activities: (not funding support) Qom Health Network and Medical Services, Qom Medical University, Qom Primary School Education Office, Fathemieh Medical University.

Mandatory Coursework Assignments Can Be, and Should Be, Eliminated!

ERIC Educational Resources Information Center

Haugan, John; Lysebo, Marius; Lauvas, Per

2017-01-01

Formative assessment can serve as a catalyst for increased student effort and student learning. Yet, many engineering degree programmes are dominated by summative assessment and make limited use of formative assessment. The present case study serves as an example on how formative assessment can be used strategically to increase student effort and…

Optimisation of simulated team training through the application of learning theories: a debate for a conceptual framework.

PubMed

Stocker, Martin; Burmester, Margarita; Allen, Meredith

2014-04-03

As a conceptual review, this paper will debate relevant learning theories to inform the development, design and delivery of an effective educational programme for simulated team training relevant to health professionals. Kolb's experiential learning theory is used as the main conceptual framework to define the sequence of activities. Dewey's theory of reflective thought and action, Jarvis modification of Kolb's learning cycle and Schön's reflection-on-action serve as a model to design scenarios for optimal concrete experience and debriefing for challenging participants' beliefs and habits. Bandura's theory of self-efficacy and newer socio-cultural learning models outline that for efficient team training, it is mandatory to introduce the social-cultural context of a team. The ideal simulated team training programme needs a scenario for concrete experience, followed by a debriefing with a critical reflexive observation and abstract conceptualisation phase, and ending with a second scenario for active experimentation. Let them re-experiment to optimise the effect of a simulated training session. Challenge them to the edge: The scenario needs to challenge participants to generate failures and feelings of inadequacy to drive and motivate team members to critical reflect and learn. Not experience itself but the inadequacy and contradictions of habitual experience serve as basis for reflection. Facilitate critical reflection: Facilitators and group members must guide and motivate individual participants through the debriefing session, inciting and empowering learners to challenge their own beliefs and habits. To do this, learners need to feel psychological safe. Let the group talk and critical explore. Motivate with reality and context: Training with multidisciplinary team members, with different levels of expertise, acting in their usual environment (in-situ simulation) on physiological variables is mandatory to introduce cultural context and social conditions to the learning experience. Embedding in situ team training sessions into a teaching programme to enable repeated training and to assess regularly team performance is mandatory for a cultural change of sustained improvement of team performance and patient safety.

Prison mental health in-reach teams in England: the care programme approach and sexual abuse/violence.

PubMed

Brooker, Charles G D; Forrester, Andrew

2017-12-01

Prison mental health in-reach teams have doubled in size over the past decade and case-loads have reduced. Since 2010 it has been mandatory for keyworkers to ask whether prisoners with serious mental illness being treated under the care programme approach have experienced sexual or physical abuse. This is known as routine enquiry and should take place for these prisoners but NHS England, the commissioners, do not audit this activity. It is time to review current interventions and their associated outcomes. © The Royal College of Psychiatrists 2017.

Iodine Intakes of Victorian Schoolchildren Measured Using 24-h Urinary Iodine Excretion

PubMed Central

Beckford, Kelsey; Margerison, Claire; Skeaff, Sheila A.

2017-01-01

Mandatory fortification of bread with iodized salt was introduced in Australia in 2009, and studies using spot urine collections conducted post fortification indicate that Australian schoolchildren are now replete. However an accurate estimate of daily iodine intake utilizing 24-h urinary iodine excretion (UIE μg/day) has not been reported and compared to the estimated average requirement (EAR). This study aimed to assess daily total iodine intake and status of a sample of primary schoolchildren using 24-h urine samples. Victorian primary school children provided 24-h urine samples between 2011 and 2013, from which urinary iodine concentration (UIC, μg/L) and total iodine excretion (UIE, μg/day) as an estimate of intake was determined. Valid 24-h urine samples were provided by 650 children, mean (SD) age 9.3 (1.8) years (n = 359 boys). The mean UIE of 4–8 and 9–13 year olds was 94 (48) and 111 (57) μg/24-h, respectively, with 29% and 26% having a UIE below the age-specific EAR. The median (IQR) UIC was 124 (83,172) μg/L, with 36% of participants having a UIC < 100 μg/L. This convenience sample of Victorian schoolchildren were found to be iodine replete, based on UIC and estimated iodine intakes derived from 24-h urine collections, confirming the findings of the Australian Health Survey. PMID:28867787

Infectious diseases in Mexico. A survey from 1995-2000.

PubMed

Flisser, Ana; Velasco-Villa, Andrés; Martínez-Campos, Carmen; González-Domínguez, Fernando; Briseño-García, Baltasar; García-Suárez, Rosario; Caballero-Servín, Angel; Hernández-Monroy, Irma; García-Lozano, Herlinda; Gutiérrez-Cogco, Lucina; Rodríguez-Angeles, Guadalupe; López-Martínez, Irma; Galindo-Virgen, Sonia; Vázquez-Campuzano, Roberto; Balandrano-Campos, Susana; Guzmán-Bracho, Carmen; Olivo-Díaz, Angélica; de la Rosa, Jorge; Magos, Clementina; Escobar-Gutiérrez, Alejandro; Correa, Dolores

2002-01-01

Data obtained at a central laboratory for emerging, re-emerging, and other infectious diseases in Mexico from 1995-2000 are presented. An outstanding increase of DEN-3 circulation was identified. Aedes aegypti, the dengue vector, is widely distributed. Leptospirosis has become the most important differential diagnosis for dengue. Identification of rabies virus variants allowed cataloging of new transmitters of rabies. Rotavirus showed a clear seasonal distribution, while different proportions of pathogenic classes of Escherichia coli under endemic and outbreak conditions were seen. Serotypes of several bacteria are reported as well as the sources of isolation and frequency of Shigella, Salmonella, and Vibrio cholerae. Rise and disappearance of cholera could be followed along the past decade. Influenza strains were identified, as were several pathogens causing sexually transmitted infections. Laboratory support was important for surveillance after Hurricane Mitch. Multidrug-resistant strains of Mycobacterium tuberculosis are emerging and primary resistance is very high. It is now mandatory to search for antibodies to Trypanosoma cruzi in blood banks. Triatoma barberi, a peridomestic bug, is the main vector of Chagas disease. Localized cutaneous leishmaniosis increased in regions having a guerrilla element in Chiapas. Modern immunodiagnostic techniques are used for control studies of cysticercosis and similar techniques were recently standardized for Trichinella spiralis detection. Low iodine values in children's urine were found in several Mexican states; therefore, use of iodized salt should be encouraged.

Iodine in diet

MedlinePlus

... products also contain iodine. Other good sources are plants grown in iodine-rich soil. Side Effects Lack ... daily recommendations by eating seafood, iodized salt, and plants grown in iodine-rich soil. When buying salt ...

The College of Anaesthetists of Ireland Simulation Training programme: a descriptive report and analysis of course participants' feedback.

PubMed

Cafferkey, Aine; Coyle, Elizabeth; Greaney, David; Harte, Sinead; Hayes, Niamh; Langdon, Miriam; Straub, Birgitt; Burlacu, Crina

2018-03-20

Simulation-based education is a modern training modality that allows healthcare professionals to develop knowledge and practice skills in a safe learning environment. The College of Anaesthetists of Ireland (CAI) was the first Irish postgraduate medical training body to introduce mandatory simulation training into its curriculum. Extensive quality assurance and improvement data has been collected on all simulation courses to date. Describe The College of Anaesthetists of Ireland Simulation Training (CAST) programme and report the analysis of course participants' feedback. A retrospective review of feedback forms from four simulation courses from March 2010 to August 2016 took place. Qualitative and quantitative data from 1069 participants who attended 112 courses was analysed. Feedback was overall very positive. Course content and delivery were deemed to be appropriate. Participants agreed that course participation would influence their future practice. A statistically significant difference (P < 0.001) between self-reported pre- and post-course confidence scores was observed in 19 out of 25 scenarios. The learning environment, learning method and debrief were highlighted as aspects of the courses that participants liked most. The mandatory integration of CAST has been welcomed with widespread enthusiasm among specialist anaesthesia trainees. Intuitively, course participation instils confidence in trainees and better equips them to manage anaesthesia emergencies in the clinical setting. It remains to be seen if translational outcomes result from this increase in confidence. Nevertheless, the findings of this extensive review have cemented the place of mandatory simulation training in specialist anaesthesia training in Ireland.

Are Students More Engaged When Schools Offer Extracurricular Activities? PISA in Focus. No. 18

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2012

2012-01-01

Are students more engaged and do they perform better in science if their school encourages them to work on science projects, participate in science fairs, belong to a science-related club or go on science-related field trips--in addition to teaching them the mandatory science curriculum? To find out, PISA (Programme for International Student…

Influence of Bisphenol A on Thyroid Volume and Structure Independent of Iodine in School Children

PubMed Central

Wang, Na; Zhou, Ying; Fu, Chaowei; Wang, Hexing; Huang, Peixin; Wang, Bin; Su, Meifang; Jiang, Feng; Fang, Hong; Zhao, Qi; Chen, Yue; Jiang, Qingwu

2015-01-01

Background Although several studies have evaluated the relationship between bisphenol A (BPA) and thyroid functions, their results are not entirely consistent. Little is known about BPA in relation to thyroid volume and structure. Methods We examined the association of BPA with thyroid volume and thyroid nodules using data from 718 Chinese children living in the East Coast of China in 2012. First morning urine samples were collected for the determination of urinary BPA, creatinine, and urinary iodine concentrations (UIC). Thyroid volume (TV) and nodules were assessed by thyroid ultrasonography. Results The median of TV was 3.14ml. 459(63.9%) children took iodized salt at home and the median of UIC was 159μg/l. BPA was detected in 99.9% of the urine samples and the medians for boys and girls were 2.64 and 2.35μg/g creatinine, respectively. Of all participants 14.0% had thyroid nodules. Urinary BPA concentration was inversely associated with thyroid volume (β = -0.033, 95% CI: -0.053, -0.013) and the risk for multiple nodules (OR = 0.78; 95% CI: 0.63, 0.97). The associations above were similar for children who consumed iodized salt and those consumed non-iodized salt. Conclusions The data suggest that BPA may be one of the influencing factors for TV and thyroid nodules and its effects are independent of iodine nutrition status in children. PMID:26496713

Status of Iodine Nutrition among Pregnant Women Attending Antenatal Clinic of a Secondary Care Hospital: A Cross-sectional Study from Northern India.

PubMed

Kant, Shashi; Haldar, Partha; Lohiya, Ayush; Yadav, Kapil; Pandav, Chandrakant S

2017-01-01

Daily requirement of iodine increases during pregnancy making pregnant women a high-risk group for iodine deficiency disorders. The limited available literature shows that even in iodine sufficient population, pregnant women are iodine deficient. The objective of this study is to assess the current iodine nutrition status among pregnant women in Ballabgarh, district Faridabad, Haryana. Pregnant women were recruited from antenatal clinic (ANC) of subdistrict hospital (SDH), Ballabgarh, Haryana. Consecutive sampling strategy was followed to recruit pregnant women, and women of all trimesters were included in the study. Urinary iodine estimation was done using simple microplate method, and salt iodine was estimated using iodometric titration. The study was approved by Institute Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Out of the total 1031 pregnant women, 90.9% were using adequately iodized salt. Median (interquartile range [IQR]) salt consumption by the pregnant women was 8.3 (6.7, 11.1) g/day. Median (IQR) urinary iodine concentration (UIC) for the pregnant women was 260 (199, 323) μg/L. Only 13.5% of pregnant women had insufficient iodine intake (UIC <150 μg/L). There was no significant difference in median UIC values by household salt iodine content and across three trimesters of pregnancy. Iodine nutrition status of the pregnant women attending ANC clinic of SDH Ballabgarh was adequate with attainment of universal salt iodization goal of >90% adequately iodized salt coverage in the study population.

Optimisation of simulated team training through the application of learning theories: a debate for a conceptual framework

PubMed Central

2014-01-01

Background As a conceptual review, this paper will debate relevant learning theories to inform the development, design and delivery of an effective educational programme for simulated team training relevant to health professionals. Discussion Kolb’s experiential learning theory is used as the main conceptual framework to define the sequence of activities. Dewey’s theory of reflective thought and action, Jarvis modification of Kolb’s learning cycle and Schön’s reflection-on-action serve as a model to design scenarios for optimal concrete experience and debriefing for challenging participants’ beliefs and habits. Bandura’s theory of self-efficacy and newer socio-cultural learning models outline that for efficient team training, it is mandatory to introduce the social-cultural context of a team. Summary The ideal simulated team training programme needs a scenario for concrete experience, followed by a debriefing with a critical reflexive observation and abstract conceptualisation phase, and ending with a second scenario for active experimentation. Let them re-experiment to optimise the effect of a simulated training session. Challenge them to the edge: The scenario needs to challenge participants to generate failures and feelings of inadequacy to drive and motivate team members to critical reflect and learn. Not experience itself but the inadequacy and contradictions of habitual experience serve as basis for reflection. Facilitate critical reflection: Facilitators and group members must guide and motivate individual participants through the debriefing session, inciting and empowering learners to challenge their own beliefs and habits. To do this, learners need to feel psychological safe. Let the group talk and critical explore. Motivate with reality and context: Training with multidisciplinary team members, with different levels of expertise, acting in their usual environment (in-situ simulation) on physiological variables is mandatory to introduce cultural context and social conditions to the learning experience. Embedding in situ team training sessions into a teaching programme to enable repeated training and to assess regularly team performance is mandatory for a cultural change of sustained improvement of team performance and patient safety. PMID:24694243

The Value of Fidelity of Implementation Criteria to Evaluate School-Based Science Curriculum Innovations

NASA Astrophysics Data System (ADS)

Lee, Yew-Jin; Chue, Shien

2013-10-01

School-based curriculum innovations, including those in science education, are usually not adequately evaluated, if at all. Furthermore, current procedures and instruments for programme evaluations are often unable to support evidence-based decision-making. We suggest that adopting fidelity of implementation (FOI) criteria from healthcare research can both characterize and narrow the separation between programme intent and actual implementation, which is a mandatory stage of evaluation before determining overall programme value. We demonstrate how such a process could be applied by science educators using data from a secondary school in Singapore that had devised a new curriculum to promote interest, investigative processes, and knowledge in science. Results showed that there were ambivalent student responses to this programme, while there were high levels of science process skill instruction and close alignment with the intended lesson design. The implementation of this programme appeared to have a satisfactory overall level of FOI, but we also detected tensions between programme intent and everyday classroom teaching. If we want to advance science education, then our argument is that applying FOI criteria is necessary when evaluating all curricular innovations, not just those that originate from schools.

Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: an observational study.

PubMed

Müller, Michael P; Richter, Torsten; Papkalla, Norbert; Poenicke, Cynthia; Herkner, Carsten; Osmers, Anne; Brenner, Sigrid; Koch, Thea; Schwanebeck, Uta; Heller, Axel R

2014-07-01

Many hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory. All healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data. For each year of the study period (2008-2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P=0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P=0.073). The NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Status of Iodine Nutrition among Pregnant Women Attending Antenatal Clinic of a Secondary Care Hospital: A Cross-sectional Study from Northern India

PubMed Central

Kant, Shashi; Haldar, Partha; Lohiya, Ayush; Yadav, Kapil; Pandav, Chandrakant S.

2017-01-01

Background: Daily requirement of iodine increases during pregnancy making pregnant women a high-risk group for iodine deficiency disorders. The limited available literature shows that even in iodine sufficient population, pregnant women are iodine deficient. Objective: The objective of this study is to assess the current iodine nutrition status among pregnant women in Ballabgarh, district Faridabad, Haryana. Materials and Methods: Pregnant women were recruited from antenatal clinic (ANC) of subdistrict hospital (SDH), Ballabgarh, Haryana. Consecutive sampling strategy was followed to recruit pregnant women, and women of all trimesters were included in the study. Urinary iodine estimation was done using simple microplate method, and salt iodine was estimated using iodometric titration. The study was approved by Institute Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Results: Out of the total 1031 pregnant women, 90.9% were using adequately iodized salt. Median (interquartile range [IQR]) salt consumption by the pregnant women was 8.3 (6.7, 11.1) g/day. Median (IQR) urinary iodine concentration (UIC) for the pregnant women was 260 (199, 323) μg/L. Only 13.5% of pregnant women had insufficient iodine intake (UIC <150 μg/L). There was no significant difference in median UIC values by household salt iodine content and across three trimesters of pregnancy. Conclusion: Iodine nutrition status of the pregnant women attending ANC clinic of SDH Ballabgarh was adequate with attainment of universal salt iodization goal of >90% adequately iodized salt coverage in the study population. PMID:29184324

Survey of iodine nutritional status in 2011, Zhejiang, China.

PubMed

Mao, Guangming; Ding, Gangqiang; Lou, Xiaoming; Zhang, Ronghua; Zheng, Pai; Mo, Zhe; Wang, Xiaofeng; Zhu, Wenming; Zhou, Jinshui; Gu, Fang

2015-01-01

Universal salt iodization (USI) was introduced in China in 1995, but whether the iodine status is optimal is questionable. This study was conducted to assess the iodine nutrition among Zhejiang population in coastal regions in China. A cross-sectional survey for iodine nutritional status was conducted with general population (n=10,350), including pregnant and lactating women (n=450 each) selected by stratified multistage sampling. Iodine content in drinking water, table salt and urine, were determined using arsenic-cerium catalytic spectrophotometry, the direct titration and the arsenic-cerium catalytic spectrophotometry, respectively, and daily iodine intake was estimated by 3 days of 24-hour recall method. The median iodine content in drinking water was 2.46 μg/L, Zhejiang belonged to the region of iodine deficiency in outer environment according to China standard. The median iodine content in table salt was 27.9 mg/kg, conforming to the standard requirements; the household coverage rate of qualified iodized salt reached 76.8%, which does not reach the standard requirement of WHO >90%. The dietary iodine intake of a reference individual averaged 379 μg/d, which indicated that the current iodine intake in diet was appropriate. In addition, the median urinary iodine concentration (UIC) was 162 μg/L in general population, and 130 μg/L in pregnant women, which didn't reach the standard requirements. The current dietary iodine intake in Zhejiang was generally sufficient and safe, but there is a risk of iodine deficiency among pregnant women and the population who do not consume iodized salt.

Center-iodized graphene as an advanced anode material to significantly boost the performance of lithium-ion batteries.

PubMed

Chen, Jie; Xu, Mao-Wen; Wu, Jinggao; Li, Chang Ming

2018-05-17

Iodine edge-doped graphene can improve the capacity and stability of lithium-ion batteries (LIBs). Our theoretical calculations indicate that center-iodization can further significantly enhance the anode catalytic process. To experimentally prove the theoretical prediction, iodine-doped graphene materials were prepared by one-pot hydrothermal and ball-milling approaches to realize different doping-sites. Results show that the center-iodinated graphene (CIG) anode exhibits a remarkably high reversible capacity (1121 mA h g-1 after 180 cycles at 0.5 A g-1), long-cycle life (0.01% decay per cycle over 300 cycles at 1 A g-1) and high-rate capacity (374 mA h g-1 after 800 cycles at 8 A g-1), which greatly improves the performance of the edge-iodinated graphene anode and these results are in good agreement with the theoretical analysis. More importantly, the CIG anode also delivers a high-rate capacity and excellent cycling stability (279 mA h g-1 after 500 cycles at 10 A g-1) in full-cells. Both the theoretical analysis and experimental investigation reveal the enhancement mechanism, in which the center-iodization increases the surface charge for fast electron transfer rate, improves the conductivity for charge transport and rationalizes the pore structure for enhanced mass transport and ion insertion/desertion, thus resulting in a high rate capacity and long cycle life. This work not only discloses the critical role of catalytic sites including both amounts and site positions but also offers great potential for high-power rechargeable LIB applications.

Assessment of iodine nutritional status in the general population in the province of Jaén.

PubMed

Olmedo Carrillo, Pablo; García Fuentes, Eduardo; Gutiérrez Alcántara, Carmen; Serrano Quero, Manuel; Moreno Martínez, Macarena; Ureña Fernández, Tomás; Santiago Fernández, Piedad

2015-10-01

Iodine deficiency affecting both pregnant women and schoolchildren has been reported in Jaén. Iodine deficiency is one of the leading causes of thyroid dysfunction and goiter, and adequate iodine prophylaxis with iodized salt, milk, and dairy products, or iodine supplementation have been shown to significantly improve iodine status in pregnancy. The purpose of this study was to assess iodine nutritional status in the general population of a iodine-deficient area with no previous institutional campaigns of iodine prophylaxis. A descriptive, cross-sectional study. Urinary iodine levels were measured in subjects from the Jaén healthcare district. The data were stratified by sex and age groups, and a survey was conducted on iodized salt consumption. Median and mean urinary iodine levels were 110.59 mcg/L and 130.11 mcg/L respectively. Urinary iodine levels were significantly higher in schoolchildren as compared to other age groups (161.52μg/L vs 109.33μg/L in subjects older than 65 years). Forty-three percent of the population had urinary iodine levels less than 100μg/L, and 68% of women of childbearing age had levels less than 150μg/L. Iodine nutritional status appears to be adequate, but the proportion of the population with urinary iodine levels less than 100μg/L is still very high, and iodized salt consumption is much less common than recommended by the WHO. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Iodine Status of Vulnerable Populations in Henan Province of China 2013-2014 After the Implementation of the New Iodized Salt Standard.

PubMed

Yang, Jin; Zhu, Lin; Li, Xiaofeng; Zheng, Heming; Wang, Zhe; Liu, Yang; Hao, Zongyu

2016-09-01

The standard of salt iodine content in China has been adjusted several times since implementation of the universal salt iodization (USI) in 1995. The new standard of iodized salt content was adjusted from 35 ± 15 to 30 ± 9 mg/kg in Henan province in 2012. We aimed to determine whether the vulnerable populations were iodine sufficient after the adjustment of salt iodine content and to provide a guideline for the adjustment of USI policy in China. Two cross-sectional surveys of iodine status in vulnerable populations, including reproductive-age, pregnant and lactating women, infants <2 years, and children aged 8-10 years, were conducted in Henan province in 2013 and 2014. In 2013, the median urinary iodine concentration (mUIC) of reproductive-age women was 200.1 μg/L and that of school children aged 8-10 years was 221.0 μg/L. These mUICs were considered as "more than adequate." The mUICs of reproductive-age women and school children in 2014 showed a significant decline compared to the mUICs in 2013 (P = 0.012 and P = 0.001, respectively). The mUICs of the pregnant women were 204.2 μg/L in 2013 and 202.5 μg/L in 2014, which both met the requirement level recommended by WHO. In 2013, the mUIC of lactating women was 169.1 μg/L and that of infants <2 years was 203.2 μg/L, which were significantly lower than that of 2014 (P < 0.001 and P < 0.001, respectively). The lactating women and infants in 2013 and 2014 were both regarded as "iodine adequate." Iodine status of the vulnerable populations is still adequate as a whole in Henan province after decreasing the salt iodine content. However, the mUIC of school children aged 8-10 years is slightly above the adequate level. To reduce the risk of iodine excess in the general population and prevent the possibility of iodine deficiency of the vulnerable population, it is necessary to explore the appropriate level of iodized salt content.

CT-guided Irreversible Electroporation in an Acute Porcine Liver Model: Effect of Previous Transarterial Iodized Oil Tissue Marking on Technical Parameters, 3D Computed Tomographic Rendering of the Electroporation Zone, and Histopathology

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

Sommer, C. M., E-mail: christof.sommer@med.uni-heidelberg.de; Fritz, S., E-mail: stefan.fritz@med.uni-heidelberg.de; Vollherbst, D., E-mail: dominikvollherbst@web.de

PurposeTo evaluate the effect of previous transarterial iodized oil tissue marking (ITM) on technical parameters, three-dimensional (3D) computed tomographic (CT) rendering of the electroporation zone, and histopathology after CT-guided irreversible electroporation (IRE) in an acute porcine liver model as a potential strategy to improve IRE performance.MethodsAfter Ethics Committee approval was obtained, in five landrace pigs, two IREs of the right and left liver (RL and LL) were performed under CT guidance with identical electroporation parameters. Before IRE, transarterial marking of the LL was performed with iodized oil. Nonenhanced and contrast-enhanced CT examinations followed. One hour after IRE, animals were killedmore » and livers collected. Mean resulting voltage and amperage during IRE were assessed. For 3D CT rendering of the electroporation zone, parameters for size and shape were analyzed. Quantitative data were compared by the Mann–Whitney test. Histopathological differences were assessed.ResultsMean resulting voltage and amperage were 2,545.3 ± 66.0 V and 26.1 ± 1.8 A for RL, and 2,537.3 ± 69.0 V and 27.7 ± 1.8 A for LL without significant differences. Short axis, volume, and sphericity index were 16.5 ± 4.4 mm, 8.6 ± 3.2 cm{sup 3}, and 1.7 ± 0.3 for RL, and 18.2 ± 3.4 mm, 9.8 ± 3.8 cm{sup 3}, and 1.7 ± 0.3 for LL without significant differences. For RL and LL, the electroporation zone consisted of severely widened hepatic sinusoids containing erythrocytes and showed homogeneous apoptosis. For LL, iodized oil could be detected in the center and at the rim of the electroporation zone.ConclusionThere is no adverse effect of previous ITM on technical parameters, 3D CT rendering of the electroporation zone, and histopathology after CT-guided IRE of the liver.« less

Prevalence of iodine deficiency and associated factors among pregnant women in Ada district, Oromia region, Ethiopia: a cross- sectional study.

PubMed

Fereja, Mengistu; Gebremedhin, Samson; Gebreegziabher, Tafere; Girma, Meron; Stoecker, Barbara J

2018-06-25

Maternal iodine deficiency (ID) during pregnancy has been recognized as a major cause of abortion, stillbirth, congenital abnormalities, perinatal mortality and irreversible mental retardation. In Ethiopia limited information is available regarding the epidemiology of maternal ID. The purpose of the present study was to assess the prevalence of iodine deficiency and associated factors among pregnant women in Ada district, Oromia region, Ethiopia. A community based, cross-sectional study was conducted in rural areas of Ada district, October to November, 2014. Data were collected from 356 pregnant women selected by multistage cluster sampling technique. Presence of goiter was examined by palpation and urinary iodine concentration was measured using inductively-coupled-plasma mass spectrometry. Salt iodine concentration was determined using a digital electronic iodine checker. Statistical analysis was done primarily using binary logistic regression. The outputs of the analysis are presented using adjusted odds ratio (AOR) with the respective 95% confidence intervals (CI). The median urinary iodine concentration (UIC) was 85.7 (interquartile range (IQR): 45.7-136) μg/L. Based on UIC, 77.6% (95% CI: 73.0-82.0%) of the study subjects had insufficient iodine intake (UIC < 150 μg/L). The goiter rate was 20.2% (95% CI: 16.0-24.0%). The median iodine concentration of the household salt samples was 12.2 (IQR: 6.9-23.8) ppm. Of the households, only 39.3% (95% CI: 34.0-44.0%) consumed adequately iodized salt (≥15 ppm). Prevalence of goiter was significantly higher among pregnant women aged 30-44 years (AOR = 2.32 (95% CI: 1.05-5.14)) than among younger women and among illiterate women (AOR = 2.71 (95% CI: 1.54-4.79)). Compared to nulliparous, women with parity of 1, 2 and 3 or more had 2.28 (95% CI: 1.01-5.16), 2.81 (95% CI: 1.17-6.74) and 4.41 (95% CI: 1.58-12.26) times higher risk of goiter. Iodine deficiency was a public health problem in the study area. This indicates the need for further strengthening of the existing salt iodization program in order to avail homogenously and adequately iodized salt. Also it is necessary to find ways to provide iodine supplements as needed until universal salt iodization (USI) is fully established.

Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?

PubMed Central

Mullan, Fitzhugh; Payne, Perry W; Ross, Heather

2010-01-01

Abstract Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. Other names for these programmes include ”obligatory”, ”mandatory”, ”required” and ”requisite.” All these different programme names refer to a country’s law or policy that governs the mandatory deployment and retention of a heath worker in the underserved and/or rural areas of the country for a certain period of time. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals’ education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce. PMID:20461136

Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. ICONA Study Group.

PubMed Central

Salmaso, S.; Rota, M. C.; Ciofi Degli Atti, M. L.; Tozzi, A. E.; Kreidl, P.

1999-01-01

In 1998, a series of regional cluster surveys (the ICONA Study) was conducted simultaneously in 19 out of the 20 regions in Italy to estimate the mandatory immunization coverage of children aged 12-24 months with oral poliovirus (OPV), diphtheria-tetanus (DT) and viral hepatitis B (HBV) vaccines, as well as optional immunization coverage with pertussis, measles and Haemophilus influenzae b (Hib) vaccines. The study children were born in 1996 and selected from birth registries using the Expanded Programme of Immunization (EPI) cluster sampling technique. Interviews with parents were conducted to determine each child's immunization status and the reasons for any missed or delayed vaccinations. The study population comprised 4310 children aged 12-24 months. Coverage for both mandatory and optional vaccinations differed by region. The overall coverage for mandatory vaccines (OPV, DT and HBV) exceeded 94%, but only 79% had been vaccinated in accord with the recommended schedule (i.e. during the first year of life). Immunization coverage for pertussis increased from 40% (1993 survey) to 88%, but measles coverage (56%) remained inadequate for controlling the disease; Hib coverage was 20%. These results confirm that in Italy the coverage of only mandatory immunizations is satisfactory. Pertussis immunization coverage has improved dramatically since the introduction of acellular vaccines. A greater effort to educate parents and physicians is still needed to improve the coverage of optional vaccinations in all regions. PMID:10593033

Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. ICONA Study Group.

PubMed

Salmaso, S; Rota, M C; Ciofi Degli Atti, M L; Tozzi, A E; Kreidl, P

1999-01-01

In 1998, a series of regional cluster surveys (the ICONA Study) was conducted simultaneously in 19 out of the 20 regions in Italy to estimate the mandatory immunization coverage of children aged 12-24 months with oral poliovirus (OPV), diphtheria-tetanus (DT) and viral hepatitis B (HBV) vaccines, as well as optional immunization coverage with pertussis, measles and Haemophilus influenzae b (Hib) vaccines. The study children were born in 1996 and selected from birth registries using the Expanded Programme of Immunization (EPI) cluster sampling technique. Interviews with parents were conducted to determine each child's immunization status and the reasons for any missed or delayed vaccinations. The study population comprised 4310 children aged 12-24 months. Coverage for both mandatory and optional vaccinations differed by region. The overall coverage for mandatory vaccines (OPV, DT and HBV) exceeded 94%, but only 79% had been vaccinated in accord with the recommended schedule (i.e. during the first year of life). Immunization coverage for pertussis increased from 40% (1993 survey) to 88%, but measles coverage (56%) remained inadequate for controlling the disease; Hib coverage was 20%. These results confirm that in Italy the coverage of only mandatory immunizations is satisfactory. Pertussis immunization coverage has improved dramatically since the introduction of acellular vaccines. A greater effort to educate parents and physicians is still needed to improve the coverage of optional vaccinations in all regions.

ESA achievements: more than thirty years of pioneering space activity

NASA Astrophysics Data System (ADS)

Wilson, Andrew

2005-06-01

Contents: ESA and science. ESA and Earth observation (Explorer Core missions, Explorer opportunity missions, Earth Watch). ESA and telecommunications. ESA and navigation. ESA and launchers. ESA and manned spaceflight. The ESA Science Programme is one of the Agency's mandatory activities, in which all Member States participate. The origins of the Science Programme, the oldest in the Agency, hark back to the days of ESRO. ESRO's seven successful scientific satellites paved the way for ESA's remarkable series of pioneering missions that have placed Europe at the vanguard of disciplines such as X-ray, gamma-ray and infrared astronomy; astrometry; solar system sciences (especially cometary), solar and heliospheric physics, as well as space plasma physics. Driven by the limited available means, ESA's Science Programme has consistently focused on missions with strong innovative contents. All of the missions launched or approved so far are covered in separate entries in this volume.

The new Italian mandatory vaccine Law as a health policy instrument against the anti-vaccination movement.

PubMed

Chirico, F

2018-01-01

In Italy, the Parliament granted recently the final approval to a law introducing a long list of childhood vaccinations mandatory for preschool and school-age children. Before the approval, a vibrant public debate took place on the traditional media, in the social networks and among policymakers because of the so called "anti-vaccination movement". In this paper, we discuss about ethical aspects and relationship between individual rights and public health. The role of social networks and the Internet is also essential to disseminate correct informations, influencing health behaviours and contributing to educating people about this major public health issue in a right way. Finally, new and specific educational programmes are needed in order to transmit the young generation the means to correctly understand scientific research about this controversial issue.

Research monitoring by US medical institutions to protect human subjects: compliance or quality improvement?

PubMed

de Jong, Jean Philippe; van Zwieten, Myra C B; Willems, Dick L

2013-04-01

In recent years, to protect the rights and welfare of human subjects, institutions in the USA have begun to set up programmes to monitor ongoing medical research. These programmes provide routine, onsite oversight, and thus go beyond existing oversight such as investigating suspected misconduct or reviewing paperwork provided by investigators. However, because of a lack of guidelines and evidence, institutions have had little guidance in setting up their programmes. To help institutions make the right choices, we used interviews and document analysis to study how and why 11 US institutions have set up their monitoring programmes. Although these programmes varied considerably, we were able to distinguish two general types. 'Compliance' programmes on the one hand were part of the institutional review board office and set up to ensure compliance with regulations. Investigators' participation was mandatory. Monitors focused on documentation. Investigators could be disciplined, and could be obliged to take corrective actions. 'Quality-improvement' programmes on the other hand were part of a separate office. Investigators requested to be monitored. Monitors focused more on actual research conduct. Investigators and other parties received feedback on how to improve the research process. Although both types of programmes have their drawbacks and advantages, we argue that if institutions want to set up monitoring programmes, quality improvement is the better choice: it can help foster an atmosphere of trust between investigators and the institutional review board, and can help raise the standards for the protection of human subjects.

Iodine Nutrition and the Prevalence of Thyroid Disease after Salt Iodization: A Cross-Sectional Survey in Shanghai, a Coastal Area in China

PubMed Central

Zou, Shurong; Wu, Fan; Guo, Changyi; Song, Jun; Huang, Cuihua; Zhu, Zhenni; Yu, Huiting; Guo, Yanfei; Lu, Xi; Ruan, Ye

2012-01-01

Background Both insufficient and excess iodine may produce thyroid disease. After salt iodization in China, the median urine iodine concentration (UIC) of children aged 8–10 years appeared adequate. However, it is unknown whether dietary changes due to rapid economic development in Shanghai have affected whole population iodine nutrition. Objective To assess dietary iodine intake, UIC and the prevalence of thyroid disease in the general population of Shanghai. Design A cross-sectional survey was conducted with general participants aged 5–69 years (n = 7,904) plus pregnant and lactating women (n = 380 each) selected by stratified multistage sampling. The iodine concentrations in their salt, drinking water and urine were measured. Daily iodine intake was estimated using the total diet study approach. Serum thyroid hormone concentrations and thyroid-related antibodies were measured and thyroid ultrasonography was performed. Results The median iodine concentration in salt was 29.5 mg/kg, and 12.8 µg/L in drinking water. Iodized salt, used by 95.3% of participants, contributed 63.5% of total dietary iodine. Estimated daily iodine intake was 225.96 µg. The median UIC of general participants was 146.7 µg/L; UIC <100 µg/L (iodine insufficiency) was seen in 28.6%; UIC >300 µg/L (iodine excess) in 10.1%. Pregnant women had a median UIC of 135.9 µg/L, with UIC <150 µg/L in 55.4%. Thyroid nodules and subclinical hypothyroidism were found in 27.44% and 9.17%, respectively. Conclusions According to published criteria, the current dietary iodine intake in Shanghai was generally sufficient and safe, but insufficient in pregnant women. Thyroid nodules and subclinical hypothyroidism were the commonest thyroid diseases identified. PMID:22911705

Doubling in the use of thyroid hormone replacement therapy in Denmark: association to iodization of salt?

PubMed

Cerqueira, Charlotte; Knudsen, Nils; Ovesen, Lars; Laurberg, Peter; Perrild, Hans; Rasmussen, Lone Banke; Jørgensen, Torben

2011-08-01

Iodization of salt is an effective strategy to prevent iodine deficiency disorders. Recent studies, however, indicate that increasing the iodine intake in a population may give rise to an increased incidence of hypothyroidism, but the association has not been fully clarified. In Denmark, iodization of salt was initiated in 1998 because of mild-to-moderate iodine deficiency. The aim of this study was to evaluate the effect of the raised iodine intake on the nationwide incident use of thyroid hormone replacement therapy (levothyroxine) to treat hypothyroidism. Data on all use of levothyroxine was extracted from the Register of Medicinal Product Statistics during the period 1995-2009 and linked to other nationwide registers by use of the Danish identification number. Persons with previous thyroid surgery were excluded. In the studied period 71,565 incident users were identified. The incidence rate increased 75% in the moderately iodine deficient region (72.2 incident users/100,000 person-years in 1997 to 126.6 in 2008) and 87% in the mildly deficient region (86.9-162.9). When stratified by sex and age-group (00-39, 40-64, 65+) the largest relative increase was seen among women in the youngest age-group, where more than a doubling was seen. The mechanisms behind the increase may be a result of iodine-induced hypothyroidism, although a higher diagnostic activity with regard to thyroid dysfunction and intensified treatment of subclinical hypothyroidism may also play a role. Our findings stress the need for caution when initiating iodine fortification programs to keep the intake within the optimal range, and the need for continuous monitoring.

Experimental study on ablation of leiomyoma by combination high-intensity focused ultrasound and iodized oil in vitro.

PubMed

Liang, Zhi-Gang; Gao, Yi; Ren, Xiao-Yan; Sun, Cui; Gu, Heng-Fang; Mou, Meng; Xiao, Yan-Bing

2017-10-01

The aim of the current study was to investigate whether iodized oil (IO) enhances high-intensity focused ultrasound (HIFU) ablation of uterine leiomyoma and to determine the features of hyperechoic changes in the target region. Forty samples of uterine leiomyoma were randomly divided into an experimental group and a control group. In the experimental group, the leiomyoma was ablated by HIFU 30 min after 1 mL of iodized oil had been injected into the center of the myoma. The hyperechoic values and areas in the target region were observed by B-modal ultrasound after HIFU ablation. The samples were cut successively into slices and stained by triphenyltetrazolium chloride (TTC) solution within 1 h after HIFU ablation. The diameters of TTC-non-stained areas were measured and tissues in the borderline of the TTC-stained and -non-stained areas were observed pathologically. All procedures in the control group were the same as those in the experimental group except IO was replaced by physiological saline. The hyperechoic value in the target region in the experimental group was higher than that in the control group 4 min after HIFU ablation (P < 0.05). Hyperechoic areas in the target region as well as TTC-non-stained volumes in the experimental group were greater than those in the control group (P < 0.05). Routine pathologic observation showed that coagulation necrosis of leiomyoma occurred in the target region in both groups. IO causes coagulation necrosis, enlarges tissue damage, and postpones the attenuation of hyperechoic changes in the target region when HIFU ablation is carried out for leiomyoma in vitro. © 2017 Japan Society of Obstetrics and Gynecology.

Drinking water contributes to excessive iodine intake among children in Hebei, China.

PubMed

Lv, S; Wang, Y; Xu, D; Rutherford, S; Chong, Z; Du, Y; Jia, L; Zhao, J

2013-09-01

In Hebei province, China, over six million people are potentially exposed to excessive iodine through consumption of high iodine underground drinking water and consumption of iodized salt. The aim of this study is to evaluate the contributions of drinking water and iodized salt on children's iodine nutrition in one area of Hebei province in order to refine strategies to correct the excessive iodine intake in these areas. To investigate the relationships between iodine content in water, iodized salt and urinary iodine content (UIC) in children (8-10 years), we randomly sampled three towns with a known median water iodine (MWI) of 150-300 μg/l in Hengshui City, Hebei province and collected water, salt and urine samples. The median UIC was 518.1 μg/l, the overall MWI was 247.0 μg/l, and 83% of children sampled were found to have urinary iodine concentrations higher than the WHO criterion of 300 μg/l. There was a significant and positive correlation between the median UIC of the children and the MWI in the 12 villages where the children lived (Spearman R=0.79, P=0.002), but the UIC was not significantly correlated with the median salt intake (MSI) (Spearman R=-0.17, P=0.6). A multiple linear regression analysis indicated that 68.7% of the variability in median UIC is associated with variability in MWI in the 12 villages. Iodine in drinking water was identified to be the key contributor to this excessive iodine in children indicating that in these areas, intervention should focus on providing alternative drinking water supplies.

[Repeated cross-sectional studies on urinary iodine and iodine content of salt among school-aged children from 2012 to 2014 in Yuhuan County, Zhejiang Province].

PubMed

Su, Meifang; Wang, Congyun; Li, Songtao; Ying, Xuhua; Zhao, Qi; Fu, Chaowei; Jiang, Qingwu

2016-01-01

To investigate the iodine status and its change among school-aged children in their morning urine and eating salt from 2012 to 2014 in Yuhuan County, Zhejiang Province, China. Three repeated cross-sectional studies were carried out at a same primary school in 2012, 2013 and 2014, respectively. Three classes were randomly selected from each of 3 to 5 grade by the cluster-stratified sampling every year. Totally, 1343 out of 1350 eligible children aged 8 to 10 years old were involved into this study. Their morning urine and salt eating at home were collected and tested. The overall median of urine iodine was 116.0 μg/L, and no significant change was found over year. The overall proportions of subjects with urine iodine < 50 μg/L, < 100 μg/L, and ≥ 300 μg/L were 4.8%, 38.6% and 3.5%, respectively, and there were little differences over year, gender and grade of children. An overall median of iodine from 1343 salt samples was 0.0 mg/kg and no year difference was statistically observed. The proportions of subjects consumed iodized salt significantly decreased from 25.1% in 2012 to 21.8% in 2013 and to 14.2% in 2014. There was a significant difference in urine iodine between subjects taken iodized salt or not and also a weak positive correlation between salt iodine and urine iodine. The nutritional status of iodine is overall stable, proper and safety in recent 3 years among school children in Yuhuan County. The coverage rate of iodized salt is very low.

Coverage and Consumption of Micronutrient Powders, Fortified Staples, and Iodized Salt Among Children Aged 6 to 23 Months in Selected Neighborhoods of Nairobi County, Kenya.

PubMed

Leyvraz, Magali; David-Kigaru, Dorcus M; Macharia-Mutie, Catherine; Aaron, Grant J; Roefs, Marlene; Tumilowicz, Alison

2018-03-01

Intake of micronutrient-rich foods among children aged 6 to 23 months in Nairobi is low. This study aimed to assess existing coverage and utilization of micronutrient powders (MNPs), fortified staples, and iodized salt among children aged 6 to 23 months prior to implementation of an MNP program. A cross-sectional survey among caregivers of children aged 6 to 23 months (n = 618) was implemented in 7 neighborhoods within Nairobi County, representing the implementation area of the new MNP program. Results for MNP coverage and utilization showed 28.5% of all caregivers were aware of MNP, 18.5% had ever received MNP for their child, and 10.8% had fed MNP to their child in the previous 7 days. Effective coverage (ie, the child had been given the MNP at least 3 times in the previous 7 days) was 5.8%. Effective coverage of infants and young children with poor feeding practices was significantly lower as compared to those with non-poor feeding practices (coverage ratio, 0.34; confidence interval, 0.12-0.70). Most households purchased iodized salt (96.9%), fortified oil (61.0%), and fortified maize flour (93.9%). An estimated 23.9% of vitamin A requirements of children (6-23 months) were provided from fortified oil and 50.7% of iron from fortified maize flour. Most households consumed processed milk (81%). Coverage of MNPs in the surveyed neighborhoods was low. Coverage of fortified salt, oil, and maize flour was high and provided significant amount of micronutrients to children. Processed milk has potential as a vehicle for food fortification.

Boosting health insurance coverage in developing countries: do conditional cash transfer programmes matter in Mexico?

PubMed

Biosca, Olga; Brown, Heather

2015-03-01

Achieving universal health insurance coverage is a goal for many developing countries. Even when universal health insurance programmes are in place, there are significant barriers to reaching the lowest socio-economic groups such as a lack of awareness of the programmes or knowledge of the benefits to participating in the insurance market. Conditional cash transfer (CCT) programmes can encourage participation through mandatory health education classes, increased contact with the health care system and cash payments to reduce costs of participating in the insurance market. To explore if participation in a CCT programme in Mexico, Oportunidades, is significantly associated with self-reported enrolment in a public health insurance programme. Cross-sectional data from 2007 collected on 29 595 Mexican households where the household head is aged between ages 15 and 60 were analysed. A logit model was used to estimate the association between Oportunidades participation and awareness of enrolment in a public health insurance programme. Participation in the Oportunidades programme is associated with a 25% higher likelihood of being actively aware of enrolment in Seguro Popular, a public health insurance scheme for the lowest socio-economic groups. Participation in the Oportunidades CCT programme is positively associated with awareness of enrolment in public health insurance. CCT programmes may be used to promote participation of the lowest socio-economic groups in universal public health insurance systems. This is crucial to achieving universal health insurance coverage in developing countries. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Two faces of patient advocacy: the current controversy in newborn screening.

PubMed

Arnold, Cosby G

2014-08-01

Newborn screening programmes began in the 1960s, have traditionally been conducted without parental permission and have grown dramatically in the last decade. Whether these programmes serve patients' best interests has recently become a point of controversy. Privacy advocates, concerned that newborn screening infringes upon individual liberties, are demanding fundamental changes to these programmes. These include parental permission and limiting the research on the blood samples obtained, an agenda at odds with the viewpoints of newborn screening advocates. This essay presents the history of newborn screening in the USA, with attention to factors that have contributed to concerns about these programmes. The essay suggests that the rapid increase in the number of disorders screened for and the addition of research without either public knowledge or informed consent were critical to the development of resistance to mandatory newborn screening and research. Future newborn screening initiatives should include public education and comment to ensure continued support. 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.

Revolution then evolution: the advance of health economic evaluation in Australia.

PubMed

Lopert, Ruth; Viney, Rosalie

2014-01-01

All governments face immense challenges in providing affordable healthcare for their citizens, and the diffusion of novel health technologies is a key driver of growth in expenditure for many. Although important methodological and process variations exist around the world, health economic evaluation is increasingly seen as an important tool to support decision-making around the introduction of new health technologies, interventions and programmes in countries of varying stages of economic development. In Australia, the assessment of the comparative cost-effectiveness of new medicines proposed for subsidy under the country's national drug subsidy programme, the Pharmaceutical Benefits Scheme, was introduced in the late 1980s and became mandatory in 1993, making Australia the first country to introduce such a requirement nationally. Since then the use of health economic evaluation has expanded and been applied to support decision-making across a broader range of health technologies, as well as to programmes in public health. Copyright © 2014. Published by Elsevier GmbH.

Iodine status of young Burkinabe children receiving small-quantity lipid-based nutrient supplements and iodised salt: a cluster-randomised trial.

PubMed

Hess, Sonja Y; Abbeddou, Souheila; Yakes Jimenez, Elizabeth; Ouédraogo, Jean-Bosco; Brown, Kenneth H

2015-12-14

The objective of the present study was to assess the impact of providing small-quantity lipid-based nutrient supplements (SQ-LNS) on the I status of young Burkinabe children. In total, thirty-four communities were assigned to intervention (IC) or non-intervention cohorts (NIC). IC children were randomly assigned to receive 20 g lipid-based nutrient supplements (LNS)/d containing 90 µg I with 0 or 10 mg Zn from 9 to 18 months of age, and NIC children received no SQ-LNS. All the children were exposed to iodised salt through the national salt iodization programme. Spot urinary iodine (UI), thyroid-stimulating hormone (TSH) and total thyroxine (T4) in dried blood spots as well as plasma thyroglobulin (Tg) concentrations were assessed at 9 and 18 months of age among 123 IC and fifty-six NIC children. At baseline and at 18 months, UI, TSH and T4 did not differ between cohorts. Tg concentration was higher in the NIC v. IC at baseline, but this difference did not persist at 18 months of age. In both cohorts combined, the geometric mean of UI was 339·2 (95% CI 298·6, 385·2) µg/l, TSH 0·8 (95% CI 0·7, 0·8) mU/l, T4 118 (95 % CI 114, 122) nmol/l and Tg 26·0 (95% CI 24·3, 27·7) µg/l at 18 months of age. None of the children had elevated TSH at 18 months of age. Marginally more children in NIC (8·9%) had low T4 (15 ppm). A reduction of SQ-LNS I content could be considered in settings with similarly successful salt iodisation programmes.

Career redevelopment programmes for inactive nurses in Japan.

PubMed

Tanaka, Sachiko; Serizawa, Takako; Sakaguchi, Chizuru

2008-12-01

The purpose of this paper is to examine the challenges and problems in using career redevelopment programmes and individual hospital programmes to prepare inactive nurses to re-enter into the workforce in Japan. It is critical to supply sufficient skilled health human resources for medical care. Although, Japan has a mandatory retraining programme for supporting nurses to return to the workplace after a career break, it is unclear to what extent there are benefits to nurses from these programmes. The research of career redevelopment programme was undertaken in three administrative divisions' nurse centres in local prefecture A, B and C. A survey of nurses participating in the programme running in T Hospital was also conducted. The issues examined were the background and motivations of participants, the length of career break, the percentages returning to work and the effectiveness of each programme. The average age of participants was 40 years, ranging widely from the 20-60 years. Local prefecture A tended to have narrower age range than others, namely from the 30-50 years. The average period of career break was around eight years at two of three. Length of experience was quite varied from entry level to 20 or 30 years in nursing. Feedback from nurses in the case study T Hospital suggests that the most effective ways of providing support through the programme was to meet the need for continuing support, including working styles after return to work and using the resources programme in their own area of domicile. In the potential return of the nurse, the following are important: (i) job support system by using social resources effectively in the community level; and (ii) introduction of diverse working styles that take account of varying work-life balance, as well as childcare support, by using existing facilities or human resources.

Comparison of two training programmes on paramedic-delivered CPR performance.

PubMed

Govender, Kevin; Sliwa, Karen; Wallis, Lee; Pillay, Yugan

2016-05-01

To compare CPR performance in two groups of paramedics who received CPR training from two different CPR training programmes. Conducted in June 2014 at the Hamad Medical Corporation Ambulance Service, the national ambulance service of the State of Qatar, the CPR performances of 149 new paramedic recruits were evaluated after they had received training from either a traditional CPR programme or a tailored CPR programme. Both programmes taught the same content but differed in the way in which this content was delivered to learners. Exclusive to the tailored programme was mandatory precourse work, continuous assessments, a locally developed CPR instructional video and pedagogical activities tailored to the background education and learner style preferences of paramedics. At the end of each respective training programme, a single examiner who was blinded to the type of training paramedics had received, rated them as competent or non-competent on basic life support skills, condition specific skills, specific overall skills and non-technical skills during a simulated out-of-hospital cardiac arrest (OHCA) assessment. Paramedics who received CPR training with the tailored programme were rated competent 70.9% of the time, compared with paramedics who attended the traditional programme and who achieved this rating 7.9% of the time (p<0.001). Specific improvements were seen in the time required to detect cardiac arrest, chest compression quality, and time to first monitored rhythm and delivered shock. In an OHCA scenario, CPR performance rated as competent was significantly higher when training was received using a tailored CPR programme. 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/

[Disease management for chronic heart failure patient].

PubMed

Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca

2011-02-01

Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

Comparative Policy Brief: Status of Intellectual Disabilities in Nepal

ERIC Educational Resources Information Center

Crishna, Brinda; Prajapati, Surya Bhakta

2008-01-01

In Nepal, the estimates of the prevalence of disabilities vary, and there is sparse information specifically about people with intellectual disabilities (ID). Existing data suggest higher rates of prevalence of ID in the more remote northern area due to use of non-iodized salt, lack of health facilities, and extreme poverty. Superstitious beliefs…

The historical evolution of thought regarding multiple micronutrient nutrition.

PubMed

Semba, Richard D

2012-01-01

Multiple micronutrient nutrition is an idea that originated in the 1940s and exemplifies the iterative nutritional paradigm. In the first four decades of the 20th century, scientists sought to separate and characterize the vitamins that were responsible for xerophthalmia, rickets, pellagra, scurvy, and beriberi. The dietary requirements of the different micronutrients began to be established in the early 1940s. Surveys showed that multiple micronutrient deficiencies were widespread in industrialized countries, and the problem was addressed by use of cod-liver oil, iodized salt, fortified margarine, and flour fortification with multiple micronutrients, and, with rising living standards, the increased availability and consumption of animal source foods. After World War II, surveys showed that multiple micronutrient deficiencies were widespread in developing countries. Approaches to the elimination of multiple micronutrient deficiencies include periodic vitamin A supplementation, iodized salt, targeted iron/folate supplementation, fortified flour, other fortified foods, home fortification with micronutrient powders, and homestead food production. The prevention of multiple micronutrient malnutrition is a key factor in achieving the Millennium Development Goals, given the important effects of micronutrients on health and survival.

Mandated reporters' experiences with reporting child maltreatment: a meta-synthesis of qualitative studies.

PubMed

McTavish, Jill R; Kimber, Melissa; Devries, Karen; Colombini, Manuela; MacGregor, Jennifer C D; Wathen, C Nadine; Agarwal, Arnav; MacMillan, Harriet L

2017-10-16

To systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters' (MRs) experiences with reporting. As no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs' experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies. All healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). The studies represent the views of 1088 MRs. Factors that influence MRs' decision to report and MRs' views towards and experiences with mandatory reporting of child maltreatment. Forty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin. The findings of this meta-synthesis suggest that there are many potentially harmful experiences associated with mandatory reporting and that research on the effectiveness of this process is urgently needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment.

PubMed

Adams, Jean; Bateman, Belinda; Becker, Frauke; Cresswell, Tricia; Flynn, Darren; McNaughton, Rebekah; Oluboyede, Yemi; Robalino, Shannon; Ternent, Laura; Sood, Benjamin Gardner; Michie, Susan; Shucksmith, Janet; Sniehotta, Falko F; Wigham, Sarah

2015-11-01

Uptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK. To provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations. Systematic review, qualitative study and discrete choice experiment (DCE) with questionnaire. Community, health and education settings in England. Qualitative study - parents and carers of preschool children, health and educational professionals. DCE - parents and carers of preschool children identified as 'at high risk' and 'not at high risk' of incompletely vaccinating their children. Qualitative study - focus groups and individual interviews. DCE - online questionnaire. The review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to 'universal' services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted. Systematic review - there was insufficient evidence to conclude that the interventions considered are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study - there was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable. Optimising current services was consistently preferred to the interventions proposed. DCE and questionnaire - universal parental financial incentives were preferred to quasi-mandatory interventions, which were preferred to targeted incentives. Those reporting that they would need an incentive to vaccinate their children completely required around £110. Those who did not felt that the maximum acceptable incentive was around £70. Systematic review - a number of relevant studies were excluded as they did not meet the study design inclusion criteria. Qualitative study - few partially and non-vaccinating parents were recruited. DCE and questionnaire - data were from a convenience sample. There is little current evidence on the effectiveness or economic costs and consequences of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Universal incentives are likely to be more acceptable than targeted ones. Preferences concerning incentives versus quasi-mandatory interventions may depend on the context in which these are elicited. Further evidence is required on (i) the effectiveness and optimal configuration of parental financial incentive and quasi-mandatory interventions for preschool vaccinations - if effectiveness is confirmed, further evidence is required on how to communicate this to stakeholders and the impact on acceptability; and (ii) the acceptability of parental financial incentive and quasi-mandatory interventions for preschool vaccinations to members of the population who are not parents of preschool children or relevant health professionals. Further consideration should be given to (i) incorporating reasons for non-vaccination into new interventions for promoting vaccination uptake; and (ii) how existing services can be optimised. This study is registered as PROSPERO CRD42012003192. The National Institute for Health Research Health Technology Assessment programme.

Iodine Deficiency and Excess Coexist in China and Induce Thyroid Dysfunction and Disease: A Cross-Sectional Study

PubMed Central

Meng, Fangang; Liu, Shoujun; Fan, Zhipeng; Wu, Junhua; Sun, Dianjun

2014-01-01

Background In spite of the salt iodization, iodine deficiency disorders (IDD) have not been sustainably eliminated in China. There are coastal areas with low iodized salt coverage rates (iodine nutrition is inadequate) and other areas with excessive amounts of iodine in the drinking water. Objective This study aimed to clarify the association of iodine deficiencies resulting from a low coverage rate of iodized salt, excess iodine intake from drinking water with thyroid function and disease in adults. Design A cross-sectional study was conducted in adults in different iodine nutrition areas in three provinces in China. Results The prevalence of thyroid nodules was 15.52%, 8.66% and 22.17% in the iodine excess, sufficient and deficient groups, respectively. The prevalence of subclinical hypothyroidism was 20.09%, 10.41%, and 2.25% in the excess, sufficient and deficient iodine groups, respectively. The prevalence of subclinical hyperthyroidism and overt hyperthyroidism in the iodine deficient group was higher than that in the iodine excess group ( = 9.302, p = 0.002) and iodine sufficient group ( = 7.553, p = 0.006). Thyroid-stimulating hormone (TSH) was significantly correlated with excess iodine intake (β = 1.764,P = 0.001) and deficient iodine intake (β = −1.219, P = 0.028). Conclusions Thyroid nodules are more likely to be present in the iodine excess and deficient areas than in the iodine sufficient areas. Subclinical hyperthyroidism and overt hyperthyroidism are more likely to be prevalent in the iodine deficient areas than in the iodine excess or sufficient areas. Subclinical hypothyroidism is more likely to be prevalent in the high iodine intake areas than in the iodine deficient or sufficient areas. Median TSH may be deemed as an alternative indicator for monitoring the iodine nutrition status of the adult population in iodine excess and deficient areas. PMID:25375854

Evolution of urinary iodine excretion over eleven years in an adult population.

PubMed

Gutiérrez-Repiso, Carolina; Colomo, Natalia; Rojo-Martinez, Gemma; Valdés, Sergio; Tapia, Maria J; Esteva, Isabel; Ruiz de Adana, Maria S; Rubio-Martin, Elehazara; Lago-Sampedro, Ana; Santiago, Piedad; Velasco, Ines; Garcia-Fuentes, Eduardo; Moreno, Jose C; Soriguer, Federico

2015-08-01

Few prospective cohort studies have evaluated dietary iodine intake and urinary iodine concentrations in the general adult population. We assess the evolution of urinary iodine excretion and factors that may influence it in an adult population followed for 11 years. A population-based cohort study was undertaken in Pizarra (Spain). In the three study phases (baseline (n = 886), and 6 (n = 788) and 11 years later (n = 501)), participants underwent an interview and a standardized clinical examination that included a food questionnaire, and thyroid hormone and urinary iodine determinations. Subjects with thyroid dysfunction, palpable goiter or urinary iodine excretion >400 μg/L were excluded. Urinary iodine increased over the years (100.6 ± 70.0 μg/L at baseline vs. 125.4 ± 95.2 μg/L at 6 years and 141.6 ± 81.4 μg/L at 11 years; p < 0.0001). Urinary iodine was significantly higher in subjects who reported iodized salt consumption and in subjects with a higher intake of dairy products (p < 0.05). Consumption of iodized salt (Risk ratio (RR) = 1.23, 95% CI [1.01-2.05]) and dairy products (RR = 2.07, 95% CI [1.01-4.23]), and a baseline urinary iodine concentration ≥100 μg/L (RR = 1.26, 95% CI [1.04-1.53]) were significantly associated with urinary iodine concentrations ≥100 μg/L at 11 years. There is no correlation between thyroid function (TSH, free triiodothyronine or free thyroxine levels) and urinary iodine concentrations in conditions of iodine sufficiency. The increase in urinary iodine concentrations over eleven years is associated with an increase in iodized salt intake and with the dairy products intake, and possibly with a higher iodine content of dairy products. However, individual variability in urinary iodine excretion was not fully explained by dietary iodine intake alone; previous urinary iodine concentrations were also important. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

[Assessment of dietary habits related to iodine intake and iodine concentration and thyroid dysfunction in a non-preselected population in Spain (the Thyrobus Project)].

PubMed

Ballester, Lluís Vila; Candil, Sergio Donnay; Reymunde, Teresa Iglesias; Escofet, Federico Soriguer; Henzi, Frederic Tortosa; Jaramillo, Sara Torrejón; Alcázar, Javier; Tapias, María José; Torres, Yolanda; Puig-Domingo, Manel

2010-11-01

Most of the studies on urinary iodine levels in Spain in the last decade have reported a significant improvement. A survey was undertaken together with an information campaign on the thyroid gland, the importance of iodine intake and hypothyroidism in four Spanish cities. The goals of the survey were to obtain information on consumption of iodine-containing foods, to measure urinary iodine levels and to evaluate the prevalence of thyroid dysfunction. A non-preselected population attending the information campaign centers located in Barcelona, La Coruña, Malaga and Madrid was studied. A questionnaire on fish, milk and iodized salt consumption was administered. Urinary iodine levels (Pino's method) and thyrotropin (TSH) concentrations (Whatman 903® dry paper method) were measured. A total of 872 questionnaires were completed (Madrid 40%; La Coruña 27%; Malaga 19%; and Barcelona 14%). The mean age was 51 years (SD 16); 81% were women. A total of 60.6% of interviewees reported they consumed iodized salt, 90.8% reported daily milk intake and 29.3% reported fish consumption ≥3 times per week. The mean urinary iodine concentration was 143.2 μg/L. The prevalence of high TSH levels (>4 mUI/L) was 1.3% and that of low TSH levels (<0.4 mUI/mL) was 1.2%. According to the World Health Organization criteria, the median urinary iodine concentration, both overall or by city, is indicative of optimal iodine intake. In addition to iodized salt intake, consumption of products such as milk and fish has probably contributed to these positive results. The prevalences of undiagnosed hyperthyroidism and hypothyroidism detected in this study were similar to those found in other studies. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

Iodine nutritional status of women in their first trimester of pregnancy in Catalonia.

PubMed

Torres, Maria Teresa; Francés, Lidia; Vila, Lluis; Manresa, Josep María; Falguera, Gemma; Prieto, Gemma; Casamitjana, Roser; Toran, Pere

2017-07-26

Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 μg/L, and tobacco use in the first trimester of pregnancy in our setting. Cross-sectional study. Data were collected during 2008-2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment. Nine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 μg/L, with 407 participants (43.1%) showing levels <150 μg/L. On multivariate logistic regression analysis, intake of 1-2 glasses of milk per day, OR = 0.636 95% CI (0.45-0.90) or >2 glasses, OR = 0.593 95% CI (0.37-0.95); iodized salt consumption, OR = 0.678 95% CI (0.51-0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31-0.54), protected against the risk of UIC <150 μg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31-0.54). The median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 μg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation.

Gender-specific determinants of goiter.

PubMed

Farahati, Jamshid; Wegscheider, Karl; Christ, Kerstin; Gilman, Elena; Oing, Wilhelm

2006-12-01

Despite the strong implications of differences between females and males in the risk of goiter, gender-specific issues have not been extensively addressed in investigations of goiter prevalence. The objective of our analysis was to investigate the gender-specific determinants of goiter. Between April 2001 and April 2002. A total of 853 healthy employees from 4 institutions in the western part of Germany between 18 and 68 yr of age were examined by ultrasound of the neck to determine the thyroid volume. Information on sex, age, daily use of iodized salt, the history of goiter in the first-degree relatives, type and amount of smoking, oral contraceptives, and number of pregnancies were assessed by standardized questionnaires. Gender-specific predictors of goiter prevalence were assessed by multivariate logistic regression. The overall prevalence of goiter among study subjects was 204/853 (23.9%). Goiter was present in 80 out of 370 females (21.6%) vs 124/483 (25.7%) in males. In general, smoking (p < 0.0001), increasing age (p < 0.0001), and lack of daily intake of iodized salt (p = 0.004) were associated with goiter prevalence, but not sex (p = 0.39) and family history of goiter (p = 0.16). In 370 females, parity (p = 0.004) and lack of daily intake of iodized salt (p = 0.01) were the major determinants for goiter, whereas age (p = 0.18), oral contraceptives (p = 0.82), family history of goiter (p = 0.33), and smoking (p = 0.09) did not affect goiter prevalence. In 483 males, smoking (p < 0.0001) and age (p < 0.001) affected goiter prevalence, but not family history of goiter (p = 0.39), and the iodine status failed just to reach the significant level (p = 0.08) in this analysis. Gender-specific determinants of goiter are parity and iodine status in females and smoking and increasing age in males.

Transformational leadership training programme for charge nurses.

PubMed

Duygulu, Sergul; Kublay, Gulumser

2011-03-01

This paper is a report of an evaluation of the effects of a transformational leadership training programme on Unit Charge Nurses' leadership practices. Current healthcare regulations in the European Union and accreditation efforts of hospitals for their services mandate transformation in healthcare services in Turkey. Therefore, the transformational leadership role of nurse managers is vital in determining and achieving long-term goals in this process. The sample consisted of 30 Unit Charge Nurses with a baccalaureate degree and 151 observers at two university hospitals in Turkey. Data were collected using the Leadership Practices Inventory-Self and Observer (applied four times during a 14-month study process from December 2005 to January 2007). The transformational leadership training programme had theoretical (14 hours) and individual study (14 hours) in five sections. Means, standard deviations and percentages, repeated measure tests and two-way factor analysis were used for analysis. According the Leadership Practices Inventory-Self and Observer ratings, leadership practices increased statistically significantly with the implementation of the programme. There were no significant differences between groups in age, length of time in current job and current position. The Unit Charge Nurses Leadership Practices Inventory self-ratings were significantly higher than those of the observers. There is a need to develop similar programmes to improve the leadership skills of Unit Charge Nurses, and to make it mandatory for nurses assigned to positions of Unit Charge Nurse to attend this kind of leadership programme. © 2010 Blackwell Publishing Ltd.

An update on EUMETSAT programmes and plans

NASA Astrophysics Data System (ADS)

Klaes, K. Dieter; Holmlund, Kenneth

2016-09-01

EUMETSAT is providing space based observations for operational meteorology and climate monitoring. The observations are measured by geostationary and sun-synchronous polar orbiting satellites in the frame of mandatory programmes. In the frame of optional programmes further observations for altimetry and oceanography are collected and disseminated. In the frame of third party programmes, EUMETSAT makes available data from other agencies' satellites to the user community. Since summer 2015 MSG-4 complements the current operational fleet of operational geostationary spacecraft, Meteosat-7, which is the last satellite of the first generation and the three satellites of the Second Generation of Meteosat, Meteosat-8, Meteosat-9 and Meteosat-10. MSG-4 became Meteosat-11 and was stored in orbit after successful commissioning. Two satellites of the EUMETSAT Polar System (EPS) provide data from sunsynchronous polar orbit. Metop-B, the second of a series of three satellites, launched in September 2012 and Metop-A, the first of the series, in orbit since October 2006 provide operational services. The satellites belong to the Initial Joint Polar System (IJPS) with the US. EUMETSAT's first optional programme continues to provide data from the Jason-2 satellite since summer 2008. As follow on the Jason-3 satellite was launched in January 2016 and is currently in commissioning. To assure continuity development of Meteosat Third Generation (MTG) is ongoing. The EPS-SG programme was fully approved in summer 2015. In the frame of the Copernicus Programme (formerly GMES (Global Monitoring for Environment and Security)) EUMETSAT will operate the marine part of the Sentinel-3 satellite. It was launched in February 2016 and is currently under commissioning.

Application of segmented dental panoramic tomography among children: positive effect of continuing education in radiation protection

PubMed Central

Waltimo-Sirén, Janna; Laatikainen, Tuula; Haukka, Jari; Ekholm, Marja

2016-01-01

Objectives: Dental panoramic tomography is the most frequent examination among 7–12-year olds, according to the Radiation Safety and Nuclear Authority of Finland. At those ages, dental panoramic tomographs (DPTs) are mostly obtained for orthodontic reasons. Children's dose reduction by trimming the field size to the area of interest is important because of their high radiosensitivity. Yet, the majority of DPTs in this age group are still taken by using an adult programme and never by using a segmented programme. The purpose of the present study was to raise the awareness of dental staff with respect to children's radiation safety, to increase the application of segmented and child DPT programmes by further educating the whole dental team and to evaluate the outcome of the educational intervention. Methods: A five-step intervention programme, focusing on DPT field limitation possibilities, was carried out in community-based dental care as a part of mandatory continuing education in radiation protection. Application of segmented and child DPT programmes was thereafter prospectively followed up during a 1-year period and compared with our similar data from 2010 using a logistic regression analysis. Results: Application of the child programme increased by 9% and the segmented programme by 2%, reaching statistical significance (odds ratios 1.68; 95% confidence interval 1.23–2.30; p-value < 0.001). The number of repeated exposures remained at an acceptable level. The segmented DPTs were most frequently taken from the maxillary lateral incisor–canine area. Conclusions: The educational intervention resulted in improvement of radiological practice in respect to radiation safety of children during dental panoramic tomography. Segmented and child DPT programmes can be applied successfully in dental practice for children. PMID:27142159

Application of segmented dental panoramic tomography among children: positive effect of continuing education in radiation protection.

PubMed

Pakbaznejad Esmaeili, Elmira; Waltimo-Sirén, Janna; Laatikainen, Tuula; Haukka, Jari; Ekholm, Marja

2016-05-23

Dental panoramic tomography is the most frequent examination among 7-12-year olds, according to the Radiation Safety and Nuclear Authority of Finland. At those ages, dental panoramic tomographs (DPTs) are mostly obtained for orthodontic reasons. Children's dose reduction by trimming the field size to the area of interest is important because of their high radiosensitivity. Yet, the majority of DPTs in this age group are still taken by using an adult programme and never by using a segmented programme. The purpose of the present study was to raise the awareness of dental staff with respect to children's radiation safety, to increase the application of segmented and child DPT programmes by further educating the whole dental team and to evaluate the outcome of the educational intervention. A five-step intervention programme, focusing on DPT field limitation possibilities, was carried out in community-based dental care as a part of mandatory continuing education in radiation protection. Application of segmented and child DPT programmes was thereafter prospectively followed up during a 1-year period and compared with our similar data from 2010 using a logistic regression analysis. Application of the child programme increased by 9% and the segmented programme by 2%, reaching statistical significance (odds ratios 1.68; 95% confidence interval 1.23-2.30; p-value < 0.001). The number of repeated exposures remained at an acceptable level. The segmented DPTs were most frequently taken from the maxillary lateral incisor-canine area. The educational intervention resulted in improvement of radiological practice in respect to radiation safety of children during dental panoramic tomography. Segmented and child DPT programmes can be applied successfully in dental practice for children.

Reflections on the influenza vaccination of healthcare workers.

PubMed

McLennan, Stuart; Wicker, Sabine

2010-11-29

Despite all that is known about the dangers of nosocomial transmission of influenza to the vulnerable patient populations in our healthcare facilities, and the benefits of the influenza vaccination, the low rates of influenza vaccination among healthcare workers (HCWs) internationally shows no sign of significant improvement. With the current voluntary 'opt-in' programmes clearly failing to adequately address this issue, the time has undoubtedly come for a new approach to vaccination to be implemented. Two different approaches to vaccination delivery have been suggested to rectify this situation, mandatory vaccination and 'opt-out' declination forms. It is suggested, however, that these two approaches are inadequate when used by themselves. In order to protect the most vulnerable patients in our healthcare facilities as best we can from serious harm or death caused by nosocomial transmission of influenza, while at the same time respecting HCWs autonomy, and in many jurisdictions, the related legal right to refuse medical treatment, it is recommended that 'op-out' declination forms should be used in conjunction with restricted mandatory vaccination. This 'combined' approach would allow any HCW to refuse the influenza vaccination, but would make the influenza vaccination a mandatory requirement for working in areas where the most vulnerable patients are cared for. Those HCWs not willing to be vaccinated should be required to work in other areas of healthcare. Copyright © 2010 Elsevier Ltd. All rights reserved.

Opportunities and barriers to cardiopulmonary resuscitation training in English secondary schools.

PubMed

Lockey, Andrew S; Barton, Katherine; Yoxall, Heather

2016-10-01

Cardiopulmonary resuscitation rates and survival from out-of-hospital cardiac arrest are poor in the UK compared with areas abroad that deliver mandatory training to all school children. We sought to identify barriers to training and develop a strategy to enable delivery of this training. Qualitative analysis, comprising semistructured interviews and group discussions, covering 14 schools in the metropolitan borough of Calderdale in West Yorkshire. Only three schools out of 14 were delivering training to entire year groups. Barriers include lack of resources, lack of training for teachers and difficulty in initiating a programme. Strategies were developed to overcome these barriers with the result that four additional schools are now teaching a whole year group. There is no single solution and bespoke plans may be needed for each school. The establishment of cardiopulmonary resuscitation training in secondary schools in the UK is achievable. The commonly perceived barriers to establishment of training are all surmountable, but solving them does not necessarily ensure universal coverage. Support from healthcare professionals, in particular public health, is essential to ensure that the training is as widespread as possible. Mandatory inclusion of this training on the school curriculum, as seen in other countries, would result in significantly improved survival rates from out-of-hospital cardiorespiratory arrest. Solutions to improve training have been proposed, which could be used in other parts of Europe where such training is not a mandatory requirement.

Mandatory communication skills training for cancer and palliative care staff: does one size fit all?

PubMed

Turner, Mary; Payne, Sheila; O'Brien, Terri

2011-12-01

There is increasing recognition of the importance of good communication between healthcare professionals and patients facing cancer or end of life. In England, a new national 3-day training programme called 'Connected' has been developed and is now mandatory for all cancer and palliative care professionals. This study aimed to explore the attitudes of staff in one region to undertaking this training. A survey questionnaire was developed through a series of discussions with experts and semi-structured interviews with five healthcare professionals. The questionnaire was distributed to 200 cancer and palliative care staff; 109 were completed and returned. There were significant differences between doctors' and nurses' attitudes to communication skills training, with doctors demonstrating more negative attitudes. More nurses than doctors felt that communication skills training should be mandatory for cancer and palliative care professionals (p ≤ 0.001), whilst more doctors felt that these staff should already be skilled communicators and not require further training (p ≤ 0.001). Nurses also self-rated their communication skills more highly than doctors. The current 'one size fits all' approach being taken nationally to advanced communication skills training does not meet the training preferences of all healthcare professionals, and it is recommended that tailoring courses to individuals' needs should be considered. Copyright © 2010 Elsevier Ltd. All rights reserved.

A Review of NICE Methods and Processes Across Health Technology Assessment Programmes: Why the Differences and What is the Impact?

PubMed

Cowles, Emma; Marsden, Grace; Cole, Amanda; Devlin, Nancy

2017-08-01

Decisions made by the National Institute for Health and Care Excellence (NICE) exert an influence on the allocation of resources within 'fixed' National Health Service budgets. Yet guidance for different types of health interventions is handled via different 'programmes' within NICE, which follow different methods and processes. The objective of this research was to identify differences in the processes and methods of NICE health technology assessment programmes and to explore how these could impact on allocative efficiency within the National Health Service. Data were extracted from the NICE technology appraisal programme, medical technologies guidance, diagnostic assessment programme, highly specialised technologies programme, and clinical guidelines process and methods manuals to undertake a systematic comparison. Five qualitative interviews were carried out with NICE members of staff and committee members to explore the reasons for the differences found. The main differences identified were in the required evidence review period, or lack thereof, mandatory funding status, the provision of a reference case for economic evaluation, the requirement for and the type of economic analysis undertaken, and the decision making criteria used for appraisal. Many of the differences found can be justified on grounds of practicality and relevance to the health technologies under assessment. Nevertheless, from a strict utilitarian view, there are several potential areas of inefficiency that could lead to the misallocation of resources within the National Health Service, although some of these might be eliminated or reduced if an egalitarian view is taken. The challenge is determining where society is willing to trade health gains between different people.

[Study on the present status of the areas with high iodine concentration in drinking water and edible salt at household levels in Ohio of Yellow River].

PubMed

Guo, Xiao-wei; Zhai, Li-ping; Liu, Yuan; Wang, Xin

2005-11-01

To understand the present condition of iodine excess areas and edible salt at household levels in Ohio of Yellow River,which will provide the evidence to control it. A cross section in one time was adopted for the epidemiological survey based on the east, west, south, north and central in all of townships from 8 counties. 2 samples of drinking water from each village were tested their water iodine content as well as the data regarding to their recourses and the depth of wells. 5 samples of edible salt were collected from each village for quantitative analysis. We investigated 451 villages in 92 townships of 8 counties. 800 samples of drinking water were tested which values of iodine content were (110.93 +/- 152.26) microg/L in main, 55.83 microg/L (0.84 - 997.82 microg/L) in medium. 102.39 thousand population are at risk for iodine excess and living in 24 townships of 7 counties where iodine concentration is over 150 microg/L in drinking water, with (327.72 +/- 192.19) microg/L in mean value or 253.87 microg/L (150.78 - 997.82 microg/L) in medium. The rate of iodized salt is 97.2%. All the iodine excess areas are located in alluvial plain of Yellow River. The etiology of high iodine in shallow well water may be supposed to be iodine aggregation formed by Yellow River in terms of thousands of flood in thousands of years. But iodine excess in deep well water may be related to rotten, deposit marine living beings rich in iodine millions upon millions years ago. There were distinctive features of iodine excess in drinking water from both shallow well and deep well, 24 iodine excess areas in Ohio of Yellow River. It has suggested that iodized salt intervention should be stopped in the areas and starting the health education project, survey of iodized salt in the region.

Investigation of iodine concentration in salt, water and soil along the coast of Zhejiang, China*

PubMed Central

Lu, Ying-li; Wang, Ning-jian; Zhu, Lan; Wang, Guo-xing; Wu, Hui; Kuang, Lin; Zhu, Wen-ming

2005-01-01

Objective: We aim to describe the environment iodine concentration in salt, water and soil along Zhejiang Province coast in the China foreland. It will be helpful for us to judge whether this area is insufficient in iodine and universal iodized salt is necessary or not. Methods: We collected iodized salt samples, drinking water samples (tap water in the towns, and well water or spring water in the villages), water samples from different sources (ditches, lakes, rivers) and soil samples through random sampling in June, 2005. Salt, water and soil iodine was detected by arsenic-cerium redox method. Statistical analysis was expressed as mean±SEM by Windows SPSS 13.0. Results: (1) The iodine concentration in salt was 27.9±4.33 mg/kg (n=108). (2) Seventy-five water samples were collected. The water iodine value was 0.6~84.8 μg/L (mean of 11.66 μg/L). The watershed along the Qiantang River has significantly higher iodine content than the water in Lin’an in mountain area (P<0.01). The iodine content and mean iodine content of tap water, well or spring water and natural water sources were 4.30±2.43 μg/L (n=34), 23.59±27.74 μg/L (n=19) and 12.72±10.72 μg/L (n=22) respectively. This indicated that among environmental water sources, the ditch iodine content was the highest with river water iodine being the lowest (P<0.01). (3) Soil iodine value was 0.11~2.93 mg/kg (mean of 1.32 mg/kg). Though there was no statistical difference of soil iodine in different districts (P=0.131), soil iodine content correlated positively with water iodine content. Conclusion: Iodine concentration in salt accords with national policy of adding iodine in salt. Foreland has more iodine in water than mountain area. The data reflected that water and soil iodine in foreland area was not high, which suggests universal iodized salt should be necessary. Environment iodine has relatively close association with pollution. PMID:16358379

[Study on the amount of daily iodine intake of inhabitants living in drinking water with excessive iodine content areas after termination of iodized salt supply].

PubMed

Zhang, Gen-hong; Li, Su-mei; Zheng, He-ming; Wang, Chuan-gang; Liu, Lie-jun; Li, Xiu-wei; Zhang, Hao-feng; Ke, Geng-yin; Ma, Jian-guo; Yang, Jin; Ma, Ying; Liu, Jin-wen

2007-03-01

To investigate the amount of daily iodine intake in the diet of the target population in drinking water with areas of excessive iodine after stopping supply of iodized salt, to provide evidence for developing strategies on control and prevention of excessive iodine. 335 objectives were selected by a two-stage sampling method in 4 administrative villages with different iodine contents in drinking water. The amount of drinking water intake and dietary survey for 335 people were done by a door-to-door survey,while the iodine contents in the drinking water of each selected family, local staple food and vegetable were measured. The median level of iodine in drinking water was 431.5 microg/L while the daily amount of iodine intake among the three groups of waters with different iodine contents were all greater than RNI. The daily iodine intake of local people was all greater than UL in the areas where the water iodine contents were more than 300 microg/L. It was of statistical sense that the iodine mean intake per capita per day of the three groups differed at different water iodine levels (P < 0.01). The iodine mean intake per capita per day of the three groups of different water iodine levels increased along with water iodine and showed a uptrend (P < 0.01). 83.2%-98.7% of the daily iodine intake of the three groups was from drinking water and 1.3%-16.8% came from food. The iodine intake had high-positive correlation relation with the content of water iodine (P < 0.01). It was concluded that drinking water was the main source of iodine intake in areas with iodine excessive water by the percentage of over 80%. It was necessary to adopt measures to improve the quality of water to decrease the iodine content other than just stopping supplies of iodized salt in the areas where the water iodine contents were greater than 300 microg/L, in order to prevent and control excessive intake of iodine.

Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease.

PubMed

Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

2010-11-01

Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year. Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on nodular thyroid disease. There are likely added benefits relating to more optimal thyroid hormone influenced brain development that are more difficult to estimate but may be even more important.

Should luteal phase support be introduced in ovarian stimulation/IUI programmes? An evidence-based review.

PubMed

Cohlen, B J

2009-01-01

World-wide, intrauterine insemination (IUI) is still one of the most applied techniques to enhance the probability of conception in couples with longstanding subfertility. The outcome of this treatment option depends on many confounding factors. One of the confounding factors receiving little attention is the quality of the luteal phase. From IVF studies, it is known that ovarian stimulation causes luteal phase deficiency. Based on the best available evidence, this short review summarizes the indications for mild ovarian stimulation combined with IUI and the optimal stimulation programme. While it has been established that stimulated IVF/intracytoplasmic sperm injection cycles have deficient luteal phases, the question remains whether the quality of the luteal phase when only two or three corpora lutea are present (as is the case in stimulated IUI cycles) is impaired as well. There are too few large non-IVF trials studying luteal phase quality to answer this question. Recently a randomized trial has been published that investigated luteal phase support in an IUI programme. This study is discussed in detail. It is recommended to apply luteal phase support in stimulated IUI cycles only when proven costeffective. Further trials are mandatory to investigate both endometrial and hormonal profile changes in the luteal phase after mild ovarian stimulation, and the cost-effectiveness of luteal support in IUI programmes.

What is the value of Values Based Recruitment for nurse education programmes?

PubMed

Groothuizen, Johanna E; Callwood, Alison; Gallagher, Ann

2018-05-01

A discussion of issues associated with Values Based Recruitment (VBR) for nurse education programmes. Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Discussion paper. This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding VBR in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of VBR, underpinned by contemporary theory and literature. Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how VBR will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of VBR methods. We call for a debate regarding the meaning and implications of VBR and further research regarding its validity and effectiveness. © 2017 John Wiley & Sons Ltd.

The “Health Coaching” programme: a new patient-centred and visually supported approach for health behaviour change in primary care

PubMed Central

2013-01-01

Background Health related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients. Methods Our new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques—such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors’ communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the “Health Coaching” programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients’ self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues. Results In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8–22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the “Health Coaching” programme were consistently high. Conclusions Our innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination. PMID:23865509

They just don't get enough! Variable intern experience in bedside procedural skills.

PubMed

Boots, R J; Egerton, W; McKeering, H; Winter, H

2009-04-01

Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures. Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of experience and confidence in clinical procedures at the beginning and end of their intern year. Attendance at and the contribution to procedural confidence of a voluntary procedural skill-training programme were examined. For the 314 interns, clinical experience before and during internship varied for each procedure and between year cohorts as did training programme attendance (44-84%). Student procedural confidence was predicted by pre-intern experience either on patients or by simulation (beta = 0.17, 95% confidence interval (CI) 0.02-0.21, P = 0.03) and age >30 years on commencing internship (beta = 8.44, 95%CI 3.03-14.06, P = 0.003. Adjusted R(2) = 0.08, P = 0.002). Intern procedural confidence by year's end was predicted by attendance at the training programme (beta = 0.48, 95%CI 0.34-0.62, P < 0.001), intern experience with patient procedures (beta = 0.34, 95%CI 0.21-0.47, P < 0.001) and a clear decision to enter a postgraduate training programme (beta = 0.13, 95%CI 0.04-0.22, P = 0.007, Adjusted R(2) = 0.50, P < 0.001). Interns and students receive variable experience to carry out procedural skills on patients. This makes designing training programmes difficult as training needs vary each year. Both mandatory supervision of key skills and opportunities to supplement limited experience are needed during the intern year to ensure a uniform experience.

The "Health Coaching" programme: a new patient-centred and visually supported approach for health behaviour change in primary care.

PubMed

Neuner-Jehle, Stefan; Schmid, Margareta; Grüninger, Ueli

2013-07-17

Health related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients. Our new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques-such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors' communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the "Health Coaching" programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients' self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues. In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8-22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the "Health Coaching" programme were consistently high. Our innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

Empowering a tea-plantation community to improve its micronutrient health.

PubMed

Gopaldas, Tara; Gujral, Sunder

2002-06-01

This project was designed to convince and empower management and plantation workers to improve their own nutritional health status and productivity. Plantations are generally bypassed by the government's primary health-care system. A nine-month intervention with iron (60 mg of elemental iron) and vitamin A supplementation and iodized salt was performed on the Balanoor Plantations in India. Of the women tea pickers, 99% (n = 334) received the supplements and bought the iodized salt from the plantation ration shop. Their mean hemoglobin level rose significantly from 11.0 to 11.9 g/dl. The women pickers gave the supplements to their families as well as themselves. The results were the same whether iron was given once or twice a week. The mean hemoglobin level of the women pickers rose significantly from 11.1 to 12.0 g/dl with the twice-weekly dose and from 10.9 to 11.8 g/dl with the weekly dose. The prevalence of clinical signs of vitamin A deficiency in the entire plantation population (about 2,500) was reduced significantly (from 19% to 4%), as was iodine deficiency (from 17% to 7%). Common health problems decreased from 88% to 54%. The number of patients referred to larger hospitals decreased significantly from 116 to 86. Absenteeism was not affected.

Mumps in Poland in 2014

PubMed

Korczyńska, Monika Roberta; Rogalska, Justyna

Vaccination against mumps from 2003 is mandatory in Poland and given as two dose scheme with MMR vaccine (mumps, measles, and rubella). Earlier this vaccination was only recommended. Despite observed decline in mumps incidence for over a decade which is a result of conducted vaccinations, mumps is still a common disease among the children. To assess epidemiological situation of mumps in Poland in 2014, including vaccination coverage in Polish population, in comparison to previous years. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins “Infectious diseases and poisonings in Poland in 2014” and “Vaccinations in Poland in 2014” (1). Mumps cases were classified according to the criteria of surveillance case definition implemented in the European Union (Commission Decision of 28 April 2008 amending Decision 2002/253/EC). National Immunisation Programme for year 2014 was also used. In total, there were 2 508 mumps cases registered in Poland in 2014. Incidence of mumps was 6.5 per 100,000 and it was higher by 3.1 % in comparison with 2013 and lower by 9.7 % in comparison with median for the years 2008-2012. The highest incidence rate was observed among children aged 4 years (61.3 per 100,000). Incidence in men (7.8 per 100,000) was higher than in women (5.3). In 2014, 31 people were hospitalized due to mumps. Vaccination coverage of children aged 3 years in Poland in 2013 was 97.0% and it was lower by 0.5 % in comparison with year 2013 (97.5 %). Systematic execution of mumps vaccination in accordance with the National Immunisation Programme resulted in a significant decrease in the number of registered cases. Due to the high vaccination coverage further decline in the number of cases is expected.

Mumps in Poland in 2013.

PubMed

Korczyńska, Monika Roberta; Rogalska, Justyna

2015-01-01

Vaccination against mumps from 2003 is mandatory in Poland and given as two dose scheme with MMR vaccine (mumps, measles, and rubella). Earlier this vaccination was only recommended. Despite observed decline in mumps incidence for over a decade which is a result of conducted vaccinations, mumps is still a common childhood disease. To assess epidemiological situation of mumps in Poland in 2013, including vaccination coverage in Polish population, in comparison to previous years. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2013" and "Vaccinations in Poland in 2013" (Czarkowski MP i in., Warszawa 2013, NIZP-PZH i GIS). Mumps cases were classified according to the criteria of surveillance case definition implemented in the European Union (Commission Decision of 28 April 2008 amending Decision 2002/253/EC). National Immunisation Programme for year 2013 was also used. In total, there were 2 436 mumps cases registered in Poland in 2013. Incidence of mumps was 6.3 per 100,000 and it was lower by 12.5% in comparison with 2012 and lower by 18.2% in comparison with median for the years 2007-2010. The highest incidence rate was observed among children aged 5 years (54.0 per 100,000). Incidence in men (7.5) was higher than in women (5.2). In 2013, 38 people were hospitalized due to mumps. Vaccination coverage of children aged 3 years in Poland in 2013 was 97.5% and it was lower by 0.4% in comparison with year 2012. Systematic execution of mumps vaccination in accordance with the National Immunisation Programme resulted in a significant decrease in the number of registered cases. Due to the high vaccination coverage further decline in the number of cases is expected.

Mumps in Poland in 2012.

PubMed

Rogalska, Justyna; Paradowska-Stankiewicz, Iwona

2014-01-01

Vaccination against mumps, introduced initially as recommended, from 2003 is mandatory in Poland and given as two dose scheme with MMR vaccine (mumps, measles, and rubella). Despite observed decline in mumps incidence for over a decade which is a result of conducted vaccinations, mumps is still a common childhood disease in Poland. To assess epidemiological situation of mumps in Poland in 2012, including vaccination coverage in Polish population, in comparison to previous years. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2012" and "Vaccinations in Poland in 2012" (Czarkowski MP i in., Warszawa 2013, NIZP-PZH i GIS). Mumps cases were classified according to the criteria of surveillance case definition implemented in the European Union (Commission Decision of 28 April 2008 amending Decision 2002/253/EC). National Immunisation Programme for year 2012 was also used. In total, there were 2779 mumps cases registered in Poland in 2012. Incidence of mumps was 7.2 per 100 000 and it was higher by 7.5% in comparison with 2011 and lower by 19.4% in comparison to median for the years 2006-2010. The highest incidence rate was observed among children aged 5 years (71.8 per 100 000). Incidence in women (5.9) was lower than in men (8.6). In 2012, 25 people were hospitalized due to mumps. Vaccination coverage of children aged 3 years in Poland in 2012 was 97.9%. Systematic execution of mumps vaccination in accordance with the National Immunisation Programme resulted in a significant decrease in the number of registered cases. Due to the high vaccination coverage further decline in the number of cases is expected.

Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies.

PubMed

Topic, Elizabeta; Beletic, Andjelo; Zima, Tomas

2013-01-01

Continuing professional development (CPD) with corresponding crediting system is recognized as essential for the laboratory medicine specialists to provide optimal service for the patients. Article presents results of the survey evaluating current CPD crediting practice among members of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). A questionnaire had been forwarded to presidents/national representatives of all EFLM members, with invitation to provide information about CPD programmes and crediting policies, as well as feedback on individual CPD categories, through scoring their relevance. Complete or partial answers were received from 28 of 38 members. In 23 countries, CPD programmes exist and earn credits, with 19 of them offering access to non-medical scientists. CPD activities are evaluated in all participating countries, regardless to the existence of an official CPD programme. Among participating members with mandatory specialists' licensing (22/28), CPD is a prerequisite for relicensing in 13 countries. Main categories recognized as CPD are: continuing education (24 countries), article/book (17/14 countries) authorship and distance learning (14 countries). The highest median score of relevance (20) is allocated to professional training, editor/authorship and official activities in professional organizations, with the first category showing the least variation among scores. Majority of EFLM members have developed CPD programmes, regularly evaluated and accompanied by crediting systems. Programmes differ in accessibility for non-medical scientists and impact on relicensing eligibility. Continuing education, authorship and e-learning are mainly recognized as CPD activities, although the professional training is appreciated as the most important individual CPD category.

Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies

PubMed Central

Topic, Elizabeta; Beletic, Andjelo; Zima, Tomas

2013-01-01

Introduction: Continuing professional development (CPD) with corresponding crediting system is recognized as essential for the laboratory medicine specialists to provide optimal service for the patients. Article presents results of the survey evaluating current CPD crediting practice among members of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Materials and methods: A questionnaire had been forwarded to presidents/national representatives of all EFLM members, with invitation to provide information about CPD programmes and crediting policies, as well as feedback on individual CPD categories, through scoring their relevance. Results: Complete or partial answers were received from 28 of 38 members. In 23 countries, CPD programmes exist and earn credits, with 19 of them offering access to non-medical scientists. CPD activities are evaluated in all participating countries, regardless to the existence of an official CPD programme. Among participating members with mandatory specialists’ licensing (22/28), CPD is a prerequisite for relicensing in 13 countries. Main categories recognized as CPD are: continuing education (24 countries), article/book (17/14 countries) authorship and distance learning (14 countries). The highest median score of relevance (20) is allocated to professional training, editor/authorship and official activities in professional organizations, with the first category showing the least variation among scores. Conclusions: Majority of EFLM members have developed CPD programmes, regularly evaluated and accompanied by crediting systems. Programmes differ in accessibility for non-medical scientists and impact on relicensing eligibility. Continuing education, authorship and e-learning are mainly recognized as CPD activities, although the professional training is appreciated as the most important individual CPD category. PMID:24266304

Testing Bonner sphere spectrometers in the JRC-IRMM mono-energetic neutron beams

NASA Astrophysics Data System (ADS)

Bedogni, R.; Domingo, C.; Esposito, A.; Chiti, M.; García-Fusté, M. J.; Lovestam, G.

2010-08-01

Within the framework of the Euratom Transnational Access programme, a specific sub-programme, called NUDAME (neutron data measurements at IRMM), was dedicated to support neutron measurement experiments at the accelerator-based facilities of the JRC-IRMM Geel, Belgium. In this context, the INFN-LNF and UAB groups undertook two separate experiments at the 7 MV Van de Graaff facility, aimed at testing their Bonner sphere spectrometers (BSS) with mono-energetic neutron beams. Both research groups routinely employ the BSS in neutron spectra measurements for radiation protection dosimetry purposes, where accurate knowledge of the BSS response is a mandatory condition for correct dose evaluations. This paper presents the results obtained by both groups, focusing on: (1) the comparison between the value of neutron fluence provided as reference data and that obtained by applying the FRUIT unfolding code to the measured BSS data and (2) the experimental validation of the response matrices of the BSSs, previously derived with Monte Carlo simulations.

What is the impact of multi-professional emergency obstetric and neonatal care training?

PubMed

Bergh, Anne-Marie; Baloyi, Shisana; Pattinson, Robert C

2015-11-01

This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed - five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all health-care providers. The challenges are as follows: scaling up such training to all institutions, sustaining regular in-service training, integrating training into institutional and health-system patient safety initiatives and 'thinking out of the box' in evaluation research. Copyright © 2015 Elsevier Ltd. All rights reserved.

Growing Physics and Astronomy Public Outreach in Montreal

NASA Astrophysics Data System (ADS)

Simard, Gabrielle; Lepo, Kelly

2017-01-01

AstroMcGill was founded in 2011 by an enthusiastic group of undergraduate students, graduate students and post-doctoral fellows. It serves as the education and public outreach (EPO) branch of the astronomy group within the Physics Department at McGill University in Montreal, Quebec. Over the last five years, AstroMcGill has grown from organizing sporadic visits in a couple primary schools to running a successful inquiry-based outreach programme for grade 4-6 students, the McGill Space Explorers. During the same time span, the attendance at public AstroNight lectures ramped up from attracting a few dozen people to over 500 people each month. We will highlight the recent successes of the programme and our best guesses for the reasons behind this success. We will also discuss the challenges of working in a bilingual city as we juggle our majority anglophone volunteers, a mandatory french science curriculum for primary school children and the (somewhat) overlapping English- and French-speaking communities in the city.

Responding to excessive alcohol consumption in third-level (REACT): a study protocol.

PubMed

Davoren, Martin P; Calnan, Susan; Mulcahy, Judith; Lynch, Emily; Perry, Ivan J; Byrne, Michael

2018-05-11

Problem alcohol use is an ongoing, worldwide phenomenon of considerable concern. Throughout the past 20 years, national policies have noted the importance of students when tackling alcohol consumption. Considering alcohol is a multifaceted issue, a multi-component response is required to combat its excessive use. This protocol sets out the approach used for developing, implementing and evaluating the REACT (Responding to Excessive Alcohol Consumption in Third-level) Programme. This evaluation will provide the evidence base for programme development, implementation and improvement. Stage one involved defining the multi-component intervention. This was developed following a systematic review of existing literature and a Delphi-consensus workshop involving university students, staff and relevant stakeholders. Following this, the programme is being implemented across the Higher Education sector in Ireland. A number of Higher Education Institutes have declined the invitation to participate in the programme. These institutions will act as control sites. Each intervention site will have a steering committee whose membership will include a mix of students and academic and student service staff. This steering committee will report to the REACT research team on the implementation of mandatory and optional action points at local sites. An online cross-sectional study at baseline and two-years post intervention will be utilised to determine the impact of the REACT programme. The impact assessment will focus on (1) whether the intervention has reduced alcohol consumption among third-level students (2); whether the programme altered students attitudes toward alcohol and (3) whether the programme has decreased the second-hand effects associated with excessive consumption. Finally, qualitative research will focus on factors influencing the take-up and implementation of this programme as well as students' views on the initiative. Alcohol consumption has remained on the policy agenda at both national and international level over recent decades. Students are regularly among the highest alcohol consumers, yet university management and public policymakers struggle to tackle this burgeoning issue. The REACT Programme provides a structure to translate policy into practice for those seeking to reduce hazardous alcohol consumption and related harms among third-level students.

Chronic thromboembolic pulmonary hypertension

PubMed Central

Reesink, H.J.; Kloek, J.J.; Bresser, P.

2006-01-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rapidly progressive and deadly disease, resulting from incomplete resolution of acute pulmonary embolism. Historically, the incidence of CTEPH was significantly underestimated but it may be as high as 3.8% following acute pulmonary embolism. Although the medical management of CTEPH may be supportive, the only curative treatment is pulmonary endarterectomy (PEA). However, a careful screening programme is mandatory to select CTEPH patients who are likely to benefit from PEA. In this review we discuss the pathophysiology, clinical and diagnostic pitfalls, surgical treatment, outcome after surgery, and the potential benefit of medical treatment in inoperable CTEPH patients. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696637

Mineral resource of the month: iodine

USGS Publications Warehouse

Polyak, Désirée E.

2009-01-01

The article focuses on iodine, its benefits and adverse effects, and its production and consumption. It states that iodine is essential to humans for it produces thyroid hormones to nourish thyroid glands but excessive intake could cause goiter, hyperthyroidism or hypothyroidism. U.S. laws require salt iodization to help prevent diseases. Chile and Japan are the world's leading iodine producer while in the U.S. iodine is mined from deep well brines in northern Oklahoma.

[Fistulography. Results of 126 examinations (author's transl)].

PubMed

Metges, P J; Silici, R; Kleitz, C; Delahaye, R P; Mine, J; Pailler, J L

1980-01-01

The authors describe the results obtained in a series of 126 patients examined by fistulography. This investigation should be conducted systematically after operative treatment of any type of fistula. The procedure involves perfusion of a water-soluble iodized contrast medium at low pressure, using a balloon sound to ensure that there are no leaks. The results supply the general or orthopedic surgeon with the information necessary for deciding the operative procedure to be used.

Safety evaluation of phytosterol-esters. Part 9: Results of a European post-launch monitoring programme.

PubMed

Lea, L J; Hepburn, P A

2006-08-01

Phytosterol-esters were developed by Unilever as a cholesterol lowering novel food ingredient for use initially in vegetable oil spreads. In addition to an extensive package of safety studies and clinical studies a programme of post-launch monitoring (PLM) was developed. PLM was used to address the following questions: (a) Is the product use as predicted/recommended? (b) Are the known effects as predicted? (c) Does the product cause unexpected health effects? The overall conclusions from the PLM programme were: the product is being bought by the target population but intakes are less than the original assumptions made in the risk assessment; long-term use of phytosterol-ester enriched spreads results in a reduction in the serum levels of the most lipophilic carotenoids but at current levels of intake this is unlikely to result in reductions in carotenoids that are of biological significance; evaluation of health related consumer complaints have not indicated any unexpected health effects associated with the use of the product in the marketplace. As part of the European approval under Regulation (EC) No. 258/97 on Novel Foods and Food Ingredients the results of the PLM programme had to be submitted to the European Commission (EC) and reviewed by the Scientific Committee on Food (SCF). They concluded that the study provided valuable information, which complemented the pre-market safety evaluation studies, and that the EC mandatory requirement had been met.

Consistency and reliability of judgements by assessors of case based discussions in general practice specialty training programmes in the United Kingdom.

PubMed

Bodgener, Susan; Denney, Meiling; Howard, John

2017-01-01

Case based discussions (CbDs) are a mandatory workplace assessment used throughout general practitioner (GP) specialty training; they contribute to the annual review of competence progression (ARCP) for each trainee. This study examined the judgements arising from CbDs made by different groups of assessors and whether or not these assessments supported ARCP decisions. The trainees selected were at the end of their first year of GP training and had been identified during their ARCPs to need extra training time. CbDs were specifically chosen as they are completed by both hospital and GP supervisors, enabling comparison between these two groups. The results raise concern with regard to the consistency of judgements made by different groups of assessors, with significant variance between assessors of different status and seniority. Further work needs to be done on whether the CbD in its current format is fit for purpose as one of the mandatory WPBAs for GP trainees, particularly during their hospital placements. There is a need to increase the inter-rater reliability of CbDs to ensure a consistent contribution to subsequent decisions about a trainee's overall progress.

The technology management process at the European space agency

NASA Astrophysics Data System (ADS)

Guglielmi, M.; Williams, E.; Groepper, P.; Lascar, S.

2010-03-01

Technology is developed at the European Space Agency (ESA) under several programmes: corporate and domain specific, mandatory and optional, with different time horizons and covering different levels of the TRL scale. To improve the transparency and efficiency of the complete process, it was felt necessary to establish an agreed end to end process for the management of all technology R&D activity that could: Include all ESA programmes and consider the requirements of European users Lead to coordinated multi-year work plan and yearly procurement plans Prepare and enable future European space programmes Be harmonized with national initiatives in Europe Thereby establishing the basis for a product policy to reduce risks to technology users, reduce costs and delays, and enhance industrial competitiveness and non-dependence. In response to the above needs, ESA has developed a technology management process called the ESA End-to-End process (E2E), from establishment of the strategy to the monitoring and evaluation of R&D results. In this paper, the complete process will be described in detail including a discussion on its strengths and limitations, and its links to the wider European Harmonization process. The paper will be concluded with the introduction of the ESA Technology Tree: a basic tool to structure and facilitate communication about technology issues.

New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India

PubMed Central

Knowles, Jacky; Bukania, Zipporah; Camara, Boubacar; Pandav, Chandrakant S.; Mwai, John Maina; Toure, Ndeye Khady; Yadav, Kapil

2018-01-01

Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households. PMID:29596369

The serological screening of deceased tissue donors within the English Blood Service for infectious agents--a review of current outcomes and a more effective strategy for the future.

PubMed

Kitchen, A D; Gillan, H L

2010-04-01

The overall effectiveness of the NHSBT screening programme for infectious agents in deceased tissue donors is examined and evaluated in terms of current outcomes and how to improve upon these outcomes. The screening results and any subsequent confirmatory results from a total of 1659 samples from NHSBT deceased donors referred to NTMRL for screening for infectious agents were included in the analysis. Overall 1566/1659 (94.4%) of the samples were screen negative. A total of 93 were repeat reactive on screening for one or more of the mandatory markers screened for, of which only 12 (13%) were subsequently confirmed to be positive on confirmatory testing. The majority of the repeat reactive samples were demonstrating non-specific reactivity with the screening assays in use. Overall, the NHSBT screening programme for infectious agents in deceased tissue donors is very effective with a relatively low overall loss of donors because of non-specific reactivity. However, unnecessary loss of tissue products is not acceptable, and although this programme compares favourably with the outcomes of other such programmes, the confirmatory results obtained demonstrate both the need and the potential for improving the outcomes. This is particularly important as one donor may donate more than one product, and can be achieved very easily with a change to the screening algorithm followed, using the confirmatory data obtained to support and validate this change. CONTENTS SUMMARY: Critical analysis of the NHSBT screening programme for infectious agents in deceased tissue donors and a strategy involving the design and use of a different screening algorithm to improve these outcomes.

[Iodine concentration in cooking salt consumed in Lubumbashi and the iodine status of vulnerable people: case study of pregnant women living in underprivileged areas].

PubMed

Banza, Bienvenue Ilunga; Lumbu, Jean Baptiste Simbi; Donnen, Philippe; Twite, Eugène Kabange; Kwete, Daniel Mikobi; Kazadi, Costa Mwadianvita; Ozoza, Jean Okolonken; Habimana, Laurence; Kalenga, Prosper Muenze Kayamba; Robert, Annie

2016-01-01

Consumption of low iodine salt can cause different types of disorders associated with iodine deficiency. This study aims to determine iodine content in table salt consumed in Lubumbashi and iodine status of pregnant women who are the main target of iodine deficiency. aAdescriptive cross-sectional study was devoted to an iodometric iodine analysis of 739 salt samples collected from the households and the markets of Lubumbashi in 2014. Previously, urinary iodine concentrations were determined in 225 pregnant women received for consultation from 15 March 2009 to 25 April 2011 by mineralization technique using ammonium persulphate. Our survey found that 47.5% of the cooking salt samples were adequately iodized (from 15 to 40 ppm), 36,9% of the samples had low iodine levels, 7,4% of the samples had too much iodine and 8,1% of the samples were not iodized. Iodine concentration in the analyzed cooking salt reached an overall average of 54,9%, being clearly below the WHO Standards (90%). By measuring urinary iodine concentration of pregnant women, iodine deficiency (urinary iodine <150 µg/l) was observed in 52%. The low availability of iodine from consumed salt in Lubumbashi could be responsible for a large proportion of the observed iodine deficiency in pregnant women, exposing them to the major risks for disorders associated with iodine deficiency.

[Study on the iodine nutrition and iodine deficiency disorders status in pasturing areas of Tibet-a non-epidemic area of iodine deficiency disorders in serious iodine deficiency district].

PubMed

DU, Dan; Li, Su-Mei; Li, Xiu-Wei; Wang, Hai-Yan; Li, Shu-Hua; Nima, Cangjue; Danzeng, Sangbu; Zhuang, Guang-Xiu

2010-08-01

To explore the status of iodine nutrition and iodine deficiency disorders in the pasturing areas and agricultural regions in Tibet. 30 families were selected respectively in pastoral Dangxiong county and agricultural Qushui county of Lasa. Drinking water and edible salt were collected for testing the iodine contents. In each type of the following populations including children aged 8 - 10, women of child-bearing age and male adults, 50 subjects were randomly sampled to examine their urinary iodine contents. Among them, 50 children and 50 women were randomly selected for goiter examination by palpation. Water iodine content was less than 2 µg/L, both in pasturing area and in agricultural areas. There was no iodized salt used in the families of pasturing areas, while 90% people consumed iodized salt in agricultural areas. The median of urinary iodine in pasturing area was 50.2 µg/L, significantly lower than that of agricultural area (193.2 µg/L). However, the goiter rate of children and women in pasturing area was significantly lower than that in agricultural area. Although iodine intake of populations in pasturing area of Tibet was severely deficient, there was no epidemic of Iodine Deficiency Disorders. This phenomenon noticed by the researchers deserved further investigation.

[Food fortified with vitamins: the history and perspectives].

PubMed

Kodentsova, V M; Vrzhesinskaia, O A; Sokol'nikov, A A

2012-01-01

The recommended daily intakes of vitamins in different countries have been compared. The data on consumption of vitamins and vitamin status are submitted. It is noted that since 2008 the values of recommended daily intakes of vitamin-antioxidants C and E and folate in Russia as in other countries has been significantly increased. The recommended vitamin D consumption in Russia has been increased 2-3-fold as in most European countries and USA, while vitamin A recommended intake, on the contrary, has been reduced by 10%. Monitoring of vitamin status of various groups of adult population (by vitamin serum blood level evaluation) during the period since 2003 to 2011 has shown that that since 2003 deficiency of B group vitamins takes place in 10-47% of surveyed, vitamin D insufficiency was detected in 20.7% of adults. Thus the deficiency of these micronutrients has been determined much more often than the deficit of vitamins E and C (2.8-11%). The key causes of vitamin deficiency among the population in current conditions have been discussed. The main ways of increasing of diet vitamin value by means of fortified foods usage or/and vitamin and mineral complexes intake have been considered. The effective and safe levels of food enrichment have been examined. Harmonized with the EU documents and Codex Alimentarius acting sanitary rules and regulations which govern the enrichment of food products of mass consumption with vitamins and minerals have been commented upon. The history of food enrichment (fortification) with vitamins and salt iodization in our country and abroad has been described. Basing on the experience of several countries in which the mandatory enrichment of regularly consumed food products (flour, breakfast cereals) had compensated inadequate intake of vitamin D, group B, iodine and iron to a large extent, the conclusion on the feasibility and health benefits of fortified foods intake has been done.

Lessons from the Johns Hopkins Multi-Disciplinary Venous Thromboembolism (VTE) Prevention Collaborative

PubMed Central

Streiff, Michael B; Carolan, Howard T; Hobson, Deborah B; Kraus, Peggy S; Holzmueller, Christine G; Demski, Renee; Lau, Brandyn D; Biscup-Horn, Paula; Pronovost, Peter J

2012-01-01

Problem Venous thromboembolism (VTE) is a common cause of potentially preventable mortality, morbidity, and increased medical costs. Risk-appropriate prophylaxis can prevent most VTE events, but only a small fraction of patients at risk receive this treatment. Design Prospective quality improvement programme. Setting Johns Hopkins Hospital, Baltimore, Maryland, USA. Strategies for change A multidisciplinary team established a VTE Prevention Collaborative in 2005. The collaborative applied the four step TRIP (translating research into practice) model to develop and implement a mandatory clinical decision support tool for VTE risk stratification and risk-appropriate VTE prophylaxis for all hospitalised adult patients. Initially, paper based VTE order sets were implemented, which were then converted into 16 specialty-specific, mandatory, computerised, clinical decision support modules. Key measures for improvement VTE risk stratification within 24 hours of hospital admission and provision of risk-appropriate, evidence based VTE prophylaxis. Effects of change The VTE team was able to increase VTE risk assessment and ordering of risk-appropriate prophylaxis with paper based order sets to a limited extent, but achieved higher compliance with a computerised clinical decision support tool and the data feedback which it enabled. Risk-appropriate VTE prophylaxis increased from 26% to 80% for surgical patients and from 25% to 92% for medical patients in 2011. Lessons learnt A computerised clinical decision support tool can increase VTE risk stratification and risk-appropriate VTE prophylaxis among hospitalised adult patients admitted to a large urban academic medical centre. It is important to ensure the tool is part of the clinician’s normal workflow, is mandatory (computerised forcing function), and offers the requisite modules needed for every clinical specialty. PMID:22718994

Elongation of labia minora in Uganda: including Baganda men in a risk reduction education programme.

PubMed

Martínez Pérez, Guillermo; Namulondo, Harriet

2011-01-01

Okukyalira ensiko or 'visiting the bush' is how, in Uganda, the Baganda people name the practice of elongating the labia minora, which young girls start performing before menarche. As a mandatory rite of passage that identifies membership of the tribe, one of its main purposes is to enhance sexual pleasure for both male and female partners. The conditions in which it is practiced involve certain physical health risks. In this qualitative study carried out in Wakiso district, a semi-structured interview was conducted among 31 Baganda men, in order to understand their perceptions, attitudes and knowledge toward the way in which their daughters practise labia minora elongation. According to our results, men highly value this practice for its capacity to enhance sexual stimulation even though they are aware of its risks. Since genital stretching is likely to endure, the authors discuss the possibility of addressing Baganda men by health workers in an education programme aimed at minimising the risks attached to the procedure and, hence, improving the sexual and reproductive health of Baganda girls.

The educational environment for training in intensive care medicine: structures, processes, outcomes and challenges in the European region.

PubMed

2009-09-01

To characterise the training environment in ICM across Europe, with a particular focus on factors influencing competency-based training. A cross-sectional web-based survey completed by the national coordinator for the CoBaTrICE (Competency-Based Training in Intensive Care medicinE) programme in each of 28 European countries. Since the last survey in 2004, 50% of EU countries have modified their training programmes. Seven have already adopted the CoBaTrICE programme since its completion in 2006. Multidisciplinary access to ICM training ('supraspeciality' model) is available in 57%, most commonly as a 2-year training programme. National examinations are held by 26 (93%); in 24 (86%) this is a mandatory exit exam; ten use the European Diploma of Intensive Care (EDIC). A formal national system for quality assurance of ICM training exists in only 18 (64%) countries. National standards for approving hospitals as training centres vary widely. In 29% there is no designated specialist with responsibility for training at the local level. Time for teaching was cited as inadequate by 93% of respondents; only 21% of trainers receive contractual recognition for their work. In 39% there is no protected teaching time for trainees. Half of countries surveyed have no formal system for workplace-based assessment of competence of trainees. There is considerable diversity in pedagogic structures, processes and quality assurance of ICM across Europe. National training organisations should develop common standards for quality assurance, health systems need to invest in educator support, and the EU should facilitate harmonisation by recognising ICM as a multidisciplinary speciality.

Review: interventions to increase influenza vaccination among healthcare workers in hospitals

PubMed Central

Hollmeyer, Helge; Hayden, Frederick; Mounts, Anthony; Buchholz, Udo

2012-01-01

Please cite this paper as: Hollmeyer et al. (2012) Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 7(4), 604–621. Annual influenza vaccination rates among hospital healthcare workers (HCW) are almost universally low despite recommendations from WHO and public health authorities in many countries. To assist in the development of successful vaccination programmes, we reviewed studies where interventions aimed to increase the uptake of influenza vaccination among hospital HCW. We searched PUBMED from 1990 up to December 2011 for publications with predetermined search strategies and of pre‐defined criteria for inclusion or exclusion. We evaluated a large number of ‘intervention programmes’ each employing one or more ‘intervention components’ or strategies, such as easy access to vaccine or educational activities, with the goal to raise influenza vaccine uptake rates in hospital HCW during one influenza season. Included studies reported results of intervention programmes and compared the uptake with the season prior to the intervention (historical control) or to another intervention programme within the same season that started from the same set of baseline activities. Twenty‐five studies performed in eight countries met our selection criteria and described 45 distinct intervention programmes. Most studies used their own facility as historical control and evaluated only one season. The following elements were used in intervention programmes that increased vaccine uptake: provision of free vaccine, easy access to the vaccine (e.g. through mobile carts or on‐site vaccination), knowledge and behaviour modification through educational activities and/or reminders and/or incentives, management or organizational changes, such as the assignment of personnel dedicated to the intervention programme, long‐term implementation of the strategy, requiring active declination and mandatory immunization policies. The number of these components applied appeared to be proportional to the increase in uptake. If influenza uptake in hospital HCW is to be increased on sustained basis, hospital managers need to be committed to conduct a well‐designed long‐term intervention programme that includes a variety of co‐ordinated managerial and organizational elements. PMID:22984794

Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile.

PubMed

Öhlin, Leif; Hesse, Morten; Fridell, Mats; Tätting, Per

2011-05-12

Continuous abstinence and retention in treatment for alcohol and drug use disorders are central challenges for the treatment providers. The literature has failed to show consistent, strong predictors of retention. Predictors and treatment structure may differ across treatment modalities. In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients dropped out within the first week. Of the remaining 123 demographic data and psychiatric assessment were used to predict involuntary discharge from treatment and corresponding cumulative abstinence probability. All subjects were administered the Structured Clinical Interview for DSM-IV-TR, and the Symptom Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews. Of 123 patients admitted, 86 (70%) remained in treatment after six months and 61 (50%) remained in treatment after 12 months. Of those discharged involuntarily, 34/62 individuals were readmitted after a suspension period of three months. Younger age at intake, poly-substance abuse at intake (number of drugs in urine), and number of conduct disorder criteria on the SCID Screen were independently associated with an increased risk of involuntary discharge. There were no significant differences between dropouts and completers on SCL-90, SSP, SOC or AUDIT. Of the patients admitted to the programme 50% stayed for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on retention and abstinence.

Sustained change in didactic skills--does teacher training last?

PubMed

Kuhnigk, Olaf; Schreiner, Julia; Harendza, Sigrid

2013-01-01

Teacher training programmes are necessary assets in faculty development. Few data exist on their long-term effects on participants' teaching skills. Our aim was to study participants' didactic competencies up to four years after attending a newly established faculty development workshop at Hamburg Medical School. Of the 322 participants who attended our teacher training between 2006 and 2009, 313 received a self-assessment and evaluation questionnaire in 2010. This follow-up self-assessment (t2) was compared with their self-assessment of the same didactic competencies before (t0) and directly after (t1) the training. Correlations between participants' personal reasons to attend the workshop and their assessment of didactic competencies were investigated. Self-assessment was significantly higher at the time of follow-up (t2) for all cohorts compared to the assessment before the workshop (t0). Personal reasons for participation differed greatly between voluntary and mandatory. However, self-assessment of the didactic competencies (t2) was not different between these groups. Participants involved in objective structured clinical examinations (OSCE) rated their competency in this field higher than participants without OSCE involvement. In conclusion, teacher training can be effective in the long run even when participation is mandatory. Competencies seem to be retained best when the content of the training fits participants' teaching activities.

Sustained change in didactic skills - does teacher training last?

PubMed Central

Kuhnigk, Olaf; Schreiner, Julia; Harendza, Sigrid

2013-01-01

Teacher training programmes are necessary assets in faculty development. Few data exist on their long-term effects on participants’ teaching skills. Our aim was to study participants’ didactic competencies up to four years after attending a newly established faculty development workshop at Hamburg Medical School. Of the 322 participants who attended our teacher training between 2006 and 2009, 313 received a self-assessment and evaluation questionnaire in 2010. This follow-up self-assessment (t2) was compared with their self-assessment of the same didactic competencies before (t0) and directly after (t1) the training. Correlations between participants’ personal reasons to attend the workshop and their assessment of didactic competencies were investigated. Self-assessment was significantly higher at the time of follow-up (t2) for all cohorts compared to the assessment before the workshop (t0). Personal reasons for participation differed greatly between voluntary and mandatory. However, self-assessment of the didactic competencies (t2) was not different between these groups. Participants involved in objective structured clinical examinations (OSCE) rated their competency in this field higher than participants without OSCE involvement. In conclusion, teacher training can be effective in the long run even when participation is mandatory. Competencies seem to be retained best when the content of the training fits participants’ teaching activities. PMID:24062817

Nurses' attitudes towards enforced measures to increase influenza vaccination: A qualitative study.

PubMed

Pless, Anina; Shaw, David; McLennan, Stuart; Elger, Bernice S

2017-05-01

Despite studies demonstrating that the annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients, vaccination rates remain very low, particularly in nursing staff. Educational programmes have failed to improve rates, which has led to a diverse range of enforced approaches being advocated and implemented. To examine the attitudes of non-vaccinated nursing staff towards various enforced measures aimed at increasing rates of influenza vaccination. Semi-structured qualitative interviews with a purposive sample of 18 non-vaccinated nurses, working in units with high-risk patients at two hospitals in Switzerland. Analysis of interviews was done using conventional content analysis. Nurses were critical of enforced measures. However, measures that include an element of choice were perceived as more acceptable. Declination forms and mandatory vaccinations as part of the employment requirements were found to be the most accepted measures. The perception of choice is crucial to the acceptance of a measure. Respect for choice and autonomy has a positive effect on behavioural change. Mandatory influenza vaccination as a condition of new (and perhaps ongoing) employment could be a feasible, effective and ethical measure to increase vaccination rates among nurses who oppose vaccination. © 2016 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Safety of Chemotherapeutic Infusion or Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Cystic Artery

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

Kang, Beomsik, E-mail: kangbs98@gmail.com; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Chung, Jin Wook, E-mail: chungjw@snu.ac.kr

Purpose: This study was designed to evaluate the safety of chemotherapeutic infusion or chemoembolization by way of the cystic artery in patients with hepatocellular carcinoma (HCC) supplied exclusively by the cystic artery. Methods: Between Jan 2002 and Dec 2011, we performed chemotherapeutic infusion or chemoembolization using iodized oil for the treatment of 27 patients with HCC supplied exclusively by the cystic artery. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. Results: The cystic artery originated from the main right hepatic artery in 24 (89 %) patients, from the right anterior hepatic artery inmore » 2 (7 %) patients, and from the left hepatic artery in 1 (4 %) patient. Selective catheterization of the cystic artery was achieved in all patients. Superselection of tumor-feeding vessels from the cystic artery was achieved in 7 patients (26 %). Chemotherapeutic infusion was performed in 18 patients (67 %), and chemoembolization was performed in 9 patients (33 %). There were no major complications and only 2 minor complications, including vasovagal syncope and nausea with vomiting. Individual tumor response supplied exclusively by the cystic artery at the follow-up enhanced CT scan were complete response (n = 16), partial response (n = 3), and stable disease (n = 8). Conclusion: HCC supplied exclusively by the cystic artery can be safely treated without severe complications by chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.« less

[A cross-sectional study on iodine nutrition in general population from Zhejiang province, China].

PubMed

Mo, Zhe; Lou, Xiao-ming; Zhu, Wen-ming; Wang, Xiao-feng; Mao, Guang-ming; Zhou, Jin-shui; Ding, Gang-qiang

2013-05-01

To understand the current status of iodine nutrition among the community residents to compare the level of iodine nutrition in different areas and groups of populations in Zhejiang province. Stratified cluster sampling method was adopted and residents from twenty-two communities in Zhejiang province were selected. A cross-sectional survey was conducted, using questionnaires, laboratory tests, on urinary iodine, water iodine and the concentration of the iodine in salt, which had played positive roles in the calculation of the level of iodine nutrition. of the iodine nutrition in this cross-sectional survey were as follows: the median water iodine and salt iodine of Zhejiang were 2.42 µg/L and 28.8 mg/kg, respectively. The coverage of iodized salts was 79.54%, with the ingesting rate of qualified iodized-salt as 76.65% and the median content of urinary iodine in the population of Zhejiang was 161 µg/L. The average iodine content among pregnant women was 138 µg/L, with the percentage of samples less than 100 µg/L as 25.92%, more than 300 µg/L as 15.30%. The proportions of iodine intake through water, salt and other foods were 1.70%, 76.41% and 21.89%, respectively. The status of iodine nutrition in Zhejiang province in general seemed to be appropriate, but the level of iodine nutrition in pregnant women was less than the requirement, which should call for attention.

47 CFR 101.73 - Mandatory negotiations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Mandatory negotiations. 101.73 Section 101.73... Mandatory negotiations. (a) A mandatory negotiation period may be initiated at the option of the ET licensee... bands will be subject to mandatory negotiations only. (b) Once mandatory negotiations have begun, an FMS...

47 CFR 101.73 - Mandatory negotiations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Mandatory negotiations. 101.73 Section 101.73... Mandatory negotiations. (a) A mandatory negotiation period may be initiated at the option of the ET licensee... bands will be subject to mandatory negotiations only. (b) Once mandatory negotiations have begun, an FMS...

47 CFR 101.73 - Mandatory negotiations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Mandatory negotiations. 101.73 Section 101.73... Mandatory negotiations. (a) A mandatory negotiation period may be initiated at the option of the ET licensee... MHz and 2160-2200 MHz bands will be subject to mandatory negotiations only. (b) Once mandatory...

47 CFR 101.73 - Mandatory negotiations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Mandatory negotiations. 101.73 Section 101.73... Mandatory negotiations. (a) A mandatory negotiation period may be initiated at the option of the ET licensee... bands will be subject to mandatory negotiations only. (b) Once mandatory negotiations have begun, an FMS...

47 CFR 101.73 - Mandatory negotiations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Mandatory negotiations. 101.73 Section 101.73... Mandatory negotiations. (a) A mandatory negotiation period may be initiated at the option of the ET licensee... MHz and 2160-2200 MHz bands will be subject to mandatory negotiations only. (b) Once mandatory...

Quality Improvement Project for Shelf Stable Bakery Products

DTIC Science & Technology

2009-07-01

noodle -making properties Instron UTM, Scanning electron microscopy, DSC Flour with lower swelling power and small starch granules resulted in...Iodized STE-1803 0.75 0.75% 68.0 gram Starch, Instant , Granular STE-715 1.00 1.00% 90.7 gram Vanilla Flavor, Liquid RUT-1450 0.09 0.09% 8.2 gram...0.73% 66.2 gram Starch, Instant , Granular STE-715 0.99 0.99% 89.8 gram Vanilla Flavor, Liquid RUT-1450 0.09 0.09% 8.2 gram Bicarbonate of Soda RUT-901

Process for the extemporaneous preparation of an injectable fatty acid tagged in the omega position by means of radioactive iodine

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

Bardy, A.; Comet, M.; Coornaert, S.

1984-10-09

A process is claimed for the preparation of a fatty acid tagged with radioactive iodine, where a brominated or iodized fatty acid is reacted, preferably in the omega position, with radioactive iodide in the dry state or with an aqueous solution of radioactive iodide, in the presence of vehicling iodide, to exchange the bromine or iodine of the fatty acid for radioactive iodine. Application to use as radio-pharmaceutical products for studying cardiac metabolism troubles in human beings by scintigraphy is mentioned.

Implementation of laparoscopic virtual-reality simulation training in gynaecology: a mixed-methods design.

PubMed

Burden, Christy; Appleyard, Tracy-Louise; Angouri, Jo; Draycott, Timothy J; McDermott, Leanne; Fox, Robert

2013-10-01

Virtual-reality (VR) training has been demonstrated to improve laparoscopic surgical skills in the operating theatre. The incorporation of laparoscopic VR simulation into surgical training in gynaecology remains a significant educational challenge. We undertook a pilot study to assess the feasibility of the implementation of a laparoscopic VR simulation programme into a single unit. An observational study with qualitative analysis of semi-structured group interviews. Trainees in gynaecology (n=9) were scheduled to undertake a pre-validated structured training programme on a laparoscopic VR simulator (LapSim(®)) over six months. The main outcome measure was the trainees' progress through the training modules in six months. Trainees' perceptions of the feasibility and barriers to the implementation of laparoscopic VR training were assessed in focus groups after training. Sixty-six percent of participants completed six of ten modules. Overall, feedback from the focus groups was positive; trainees felt training improved their dexterity, hand-eye co-ordination and confidence in theatre. Negative aspects included lack of haptic feedback, and facility for laparoscopic port placement training. Time restriction emerged as the main barrier to training. Despite positive perceptions of training, no trainee completed more than two-thirds of the modules of a self-directed laparoscopic VR training programme. Suggested improvements to the integration of future laparoscopic VR training include an additional theoretical component with a fuller understanding of benefits of VR training, and scheduled supervision. Ultimately, the success of a laparoscopic VR simulation training programme might only be improved if it is a mandatory component of the curriculum, together with dedicated time for training. Future multi-centred implementation studies of validated laparoscopic VR curricula are required. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Rationales for home safety promotion in the Iranian primary healthcare system: results from a pilot study.

PubMed

Mohammadi, R; Ekman, R; Svanström, L; Gooya, M M

2006-01-01

To analyse the prerequisites for a nationwide primary healthcare (PHC) home safety promotion programme in Iran. Injury is a major public health problem throughout the world, currently accounting for one-seventh of all premature deaths and disabilities. Within 20 years, it is estimated that the proportion will increase to one-fifth. The present healthcare system in Iran was started in 1979, with a major focus on easy access to services and prevention. The system is based on the 'health house', which is run by community health workers. A survey shows that 36% of injuries occur in the home environment. A pilot phase of the Home Safety Promotion Programme was initiated in 1994, and included safety checking at home for fences, kitchens, drugs and poisons, heaters, electricity, and stairs and ladders. The pilot study covered 478,551 households out of the 12 million (approximately) in Iran. Sixty-nine supervisors were involved individually, assembled into eight focus groups. Household safety increased by 10-20% over the 4 years of the study. The frequency of home visits changed from annual to seasonal, since all participants agreed that there were seasonal differences in safety problems. The supervisors showed a high level of knowledge of injury as a public health problem, and also positive attitudes towards doing something about safety on the basis of a PHC scheme. The role of a surveillance system was highlighted, and it was suggested that such a system should be added to the programme. Based on our preliminary findings, there were reasons to obtain a policy decision concerning a national programme for safety promotion before extending the pilot scheme to the whole country. A national safety programme was decided upon following completion of the pilot study. It includes a home-related-injury surveillance system that is mandatory in rural areas and voluntary in some cities.

The Norwegian immunisation register--SYSVAK.

PubMed

Trogstad, L; Ung, G; Hagerup-Jenssen, M; Cappelen, I; Haugen, I L; Feiring, B

2012-04-19

The Norwegian immunisation register, SYSVAK, is a national electronic immunisation register. It became nationwide in 1995. The major aim was to register all vaccinations in the Childhood Immunisation Programme to ensure that all children are offered adequate vaccination according to schedule in the programme, and to secure high vaccination coverage. Notification to SYSVAK is mandatory, based on personal identification numbers. This allows follow up of individual vaccination schedules and linkage of SYSVAK data to other national health registers for information on outcome diagnoses, such as the surveillance system for communicable diseases. Information from SYSVAK is used to determine vaccine coverage in a timely manner. Coverage can be broken down to regional/local levels and used for active surveillance of vaccination coverage and decisions about interventions. During the 2009 influenza A(H1N1)pdm09 pandemic, an adaptation of SYSVAK enabled daily surveillance of vaccination coverage on national and regional levels. Currently, data from SYSVAK are used, among others, in studies on adverse events related to pandemic vaccination. Future challenges include maximising usage of collected data in surveillance and research, and continued improvement of data quality. Immunisation registers are rich sources for high quality surveillance of vaccination coverage, effectiveness, vaccine failure and adverse events, and gold mines for research.

Advances in the diagnosis of bovine besnoitiosis: current options and applications for control.

PubMed

Gutiérrez-Expósito, Daniel; Ferre, Ignacio; Ortega-Mora, Luis M; Álvarez-García, Gema

2017-10-01

Bovine besnoitiosis, which is caused by the tissue cyst-forming intracellular parasite Besnoitia besnoiti, is a chronic and debilitating disease that is responsible for severe economic losses in the cattle raised under extensive husbandry systems. The absence of vaccines, treatments or a health scheme at local, national and international levels has led to a rapid spread of bovine besnoitiosis from western Europe towards eastern countries and northwards. Moreover, this parasitic disease is widely present in many sub-Saharan countries. Thus, bovine besnoitiosis should be included in the animal health scheme of beef cattle herds. Accurate diagnostic tools and common diagnostic procedures are mandatory in any control programme. Relevant advances have been made in this field during the last decade. Succeeding with accurate diagnosis relies on the technique employed and the antibody and parasite kinetics of the infection stage, which may notably influence control programmes and surveillance. Moreover, control programmes should be adapted to the epidemiological status of the disease, as the disease presentation in a herd has important implications for prospective control. Herein, we review the clinical disease presentation of bovine besnoitiosis and the correlation between its clinical course and laboratory parameters. We also provide an update on the available diagnostic tools, discuss their strengths and pitfalls, and provide guidelines for their use in control, surveillance and epidemiological studies. A rational control strategy is also recommended. Copyright © 2017 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.

The Austrian Space Plan

NASA Astrophysics Data System (ADS)

Pseiner, K.; Balogh, W.

2002-01-01

After several years of preparation and discussion among the involved players, the Austrian Space Plan was approved for implementation in November 2001. Based on careful benchmarking and analysis of the capabilities of the Austrian space sector it aims to create excellent conditions for the sector's further development. The new space strategy embraces Austria's participation in the mandatory and optional programmes of the European Space Agency and establishes a National Space Programme supported by separate funding opportunities. A set of clearly-defined indicators ensures that the progress in implementing the Space Plan can be objectively judged through independent, annual reviews. The National Space Programme promotes international cooperation in space research and space activities with the aim to strengthen the role of space science and to better prepare Austrian space industry for the commercial space market. In the framework of the Space Plan the Austrian Space Agency has been tasked with integrating the industry's growing involvement in aeronautics activities to better utilize synergies with the space sector. This paper reviews the various steps leading to the approval of the new space strategy and discusses the hurdles mastered in this process. It reports on the Space Plan's first results, specifically taking into account projects involving international cooperation. For the first the Austria aerospace-sector can rely on an integrated strategy for aeronautics- and space activities which is firmly rooted in the efforts to enhance the country's R&D activities. It may also act as a useful example for other small space- using countries planning to enhance their involvement in space activities.

Child and adolescent injury as a result of falls from buildings and structures.

PubMed

Pressley, J C; Barlow, B

2005-10-01

To examine incidence, demographic risk factors, and patterns of injury resulting from falls from buildings and structures in areas with and without a legislation based prevention programme. The Health Care Cost and Utilization Project (KID-HCUP) was used to produce national estimates of hospital admissions due to falls from buildings in the US. Areas of New York with and without window guard legislation were identified through the New York Statewide Planning and Research Cooperative System (SPARCS). Children and adolescents aged 0-18 years. Legislation based window fall prevention programme with enforcement. Hospitalization for injury as a result of falls from buildings and structures in areas with and without enforced mandatory window guard legislation. New York City has a higher proportion of the population residing in multi-family dwellings with 10 or more units compared with the nation (53.8% v 12.6%, p<0.0001), but the incidence of injury resulting from falls from buildings is nearly half that observed in the US. For young children, warm weather risks begin earlier and extend later than previously reported. Incidence in very young minority children is nearly twice that of whites. Nearly 90% of children aged 0--4 years fall at home, but the proportion decreases linearly with age. Window guards are associated with reduced injury resulting from falls from buildings and should be mandated in multi-family dwellings where small children reside. Prevention programmes for young children should be initiated in early spring and continued through fall.

[Assessment of iodine nutritional status and thyroxine levels in pregnant women from different geographic areas of the Castile and Leon].

PubMed

González Mateo, M Carmen; Fernández Fernández, Marta; Valdazo Revenga, Vega; García Menéndez, Luis; Díez Hernández, Alberto; Rodríguez Rodríguez, Rosario

2011-10-01

Iodine nutritional status in pregnant women is important for neuronal development of the fetus, and may vary depending on the geographic area. Thyroid function and urinary iodine excretion were therefore assessed in pregnant women from three different provinces of a large Spanish autonomous community. A descriptive study was conducted in the three healthcare areas of Burgos, Avila, and Ponferrada on 1,200 women in the first trimester of pregnancy The study consisted of a survey and thyroid hormone and urinary iodine measurements. Use of iodized salt and iodine-containing pharmacological compounds was reported by 40% and 17% of pregnant women respectively. Median urinary iodine excretion in the total group was 121 mcg/L, with lower values in Burgos (117 mcg/L) and Ponferrada (118 mcg/L) and higher levels in Avila (130 mcg/L). Urinary iodine excretion was less than 100 mcg/L in 34% of women and was undetectable in 3.3%. Excretion levels lower than 150 mcg/L were found in 69.8% of women. Low thyroxine levels were detected in 1.1%, and thyrotropin levels were increased in 4.7%. Iodine deficiency currently exists in pregnant women from different areas of our large autonomous community. Consumption of iodized salt and iodine-containing pharmacological compounds is not widely established. It would be of great interest to conduct studies in other geographic areas and to advise an increased iodine intake in women who plan to become pregnant and in pregnant women from the very start of pregnancy. Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.

[Risk factors associated with bacterial growth in derivative systems from cerebrospinal liquid in pediatric patients].

PubMed

de Jesús Vargas-Lares, José; Andrade-Aguilera, Angélica Rocío; Díaz-Peña, Rafael; Barrera de León, Juan Carlos

2015-01-01

To determine risk factors associated with bacterial growth in systems derived from cerebrospinal fluid in pediatric patients. Case and controls study from January to December 2012, in patients aged <16 years who were carriers of hydrocephalus and who required placement or replacement of derivative system. Cases were considered as children with cultures with bacterial growth and controls with negative bacterial growth. Inferential statistics with Chi-squared and Mann-Whitney U tests. Association of risk with odds ratio. We reviewed 746 registries, cases n=99 (13%) and controls n=647 (87%). Masculine gender 58 (57%) vs. feminine gender 297 (46%) (p=0.530). Age of cases: median, five months and controls, one year (p=0.02). Median weight, 7 vs. 10 kg (p=0.634). Surgical interventions: median n=2 (range, 1-8) vs. n=1 (range, 1-7). Infection rate, 13.2%. Main etiology ductal stenosis, n=29 (29%) vs. n=50 (23%) (p=0.530). Non-communicating, n=50 (51%) vs. 396 (61%) (p=0.456). Predominant microorganisms: enterobacteria, pseudomonas, and enterococcus. Non-use of iodized dressing OR=2.6 (range, 1.8-4.3), use of connector OR=6.8 (range, 1.9-24.0), System replacement OR=2.0 (range, 1.3-3.1), assistant without surgical facemask OR=9.7 (range, 2.3-42.0). Being a breastfeeding infant, of low weight, non-application of iodized dressing, use of connector, previous derivation, and lack of adherence to aseptic technique were all factors associated with ependymitis.

Permeation of iodide from iodine-enriched yeast through porcine intestine.

PubMed

Ryszka, Florian; Dolińska, Barbara; Zieliński, Michał; Chyra, Dagmara; Dobrzański, Zbigniew

2013-01-01

Iodine deficiency is a common phenomenon, threatening the whole global human population. Recommended daily intake of iodine is 150 μg for adults and 250 μg for pregnant and breastfeeding women. About 50% of human population can be at risk of moderate iodine deficiency. Due to this fact, increased iodine supplementation is recommended, through intake of iodized mineral water and salt iodization. The aim of this study was to investigate permeation and absorption of iodide from iodine bioplex (experimental group) in comparison with potassium iodide (controls). Permeation and absorption processes were investigated in vitro using a porcine intestine. The experimental model was based on a standard Franz diffusion cell (FD-Cell). The iodine bioplex was produced using Saccharomyces cerevisiae yeast and whey powder: iodine content - 388 μg/g, total protein - 28.5%, total fat - 0.9%., glutamic acid - 41.2%, asparaginic acid - 29.4%, lysine - 24.8%; purchased from: F.Z.N.P. Biochefa, Sosnowiec, Poland. Potassium iodide was used as controls, at 388 μg iodine concentration, which was the same as in iodine-enriched yeast bioplex. A statistically significant increase in iodide permeation was observed for iodine-enriched yeast bioplex in comparison with controls - potassium iodide. After 5h the total amount of permeated iodide from iodine-enriched yeast bioplex was 85%, which is ~ 2-fold higher than controls - 37%. Iodide absorption was by contrast statistically significantly higher in controls - 7.3%, in comparison with 4.5% in experimental group with iodine-enriched yeast bioplex. Presented results show that iodide permeation process dominates over absorption in case of iodine-enriched yeast bioplex.

From mandatory to voluntary testing: balancing human rights, religious and cultural values, and HIV/AIDS prevention in Ghana.

PubMed

Luginaah, Isaac N; Yiridoe, Emmanuel K; Taabazuing, Mary-Margaret

2005-10-01

This paper examines efforts by some churches in Ghana to reduce the spread of HIV/AIDS. The analysis is based on focus group discussions with two groups of men and two groups of women, along with in-depth interviews with 13 pastors and marriage counsellors in the churches studied. In response to government and public criticisms about human rights violations, churches that previously imposed mandatory HIV testing on members planning to marry now have voluntary testing programmes. However, the results suggest that what the churches refer to as voluntary testing may not be truly voluntary. Cultural values and traditional practices, including traditional courtship and marriage rites (which are performed before church weddings), not only clash with considerations about pre-marital HIV testing but also complicate the contentious issue of confidentiality of information on HIV testing. Associated with these complexities and issues of confidentiality is a reluctance among participants, particularly those from northern Ghana, to test for HIV. The results reveal how broader social impacts of HIV testing for those planning to marry may extend beyond individuals or couples in different cultural contexts. The findings also support the general view that there are no perfect or easy solutions to combating the HIV/AIDS pandemic. Practical solutions and programs for Ghana cannot be neutral to cultural values and need to be tailored for particular (ethnic) populations.

Laparoscopic simulation training in gynaecology: Current provision and staff attitudes - a cross-sectional survey.

PubMed

Burden, Christy; Fox, Robert; Hinshaw, Kim; Draycott, Timothy J; James, Mark

2016-01-01

The objectives of this study were to explore current provision of laparoscopic simulation training, and to determine attitudes of trainers and trainees to the role of simulators in surgical training across the UK. An anonymous cross-sectional survey with cluster sampling was developed and circulated. All Royal College of Obstetricians and Gynaecologists (RCOG) Training Programme Directors (TPD), College Tutors (RCT) and Trainee representatives (TR) across the UK were invited to participate. One hundred and ninety-six obstetricians and gynaecologists participated. Sixty-three percent of hospitals had at least one box trainer, and 14.6% had least one virtual-reality simulator. Only 9.3% and 3.6% stated that trainees used a structured curriculum on box and virtual-reality simulators, respectively. Respondents working in a Large/Teaching hospital (p = 0.008) were more likely to agree that simulators enhance surgical training. Eighty-nine percent agreed that simulators improve the quality of training, and should be mandatory or desirable for junior trainees. Consultants (p = 0.003) and respondents over 40 years (p = 0.011) were more likely to hold that a simulation test should be undertaken before live operation. Our data demonstrated, therefore, that availability of laparoscopic simulators is inconsistent, with limited use of mandatory structured curricula. In contrast, both trainers and trainees recognise a need for greater use of laparoscopic simulation for surgical training.

Left and Right Ventricle Leads Switch as a Solution for TWave Oversensing - How a Good Idea Turned Out Bad.

PubMed

Alzand, Bsn; Phlips, Tje; Willems, R

2014-05-01

A 50-year-old male with a CRT defibrillator received inappropriate ICD shocks due to T-wave oversensing. Decreasing the sensitivity to avoid T wave oversensing was not an option due to a suboptimal R-wave sensing amplitude. We decided to re-plug the LV lead in the RV port and the RV lead in the LV port. This however led to intermittent phrenic nerve stimulation due to mandatory bipolar (tip-ring) or unipolar (tip-can) pacing on the LV-lead from the RV port. Re-intervention was necessary with the implantation of an additional pacing/sensing RV lead. A software programmable choice to switch sensing and tachycardia detection from RV to LV lead could be a valuable feature in future CRT devices.

47 CFR 27.1251 - Mandatory Negotiations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Mandatory Negotiations. 27.1251 Section 27.1251... 2150-2160/62 Mhz Band § 27.1251 Mandatory Negotiations. (a) Once mandatory negotiations have begun, a... licensee. (c) Mandatory negotiations will commence for each BRS licensee when the AWS licensee informs the...

47 CFR 27.1251 - Mandatory Negotiations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 2 2012-10-01 2012-10-01 false Mandatory Negotiations. 27.1251 Section 27.1251... 2150-2160/62 Mhz Band § 27.1251 Mandatory Negotiations. (a) Once mandatory negotiations have begun, a... licensee. (c) Mandatory negotiations will commence for each BRS licensee when the AWS licensee informs the...

47 CFR 27.1251 - Mandatory Negotiations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 2 2014-10-01 2014-10-01 false Mandatory Negotiations. 27.1251 Section 27.1251... 2150-2160/62 Mhz Band § 27.1251 Mandatory Negotiations. (a) Once mandatory negotiations have begun, a... licensee. (c) Mandatory negotiations will commence for each BRS licensee when the AWS licensee informs the...

47 CFR 27.1251 - Mandatory Negotiations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Mandatory Negotiations. 27.1251 Section 27.1251... 2150-2160/62 Mhz Band § 27.1251 Mandatory Negotiations. (a) Once mandatory negotiations have begun, a... licensee. (c) Mandatory negotiations will commence for each BRS licensee when the AWS licensee informs the...

47 CFR 27.1251 - Mandatory Negotiations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Mandatory Negotiations. 27.1251 Section 27.1251... 2150-2160/62 Mhz Band § 27.1251 Mandatory Negotiations. (a) Once mandatory negotiations have begun, a... licensee. (c) Mandatory negotiations will commence for each BRS licensee when the AWS licensee informs the...

Principles, main goals and methods of the nationwide program: "investigations on iodine deficiency and model of iodine prophylaxis in Poland".

PubMed

Szybiński, Z; Nauman, J; Gembicki, M; Rybakowa, M; Huszno, B; Gołkowski, F; Drozdz, R; Stanuch, H; Starkel, L; Skalski, M

1993-01-01

The main reasons to start investigations on IDD in Poland as a nationwide project of the Ministry of Health and Welfare sponsored by the State Committee For Scientific Research and Foundation for Polish Science were: cessation of iodizing of kitchen salt in Poland in 1980, increase of the incidence of goitre in the population and hyperthyrotropinemia in newborns, results of the survey undertaken after Chernobyl disaster indicating an increase of goiter incidence (Nauman et al.) and results of the pilot study (Gutekunst, Gembicki, Kinalska and Rybakowa) indicating an increase of thyroid volume and diminishing of iodine excretion in urine of children in Kraków, Białystok ad Poznań regions. Therefore the main goals of the project were as follows: to evaluate IDD in Poland on the population basis, to map goiter incidence and iodine deficiency in geographic areas, to evaluate a voluntary model of iodine prophylaxis in Poland (20 mg of KI/kg of salt). The investigations were carried out in 19330 children (48.7% of boys and 51.3% for girls) in age group 6-13 years, attending 111 coeducational randomly selected schools from all the country. This number represents 0.35% of children subpopulation in the above age-groups. For practical purposes local coordinating centers at the relevant Departments of Endocrinology and Board of Coordinators were set up. The programme of survey included: filling the questionnaire by children's parents, thyroid palpation and classification according to WHO and ICCIDD criteria, thyroid volume determination by means of ultrasonograph Kontron Sigma 1 L with linear transducer 7.5 MHz, determination of iodine in casual morning urine sample using Sandell and Kalthoff method. Determination of iodine concentration in urine was performed in each case of goiter and in the same number of children without goiter. The results were segregated according to coordinating centers and according to 6 geographical areas of the country. The results were calculated according to the descriptive statistics using Student's test, Chi-square test F-test and Leven's test. The results segregated according to geographic areas were tested by means of analysis of variance using the linear model. The final results of the programme are presented in the next papers.

State mandatory overtime regulations and newly licensed nurses' mandatory and voluntary overtime and total work hours.

PubMed

Bae, Sung-Heui; Brewer, Carol S; Kovner, Christine T

2012-01-01

Nurse overtime has been used to handle normal variations in patient census and to control chronic understaffing. By 2010, 16 states had regulations to limit nurse overtime. We examined mandatory overtime regulations and their association with mandatory and voluntary overtime and total hours worked by newly licensed registered nurses (NLRNs). For this secondary data analysis, we used a panel survey of NLRNs; the final dataset consisted of 1,706 NLRNs. Nurses working in states that instituted overtime regulations after 2003 or in states that restricted any type of mandatory overtime had a lower probability of experiencing mandatory overtime than those nurses working in states without regulations. Nurses who worked in states with mandatory overtime regulations reported fewer total hours worked per week. The findings of this study provided insight into how mandatory overtime regulations were related to nurse mandatory and voluntary overtime and the total number of hours worked. Future research should investigate institutions' compliance with regulations and the impact of regulations on nurse and patient outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

The development and implementation of the structured training programme for caregivers of inpatients after stroke (TRACS) intervention: the London Stroke Carers Training Course.

PubMed

Forster, Anne; Dickerson, Josie; Melbourn, Anne; Steadman, Jayne; Wittink, Margreet; Young, John; Kalra, Lalit; Farrin, Amanda

2015-03-01

To describe the content and delivery of the adapted London Stroke Carers Training Course intervention evaluated in the Training Caregivers after Stroke (TRACS) trial. The London Stroke Carers Training Course is a structured training programme for caregivers of inpatients who are likely to return home after their stroke. The course was delivered by members of the multidisciplinary team while the patient was in the stroke unit with one recommended 'follow through' session after discharge home. The intervention consists of 14 training components (six mandatory) that were identified as important knowledge/skills that caregivers would need to be able to care for the stroke patient after discharge home. Following national training days, the London Stroke Carers Training Course was disseminated to intervention sites by the cascade method of implementation. The intervention was adapted for implementation across a range of stroke units. Training days were well attended (median 2.5 and 2.0 attendees per centre for the first and second days, respectively) and the feedback positive, demonstrating 'face validity' for the intervention. However cascading of this training to other members of the multidisciplinary team was not consistent, with 7/18 centres recording no cascade training. The adapted London Stroke Carers Training Course provided a training programme that could be delivered in a standardised, structured way in a variety of stroke unit settings throughout the UK. The intervention was well received by stroke unit staff, however, the cascade method of implementation was not as effective as we would have wished. © The Author(s) 2014.

Multidisciplinary breast centres in Germany: a review and update of quality assurance through benchmarking and certification.

PubMed

Wallwiener, Markus; Brucker, Sara Y; Wallwiener, Diethelm

2012-06-01

This review summarizes the rationale for the creation of breast centres and discusses the studies conducted in Germany to obtain proof of principle for a voluntary, external benchmarking programme and proof of concept for third-party dual certification of breast centres and their mandatory quality management systems to the German Cancer Society (DKG) and German Society of Senology (DGS) Requirements of Breast Centres and ISO 9001 or similar. In addition, we report the most recent data on benchmarking and certification of breast centres in Germany. Review and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes. Improvements in surrogate parameters as represented by structural and process quality indicators suggest that outcome quality is improving. The voluntary benchmarking programme has gained wide acceptance among DKG/DGS-certified breast centres. This is evidenced by early results from one of the largest studies in multidisciplinary cancer services research, initiated by the DKG and DGS to implement certified breast centres. The goal of establishing a nationwide network of certified breast centres in Germany can be considered largely achieved. Nonetheless the network still needs to be improved, and there is potential for optimization along the chain of care from mammography screening, interventional diagnosis and treatment through to follow-up. Specialization, guideline-concordant procedures as well as certification and recertification of breast centres remain essential to achieve further improvements in quality of breast cancer care and to stabilize and enhance the nationwide provision of high-quality breast cancer care.

Selective boron delivery by intra-arterial injection of BSH-WOW emulsion in hepatic cancer model for neutron capture therapy

PubMed Central

Dewi, Novriana; Higashi, Syushi; Ikushima, Ichiro; Seguchi, Koji; Mizumachi, Ryoji; Murata, Yuji; Morishita, Yasuyuki; Shinohara, Atsuko; Mikado, Shoji; Yasuda, Nakahiro; Fujihara, Mitsuteru; Sakurai, Yuriko; Mouri, Kikue; Yanagawa, Masashi; Iizuka, Tomoya; Suzuki, Minoru; Sakurai, Yoshinori; Masunaga, Shin-ichiro; Tanaka, Hiroki; Matsukawa, Takehisa; Yokoyama, Kazuhito; Fujino, Takashi; Ogura, Koichi; Nonaka, Yasumasa; Sugiyama, Hirotaka; Kajiyama, Tetsuya; Yui, Sho; Nishimura, Ryohei; Ono, Koji; Takamoto, Sinichi; Nakajima, Jun; Ono, Minoru; Eriguchi, Masazumi; Hasumi, Kenichiro; Takahashi, Hiroyuki

2017-01-01

Objective: Boron neutron-capture therapy (BNCT) has been used to inhibit the growth of various types of cancers. In this study, we developed a 10BSH-entrapped water-in-oil-in-water (WOW) emulsion, evaluated it as a selective boron carrier for the possible application of BNCT in hepatocellular carcinoma treatment. Methods: We prepared the 10BSH-entrapped WOW emulsion using double emulsification technique and then evaluated the delivery efficacy by performing biodistribution experiment on VX-2 rabbit hepatic tumour model with comparison to iodized poppy-seed oil mix conventional emulsion. Neutron irradiation was carried out at Kyoto University Research Reactor with an average thermal neutron fluence of 5 × 1012 n cm−2. Morphological and pathological analyses were performed on Day 14 after neutron irradiation. Results: Biodistribution results have revealed that 10B atoms delivery with WOW emulsion was superior compared with those using iodized poppy-seed oil conventional emulsion. There was no dissemination in abdomen or lung metastasis observed after neutron irradiation in the groups treated with 10BSH-entrapped WOW emulsion, whereas many tumour nodules were recognized in the liver, abdominal cavity, peritoneum and bilateral lobes of the lung in the non-injected group. Conclusion: Tumour growth suppression and cancer-cell-killing effect was observed from the morphological and pathological analyses of the 10BSH-entrapped WOW emulsion-injected group, indicating its feasibility to be applied as a novel intra-arterial boron carrier for BNCT. Advances in knowledge: The results of the current study have shown that entrapped 10BSH has the potential to increase the range of therapies available for hepatocellular carcinoma which is considered to be one of the most difficult tumours to cure. PMID:28406315

Intensifying efforts to reduce child malnutrition in India: an evaluation of the Dular program in Jharkhand, India.

PubMed

Dubowitz, Tamara; Levinson, Dorothy; Peterman, Jerusha Nelson; Verma, Geeta; Jacob, Sangita; Schultink, Werner

2007-09-01

The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition. An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status. Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages. Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.

Cognitive and motor functions of iodine-deficient but euthyroid children in Bangladesh do not benefit from iodized poppy seed oil (Lipiodol).

PubMed

Huda, S N; Grantham-McGregor, S M; Tomkins, A

2001-01-01

Iodine supplementation before pregnancy in iodine-deficient women prevents cretinism and neuromotor deficits in their offspring. It is unclear whether iodine supplementation benefits cognitive function in iodine-deficient school-aged children. We therefore conducted a double-blind, randomized, controlled trial of the effects of iodized poppy seed oil (Lipiodol) on cognitive and motor function and weight gain of iodine-deficient school children. The study was conducted with 305 children in grades 1 and 2 from 10 primary schools in two iodine-deficient areas in Bangladesh. The children were stratified by school and grade and randomly assigned to receive 400 mg of oral Lipiodol or a placebo. All children were given a battery of cognitive and motor function tests and had their weights, serum thyroxine (T4) and thyroid-stimulating hormone (TSH) and urinary iodine levels measured before and 4 mo after the intervention. On enrollment, both groups were moderately iodine deficient (median urinary iodine values: placebo group = 3.3 micromol/L, n = 148; iodine group = 3.1 micromol/L, n = 152; goiter prevalence in both groups >95%). However, their T4 and TSH levels were within the normal range. After 4 mo, there was a significant treatment effect on urinary iodine levels (P < 0.0001), but the levels of the treated group were still below normal (median = 7.9 micromol/L). No significant differences were found in T4 and TSH levels, weight gain, cognitive or motor function. The findings suggest that Lipiodol supplementation in moderately iodine-deficient children with normal T4 levels is unlikely to benefit their cognitive function. However, it remains possible that other iodine preparations may have benefits.

Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies

PubMed Central

Katagiri, Ryoko; Yuan, Xiaoyi; Kobayashi, Satomi; Sasaki, Satoshi

2017-01-01

Background Although several reports concerning the association of iodine excess and thyroid disease have appeared, no systematic review of the association between iodine excess intake and thyroid diseases, especially hyperthyroidism and hypothyroidism, has yet been reported. Method We conducted a systematic search of Ovid MEDLINE, PubMed, Cochrane Central Register of Controlled Trials databases, Ichushi-Web and CiNii database for intervention trials and observational studies. Search terms were constructed from related words for excess AND iodine intake or excretion AND thyroid hormones or diseases AND study designs. After considering the qualitative heterogeneity among studies, a meta-analysis was conducted and odds ratios and 95% confidence intervals (CI) were estimated in random-effects models. A protocol was registered with PROSPERO (No. CRD42015028081). Results 50 articles were included, including three intervention trials, six case-control studies, six follow-up studies and 35 cross-sectional studies. Three cross-sectional studies in adults included in meta-analysis. Odds ratio of overt and subclinical hypothyroidism between excess and adequate populations were 2.78 (CI:1.47 to 5.27) and 2.03 (CI:1.58 to 2.62) in adults, respectively. Source of excess iodine status was mainly iodized salt or water in included studies. Conclusion Although universal salt iodization has improved goiter rates, chronic exposure to excess iodine from water or poorly monitored salt are risk factors for hypothyroidism in free-living populations. Monitoring of both iodine concentration in salt as well as the iodine concentration in local drinking water are essential to preventing thyroid diseases. Hypothyroidism should be also carefully monitored in areas with excess iodine. Because of the low quality and limited number of included studies, further evidence and review are required. PMID:28282437

Iodine Deficiency and Iodine Prophylaxis in Pregnancy.

PubMed

Trofimiuk-Mudlner, Malgorzata; Hubalewska-Dydejczyk, Alicja

2017-01-01

Physiological changes in pregnancy result in increased iodine demand, which may not be met in areas of mild-to-moderate iodine deficiency or borderline sufficiency. As a pregnant woman is the only source of thyroid hormones for her child during early gestation, iodine deficiencyinduced hypothyroxinemia may have deleterious effects on fetal development. To present the current approach to iodine deficiency and its prophylaxis during pregnancy. A review of the current literature including patents on iodine deficiency in pregnancy has been performed. Negative influence of severe iodine deficiency on fetal development has been proved, and evidence on a deleterious impact of milder forms of iodine deficiency on cognition of the offspring is rapidly growing. Although the WHO has addressed the issues of monitoring iodine status during pregnancy, prophylactic measures and assessment of their effectiveness, there are some controversies, regarding for example the best methods for control of iodine status. New patents in urinary iodine measurement methods may make iodine nutrition monitoring easier. The main method of iodine prophylaxis, in pregnancy also, is universal salt iodization. However, particularly if there is not sufficient coverage of the households with iodized salt, additional measures, such as oral supplementation with potassium iodide tablets, are necessary in pregnant women to provide adequate iodine nutrition. Iodine supplementation improves maternal thyroid function indices; particularly, it prevents goiter formation. Stronger evidence on beneficial effects of iodine supplementation of mild-to-moderate iodine deficient pregnant women on cognitive function of their children is still needed. It may be provided by randomized controlled trials and international initiatives. Changes in the iodine prophylaxis system should be monitored, both to prevent decreased or excessive iodine intake. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Iodine nutrition status and prevalence of abnormal TSH levels in schoolchildren aged 6-7 years in the autonomous community of the Basque Country.

PubMed

Arrizabalaga, Juan José; Jalón, Mercedes; Espada, Mercedes; Cañas, Mercedes; Arena, José María; Vila, Lluís

2018-05-01

An epidemiological study conducted between 1988 and 1992 showed iodine deficiency and endemic goiter in the schoolchildren of the autonomous community of the Basque Country. 1) To ascertain the iodine nutrition status of schoolchildren aged 6-7 years, and 2) to estimate the prevalence of abnormal TSH levels in capillary blood. The study was conducted on 497 schoolchildren selected by random sampling. Median urinary iodine concentration (mUIC) was used to assess iodine nutritional status, and the reference interval derived from the study population was used to estimate the prevalence of abnormal TSH levels. The mUIC (P 25 -P 75 ) was 140 (82-217) μg/L. A higher value was found in those who used iodized salt at home than in those who did not (146 [85-222] versus 126 μg/L [73-198], P<0.05). It was also higher in those who consumed 2 or more daily servings of milk and yogurt than in those taking less than 2 servings (146 [87-225] versus 110 μg/L [66-160], P<0.0001). Abnormal TSH levels were found in 2% of children. There was no correlation between TSH levels in capillary blood and urinary iodine concentrations (R=0.082; P=0.076). Schoolchildren aged 6-7 years of the autonomous community of the Basque Country have an adequate iodine nutrition status. Use of iodized salt at home and daily consumption of milk and yogurt were associated to the highest UICs. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Iodine status in pregnancy and household salt iodine content in rural Bangladesh.

PubMed

Shamim, Abu Ahmed; Christian, Parul; Schulze, Kerry J; Ali, Hasmot; Kabir, Alamgir; Rashid, Mahbubur; Labrique, Alain; Salamatullah, Qauzi; West, Keith P

2012-04-01

Adequate maternal iodine intake is essential during pregnancy for the development of the foetus. To assess the extent of iodine insufficiency and its association with household iodized salt in rural Bangladesh, we measured urinary iodine and household salt iodine content among pregnant women in early (≤16 weeks, n = 1376) and late (≥32 weeks, n = 1114) pregnancy. Salt (∼20 g) and a spot urine sample (∼10 mL) were collected from women participating in a randomized, placebo-controlled trial of vitamin A or beta-carotene supplementation in rural northwestern Bangladesh during home visits in early and late pregnancy. Salt iodine was analyzed by iodometric titration, and urinary iodine by the Ohashi method. Almost all salt samples had some detectable iodine, but over 75% contained <15 ppm. Median (interquartile range) urinary iodine concentrations were 66 (34-133) and 55 (28-110) µg L⁻¹ in early and late pregnancy, respectively; urinary iodine <150 µg L⁻¹ was found in ∼80% of women at both times in pregnancy. Although the risk of iodine insufficiency declined with increasing iodine content of household salt (P for trend <0.05), median urinary iodine did not reach 150 µg L⁻¹ until iodine in household salt was at least 32 ppm and 51 ppm during early and late pregnancy, respectively. Despite a national policy on universal salt iodization, salt iodine content remains insufficient to maintain adequate maternal iodine status throughout pregnancy in rural northern Bangladesh. Alternative measures like direct iodine supplementation during pregnancy could be considered to assure adequate iodine status during this high-risk period of life. © 2010 Blackwell Publishing Ltd.

Mandatory and Self-citation; Types, Reasons, Their Benefits and Disadvantages.

PubMed

Hemmat Esfe, Mohammad; Wongwises, Somchai; Asadi, Amin; Karimipour, Arash; Akbari, Mohammad

2015-12-01

This paper defines and discusses two important types of citations, self-citation and mandatory citation, in engineering journals. Citation can be classified in three categories: optional; semi-mandatory; and mandatory. There are some negative and positive impacts for the authors' paper and journals' reputation if mandatory citation of a paper or set of papers is requested. These effects can be different based on the recommended papers for citing in the new research. Mandatory citation has various types discussed in this paper. Self-citation and its reasons and impacts are also discussed in the present study.

Concerns raised about Botswana's proposed HIV-disclosure law.

PubMed

Ahmad, K

2000-08-19

On August 10, 2000, Botswana's Minister for Health, Joy Phumaphi, announced that the country is considering legislation making disclosure of one's HIV status to a sex partner mandatory. The legislation would make sexual activity without information a criminal offense. However, Phumaphi's statement has created worldwide concern. Ethicists Anna Mastroianni of the University of Washington and Jeffrey Kahn of the University of Minnesota argue that such a policy, if enacted, would further increase the spread of HIV/AIDS because people would not present for HIV testing. Moreover, Josef Decosas of the Southern Africa AIDS Training Programme, Harare, Zimbabwe adds that such legislation would disempower women and be used to criminalize prostitution and drive the industry further underground. He rather recommends regular access to sexual health care services and intensive support for consistent condom use in containing HIV epidemic in Botswana.

5 CFR 890.1004 - Bases for mandatory debarments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Bases for mandatory debarments. 890.1004 Section 890.1004 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE... Health Care Providers Mandatory Debarments § 890.1004 Bases for mandatory debarments. (a) Debarment...

5 CFR 890.1004 - Bases for mandatory debarments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Bases for mandatory debarments. 890.1004 Section 890.1004 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE... Health Care Providers Mandatory Debarments § 890.1004 Bases for mandatory debarments. (a) Debarment...

5 CFR 890.1004 - Bases for mandatory debarments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Bases for mandatory debarments. 890.1004 Section 890.1004 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE... Health Care Providers Mandatory Debarments § 890.1004 Bases for mandatory debarments. (a) Debarment...

5 CFR 890.1004 - Bases for mandatory debarments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Bases for mandatory debarments. 890.1004 Section 890.1004 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE... Health Care Providers Mandatory Debarments § 890.1004 Bases for mandatory debarments. (a) Debarment...

Medical education in Sweden.

PubMed

Lindgren, Stefan; Brännström, Thomas; Hanse, Eric; Ledin, Torbjörn; Nilsson, Gunnar; Sandler, Stellan; Tidefelt, Ulf; Donnér, Jakob

2011-01-01

Undergraduate medical education in Sweden has moved from nationally regulated, subject-based courses to programmes integrated either around organ systems or physiological and patho-physiological processes, or organised around basic medical science in conjunction with clinical specialities, with individual profiles at the seven medical schools. The national regulations are restricted to overall academic and professional outcomes. The 5½ year long university undergraduate curriculum is followed by a mandatory 18 months internship, delivered by the County Councils. While quality control and accreditation for the university curriculum is provided by the Swedish National Agency for Higher Education, no such formal control exists for the internship; undergraduate medical education is therefore in conflict with EU directives from 2005. The Government is expected to move towards 6 years long university undergraduate programmes, leading to licence, which will facilitate international mobility of both Swedish and foreign medical students and doctors. Ongoing academic development of undergraduate education is strengthened by the Bologna process. It includes outcome (competence)-based curricula, university Masters level complying with international standards, progression of competence throughout the curriculum, student directed learning, active participation and roles in practical clinical education and a national assessment model to assure professional competence. In the near future, the dimensioning of Swedish undergraduate education is likely to be decided more by international demands and aspects of quality than by national demands for doctors.

Implementing cognitive remediation therapy (CRT) in a mental health service: staff training.

PubMed

Dark, Frances; Newman, Ellie; Harris, Meredith; Cairns, Alice; Simpson, Michael; Gore-Jones, Victoria; Whiteford, Harvey; Harvey, Carol; Crompton, David

2016-04-01

This paper describes the establishment of training in cognitive remediation for psychosis within a community mental health service. Clinical staff working in the community of a mental health service were surveyed to ascertain their interest in cognitive aspects of psychosis and skills training in cognitive remediation (CR). Based on the results of the survey a tiered training programme was established with attendance figures reported for each level of training. Fidelity assessment was conducted on the five CR programmes operating. Of 106 clinical staff working in the community with people diagnosed with a psychotic illness 51 completed the survey (48% response rate). The training needs varied with all 106 staff receiving the fundamental (mandatory) training and 51 staff receiving CR facilitator training. Thirty three percent of staff trained as facilitators were delivering CR. Up skilling the mental health workforce to incorporate an understanding of the cognitive aspects of psychosis into care delivery can be facilitated by a tiered training structure. Fundamental training on the psychosocial aspects of psychosis can act as a platform for focussed CR skills based training. There is also a need for accessible therapy based supervision for staff wishing to develop competencies as CR therapists. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Evaluating effectiveness of small group information literacy instruction for Undergraduate Medical Education students using a pre- and post-survey study design.

PubMed

McClurg, Caitlin; Powelson, Susan; Lang, Eddy; Aghajafari, Fariba; Edworthy, Steven

2015-06-01

The Undergraduate Medical Education (UME) programme at the University of Calgary is a three-year programme with a strong emphasis on small group learning. The purpose of our study was to determine whether librarian led small group information literacy instruction, closely integrated with course content and faculty participation, but without a hands on component, was an effective means to convey EBM literacy skills. Five 15-minute EBM information literacy sessions were delivered by three librarians to 12 practicing physician led small groups of 15 students. Students were asked to complete an online survey before and after the sessions. Data analysis was performed through simple descriptive statistics. A total of 144 of 160 students responded to the pre-survey, and 112 students answered the post-survey. Instruction in a small group environment without a mandatory hands on component had a positive impact on student's evidence-based information literacy skills. Students were more likely to consult a librarian and had increased confidence in their abilities to search and find relevant information. Our study demonstrates that student engagement and faculty involvement are effective tools for delivering information literacy skills when working with students in a small group setting outside of a computer classroom. © 2015 Health Libraries Group.

49 CFR 220.61 - Radio transmission of mandatory directives.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Radio transmission of mandatory directives. 220.61... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.61 Radio transmission of mandatory directives. (a) Each mandatory directive may be transmitted by...

47 CFR 0.503 - Submission of requests for mandatory declassification review.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ORGANIZATION Mandatory Declassification of National Security Information § 0.503 Submission of requests for mandatory declassification review. (a) Requests for mandatory review of national security information shall be in writing, addressed to the Managing Director, and reasonably describe the information sought...

49 CFR 220.61 - Radio transmission of mandatory directives.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.61 Radio transmission of mandatory directives. (a) Each mandatory directive may be transmitted by... 49 Transportation 4 2014-10-01 2014-10-01 false Radio transmission of mandatory directives. 220.61...

49 CFR 220.61 - Radio transmission of mandatory directives.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.61 Radio transmission of mandatory directives. (a) Each mandatory directive may be transmitted by... 49 Transportation 4 2013-10-01 2013-10-01 false Radio transmission of mandatory directives. 220.61...

20 CFR 416.2060 - Mandatory minimum supplementary payments not applicable.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Mandatory minimum supplementary payments not applicable. 416.2060 Section 416.2060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... § 416.2060 Mandatory minimum supplementary payments not applicable. An individual eligible for mandatory...

20 CFR 416.2060 - Mandatory minimum supplementary payments not applicable.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Mandatory minimum supplementary payments not applicable. 416.2060 Section 416.2060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... § 416.2060 Mandatory minimum supplementary payments not applicable. An individual eligible for mandatory...

20 CFR 416.2060 - Mandatory minimum supplementary payments not applicable.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Mandatory minimum supplementary payments not applicable. 416.2060 Section 416.2060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... § 416.2060 Mandatory minimum supplementary payments not applicable. An individual eligible for mandatory...

20 CFR 416.2060 - Mandatory minimum supplementary payments not applicable.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Mandatory minimum supplementary payments not applicable. 416.2060 Section 416.2060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... § 416.2060 Mandatory minimum supplementary payments not applicable. An individual eligible for mandatory...

47 CFR 0.503 - Submission of requests for mandatory declassification review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ORGANIZATION Mandatory Declassification of National Security Information § 0.503 Submission of requests for mandatory declassification review. (a) Requests for mandatory review of national security information shall be in writing, addressed to the Managing Director, and reasonably describe the information sought...

[The mandatory medical insurance through eyes of medical personnel].

PubMed

Semenov, V Yu; Lakunin, K Yu; Livshits, S A

2014-01-01

The article considers the results of sociological survey carries out among medical personnel of the Moscowskaya oblast in August-September 2013. The purpose of the study was to examine opinions of medical personnel about system of mandatory insurance in conditions of implementation of the new law regulating system of mandatory medical insurance during last three years. The sampling included 932 respondents that corresponds approximately 1% of all medical personnel in the oblast. It is established that even 20 years later after the moment of organization of the system of mandatory medical insurance not all medical personnel is oriented in it. More than 70% of respondents consider this system too convoluted and over bureaucratized and only 22.2% of respondents assume that medical insurance organizations defense interests of patient and 25.8% feel no impact of mandatory medical insurance funds on functioning of medical organizations. Most of respondents consider functions of mandatory medical insurance organizations and mandatory medical insurance funds as controlling only. Only 31% of respondents support the actual system of mandatory medical insurance.

Design Authority in the Test Programme Definition: The Alenia Spazio Experience

NASA Astrophysics Data System (ADS)

Messidoro, P.; Sacchi, E.; Beruto, E.; Fleming, P.; Marucchi Chierro, P.-P.

2004-08-01

In addition, being the Verification and Test Programme a significant part of the spacecraft development life cycle in terms of cost and time, very often the subject of the mentioned discussion has the objective to optimize the verification campaign by possible deletion or limitation of some testing activities. The increased market pressure to reduce the project's schedule and cost is originating a dialecting process inside the project teams, involving program management and design authorities, in order to optimize the verification and testing programme. The paper introduces the Alenia Spazio experience in this context, coming from the real project life on different products and missions (science, TLC, EO, manned, transportation, military, commercial, recurrent and one-of-a-kind). Usually the applicable verification and testing standards (e.g. ECSS-E-10 part 2 "Verification" and ECSS-E-10 part 3 "Testing" [1]) are tailored to the specific project on the basis of its peculiar mission constraints. The Model Philosophy and the associated verification and test programme are defined following an iterative process which suitably combines several aspects (including for examples test requirements and facilities) as shown in Fig. 1 (from ECSS-E-10). The considered cases are mainly oriented to the thermal and mechanical verification, where the benefits of possible test programme optimizations are more significant. Considering the thermal qualification and acceptance testing (i.e. Thermal Balance and Thermal Vacuum) the lessons learned originated by the development of several satellites are presented together with the corresponding recommended approaches. In particular the cases are indicated in which a proper Thermal Balance Test is mandatory and others, in presence of more recurrent design, where a qualification by analysis could be envisaged. The importance of a proper Thermal Vacuum exposure for workmanship verification is also highlighted. Similar considerations are summarized for the mechanical testing with particular emphasis on the importance of Modal Survey, Static and Sine Vibration Tests in the qualification stage in combination with the effectiveness of Vibro-Acoustic Test in acceptance. The apparent relative importance of the Sine Vibration Test for workmanship verification in specific circumstances is also highlighted. Fig. 1. Model philosophy, Verification and Test Programme definition The verification of the project requirements is planned through a combination of suitable verification methods (in particular Analysis and Test) at the different verification levels (from System down to Equipment), in the proper verification stages (e.g. in Qualification and Acceptance).

Mothers and vaccination: knowledge, attitudes, and behaviour in Italy.

PubMed

Angelillo, I F; Ricciardi, G; Rossi, P; Pantisano, P; Langiano, E; Pavia, M

1999-01-01

The study evaluates knowledge, attitudes, and behaviour of mothers regarding the immunization of 841 infants who attended public kindergarten in Cassino and Crotone, Italy. Overall, 57.8% of mothers were aware about all four mandatory vaccinations for infants (poliomyelitis, tetanus, diphtheria, hepatitis B). The results of a multiple logistic regression analysis showed that this knowledge was significantly greater among mothers with a higher education level and among those who were older at the time of the child's birth. Respondents' attitudes towards the utility of vaccinations for preventing infectious diseases were very favourable. Almost all children (94.4%) were vaccinated with all three doses of diphtheria-tetanus (DT), oral poliovirus vaccine (OPV), and hepatitis B. The proportion of children vaccinated who received all three doses of OPV, DT or diphtheria-tetanus-pertussis (DTP), and hepatitis B vaccines within 1 month of becoming age-eligible ranged from 56.6% for the third dose of hepatitis B to 95.7% for the first dose of OPV. Results of the regression analysis performed on the responses of mothers who had adhered to the schedule for all mandatory vaccinations indicated that birth order significantly predicted vaccination nonadherence, since children who had at least one older sibling in the household were significantly less likely to be age-appropriately vaccinated. The coverage for the optional vaccines was only 22.5% and 31% for measles-mumps-rubella and for all three doses against pertussis, respectively. Education programmes promoting paediatric immunization, accessibility, and follow-up should be targeted to the entire population.

Current status of semen banking in the USA.

PubMed

Critser, J K

1998-05-01

Anonymous donor sperm banking has been a fundamental aspect of reproductive medicine for several decades. In 1987, >170,000 women in the USA were treated for infertility using artificial insemination. Current estimates suggest that the number of women seeking treatment for infertility has increased markedly since that time; however, there are no accurate, updated data to indicate the magnitude of that increase. Most anonymous donor sperm banks in the USA can be categorized as one of three types based upon administrative structure: (i) physician practice based; (ii) hospital/clinic based; or (iii) commercial corporations. Of these it is estimated that the most common structures are the physician office and hospital/clinic based banks. However, the largest (i.e. those processing the most units) are the for-profit corporate banks. A survey conducted in 1989 found that there were at least 135 sperm banks operating in the USA. More recent information indicates the number of banks to be somewhere between 50 and 150. Guidelines for anonymous donor sperm banking practices have been established by the American Society for Reproductive Medicine and standards have been established by the American Association of Tissue Banks (AATB). The AATB has recently established an inspection and accreditation programme and six anonymous donor banks have been accredited in the last few years. It is anticipated that mandatory registration of all donor banks will be required by the FDA in the near future with mandatory inspection and accreditation to follow shortly thereafter.

7 CFR 59.204 - Mandatory weekly reporting for swine.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 3 2012-01-01 2012-01-01 false Mandatory weekly reporting for swine. 59.204 Section 59.204 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING... (CONTINUED) LIVESTOCK MANDATORY REPORTING Swine Reporting § 59.204 Mandatory weekly reporting for swine. (a...

7 CFR 59.204 - Mandatory weekly reporting for swine.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Mandatory weekly reporting for swine. 59.204 Section 59.204 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING... (CONTINUED) LIVESTOCK MANDATORY REPORTING Swine Reporting § 59.204 Mandatory weekly reporting for swine. (a...

7 CFR 59.204 - Mandatory weekly reporting for swine.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 3 2014-01-01 2014-01-01 false Mandatory weekly reporting for swine. 59.204 Section 59.204 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING... (CONTINUED) LIVESTOCK MANDATORY REPORTING Swine Reporting § 59.204 Mandatory weekly reporting for swine. (a...

7 CFR 59.204 - Mandatory weekly reporting for swine.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 3 2013-01-01 2013-01-01 false Mandatory weekly reporting for swine. 59.204 Section 59.204 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING... (CONTINUED) LIVESTOCK MANDATORY REPORTING Swine Reporting § 59.204 Mandatory weekly reporting for swine. (a...

7 CFR 59.204 - Mandatory weekly reporting for swine.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Mandatory weekly reporting for swine. 59.204 Section 59.204 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING... (CONTINUED) LIVESTOCK MANDATORY REPORTING Swine Reporting § 59.204 Mandatory weekly reporting for swine. (a...

Mandatory overtime regulations and nurse overtime.

PubMed

Bae, Sung-Heui; Brewer, Carol

2010-05-01

A descriptive study used data from the 2004 National Sample Survey of Registered Nurses to examine the nature and occurrence of RN mandatory, voluntary overtime, paid on-call, and total work hours and their association with mandatory overtime regulations in United States. About half of the nurses worked more than 40 hrs per week. Nurses working in states regulating mandatory overtime reported lower levels of mandatory overtime hours than states without regulations or states restricting total work hours. The percent of RNs working 61 hrs and over per week in states without regulations was lower than that in states with regulations. Nurses working in nursing homes reported higher levels of the percentage of mandatory overtime hours worked than those working in hospitals. This suggested that governments need to continuously supervise healthcare institutions, including both hospitals and nursing homes, to ensure adherence to mandatory overtime regulations.

[The methods within the evaluation of disease management programmes in control-group designs using the example of diabetes mellitus - a systematic literature review].

PubMed

Drabik, A; Sawicki, P T; Müller, D; Passon, A; Stock, S

2012-08-01

Disease management programmes (DMPs) were implemented in Germany in 2002. Their evaluation is required by law. Beyond the mandatory evaluation, a growing number of published studies evaluate the DMP for diabetes mellitus type 2 in a control-group design. As patients opt into the programme on a voluntary basis it is necessary to adjust the inherent selection bias between groups. The aim of this study is to review published studies which evaluate the diabetes DMP using a control-group design with respect to the methods used. A systematic literature review of electronic databases (PUBMED, Cochrane Library, EMBASE, MEDPILOT) and a hand search of reference lists of the relevant publications was conducted to identify studies evaluating the DMP diabetes mellitus in a control-group design. 8 studies were included in the systematic literature review. 4 studies gathered retrospective claims data from sickness funds, one from physician's records, one study used prospective data from ambulatory care, and 2 studies were based on one patient survey. Methods used for adjustment of selection bias included exact matching, matching using propensity score methods, age-adjusted and sex-separated analysis, and adjustment in a regression model/analysis of covariance. One study did not apply adjustment methods. The intervention period ranged from 1 day to 4 years. Considered outcomes of studies (surrogate parameter, diabetes complications, mortality, quality of life, and claim data) depended on the database. In the evaluation of the DMP diabetes mellitus based on a control-group design neither the database nor the methods used for selection bias adjustment were consistent in the available studies. Effectiveness of DMPs cannot be judged based on this review due to heterogeneity of study designs. To allow for a comprehensive programme evaluation standardised minimum requirements for the evaluation of DMPs in the control group design are required. © Georg Thieme Verlag KG Stuttgart · New York.

Epidemiology and statistics at the Nordic School of Public Health: Teaching and research 1979-2014.

PubMed

Eriksson, Bo

2015-08-01

The Nordic School of Public Health (NHV) was jointly founded in 1953 by the Nordic countries. Until 1979, the school provided ad hoc courses on public health topics, using external teachers drawn mainly from the Nordic countries. At the time, the permanent staff of the school was small. In 1979, it began a Master's degree programme and a few academic positions were established and filled, to support these courses. The programme included four main areas: Epidemiology, Social Medicine, Environmental Health and Health Services Administration. Epidemiology was compulsory in all Master of Public Health (MPH) exams, but there were a handful of optional courses that could be substituted for the other subjects.This paper tells the story of Epidemiology at NHV from about 1980, up until closure of the school in 2014. The original MPH model ran until 1995. Nursing Science entered NHV from about 1985 and worked mainly with qualitative research that often focused on individual patients. The new methods attracted nurses, midwives, psychologists and other groups that previously had been less represented in NHV. Being quantitative and population oriented, Epidemiology lost its unique position as a mandatory subject for the MPH examination. In addition the 'New Public Health' proposed by the World Health Organisation (WHO) that advocated health promotion and the philosophy of salutogenesis became a challenge for the programme in epidemiology: pathogenesis no longer was of primary interest. From 1995, the MPH format changed repeatedly and a DrPH programme was begun. For the last 8 years of its existence, NHV offered a reasonably comprehensive, basic course in Epidemiology.Throughout the years, epidemiology training and research at NHV were very traditional. In being a relatively free institution in terms of academic choices, NHV should have contributed to the development and innovation of epidemiology in public health. For several reasons, this did not happen. © 2015 the Nordic Societies of Public Health.

Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery.

PubMed

Patel, P; Hartland, A; Hollis, A; Ali, R; Elshaw, A; Jain, S; Khan, A; Mirza, S

2015-04-01

In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort). A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss. The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18-69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4-93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17-51%, SD: 0.09 percentage points) compared with 27% (range: 14-48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037). Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.

7 CFR 59.104 - Mandatory reporting of boxed beef sales.

Code of Federal Regulations, 2013 CFR

2013-01-01

... product delivery period; and (ix) The beef type (steer/heifer, dairy steer/heifer, or cow). (b... 7 Agriculture 3 2013-01-01 2013-01-01 false Mandatory reporting of boxed beef sales. 59.104... (CONTINUED) LIVESTOCK MANDATORY REPORTING Cattle Reporting § 59.104 Mandatory reporting of boxed beef sales...

7 CFR 59.104 - Mandatory reporting of boxed beef sales.

Code of Federal Regulations, 2014 CFR

2014-01-01

... product delivery period; and (ix) The beef type (steer/heifer, dairy steer/heifer, or cow). (b... 7 Agriculture 3 2014-01-01 2014-01-01 false Mandatory reporting of boxed beef sales. 59.104... (CONTINUED) LIVESTOCK MANDATORY REPORTING Cattle Reporting § 59.104 Mandatory reporting of boxed beef sales...

7 CFR 59.104 - Mandatory reporting of boxed beef sales.

Code of Federal Regulations, 2012 CFR

2012-01-01

... product delivery period; and (ix) The beef type (steer/heifer, dairy steer/heifer, or cow). (b... 7 Agriculture 3 2012-01-01 2012-01-01 false Mandatory reporting of boxed beef sales. 59.104... (CONTINUED) LIVESTOCK MANDATORY REPORTING Cattle Reporting § 59.104 Mandatory reporting of boxed beef sales...

7 CFR 59.104 - Mandatory reporting of boxed beef sales.

Code of Federal Regulations, 2011 CFR

2011-01-01

... product delivery period; and (ix) The beef type (steer/heifer, dairy steer/heifer, or cow). (b... 7 Agriculture 3 2011-01-01 2011-01-01 false Mandatory reporting of boxed beef sales. 59.104... (CONTINUED) LIVESTOCK MANDATORY REPORTING Cattle Reporting § 59.104 Mandatory reporting of boxed beef sales...

47 CFR 1.10006 - Is electronic filing mandatory?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Is electronic filing mandatory? 1.10006 Section... International Bureau Filing System § 1.10006 Is electronic filing mandatory? Electronic filing is mandatory for... System (IBFS) form is available. Applications for which an electronic form is not available must be filed...

7 CFR 59.302 - Mandatory weekly reporting for lambs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Mandatory weekly reporting for lambs. 59.302 Section... (CONTINUED) LIVESTOCK MANDATORY REPORTING Lamb Reporting § 59.302 Mandatory weekly reporting for lambs. (a... domestic from imported market purchases: (1) The quantity of lambs purchased through a negotiated purchase...

22 CFR 213.39 - Exceptions to mandatory transfer.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Exceptions to mandatory transfer. 213.39 Section 213.39 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Mandatory Transfer... Exceptions to mandatory transfer. USAID is not required to transfer a debt to FMS pursuant to § 213.37(b...

22 CFR 213.39 - Exceptions to mandatory transfer.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Exceptions to mandatory transfer. 213.39 Section 213.39 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Mandatory Transfer... Exceptions to mandatory transfer. USAID is not required to transfer a debt to FMS pursuant to § 213.37(b...

40 CFR 95.4 - Limitations on mandatory licenses

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Limitations on mandatory licenses 95.4...) MANDATORY PATENT LICENSES § 95.4 Limitations on mandatory licenses (a) If the Administrator, or the... with § 95.3, the application shall include a proposed patent license with the following limitations: (1...

36 CFR 1260.60 - What are agency responsibilities with regard to mandatory review requests for White House...

Code of Federal Regulations, 2010 CFR

2010-07-01

... responsibilities with regard to mandatory review requests for White House originated information? 1260.60 Section... responsibilities with regard to mandatory review requests for White House originated information? When an agency receives a mandatory review request from NARA for consultation on declassification of White House...

7 CFR 59.301 - Mandatory Daily Reporting for Lambs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Mandatory Daily Reporting for Lambs. 59.301 Section 59... (CONTINUED) LIVESTOCK MANDATORY REPORTING Lamb Reporting § 59.301 Mandatory Daily Reporting for Lambs. (a) In... prices for lambs (per hundredweight) established on that day as F.O.B. feedlot or delivered at the plant...

36 CFR 1260.60 - What are agency responsibilities with regard to mandatory review requests for White House...

Code of Federal Regulations, 2011 CFR

2011-07-01

... responsibilities with regard to mandatory review requests for White House originated information? 1260.60 Section... responsibilities with regard to mandatory review requests for White House originated information? When an agency receives a mandatory review request from NARA for consultation on declassification of White House...

7 CFR 59.102 - Mandatory daily reporting for cows and bulls.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Mandatory daily reporting for cows and bulls. 59.102... (CONTINUED) LIVESTOCK MANDATORY REPORTING Cattle Reporting § 59.102 Mandatory daily reporting for cows and bulls. (a) In General. The corporate officers or officially designated representatives of each cow and...

5 CFR 890.1009 - Contesting proposed mandatory debarments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1009 Contesting proposed mandatory debarments. (a...

5 CFR 890.1007 - Minimum length of mandatory debarments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1007 Minimum length of mandatory debarments. (a...

41 CFR 301-70.701 - Who has the authority to grant exemptions to mandatory use of Government contractor-issued travel...

Code of Federal Regulations, 2010 CFR

2010-07-01

... grant exemptions to mandatory use of Government contractor-issued travel charge card for official travel... REQUIREMENTS Policies and Procedures Relating to Mandatory Use of the Government Contractor-Issued Travel Charge Card for Official Travel § 301-70.701 Who has the authority to grant exemptions to mandatory use...

Implications of Mandatory Pupil Assignment for Desegregation. A Review of the Existing Research and a Survey of the District's Parents. Report No. 8402.

ERIC Educational Resources Information Center

Raivetz, Mark J.

The implications of a mandatory pupil assignment desegregation plan for the racial composition of the School District of Philadelphia are assessed in this report. The first section of the report reviews desegregation literature relating to mandatory pupil assignment. Virtually all of the research indicates that mandatory white reassignments…

29 CFR Appendix A to Subpart P of... - Model Fire Safety Plan (Non-Mandatory)

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 7 2013-07-01 2013-07-01 false Model Fire Safety Plan (Non-Mandatory) A Appendix A to...—Model Fire Safety Plan (Non-Mandatory) Model Fire Safety Plan Note: This appendix is non-mandatory and provides guidance to assist employers in establishing a Fire Safety Plan as required in § 1915.502. Table...

29 CFR Appendix A to Subpart P to... - Model Fire Safety Plan (Non-Mandatory)

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 7 2012-07-01 2012-07-01 false Model Fire Safety Plan (Non-Mandatory) A Appendix A to...—Model Fire Safety Plan (Non-Mandatory) Model Fire Safety Plan Note: This appendix is non-mandatory and provides guidance to assist employers in establishing a Fire Safety Plan as required in § 1915.502. Table...

29 CFR Appendix A to Subpart P of... - Model Fire Safety Plan (Non-Mandatory)

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 7 2014-07-01 2014-07-01 false Model Fire Safety Plan (Non-Mandatory) A Appendix A to...—Model Fire Safety Plan (Non-Mandatory) Model Fire Safety Plan Note: This appendix is non-mandatory and provides guidance to assist employers in establishing a Fire Safety Plan as required in § 1915.502. Table...

Tuberculosis--a notifiable disease.

PubMed

Roy, Sukhendu; Rai, D R; Suresh, Gutta

2012-10-01

In a landmark development, the Ministry of Health and Family Welfare, Government of India, has taken important steps to establish the compulsory notification of tuberculosis in the country. A Government Order to this effect was issued on 7 May 2012. In addition to this IMA passed a resolution on TB notification in CWC on 22nd April 2012 at Mumbai: "In conformity with the requirements of ISTC, Indian Medical Association (IMA) desires that Notification of TB patient to the National Programme be made mandatory. IMA also recommends to the medical practitioner to follow the ISTC guidelines in diagnosis and management of TB care". Notification of TB will facilitate early diagnosis and treatment, prevention of MDR and XDR, reduce TB deaths, better quality diagnostic and treatment services for the TB patients. RNTCP will realistically estimateTB burden, plan resources and control measures to commensurate with the actual burden of disease.

Hospital implementation of resuscitation guidelines and review of CPR training programmes: a nationwide study.

PubMed

Schmidt, Anders S; Lauridsen, Kasper G; Adelborg, Kasper; Løfgren, Bo

2016-06-01

This study aimed to investigate cardiopulmonary resuscitation (CPR) guideline implementation and CPR training in hospitals. This nationwide study included mandatory resuscitation protocols from each Danish hospital. Protocols were systematically reviewed for adherence to the European Resuscitation Council (ERC) 2010 guidelines and CPR training in each hospital. Data were included from 45 of 47 hospitals. Adherence to the ERC basic life support (BLS) algorithm was 49%, whereas 63 and 58% of hospitals adhered to the recommended chest compression depth and rate. Adherence to the ERC advanced life support (ALS) algorithm was 81%. Hospital BLS course duration was [median (interquartile range)] 2.3 (1.5-2.5) h, whereas ALS course duration was 4.0 (2.5-8.0) h. Implementation of ERC 2010 guidelines on BLS is limited in Danish hospitals 2 years after guideline publication, whereas the majority of hospitals adhere to the ALS algorithm. CPR training differs among hospitals.

[Anti-hepatitis B surface antigen titres in vaccinated dentistry students at Damascus University].

PubMed

Srour, I H; Mashlah, A

2012-06-01

Dental practice carries considerable danger for acquiring bloodborne pathogens such as hepatitis B virus (HBV). Vaccination against this virus is an important approach to reducing the infection. Post-vaccination test to confirm the seroconversion is important also. Over the period 1 March-31 May 2010, we assessed the efficacy of HBV vaccination among 91 fourth-year dental students at Damascus University, who were vaccinated under the mandatory Faculty of Dentistry programme. Anti-HBsAg antibody titres were determined in the blood samples using an enzyme immunoassay to measure; > or = 10 IU/mm was considered an adequate response titer. Seven of the 91 dentistry students (7.7%) had anti-HBs antibody titre < 10 mlU/mL. The frequency of unresponsiveness was significantly higherwith smoking (P = 0.012) and alcohol consumption (P = 0.014). Anti-HBs test should be included in routine immunization services of the School of Dentistry at Damascus University.

Experimental programme on absolute fission fragment yields with the lohengrin spectrometer: New optical and statistical methodologies

NASA Astrophysics Data System (ADS)

Abdelaziz, Chebboubi; Grégoire, Kessedjian; Olivier, Serot; Sylvain, Julien-Laferriere; Christophe, Sage; Florence, Martin; Olivier, Méplan; David, Bernard; Olivier, Litaize; Aurélien, Blanc; Herbert, Faust; Paolo, Mutti; Ulli, Köster; Alain, Letourneau; Thomas, Materna; Michal, Rapala

2017-09-01

The study of fission yields has a major impact on the characterization and understanding of the fission process and is mandatory for reactor applications. In the past with the LOHENGRIN spectrometer of the ILL, priority has been given for the studies in the light fission fragment mass range. The LPSC in collaboration with ILL and CEA has developed a measurement program on symmetric and heavy mass fission fragment distributions. The combination of measurements with ionisation chamber and Ge detectors is necessary to describe precisely the heavy fission fragment region in mass and charge. Recently, new measurements of fission yields and kinetic energy distributions are has been made on the 233U(nth,f) reaction. The focus of this work has been on the new optical and statistical methodology and the self-normalization of the data to provide new absolute measurements, independently of any libraries, and the associated experimental covariance matrix.

Cysticercosis in the pig.

PubMed

de Aluja, A S

2008-01-01

Taenia solium cysticercosis is still an important parasitosis in rural pigs in many developing countries, México among them. The main causes for the persistence of this condition are lack of hygiene in the rural communities, lack of education of the animal owners, lack of control in the trade of pigs and their meat and lack of conscientious meat inspection. The pig production systems in the marginated areas of Mexico are briefly mentioned and it is stressed that among the important reasons for the persistence of the reproductive cycle of Taenia solium is the fact that appropriate toilet facilities in village dwellings are not mandatory. The diagnostic methods of cysticercosis in the living pigs and in their meat are discussed and the degenerative stages of the larvae as well as methods to test their viability are explained. The treatment of infected pigs and their meat is discussed. Recommendations for control programmes are given.

An external dosimetry audit programme to credential static and rotational IMRT delivery for clinical trials quality assurance.

PubMed

Eaton, David J; Tyler, Justine; Backshall, Alex; Bernstein, David; Carver, Antony; Gasnier, Anne; Henderson, Julia; Lee, Jonathan; Patel, Rushil; Tsang, Yatman; Yang, Huiqi; Zotova, Rada; Wells, Emma

2017-03-01

External dosimetry audits give confidence in the safe and accurate delivery of radiotherapy. The RTTQA group have performed an on-site audit programme for trial recruiting centres, who have recently implemented static or rotational IMRT, and those with major changes to planning or delivery systems. Measurements of reference beam output were performed by the host centre, and by the auditor using independent equipment. Verification of clinical plans was performed using the ArcCheck helical diode array. A total of 54 measurement sessions were performed between May 2014 and June 2016 at 28 UK institutions, reflecting the different combinations of planning and delivery systems used at each institution. Average ratio of measured output between auditor and host was 1.002±0.006. Average point dose agreement for clinical plans was -0.3±1.8%. Average (and 95% lower confidence intervals) of gamma pass rates at 2%/2mm, 3%/2mm and 3%/3mm respectively were: 92% (80%), 96% (90%) and 98% (94%). Moderately significant differences were seen between fixed gantry angle and rotational IMRT, and between combination of planning systems and linac manufacturer, but not between anatomical treatment site or beam energy. An external audit programme has been implemented for universal and efficient credentialing of IMRT treatments in clinical trials. Good agreement was found between measured and expected doses, with few outliers, leading to a simple table of optimal and mandatory tolerances for approval of dosimetry audit results. Feedback was given to some centres leading to improved clinical practice. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Learning, education and satisfaction after compulsory rotating internship in Kathmandu University Medical School: a qualitative study of interns' response.

PubMed

Shrestha, D; Mishra, B

2008-01-01

Internship is an integral part of MBBS training programme and mandatory to all students. Kathmandu University Medical School has adopted a programme of compulsory one year rotating internship including 6 weeks community exposure in out reach clinics for the first batch of students. The purpose of the study is to evaluate interns' feedback concerning learning, education and satisfaction. A questionnaire with 47 items was administered to 30 interns who had finished one year rotating internship in Kathmandu University Medical School. Fourty-two responses were graded according in Likert scale and 5 open ended questions were analyzed for common themes. The mean age of the interns was 24.77+/-0.67 yrs with female: male ratio of 1.5:1. Confidence level of communication of interns with faculties was lesser than with junior doctors and patients. Junior doctors and colleagues contributed more in interns' learning than faculties. Community exposure for 6 weeks was considered lengthy and lacking of clear objectives. However, 53.3% interns agreed that achievement of objectives of community posting was high or very high. Of the interns, 50% perceived certain degree of physical or mental or sexual harassment during internship. Interns raised the issue of not involving them as a part of team during clinical posting. Clinical competencies for most of the skills were high or very high. Interns have learned clinical skills and patient care in one year internship programme but contribution of junior doctors and colleague are more than teachers. Clear objectives are needed before clinical and community postings. Process of providing regular feedback from interns and vice versa should be implemented to improve interns' learning, education and satisfaction.

Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program.

PubMed

Limón, E; Shaw, E; Badia, J M; Piriz, M; Escofet, R; Gudiol, F; Pujol, M

2014-02-01

Surgical site infection (SSI) after colorectal procedures represents a measurable quality indicator of a healthcare system. There is an increasing interest in comparing SSI rates between different hospitals and countries: however, the variability of the data regarding the incidence of SSI makes this comparison difficult. For the purposes of evaluation, data collection must be standardized and must include reliable post-discharge surveillance (PDS). To determine impact and risk factors for PDS SSI after elective colorectal surgery. VINCat is a nosocomial infection surveillance programme in Catalonia, Spain. Between 2007 and 2011, 52 hospitals joined the programme. Hospitals performed active, prospective, standardized surveillance of elective colorectal resection. PDS was implemented by a multimodal approach and was mandatory within the first 30 days after surgery. During the study period, 13,661 elective colorectal procedures were included. SSI was diagnosed in 2826 (20.7%) patients, of whom 22.5% during PDS; of these, 52% required readmission. Patients with PDS SSI were younger (odds ratio: 1.57; 95% confidence interval: 1.29-1.91), predominantly female (1.40; 1.16-1.69), had more frequently undergone endoscopic procedures (1.56; 1.30-1.88) and had more incisional SSI (1.88; 1.54-2.28) than patients with in-hospital SSI. SSI rates in elective colorectal procedures at VINCat hospitals were inside the higher range of those reported by other national programmes. PDS SSI increased the overall rate of SSI, had a significant clinical impact, and accounted for almost a quarter of SSI. Younger age and laparoscopic procedures were the most relevant risk factors. Standardized multimodal PDS should be implemented for hospitals performing surveillance of colorectal surgery. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Total control: a critical analysis of mandatory HIV testing in U.S. prisons.

PubMed

Gagnon, Marilou; Jacob, Jean Daniel; Cormier, Luc

2013-01-01

The aim of this paper is to explore the relationship between mandatory HIV testing and the institutional management of inmates in U.S. prisons. Mandatory HIV testing has been largely overlooked by the nursing community even though it has important human rights and ethical implications. Drawing on the work of Goffman (1990) on the inner workings of total institutions, the present article critically examines the deployment of mandatory HIV testing in U.S. prisons. To set the stage, we define mandatory HIV testing and describe the methods of HIV testing currently used in U.S. prison settings. Then, we provide a brief overview of the concept of total institution and the mortification process. Finally, we expand on the relationship between mandatory HIV testing and much larger institutional objectives of total control, total structuring, total isolation, and separation of inmates from society (as summarized by Farrington, 1992). And lastly, we provide a brief discussion on the implications of mandatory HIV testing (as a method of HIV testing) from a nursing perspective.

5 CFR 890.1008 - Mandatory debarment for longer than the minimum length.

Code of Federal Regulations, 2011 CFR

2011-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1008 Mandatory debarment for...

41 CFR 301-53.5 - Are there exceptions to the mandatory use of contract city-pair fares and an agency's travel...

Code of Federal Regulations, 2011 CFR

2011-07-01

... the mandatory use of contract city-pair fares and an agency's travel management service? 301-53.5... the mandatory use of contract city-pair fares and an agency's travel management service? Yes, the... contract city-pair fare, and § 301-73.103 of this chapter for the mandatory use of a travel management...

41 CFR 301-53.5 - Are there exceptions to the mandatory use of contract city-pair fares and an agency's travel...

Code of Federal Regulations, 2010 CFR

2010-07-01

... the mandatory use of contract city-pair fares and an agency's travel management service? 301-53.5... the mandatory use of contract city-pair fares and an agency's travel management service? Yes, the... contract city-pair fare, and § 301-73.103 of this chapter for the mandatory use of a travel management...

76 FR 12887 - Wholesale Pork Reporting Negotiated Rulemaking Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... Livestock Mandatory Reporting (LMR) regulations to implement mandatory pork price reporting, as directed by... U.S.C. 561-570); the Mandatory Price Reporting Act of 2010 (Pub. L. 111-239); the Livestock...

76 FR 23513 - Wholesale Pork Reporting Negotiated Rulemaking Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-27

... Livestock Mandatory Reporting (LMR) regulations to implement mandatory pork price reporting, as directed by... Livestock Mandatory Reporting Act of 1999 (7 U.S.C. 1635-1636i); and 7 CFR part 59. III. Negotiated...

British surgeons' experiences of mandatory online workplace-based assessment.

PubMed

Pereira, Erlick A C; Dean, Benjamin J F

2009-07-01

An online workplace-based assessment tool, the Intercollegiate Surgical Curriculum Programme (ISCP), has become mandatory for all British surgical trainees appointed since August 2007. A compulsory pound125 annual trainee fee has also been introduced to fund its running costs. The study sought to evaluate user satisfaction with the ISCP. A total of 539 users across all surgical specialties (including 122 surgeons acting as assessors) were surveyed in late 2008 by online questionnaire regarding their experiences with the ISCP. Sixty-seven percent had used the tool for at least one year. It was rated above average by only 6% for its registration process and only 11% for recording meetings and objectives. Forty-nine percent described its online assessments as poor or very poor, only 9% considering them good or very good. Seventy-nine percent rated the website's user friendliness as average or worse, as did 72% its peer-assessment tool and 61% its logbook of procedures. Seventy-six percent of respondents had carried out paper assessments due to difficulties using the website. Six percent stated that the ISCP had impacted negatively on their training opportunities, 41% reporting a negative impact overall upon their training; only 6% reported a positive impact. Ninety-four percent did not consider the trainee fee good value, only 2% believing it should be paid by the trainee. The performance of the ISCP leaves large numbers of British surgeons unsatisfied. Its assessments lack appropriate evidence of validity and its introduction has been problematic. With reducing training hours, the increased online bureaucratic burden exacerbates low morale of trainees and trainers, adversely impacting potentially upon both competency and productivity.

Chickenpox in Poland in 2012.

PubMed

Rogalska, Justyna; Paradowska-Stankiewicz, Iwona

2014-01-01

A number of chickenpox cases, occurring especially in children, indicates the rationale for the use of chickenpox vaccinations. In Poland since 2002, chickenpox vaccination is included in the National Immunisation Programme as recommended. To assess epidemiological situation of chickenpox in Poland in 2012 in comparison to previous years. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2012" and "Vaccinations in Poland in 2012" (Czarkowski MP i in., Warszawa 2013, NIZP-PZH i GIS). National Immunisation Programme for year 2012 was also used. In 2012, 208 276 cases of chickenpox were registered in Poland. The highest number of cases was reported in Śląskie voivodeship, the lowest in Podlaskie voivodeship. Mumps incidence was 540.5 per 100 000 and was higher than in 2011 (448.7). The highest incidence was recorded in children aged 4 years (7 611.5 per 100 000). The chickenpox incidence among men (570.7) was higher than among women (512.2). The incidence among rural residents (553.9) was higher than among urban residents (531.8). Number of cases hospitalized due to mumps was 1 361. Number of people vaccinated against chickenpox was 56 213. In 2012, there was an increase in the incidence of smallpox in Poland. This trend is continuing since 2004, which can be partly explained by improved surveillance of the disease.

Decentralized nursing education in northern Norway: a basis for continuing education to meet competence needs in rural Arctic healthcare services.

PubMed

Skaalvik, Mari Wolff; Gaski, Margrete; Norbye, Bente

2014-01-01

Ensuring a sufficient nursing workforce, with respect to both number and relevant professional competencies, is crucial in rural Arctic regions in Norway. This study examines the continuing education (CE) of nurses who graduated from a decentralized nursing programme between 1994 and 2011. This study aims to measure the extent to which the decentralized nursing education (DNE) in question has served as a basis for CE that is adapted to current and future community health care service needs in rural Arctic regions in northern Norway. More specifically, the study aims to investigate the frequency and scope of CE courses among the graduates of a DNE, the choice of study model and the degree of employment with respect to the relevant CE. This study is a quantitative survey providing descriptive statistics. The primary finding in this study is that 56% of the participants had engaged in CE and that they were employed in positions related to their education. The majority of students with decentralized bachelor's degrees engaged in CE that was part time and/or decentralized. More than half of the population in this study had completed CE despite no mandatory obligation in order to maintain licensure. Furthermore, 31% of the participants had completed more than one CE programme. The findings show that the participants preferred CE organized as part time and or decentralized studies.

Child and adolescent injury as a result of falls from buildings and structures

PubMed Central

Pressley, J; Barlow, B

2005-01-01

Design and setting: The Health Care Cost and Utilization Project (KID-HCUP) was used to produce national estimates of hospital admissions due to falls from buildings in the US. Areas of New York with and without window guard legislation were identified through the New York Statewide Planning and Research Cooperative System (SPARCS). Subjects: Children and adolescents aged 0–18 years. Interventions: Legislation based window fall prevention programme with enforcement. Main outcome measures: Hospitalization for injury as a result of falls from buildings and structures in areas with and without enforced mandatory window guard legislation. Results: New York City has a higher proportion of the population residing in multifamily dwellings with 10 or more units compared with the nation (53.8% v 12.6%, p<0.0001), but the incidence of injury resulting from falls from buildings is nearly half that observed in the US. For young children, warm weather risks begin earlier and extend later than previously reported. Incidence in very young minority children is nearly twice that of whites. Nearly 90% of children aged 0–4 years fall at home, but the proportion decreases linearly with age. Conclusions: Window guards are associated with reduced injury resulting from falls from buildings and should be mandated in multifamily dwellings where small children reside. Prevention programmes for young children should be initiated in early spring and continued through fall. PMID:16203834

5 CFR 890.1004 - Bases for mandatory debarments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Section 890.1004 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1004 Bases for mandatory debarments. (a) Debarment...

5 CFR 890.1009 - Contesting proposed mandatory debarments.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... 890.1009 Section 890.1009 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1009 Contesting proposed mandatory debarments. (a...

5 CFR 890.1009 - Contesting proposed mandatory debarments.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... 890.1009 Section 890.1009 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1009 Contesting proposed mandatory debarments. (a...

5 CFR 890.1009 - Contesting proposed mandatory debarments.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... 890.1009 Section 890.1009 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1009 Contesting proposed mandatory debarments. (a...

48 CFR 1631.205-79 - Mandatory statutory reserves.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-79 Mandatory statutory reserves. Charges for mandatory statutory reserves are not allowed unless provided for in the contract...

Outcomes, Approaches, and Challenges to Developing and Passing a Countywide Mandatory Vaccination Policy: St. Louis County's Experience with Hepatitis A Vaccine for Food Service Personnel.

PubMed

Rebmann, Terri; Wilson, Kristin D; Loux, Travis; Iqbal, Ayesha Z; Peters, Eleanor B; Peavler, Olivia

2016-01-01

In the early 1990s, St. Louis County had multiple foodservice worker-related hepatitis A outbreaks uncontrolled by standard outbreak interventions. Restaurant interest groups and the general public applied political pressure to local public health officials for more stringent interventions, including a mandatory vaccination policy. Local health departments can enact mandatory vaccination policies, but this has rarely been done. The study objectives were to describe the approach used to pass a mandatory vaccination policy at the local jurisdiction level and illustrate the outcome from this ordinance 15 years later. A case study design was used. In-depth, semi-structured interviews using guided questions were conducted in spring, 2015, with six key informants who had direct knowledge of the mandatory vaccination policy process. Meeting minutes and/or reports were also analyzed. A Poisson distribution analysis was used to calculate the rate of outbreaks before and after mandatory vaccination policy implementation. The policy appears to have reduced the number of hepatitis A outbreaks, lowering the morbidity and economic burden in St. Louis County. The lessons learned by local public health officials in passing a mandatory hepatitis A vaccination policy are important and relevant in today's environment. The experience and lessons learned may assist other local health departments when faced with the potential need for mandatory policies for any vaccine preventable disease.

Outcomes, Approaches, and Challenges to Developing and Passing a Countywide Mandatory Vaccination Policy: St. Louis County's Experience with Hepatitis A Vaccine for Food Service Personnel

PubMed Central

Rebmann, Terri; Wilson, Kristin D.; Loux, Travis; Iqbal, Ayesha Z.; Peters, Eleanor B.; Peavler, Olivia

2016-01-01

In the early 1990s, St. Louis County had multiple foodservice worker-related hepatitis A outbreaks uncontrolled by standard outbreak interventions. Restaurant interest groups and the general public applied political pressure to local public health officials for more stringent interventions, including a mandatory vaccination policy. Local health departments can enact mandatory vaccination policies, but this has rarely been done. The study objectives were to describe the approach used to pass a mandatory vaccination policy at the local jurisdiction level and illustrate the outcome from this ordinance 15 years later. A case study design was used. In-depth, semi-structured interviews using guided questions were conducted in spring, 2015, with six key informants who had direct knowledge of the mandatory vaccination policy process. Meeting minutes and/or reports were also analyzed. A Poisson distribution analysis was used to calculate the rate of outbreaks before and after mandatory vaccination policy implementation. The policy appears to have reduced the number of hepatitis A outbreaks, lowering the morbidity and economic burden in St. Louis County. The lessons learned by local public health officials in passing a mandatory hepatitis A vaccination policy are important and relevant in today's environment. The experience and lessons learned may assist other local health departments when faced with the potential need for mandatory policies for any vaccine preventable disease. PMID:29546151

76 FR 80903 - Mandatory Declassification Review Addresses

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... DEPARTMENT OF DEFENSE Office of the Secretary Mandatory Declassification Review Addresses AGENCY... addresses to which Mandatory Declassification Review requests may be sent. This notice benefits the public in advising them where to send such requests for declassification review. FOR FURTHER INFORMATION...

76 FR 59032 - Mandatory Declassification Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... CENTRAL INTELLIGENCE AGENCY 32 CFR Part 1908 Mandatory Declassification Review AGENCY: Central... Central Intelligence Agency (CIA) has undertaken and completed a review of its public Mandatory Declassification Review (MDR) regulations that govern certain aspects of its processing of MDR requests. As a...

5 CFR 831.908 - Mandatory separation.

Code of Federal Regulations, 2010 CFR

2010-01-01

....908 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Law Enforcement Officers and Firefighters § 831.908 Mandatory separation. (a) The mandatory separation provisions of 5 U.S.C. 8335(b) apply to all law enforcement officers and firefighters...

5 CFR 831.908 - Mandatory separation.

Code of Federal Regulations, 2011 CFR

2011-01-01

....908 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Law Enforcement Officers and Firefighters § 831.908 Mandatory separation. (a) The mandatory separation provisions of 5 U.S.C. 8335(b) apply to all law enforcement officers and firefighters...

5 CFR 831.908 - Mandatory separation.

Code of Federal Regulations, 2012 CFR

2012-01-01

....908 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Law Enforcement Officers and Firefighters § 831.908 Mandatory separation. (a) The mandatory separation provisions of 5 U.S.C. 8335(b) apply to all law enforcement officers and firefighters...

5 CFR 831.908 - Mandatory separation.

Code of Federal Regulations, 2014 CFR

2014-01-01

....908 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Law Enforcement Officers and Firefighters § 831.908 Mandatory separation. (a) The mandatory separation provisions of 5 U.S.C. 8335(b) apply to all law enforcement officers and firefighters...

5 CFR 831.908 - Mandatory separation.

Code of Federal Regulations, 2013 CFR

2013-01-01

....908 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Law Enforcement Officers and Firefighters § 831.908 Mandatory separation. (a) The mandatory separation provisions of 5 U.S.C. 8335(b) apply to all law enforcement officers and firefighters...

5 CFR 890.1007 - Minimum length of mandatory debarments.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... 890.1007 Section 890.1007 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1007 Minimum length of mandatory debarments. (a...

5 CFR 890.1007 - Minimum length of mandatory debarments.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... 890.1007 Section 890.1007 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1007 Minimum length of mandatory debarments. (a...

5 CFR 890.1007 - Minimum length of mandatory debarments.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... 890.1007 Section 890.1007 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1007 Minimum length of mandatory debarments. (a...

Nurse educators' perceived challenges in mandatory continuing nursing education.

PubMed

Xiao, L D

2006-09-01

This paper reports a study that leads to understanding challenges facing nurse educators implementing mandatory continuing nursing education in The People's Republic of China. Mandatory continuing nursing education was instituted to maintain and develop registered nurses' competence in the context of healthcare reform in China in 1996. However, there is an increasing complaint of credit-focused and teacher-centred learning in Chinese literature. Despite an increasing appeal to improve the learning situation, little consensus has been reached. By examining nurse educators' perceived challenges and their coping strategies in implementing mandatory continuing nursing education, this study illuminates the possibilities for reform in mandatory continuing nursing education. Data were collected through in-depth interactive dialogues between the researcher and five nurse educators in five healthcare organizations in China, utilizing Gadamer's philosophical hermeneutics. Three themes were found in this study described as finding a way to support nurses' competence within a constrained situation, reconciling credit requirements and representing all stakeholders' interests. A tension between the mandatory continuing nursing education policy and the context of implementing the policy can contribute to credit-focused and teacher-centred learning. Regular policy review and educational support for nurse educators are crucial aspects to improve mandatory continuing nursing education.

Mandatory continuing professional education in pharmacy: the Singapore experience.

PubMed

Ang, Hui-Gek; Pua, Yong-Hao; Subari, Nur Azah

2013-08-01

Mandatory Continuing Professional Education (CPE) for the renewal of pharmacists' practising certificate was implemented in Singapore in 2008 OBJECTIVE: To study pharmacists' perceptions and attitudes about the impact of mandatory CPE in Singapore. Singapore. Internet-based questionnaire survey, conducted between May and June 2011. Pharmacists' perceptions and attitudes toward mandatory CPE and the perceived difficulty in fulfilling the CPE requirements. The overall survey response rate was 52 % (840/1,609). Of the respondents, 32 % were non-practising, 49 % were practising in patient care areas, and 19 % were practising in non-patient care areas. More than half the pharmacists agreed that mandatory CPE (1) enhanced or increased their knowledge base and skills (70 %; 95 % CI 67-73 %), (2) motivated them to continually learn (64 %; 95 % CI, 60-67 %), and (3) motivated them to reflect on their professional practice or work (58 %; 95 % CI, 54-61 %). Mandatory CPE was not perceived to enhance or increase employability. Non-practising pharmacists appeared to have the greatest difficulty meeting the CPE requirements. In general, pharmacists value mandatory CPE more for positive professional reasons than for employability reasons. The survey results may serve as useful baseline data for future studies of pharmacists' perceptions and attitudes toward CPE in Singapore.

Effects of Maternal Iodine Nutrition and Thyroid Status on Cognitive Development in Offspring: A Pilot Study.

PubMed

Moleti, Mariacarla; Trimarchi, Francesco; Tortorella, Gaetano; Candia Longo, Alice; Giorgianni, Grazia; Sturniolo, Giacomo; Alibrandi, Angela; Vermiglio, Francesco

2016-02-01

Maternal iodine nutrition and thyroid status may influence neurocognitive development in offspring. This study investigated the effects on the intelligence quotient (IQ) of children born to mothers with different levels of iodine supplementation, with or without the administration of levothyroxine (LT4), prior to and during pregnancy. This pilot, prospective, observational study included four study groups, each comprising 15 mother-child pairs, identified on the basis of maternal histories of iodized salt consumption and LT4 treatment prior to and during pregnancy. The groups were labeled as follows: iodine (I), no iodine (no-I), iodine + LT4 (I + T4), and no iodine + LT4 (no-I + T4). IQ tests were administered to children at 6-12 years of age with the Wechsler Intelligence Scale for Children-3rd Edition (WISC-III), with full-scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ) being evaluated. Children of I and I + T4 mothers had similar verbal, performance, and FSIQs, which were 14, 10, and 13 points higher, respectively, than children born to no-I and no-I + T4 mothers. A positive association was found between VIQ and maternal urinary iodine (β = 1.023 [confidence interval (CI) 1.003-1.043]; p = 0.028), but not with maternal free thyroxine concentrations at any stage of pregnancy. Overall, the prevalence of borderline or defective cognitive function was more than threefold higher in the children of mothers not using iodized salt than of those mothers using it (76.9% vs. 23.1%, odds ratio 7.667 [CI 2.365-24.856], χ2 = 12.65; p = 0.0001). Neuro-intellectual outcomes in children appear to be more dependent on their mothers' nutritional iodine status than on maternal thyroid function. These results support the growing body of evidence that prenatal, mild-to-moderate iodine deficiency adversely affects cognitive development later in life, with a seemingly greater impact on verbal abilities.

FDA regulations regarding iodine addition to foods and labeling of foods containing added iodine12

PubMed Central

Trumbo, Paula R

2016-01-01

The US Food and Drug Administration (FDA) regulates the addition of iodine to infant formulas, the iodization of salt, and the addition of salt and iodine to foods. The required amount of iodine in infant formulas is based on caloric content, and the label must provide the iodine content per 100 kcal. Cuprous iodide and potassium iodide may be added to table salt as a source of dietary iodine at a maximum amount of 0.01%; if added, the label must indicate that the salt is iodized. Table salt to which iodine has not been added must bear the statement, “This salt does not supply iodide, a necessary nutrient.” If a nutrient is to be appropriately added to a food for the purpose of correcting a dietary insufficiency, there should be sufficient scientific information available to demonstrate a nutritional deficiency and/or identify a public health problem. Furthermore, the population groups that would benefit from the proposed fortification should be identified. If iodine is added to a food, the percent Daily Value of iodine must be listed. There are no FDA regulations governing ingredient standards for dietary supplements. As a result, some dietary supplements include iodine and others do not. If a supplement contains iodine, the Supplement Facts label must list iodine as a nutrient ingredient. If iodine is not listed on the Supplement Facts label, then it has not been added. There are similarities between the FDA, which establishes US food regulations and policies, and the Codex Alimentarius (Codex), which develops international food standards and guidelines under the aegis of the FAO and the WHO. Both the FDA and Codex call for the labeling of table salt to indicate fortification with iodine, voluntary labeling of iodine on foods, and a Daily Value (called a Nutrient Reference Value by Codex) of 150 μg for iodine. PMID:27534626

FDA regulations regarding iodine addition to foods and labeling of foods containing added iodine.

PubMed

Trumbo, Paula R

2016-09-01

The US Food and Drug Administration (FDA) regulates the addition of iodine to infant formulas, the iodization of salt, and the addition of salt and iodine to foods. The required amount of iodine in infant formulas is based on caloric content, and the label must provide the iodine content per 100 kcal. Cuprous iodide and potassium iodide may be added to table salt as a source of dietary iodine at a maximum amount of 0.01%; if added, the label must indicate that the salt is iodized. Table salt to which iodine has not been added must bear the statement, "This salt does not supply iodide, a necessary nutrient." If a nutrient is to be appropriately added to a food for the purpose of correcting a dietary insufficiency, there should be sufficient scientific information available to demonstrate a nutritional deficiency and/or identify a public health problem. Furthermore, the population groups that would benefit from the proposed fortification should be identified. If iodine is added to a food, the percent Daily Value of iodine must be listed. There are no FDA regulations governing ingredient standards for dietary supplements. As a result, some dietary supplements include iodine and others do not. If a supplement contains iodine, the Supplement Facts label must list iodine as a nutrient ingredient. If iodine is not listed on the Supplement Facts label, then it has not been added. There are similarities between the FDA, which establishes US food regulations and policies, and the Codex Alimentarius (Codex), which develops international food standards and guidelines under the aegis of the FAO and the WHO. Both the FDA and Codex call for the labeling of table salt to indicate fortification with iodine, voluntary labeling of iodine on foods, and a Daily Value (called a Nutrient Reference Value by Codex) of 150 μg for iodine. © 2016 American Society for Nutrition.

49 CFR 8.15 - Mandatory review for classification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Mandatory review for classification. 8.15 Section 8.15 Transportation Office of the Secretary of Transportation CLASSIFIED INFORMATION: CLASSIFICATION/DECLASSIFICATION/ACCESS Classification/Declassification of Information § 8.15 Mandatory review for classification...

5 CFR 890.1008 - Mandatory debarment for longer than the minimum length.

Code of Federal Regulations, 2014 CFR

2014-01-01

... minimum length. 890.1008 Section 890.1008 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1008 Mandatory debarment for...

5 CFR 890.1008 - Mandatory debarment for longer than the minimum length.

Code of Federal Regulations, 2013 CFR

2013-01-01

... minimum length. 890.1008 Section 890.1008 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1008 Mandatory debarment for...

5 CFR 351.606 - Mandatory exceptions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Mandatory exceptions. 351.606 Section 351.606 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS REDUCTION IN FORCE Release From Competitive Level § 351.606 Mandatory exceptions. (a) Armed Forces restoration rights...

5 CFR 351.606 - Mandatory exceptions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Mandatory exceptions. 351.606 Section 351.606 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS REDUCTION IN FORCE Release From Competitive Level § 351.606 Mandatory exceptions. (a) Armed Forces restoration rights...

The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives.

PubMed

Laurberg, Peter; Jørgensen, Torben; Perrild, Hans; Ovesen, Lars; Knudsen, Nils; Pedersen, Inge Bülow; Rasmussen, Lone B; Carlé, Allan; Vejbjerg, Pernille

2006-08-01

Denmark was an area of iodine deficiency, and mandatory iodine fortification of table salt and salt in bread (13 p.p.m. iodine) was initiated in 2000/2001. The Danish investigation on iodine intake and thyroid disease (DanThyr) is the monitoring of the iodine fortification program. DanThyr consists of three main parts: a study of population cohorts initialized before (n=4649) and after (n=3570) iodization of salt, a prospective identification of incident cases of overt hyper- and hypothyroidism in a population of around 550,000 people since 1997, and compilation of data from the national registers on the use of thyroid medication, thyroid surgery, and radioiodine therapy. Studies were carried-out in parallel in subcohorts living in areas with differences in iodine content of ground water. The study showed profound effects of even small differences in iodine intake level on the prevalence of goiter, nodules, and thyroid dysfunction. Mild and moderate iodine deficiency was associated with a decrease in serum TSH with age. Other environmental factors were also important for goiter development (increase in risk, smoking and pregnancy; decrease in risk, oral contraception and alcohol consumption), and the individual risk depended on the genetic background. Environmental factors had only a minor influence on the prevalence of thyroid autoantibodies in the population. There were more cases of overt hypothyroidism in mild than in moderate iodine deficiency caused by a 53% higher incidence of spontaneous (presumably autoimmune) hypothyroidism. On the other hand, there were 49% more cases of overt hyperthyroidism in the area with moderate iodine deficiency. The cautious iodine fortification program, aiming at an average increase in iodine intake of 50 mug/day has been associated with a 50% increase in incidence of hyperthyroidism in the area with the most severe iodine deficiency. The incidence is expected to decrease in the future, but there may be more cases of Graves' hyperthyroidism in young people. A number of environmental factors influence the epidemiology of thyroid disorders, and even relatively small abnormalities and differences in the level of iodine intake of a population have profound effects on the occurrence of thyroid abnormalities. Monitoring and adjustment of iodine intake in the population is an important part of preventive medicine.

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective.

PubMed

Khattak, Rehman Mehmood; Khattak, Muhammad Nasir Khan; Ittermann, Till; Völzke, Henry

2017-06-01

Iodine deficiency remains a considerable challenge worldwide, even after decades of efforts to address the problem. The aim of this review is to present the current situation in historically iodine-deficient Pakistan regarding iodine nutritional status and place it in a global perspective. We collected relevant articles from online bibliographic databases and websites of concerned organizations that addressed prevalence of goiter/iodine deficiency and barriers to sustainable control. We divided the studies into pre- and post-1994, a landmark year when Pakistan formally adopted the universal salt iodization (USI) programme. Overall, 56 studies reported goiter/iodine deficiency prevalence in Pakistan. Before 1994, six studies (30%) reported a goiter prevalence ≥70%, while nine studies (45%) reported a goiter prevalence between 30% and 70%. Only five studies (25%) found a goiter prevalence less than 30%, of which only two studies reported prevalence <10%. From 1994 onwards, 15 studies (41.7%) reported a goiter/iodine deficiency (ID) prevalence ≥50%, of which seven studies reported prevalence ≥70%, while three studies (8.3%) found a goiter prevalence of 30%-49%, nine studies (25%) found a goiter prevalence of 10%-29%, and five studies (13.9%) reported prevalence of <10%. Four studies (11.1%) reported lower goiter prevalence but higher prevalence of iodine deficiency. The efforts in the past two decades resulted in up to a 50% decline in iodine deficiency disorders (IDD). Variable remaining factors and the recent results, however, indicate that this decline may be non-uniform and even over-estimated. Coordinated and regionally adopted efforts for eradication of IDD from all stakeholders should be pursued. Policy makers should take steps to protect future generations and alert concerned organizations about the importance of careful assessments and estimates of iodine nutritional status. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

A survey of schoolchildren from a severe endemic goitre area in Spain.

PubMed

Escobar del Rey, F; Gomez-Pan, A; Obregon, M J; Mallol, J; Arnao, M D; Aranda, A; Morreale de Escobar, G

1981-01-01

All the boys and girls between six and fourteen years old regularly attending school in three villages from an area in Spain known ass Las Hurdes were studied with respect to thyroid size, body weight and height. Casual urine samples were obtained for the determination of iodine and creatine concentrations. Capillary blood was spotted on filter paper and used for the determination of thyroxine and thyrotropin by radioimmunoassay. The same survey was carried out in 354 school children from Madrid, whose data were used as a reference of the adequacy of the methods employed in Las Hurdes. Goitre prevalence was very high, the overall frequency being 86 per cent. The concentration of iodine in the urine was less than 20 micrograms/1 in 71 per cent of the school children. The concentration of creatine in the urine was also half that found in children from Madrid, and the daily creatine excretion in children from Las Hurdes was lower than expected from their body weight. Their somatic development, as measured by height and weight, was retarded markedly, both as compared to the Madrid reference group and to international charts. Serum T4 was less than 78 nmol/l ( micrograms/kl) in 46 per cent, of the children from Hurdes, and serum TSH greater than 7.5 mU/l in 40 per cent. A relatively low stature (below the 10th percentile) was associated with either a low serum T4, an elevated serum TSH, or both, in 30 per cent of the children. These results indicate that the persistence of endemic goitre in Las Hurdes is of great significance and that there is a continuing risk of the birth of cretins. Observations made a decade earlier in the same area show that the goitre endemic is not diminishing, and that an iodization programme is urgently needed. It also appears that a high proportion of the "normal' schoolchildren have features found in hypothyroidism.

Iodine deficiency during pregnancy: a national cross-sectional survey in Latvia.

PubMed

Konrade, Ilze; Kalere, Ieva; Strele, Ieva; Makrecka-Kuka, Marina; Jekabsone, Anna; Tetere, Elina; Veisa, Vija; Gavars, Didzis; Rezeberga, Dace; Pīrāgs, Valdis; Lejnieks, Aivars; Dambrova, Maija

2015-11-01

Low iodine intake during pregnancy may cause thyroid dysfunction, which results in inadequate fetal brain development. In the absence of a universal salt iodization programme, we conducted a nationwide survey of iodine deficiency in pregnant women in Latvia. A countrywide twenty-cluster survey, with at least twenty women per cluster. Participants completed a questionnaire on dietary habits concerning iodine intake (n 739). Thyroid function (thyroid-stimulating hormone, free thyroxine and thyroperoxidase antibodies) was measured (n 550). Urinary iodine was measured using the ammonium persulfate method (n 696). The survey was performed in all regions of Latvia during the spring and autumn seasons in 2013. Pregnant women (n 829). The median creatinine (Cr)-standardized urinary iodine concentration (UIC) was 80·8 (interquartile range (IQR) 46·1-130·6) µg/g Cr or 69·4 (IQR 53·9-92·6) µg/l during pregnancy, and 81% of pregnant women had UIC levels below the WHO recommended range of 150-250 µg/g Cr. The UIC was lowest during the first trimester of pregnancy, 56·0 (IQR 36·4-100·6) µg/g Cr, reaching higher concentrations of 87·5 (IQR 46·4-141·7) µg/g Cr and 86·9 (IQR 53·8-140·6) µg/g Cr in the second and third trimesters, respectively. Women taking supplements containing ≥150 µg iodine (6·8% of respondents) had non-significantly higher UIC than did women without supplementation (96·2 v. 80·3 µg/g Cr, respectively, P=NS). Thyroperoxidase antibody concentration did not correlate significantly with UIC: Spearman's ρ=-0·012, P=0·78. The median UIC indicates iodine deficiency in pregnant women in Latvia. Iodine supplementation (150 µg daily) and regular UIC monitoring should be suggested to overcome iodine deficiency and to reach the recommended levels without inducing autoimmune processes.

High prevalence of iodine deficiency in pregnant women living in adequate iodine area

PubMed Central

Mioto, Verônica Carneiro Borges; Monteiro, Ana Carolina de Castro Nassif Gomes; de Camargo, Rosalinda Yossie Asato; Borel, Andréia Rodrigues; Catarino, Regina Maria; Kobayashi, Sergio; Chammas, Maria Cristina; Marui, Suemi

2018-01-01

Objectives Iodine deficiency during pregnancy is associated with obstetric and neonatal adverse outcomes. Serum thyroglobulin (sTg) and thyroid volume (TV) are optional tools to urinary iodine concentration (UIC) for defining iodine status. This cross-sectional study aims to evaluate the iodine status of pregnant women living in iodine-adequate area by spot UIC and correlation with sTg, TV and thyroid function. Methods Two hundred and seventy-three pregnant women were evaluated at three trimesters. All had no previous thyroid disease, no iodine supplementation and negative thyroperoxidase and thyroglobulin antibodies. Thyroid function and sTg were measured using electrochemiluminescence immunoassays. TV was determined by ultrasonography; UIC was determined using a modified Sandell–Kolthoff method. Results Median UIC was 146 µg/L, being 52% iodine deficient and only 4% excessive. TSH values were 1.50 ± 0.92, 1.50 ± 0.92 and 1.91 ± 0.96 mIU/L, respectively, in each trimester (P = 0.001). sTg did not change significantly during trimesters with median 11.2 ng/mL and only 3.3% had above 40 ng/mL. Mean TV was 9.3 ± 3.4 mL, which positively correlated with body mass index, but not with sTg. Only 4.5% presented with goitre. When pregnant women were categorized as iodine deficient (UIC < 150 µg/L), adequate (≥150 and <250 µg/L) and excessive (≥250 µg/L), sTg, thyroid hormones and TV at each trimester showed no statistical differences. Conclusions Iodine deficiency was detected frequently in pregnant women living in iodine-adequate area. sTg concentration and TV did not correlate to UIC. Our observation also demonstrated that the Brazilian salt-iodization programme prevents deficiency, but does not maintain iodine status within adequate and recommended ranges for pregnant women. PMID:29700098

High prevalence of iodine deficiency in pregnant women living in adequate iodine area.

PubMed

Mioto, Verônica Carneiro Borges; Monteiro, Ana Carolina de Castro Nassif Gomes; de Camargo, Rosalinda Yossie Asato; Borel, Andréia Rodrigues; Catarino, Regina Maria; Kobayashi, Sergio; Chammas, Maria Cristina; Marui, Suemi

2018-05-01

Iodine deficiency during pregnancy is associated with obstetric and neonatal adverse outcomes. Serum thyroglobulin (sTg) and thyroid volume (TV) are optional tools to urinary iodine concentration (UIC) for defining iodine status. This cross-sectional study aims to evaluate the iodine status of pregnant women living in iodine-adequate area by spot UIC and correlation with sTg, TV and thyroid function. Two hundred and seventy-three pregnant women were evaluated at three trimesters. All had no previous thyroid disease, no iodine supplementation and negative thyroperoxidase and thyroglobulin antibodies. Thyroid function and sTg were measured using electrochemiluminescence immunoassays. TV was determined by ultrasonography; UIC was determined using a modified Sandell-Kolthoff method. Median UIC was 146 µg/L, being 52% iodine deficient and only 4% excessive. TSH values were 1.50 ± 0.92, 1.50 ± 0.92 and 1.91 ± 0.96 mIU/L, respectively, in each trimester ( P  = 0.001). sTg did not change significantly during trimesters with median 11.2 ng/mL and only 3.3% had above 40 ng/mL. Mean TV was 9.3 ± 3.4 mL, which positively correlated with body mass index, but not with sTg. Only 4.5% presented with goitre.When pregnant women were categorized as iodine deficient (UIC < 150 µg/L), adequate (≥150 and <250 µg/L) and excessive (≥250 µg/L), sTg, thyroid hormones and TV at each trimester showed no statistical differences. Iodine deficiency was detected frequently in pregnant women living in iodine-adequate area. sTg concentration and TV did not correlate to UIC. Our observation also demonstrated that the Brazilian salt-iodization programme prevents deficiency, but does not maintain iodine status within adequate and recommended ranges for pregnant women. © 2018 The authors.

Women with high early pregnancy urinary iodine levels have an increased risk of hyperthyroid newborns: the population-based Generation R Study.

PubMed

Medici, Marco; Ghassabian, Akhgar; Visser, Willy; de Muinck Keizer-Schrama, Sabine M P F; Jaddoe, Vincent W V; Visser, W Edward; Hooijkaas, Herbert; Hofman, Albert; Steegers, Eric A P; Bongers-Schokking, Jacoba J; Ross, H Alec; Tiemeier, Henning; Visser, Theo J; de Rijke, Yolanda B; Peeters, Robin P

2014-04-01

Iodine deficiency during pregnancy results in thyroid dysfunction and has been associated with adverse obstetric and foetal effects, leading to worldwide salt iodization programmes. As nowadays 69% of the world's population lives in iodine-sufficient regions, we investigated the effects of variation in iodine status on maternal and foetal thyroid (dys)function in an iodine-sufficient population. Urinary iodine, serum TSH, free T4 (FT4) and TPO-antibody levels were determined in early pregnancy (13·3 (1·9) week; mean (SD)) in 1098 women from the population-based Generation R Study. Newborn cord serum TSH and FT4 levels were determined at birth. The median urinary iodine level was 222·5 μg/l, indicating an iodine-sufficient population. 30·8% and 11·5% had urinary iodine levels <150 and >500 μg/l, respectively. When comparing mothers with urinary iodine levels <150 vs ≥150 μg/l, and >500 vs ≤500 μg/l, there were no differences in the risk of maternal increased or decreased TSH, hypothyroxinaemia or hyperthyroidism. Mothers with urinary iodine levels >500 μg/l had a higher risk of a newborn with decreased cord TSH levels (5·6 ± 1·4 (mean ± SE) vs 2·1 ± 0·5%, P = 0·04), as well as a higher risk of a hyperthyroid newborn (3·1 ± 0·9 vs 0·6 ± 0·3%, P = 0·02). These mothers had newborns with higher cord FT4 levels (21·7 ± 0·3 vs 21·0 ± 0·1 pm, P = 0·04). Maternal urinary iodine levels <150 μg/l were not associated with newborn thyroid dysfunction. In an iodine-sufficient population, higher maternal urinary iodine levels are associated with an increased risk of a hyperthyroid newborn. © 2013 John Wiley & Sons Ltd.

77 FR 46434 - Agency Information Collection Activities: Submission for OMB Review; Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-03

... Review; Comment Request; Certification of Compliance With Mandatory Bars to Employment AGENCY: Federal... on renewal of the following information collection: Certification of Compliance with Mandatory Bars... currently approved collection of information: Title: Certification of Compliance with Mandatory Bars to...

22 CFR 9.10 - Mandatory declassification review.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 9.10 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.10 Mandatory... agency to declassify and release information shall result in a prompt declassification review of the information in accordance with procedures set forth in 22 CFR 171.20-25. Mandatory declassification review...

14 CFR 223.3 - Mandatory free transportation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Mandatory free transportation. 223.3 Section 223.3 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS FREE AND REDUCED-RATE TRANSPORTATION General Provisions § 223.3 Mandatory...

7 CFR 59.101 - Mandatory daily reporting for steers and heifers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) LIVESTOCK MANDATORY REPORTING Cattle Reporting § 59.101 Mandatory daily reporting for steers and...

42 CFR 1002.203 - Mandatory exclusion.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Mandatory exclusion. 1002.203 Section 1002.203 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-STATE-INITIATED EXCLUSIONS FROM MEDICAID Mandatory Exclusion § 1002.203...

14 CFR 223.3 - Mandatory free transportation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Mandatory free transportation. 223.3 Section 223.3 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS FREE AND REDUCED-RATE TRANSPORTATION General Provisions § 223.3 Mandatory...

14 CFR 223.3 - Mandatory free transportation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Mandatory free transportation. 223.3 Section 223.3 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS FREE AND REDUCED-RATE TRANSPORTATION General Provisions § 223.3 Mandatory...

14 CFR 223.3 - Mandatory free transportation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Mandatory free transportation. 223.3 Section 223.3 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS FREE AND REDUCED-RATE TRANSPORTATION General Provisions § 223.3 Mandatory...

Mandatory seat belt use laws.

DOT National Transportation Integrated Search

1985-01-01

The purposes of this study were to review mandatory seat belt use laws as they have been used around the world, to forecast the impact of such a law in Virginia, and, if appropriate, to propose a mandatory seat belt law for inclusion in the Code of V...

76 FR 74063 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Federal Workplace Drug Testing Programs (Mandatory Guidelines), effective on October 1, 2010, addresses... for physicians performing a review of Federal employee drug testing results that seek approval by the...

6 CFR 7.31 - Mandatory review for declassification requests.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Mandatory review for declassification requests. 7.31 Section 7.31 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLASSIFIED NATIONAL SECURITY INFORMATION Classified Information § 7.31 Mandatory review for declassification...

22 CFR 9.10 - Mandatory declassification review.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 9.10 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.10 Mandatory... agency to declassify and release information shall result in a prompt declassification review of the information in accordance with procedures set forth in 22 CFR 171.20-25. Mandatory declassification review...

5 CFR 890.1008 - Mandatory debarment for longer than the minimum length.

Code of Federal Regulations, 2010 CFR

2010-01-01

... that were not adjudicated, adversely affected the physical, mental, or financial well-being of one or... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1008 Mandatory debarment for...

Mandatory seat belt use.

DOT National Transportation Integrated Search

1984-01-01

The purposes of this study were to review mandatory seat belt use laws as they have been used around the world, to forecast the impact of such a law in Virginia, and, if appropriate, to propose a mandatory seat belt law for inclusion in the Code of V...

21 CFR 810.13 - Mandatory recall order.

Code of Federal Regulations, 2010 CFR

2010-04-01

... and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE RECALL AUTHORITY Mandatory Medical Device Recall Procedures § 810.13 Mandatory... § 810.12, FDA determines that the order should be amended to require a recall of the device with respect...

21 CFR 810.13 - Mandatory recall order.

Code of Federal Regulations, 2011 CFR

2011-04-01

... and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE RECALL AUTHORITY Mandatory Medical Device Recall Procedures § 810.13 Mandatory... § 810.12, FDA determines that the order should be amended to require a recall of the device with respect...

75 FR 22699 - Mandatory Reporting of Greenhouse Gases: Minor Harmonizing Changes to the General Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

... Mandatory Reporting of Greenhouse Gases: Minor Harmonizing Changes to the General Provisions AGENCY... provisions for the Mandatory Greenhouse Gas (GHG) Reporting Rule, published on March 16, 2010. DATES... practice and procedure, Greenhouse gases, Suppliers, Reporting and recordkeeping requirements. Dated: April...

22 CFR 213.39 - Exceptions to mandatory transfer.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Exceptions to mandatory transfer. 213.39 Section 213.39 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Mandatory Transfer of Delinquent Debt to Financial Management Service (FMS) of the Department of Treasury § 213.39...

18 CFR 40.2 - Mandatory Reliability Standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

...-POWER SYSTEM § 40.2 Mandatory Reliability Standards. (a) Each applicable user, owner or operator of the Bulk-Power System must comply with Commission-approved Reliability Standards developed by the Electric... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Mandatory Reliability...

Mandatory School Uniforms.

ERIC Educational Resources Information Center

Cohn, Carl A.

1996-01-01

Shortly after implementing a mandatory school uniform policy, the Long Beach (California) Public Schools can boast 99% compliance and a substantial reduction in school crime. The uniforms can't be confused with gang colors, save parents money, and help identify outsiders. A sidebar lists ingredients for a mandatory uniform policy. (MLH)

47 CFR 1.10006 - Is electronic filing mandatory?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Is electronic filing mandatory? 1.10006 Section... Random Selection International Bureau Filing System § 1.10006 Is electronic filing mandatory? Electronic... International Bureau Filing System (IBFS) form is available. Applications for which an electronic form is not...

20 CFR 416.1513 - Mandatory use of electronic services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Mandatory use of electronic services. 416.1513 Section 416.1513 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Representation of Parties § 416.1513 Mandatory use of electronic...

47 CFR 1.10006 - Is electronic filing mandatory?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Is electronic filing mandatory? 1.10006 Section... Random Selection International Bureau Filing System § 1.10006 Is electronic filing mandatory? Electronic... International Bureau Filing System (IBFS) form is available. Applications for which an electronic form is not...

20 CFR 404.1713 - Mandatory use of electronic services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Mandatory use of electronic services. 404.1713 Section 404.1713 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Representation of Parties § 404.1713 Mandatory use of electronic services. A...

20 CFR 404.1713 - Mandatory use of electronic services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Mandatory use of electronic services. 404.1713 Section 404.1713 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Representation of Parties § 404.1713 Mandatory use of electronic services. A...

47 CFR 1.10006 - Is electronic filing mandatory?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Is electronic filing mandatory? 1.10006 Section... Random Selection International Bureau Filing System § 1.10006 Is electronic filing mandatory? Electronic... International Bureau Filing System (IBFS) form is available. Applications for which an electronic form is not...

20 CFR 416.1513 - Mandatory use of electronic services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Mandatory use of electronic services. 416.1513 Section 416.1513 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Representation of Parties § 416.1513 Mandatory use of electronic...

78 FR 2675 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Federal Workplace Drug Testing Programs (Mandatory Guidelines), effective on October 1, 2010, addresses... performing a review of Federal employee drug testing results that seek approval by the Secretary must submit...

75 FR 76478 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Drug Testing Programs (Mandatory Guidelines) which took effect on October 1, 2010 address the role and... Federal employee drug testing results that seek approval by the Secretary must submit their qualifications...

22 CFR 301.2 - Requests for mandatory declassification review.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Requests for mandatory declassification review. 301.2 Section 301.2 Foreign Relations PEACE CORPS PUBLIC ACCESS TO CLASSIFIED MATERIAL § 301.2 Requests for mandatory declassification review. (a) All information originally classified by the Peace...

22 CFR 301.2 - Requests for mandatory declassification review.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Requests for mandatory declassification review. 301.2 Section 301.2 Foreign Relations PEACE CORPS PUBLIC ACCESS TO CLASSIFIED MATERIAL § 301.2 Requests for mandatory declassification review. (a) All information originally classified by the Peace...

37 CFR 41.8 - Mandatory notices.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Mandatory notices. 41.8 Section 41.8 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD General Provisions § 41.8 Mandatory notices. (a...

22 CFR 301.2 - Requests for mandatory declassification review.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Requests for mandatory declassification review. 301.2 Section 301.2 Foreign Relations PEACE CORPS PUBLIC ACCESS TO CLASSIFIED MATERIAL § 301.2 Requests for mandatory declassification review. (a) All information originally classified by the Peace...

12 CFR 1229.8 - Mandatory actions applicable to significantly undercapitalized Banks.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Mandatory actions applicable to significantly undercapitalized Banks. 1229.8 Section 1229.8 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTITY REGULATIONS CAPITAL CLASSIFICATIONS AND PROMPT CORRECTIVE ACTION Federal Home Loan Banks § 1229.8 Mandatory actions...

12 CFR 1229.6 - Mandatory actions applicable to undercapitalized Banks.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Mandatory actions applicable to undercapitalized Banks. 1229.6 Section 1229.6 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTITY REGULATIONS CAPITAL CLASSIFICATIONS AND PROMPT CORRECTIVE ACTION Federal Home Loan Banks § 1229.6 Mandatory actions...

31 CFR 50.4 - Mandatory participation in Program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Mandatory participation in Program. 50.4 Section 50.4 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM General Provisions § 50.4 Mandatory participation in Program. Any entity that meets the...

31 CFR 50.4 - Mandatory participation in Program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Mandatory participation in Program. 50.4 Section 50.4 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM General Provisions § 50.4 Mandatory participation in Program. Any entity that meets the...

31 CFR 50.4 - Mandatory participation in Program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Mandatory participation in Program. 50.4 Section 50.4 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM General Provisions § 50.4 Mandatory participation in Program. Any entity that meets the...

31 CFR 50.4 - Mandatory participation in Program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Mandatory participation in Program. 50.4 Section 50.4 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM General Provisions § 50.4 Mandatory participation in Program. Any entity that meets the...

75 FR 43889 - Proposed Confidentiality Determinations for Data Required Under the Mandatory Greenhouse Gas...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... Proposed Confidentiality Determinations for Data Required Under the Mandatory Greenhouse Gas Reporting Rule... Greenhouse Gas Reporting Rule and Proposed Amendment to Special Rules Governing Certain Information Obtained... the Mandatory Reporting of Greenhouse Gases Rule,'' also signed today. This action addresses only the...

Mandatory Production Controls. Issues in Agricultural Policy. Agriculture Information Bulletin Number 520.

ERIC Educational Resources Information Center

Economic Research Service (USDA), Washington, DC.

Mandatory restrictions on agricultural production continue to be suggested as an alternative policy for reducing price-depressing surplus production, increasing farm income, and cutting farm program costs. A mandatory production control program (MPCP) can be implemented through two methods: (1) acreage allotments, which restrict individual farmers…

46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Mandatory chemical testing following serious marine incidents. 122.212 Section 122.212 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

24 CFR 5.350 - Mandatory pet rules for housing programs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Mandatory pet rules for housing... and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities Pet Ownership Requirements for Housing Programs § 5.350 Mandatory pet rules for...

46 CFR 185.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Mandatory chemical testing following serious marine... PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a...

46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Mandatory chemical testing following serious marine... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a casualty or incident that is, or...

46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Mandatory chemical testing following serious marine... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a casualty or incident that is, or...

46 CFR 185.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Mandatory chemical testing following serious marine... PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a...

46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Mandatory chemical testing following serious marine... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a casualty or incident that is, or...

46 CFR 185.212 - Mandatory chemical testing following serious marine incidents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Mandatory chemical testing following serious marine... PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a...

78 FR 59946 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-30

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 503 of Public Law 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as...

76 FR 161 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 54597 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 24501 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the...

77 FR 20832 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as amended in the revisions listed above...

77 FR 45645 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as amended in the...

76 FR 68201 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 72684 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 503 of Publicc Law 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs...

76 FR 31969 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 314 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

75 FR 67749 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as amended in the...

78 FR 14100 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-04

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 69642 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-20

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 66034 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... Engage in Urine Drug Testing For Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 503 of Public Law 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as...

77 FR 5037 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 75889 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

75 FR 22809 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... for Federal Workplace Drug Testing Programs (Mandatory Guidelines) from May 1, 2010, to October 1... drug testing programs as soon as possible that they will not be expected to implement the revisions to...

77 FR 60449 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 26022 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 61110 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as amended in the revisions listed above...

77 FR 32653 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the...

78 FR 54903 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 503 of Public Law 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as...

76 FR 18770 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-05

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs,'' as amended in the revisions listed above...

76 FR 40924 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 54477 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 19500 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 46309 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 6147 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

76 FR 11802 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 71605 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the...

77 FR 39501 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 33429 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-04

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 25461 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 12862 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-02

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 7795 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... Public Law 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended...

75 FR 12489 - Mandatory Reporting of Greenhouse Gases: Minor Harmonizing Changes to the General Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... distribution facilities. 211112 Natural gas liquid extraction facilities. Suppliers of Industrial GHGs 325120... Mandatory Reporting of Greenhouse Gases: Minor Harmonizing Changes to the General Provisions AGENCY... provisions for the Mandatory Greenhouse Gas (GHG) Reporting Rule. The amendments do not change the...

5 CFR 536.301 - Mandatory pay retention.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Mandatory pay retention. 536.301 Section... PAY RETENTION Pay Retention § 536.301 Mandatory pay retention. (a) Subject to the requirements in § 536.102 and this section, an agency must provide pay retention to an employee who moves between...

31 CFR 50.4 - Mandatory participation in Program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Mandatory participation in Program. 50.4 Section 50.4 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM General Provisions § 50.4 Mandatory participation in Program. Any entity that meets the...

Mandatory Nap Times and Group Napping Patterns in Child Care: An Observational Study.

PubMed

Staton, Sally L; Smith, Simon S; Hurst, Cameron; Pattinson, Cassandra L; Thorpe, Karen J

2017-01-01

Policy provision for naps is typical in child care settings, but there is variability in the practices employed. One practice that might modify children's early sleep patterns is the allocation of a mandatory nap time in which all children are required to lie on their beds without alternate activity permitted. There is currently limited evidence of the effects of such practices on children's napping patterns. This study examined the association between duration of mandatory nap times and group-level napping patterns in child care settings. Observations were undertaken in a community sample of 113 preschool rooms with a scheduled nap time (N = 2,114 children). Results showed that 83.5% of child care settings implemented a mandatory nap time (range = 15-145 min) while 14.2% provided alternate activities for children throughout the nap time period. Overall, 31% of children napped during nap times. Compared to rooms with ≤ 30 min of mandatory nap time, rooms with 31-60 min and > 60 min of mandatory nap time had a two-and-a-half and fourfold increase, respectively, in the proportion of children napping. Nap onset latency did not significantly differ across groups. Among preschool children, exposure to longer mandatory nap times in child care may increase incidence of napping.

Increase in iodine deficiency disorder due to inadequate sustainability of supply of iodized salt in District Solan, Himachal Pradesh.

PubMed

Kapil, Umesh; Pandey, R M; Jain, Vandana; Kabra, Madhulika; Sareen, Neha; Bhadoria, Ajeet Singh; Vijay, Jyoti; Nigam, Sukirty; Khenduja, Preetika

2013-12-01

Himachal Pradesh is a known endemic area for iodine deficiency disorders. A study was conducted in district Solan with the objective of assessing the prevalence of iodine deficiency disorders in school-age children. Thirty clusters were selected by using the probability-proportionate-to-size cluster sampling methodology. Clinical examination of the thyroid of 1898 children in the age-group of 6-12 years was conducted. Urine and salt samples were collected. The total goiter rate was found to be 15.4%. Median urinary iodine excretion level was 62.5 μg/l. Only 39% of the salt samples had iodine content of ≥15 ppm. Mild iodine deficiency was present in the subjects studied.

47 CFR 1.3003 - Mandatory factors for evaluating conflicts of interest.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Mandatory factors for evaluating conflicts of... Unconditional Gifts, Donations and Bequests § 1.3003 Mandatory factors for evaluating conflicts of interest. No... create a conflict of interest or the appearance of a conflict of interest. In making conflict of interest...

76 FR 11187 - Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health or Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health or Safety Standards... rule addressing Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health..., and weekly examinations of underground coal mines. This extension gives commenters an additional 30...

75 FR 65034 - Petition for Modification of Existing Mandatory Safety Standard

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-21

... application, processing, and disposition of petitions for modification. This notice is a summary of a petition for modification filed by the party listed below to modify the application of an existing mandatory... operator or representative of miners to file a petition to modify the application of any mandatory safety...

Mandatory Consent to Treatment by Students in Dental Education: Legal and Policy Considerations.

ERIC Educational Resources Information Center

Cameron, Cheryl A.

1995-01-01

The issue of mandatory dental student consent to provision of clinical services by student colleagues is discussed, particularly when a student seeks to avoid mandatory treatment requirements or refuses treatment from an assigned student care provider, or is denied enrollment based on refusal to consent to treatment. Legal and policy…

78 FR 60285 - Final Notice To Announce the Implementation of Required Electronic Submission of State or Tribal...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-01

... Financial Reporting Forms for Mandatory Grant Programs AGENCY: Office of Administration (OA), ACF, HHS... Tribal plans, and program and financial reporting forms for mandatory grant programs to ACF's Online Data... mandatory grant programs will be required to submit State plans, and programmatic and financial reporting...

22 CFR 213.38 - Mandatory transfer of debts to FMS-general.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Mandatory transfer of debts to FMS-general. 213.38 Section 213.38 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Mandatory Transfer of Delinquent Debt to Financial Management Service (FMS) of the Department of Treasury § 213.38...

78 FR 38989 - New Policies and Procedural Requirements for Electronic Submission of State Plans, and Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

...). Child Care and Development Fund Form ACF-696T: Child Care and Mandatory & Matching. Development Fund Annual Financial Report for Tribes. Child Care and Development Fund Form ACF-402: Improper Mandatory & Matching. Authorizations. Child Care and Development Fund Form ACF-696: Child Care and Mandatory & Matching...

Evaluation of the Mandatory Construction Induction Training Program in Western Australia: Unanticipated Consequences

ERIC Educational Resources Information Center

Bahn, Susanne; Barratt-Pugh, Llandis

2012-01-01

Since January 1, 2007, Government legislation in Western Australia required all workers in construction to complete mandatory safety awareness training before they began work on site. During the implementation of this new legislation there was considerable resistance from the construction sector due to the mandatory nature of the training. The…

Dramatic impact of using protective equipment on the level of hurling-related head injuries: an ultimately successful 27-year programme.

PubMed

Crowley, Patrick J; Crowley, Michael J

2014-01-01

Major head injuries are not uncommon in the Irish national game of hurling. Historically, helmets were not worn. We report a multistage campaign to facilitate and encourage the use of appropriate headgear among the estimated 100 000 hurling players in Ireland. This campaign lasted for 27 years between 1985 and 2012, and involved a number of different stages including: (1) facilitating the establishment of a business dedicated to developing head protection equipment suitable for hurling, (2) placing a particular emphasis on continual product enhancement to the highest industrial standards, (3) engaging continually with the game's controlling body, the Gaelic Athletic Association (GAA), with the ultimate objective of securing a mandatory usage policy for protective helmets and faceguards, (4) longitudinal research to monitor hurling injury, equipment usage and players' attitudes and (5) widely communicating key research findings to GAA leaders and members, as well as to 1000 clubs and schools. One of our three relevant studies included 798 patients and identified a dramatic association between the type of head protection used by a player, if any, and the site of the injury requiring treatment. While 51% of the injured players without head protection suffered head trauma, this rate was only 35% among the players wearing helmets and 5% among players who were wearing full head protection (both a helmet and faceguard). The GAA responded in three stages to the accumulating evidence: (1) they introduced a mandatory regulation for those aged less than 18 years in 2005; (2) this ruling was extended to all players under 21 years in 2007 and (3) finally extended to all players irrespective of age, gender or grade from January 2010. The latter ruling applied to both games and organised training sessions.

High efficacy and students' satisfaction after voluntary vs mandatory use of an e-learning program in traumatology and orthopedics--a follow-up study.

PubMed

Back, David Alexander; Haberstroh, Nicole; Sostmann, Kai; Schmidmaier, Gerhard; Putzier, Michael; Perka, Carsten; Hoff, Eike

2014-01-01

Within the last decade, e-learning has gained a consistent place in surgical teaching. However, as the use of new programs is often voluntary, more information on the implications of the data regarding user acceptance and knowledge with mandatory use is desirable, especially in the context of the long-term developments of courses. Starting in 2009, the e-learning program Network for Students in Traumatology and Orthopedics was offered in a voluntary blended learning context. Students' satisfaction and increase in knowledge were evaluated using questionnaires and written tests. With proven effectiveness, the program became a mandatory part of the curriculum, and students' attitudes and gain of knowledge were re-evaluated in 2010 and 2011 to detect differences in voluntary vs mandatory use. In the evaluation questionnaires (n = 108 voluntary vs n = 361 mandatory), the overall appreciation regarding the offerings remained high. Significantly more students felt better prepared for clinical situations (p < 0.001) and asked for e-tutoring (p = 0.025) with mandatory use. In written tests, both voluntary (n = 70) and mandatory (n = 147) users showed significantly increased knowledge (p < 0.001). Starting with a lower base level (p < 0.001), mandatory users had a significantly higher absolute increase compared with voluntary users (p = 0.015), leading to a similar final level. The presented blended learning concept was an efficient way to teach students orthopedics and traumatology. Data can support the assumption that even if the voluntary evaluation of e-learning offerings might be subject to a selection bias, the results can serve as a representative impression for the students' overall mood and their gain in knowledge. However, as changes would have to be anticipated when shifting to mandatory use, users' perceptions should be constantly evaluated. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Decentralized nursing education in Northern Norway: a basis for continuing education to meet competence needs in rural Arctic healthcare services

PubMed Central

Skaalvik, Mari Wolff; Gaski, Margrete; Norbye, Bente

2014-01-01

Background Ensuring a sufficient nursing workforce, with respect to both number and relevant professional competencies, is crucial in rural Arctic regions in Norway. This study examines the continuing education (CE) of nurses who graduated from a decentralized nursing programme between 1994 and 2011. Objective This study aims to measure the extent to which the decentralized nursing education (DNE) in question has served as a basis for CE that is adapted to current and future community health care service needs in rural Arctic regions in northern Norway. More specifically, the study aims to investigate the frequency and scope of CE courses among the graduates of a DNE, the choice of study model and the degree of employment with respect to the relevant CE. Design This study is a quantitative survey providing descriptive statistics. Results The primary finding in this study is that 56% of the participants had engaged in CE and that they were employed in positions related to their education. The majority of students with decentralized bachelor's degrees engaged in CE that was part time and/or decentralized. Conclusions More than half of the population in this study had completed CE despite no mandatory obligation in order to maintain licensure. Furthermore, 31% of the participants had completed more than one CE programme. The findings show that the participants preferred CE organized as part time and or decentralized studies. PMID:25279355

Chickenpox in Poland in 2013.

PubMed

Korczyńska, Monika Roberta; Rogalska, Justyna

2015-01-01

A large number of chickenpox cases, occurring especially in children, indicates the rationale for the use of chickenpox vaccinations. In Poland since 2002, chickenpox vaccination is included in the National Immunisation Programme as recommended. To assess epidemiological situation of chickenpox in Poland in 2013 in comparison to previous years. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2013" and "Vaccinations in Poland in 2013" (Czarkowski MP i in., Warszawa 2014, NIZP-PZH i GIS). National Immunisation Programme for year 2013 was also used. In 2013, 178 501 cases of chickenpox were registered in Poland. The incidence was 463.6 and was lower than in 2012 (540.5). The highest number of cases was reported in mazowieckie voivodeship, the lowest in podlaskie voivodeship. The highest incidence was recorded in children aged 4 years (6 545.1 per 100,000). The chickenpox incidence among men (491.7) was higher by 12.4% comparing to women (437.3). The incidence among rural residents (497.2) was higher than among urban residents (441.7). Number of cases hospitalized due to mumps was 1 184. Number of people vaccinated against chickenpox was 57 168. In 2013, there was decrease in the incidence of chickenpox [corrected] in Poland with small fluctuations. Since 2002 the number of people vaccinated against chickenpox increased. The increase in the number of people vaccinated against chickenpox would help maintain the downward trend in subsequent years.

Workers' health surveillance: implementation of the Directive 89/391/EEC in Europe.

PubMed

Colosio, C; Mandic-Rajcevic, S; Godderis, L; van der Laan, G; Hulshof, C; van Dijk, F

2017-10-01

European Union (EU) Directive 89/391 addressed occupational health surveillance, which recommends to provide workers with 'access to health surveillance at regular intervals', aiming to prevent work-related and occupational diseases. To investigate how EU countries adopted this Directive. We invited one selected representative per member state to complete a questionnaire. All 28 EU countries implemented the Directive in some form. Workers' health surveillance (WHS) is available to all workers in 15 countries, while in 12, only specific subgroups have access. In 21 countries, workers' participation is mandatory, and in 22, the employer covers the cost. In 13 countries, access to WHS is not available to all workers but depends on exposure to specific risk factors, size of the enterprise or belonging to vulnerable groups. In 26 countries, the employer appoints and revokes the physician in charge of WHS. Twelve countries have no recent figures, reports or cost-benefit analyses of their WHS programmes. In 15 countries where reports exist, they are often in the native language. Coverage and quality of occupational health surveillance should be evaluated to facilitate learning from good practice and from scientific studies. We propose a serious debate in the EU with the aim of protecting workers more effectively, including the use of evidence-based WHS programmes. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

PubMed

Ng, G K B; Leung, G K K; Johnston, J M; Cowling, B J

2013-10-01

The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

The Health and Safety in Employment Act and the influenza vaccination of healthcare workers.

PubMed

McLennan, Stuart; Celi, Leo Anthony; Roth, Paul

2007-03-02

Despite studies demonstrating that the annual influenza vaccination of healthcare workers has a statistically significant reduction of morbidity and mortality among the patients they care for, and District Health Boards (DHBs) establishing voluntary programs to provide the influenza vaccine to healthcare workers free of charge, vaccination rates among healthcare workers are dismal, with only about 20%-40% coverage rates being achieved. With these low rates posing a serious health threat to the vulnerable patient populations that are entrusted into healthcare workers' care, and the current voluntary programmes clearly failing to adequately address this issue, we believe the time has come for the annual influenza vaccination to be made a mandatory requirement for all healthcare workers with direct patient contact unless a medical contraindication exists. Indeed, a compelling case may be made that the duties imposed on DHBs and healthcare workers under the Health and Safety in Employment Act 1992 requires making the annual influenza vaccination an occupational requirement.

Marine microbial biodiversity, bioinformatics and biotechnology (M2B3) data reporting and service standards

PubMed Central

2015-01-01

Contextual data collected concurrently with molecular samples are critical to the use of metagenomics in the fields of marine biodiversity, bioinformatics and biotechnology. We present here Marine Microbial Biodiversity, Bioinformatics and Biotechnology (M2B3) standards for “Reporting” and “Serving” data. The M2B3 Reporting Standard (1) describes minimal mandatory and recommended contextual information for a marine microbial sample obtained in the epipelagic zone, (2) includes meaningful information for researchers in the oceanographic, biodiversity and molecular disciplines, and (3) can easily be adopted by any marine laboratory with minimum sampling resources. The M2B3 Service Standard defines a software interface through which these data can be discovered and explored in data repositories. The M2B3 Standards were developed by the European project Micro B3, funded under 7th Framework Programme “Ocean of Tomorrow”, and were first used with the Ocean Sampling Day initiative. We believe that these standards have value in broader marine science. PMID:26203332

High Voltage Insulation Technology

NASA Astrophysics Data System (ADS)

Scherb, V.; Rogalla, K.; Gollor, M.

2008-09-01

In preparation of new Electronic Power Conditioners (EPC's) for Travelling Wave Tub Amplifiers (TWTA's) on telecom satellites a study for the development of new high voltage insulation technology is performed. The initiative is mandatory to allow compact designs and to enable higher operating voltages. In a first task a market analysis was performed, comparing different materials with respect to their properties and processes. A hierarchy of selection criteria was established and finally five material candidates (4 Epoxy resins and 1 Polyurethane resin) were selected to be further investigated in the test program. Samples for the test program were designed to represent core elements of an EPC, the high voltage transformer and Printed Circuit Boards of the high voltage section. All five materials were assessed in the practical work flow of the potting process and electrical, mechanical, thermal and lifetime testing was performed. Although the lifetime tests results were overlayed by a larges scatter, finally two candidates have been identified for use in a subsequent qualification program. This activity forms part of element 5 of the ESA ARTES Programme.

First Amendment Challenges to the Use of Mandatory Student Fees to Help Fund Student Abortions.

ERIC Educational Resources Information Center

Antonini, Thomas J.

1988-01-01

First amendment challenges to the use of mandatory student fees for abortion services have not reached federal courts, and the only pertinent state decision upheld the mandatory fee system. However, recent decisions and historical analysis suggest the court must grant relief to students whose right to free worship is violated. (Author/MSE)

10 CFR 1045.42 - Mandatory and Freedom of Information Act reviews for declassification of restricted data and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Mandatory and Freedom of Information Act reviews for... of Documents Containing Restricted Data and Formerly Restricted Data § 1045.42 Mandatory and Freedom... and Freedom of Information Act (FOIA) requests for these documents from the public. (2) In response to...

29 CFR (non - mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 8 2010-07-01 2010-07-01 false mandatory) Appendix E to Subpart L of Part 1926-Drawings..., Subpt. L, App. E (Non-mandatory) Appendix E to Subpart L of Part 1926—Drawings and Illustrations This Appendix provides drawings of particular types of scaffolds and scaffold components, and graphic...

An Interview Study of Learner Motivation and Learner Involvement in Mandatory College-Level Academic Writing Classes

ERIC Educational Resources Information Center

Vanniarajan, Swathi M.

2011-01-01

Scholarship in applied linguistics has not sufficiently addressed learner motivation in mandatory writing classes in postsecondary settings. The data collected through short interviews from 20 students enrolled in a mandatory academic writing program at the junior/senior level in a California State University indicated that learner motivation in…

33 CFR 169.100 - What mandatory ship reporting systems are established by this subpart?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false What mandatory ship reporting systems are established by this subpart? 169.100 Section 169.100 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY SHIP REPORTING SYSTEMS Establishment of Two Mandatory Ship Reporting...

Mandatory Online Training: Transmissive Learning, Issues of Abuse and Hidden Agendas

ERIC Educational Resources Information Center

Barratt-Pugh, Llandis; Bahn, Susanne; Scholz, Alex

2011-01-01

This paper is based on two studies of mandatory online learning which although unrelated and conducted eight years apart nevertheless provide an illuminating comparison of mandatory training delivered online. The first study was carried out in 2002 in a state government department and the second in 2010 with the commercial construction industry,…

36 CFR 1260.56 - Is White House originated information subject to mandatory review?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Is White House originated... Mandatory Review § 1260.56 Is White House originated information subject to mandatory review? White House... administrations pursuant to 44 U.S.C. 2107 and 2111. Unless precluded by such laws or agreements, White House...

14 CFR Special Federal Aviation... - Process for Requesting Waiver of Mandatory Separation Age for a Federal Aviation Administration...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Process for Requesting Waiver of Mandatory Separation Age for a Federal Aviation Administration Air Traffic Control Specialist In Flight Service..., SFAR 103 Special Federal Aviation Regulation No. 103—Process for Requesting Waiver of Mandatory...

36 CFR 1260.56 - Is White House originated information subject to mandatory review?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Is White House originated... Mandatory Review § 1260.56 Is White House originated information subject to mandatory review? White House... administrations pursuant to 44 U.S.C. 2107 and 2111. Unless precluded by such laws or agreements, White House...

36 CFR 1260.58 - What are the procedures for requesting a mandatory review of White House originated information?

Code of Federal Regulations, 2011 CFR

2011-07-01

... requesting a mandatory review of White House originated information? 1260.58 Section 1260.58 Parks, Forests... review of White House originated information? (a) Requests for mandatory review must describe the...) NARA will promptly acknowledge to the requester the receipt of a request for White House originated...

Nurse overtime, working conditions, and the presence of mandatory nurse overtime regulations.

PubMed

Bae, Sung-Heui

2012-05-01

Although more states have regulated mandatory nurse overtime, limited research has examined the impact of these regulations on the actual time nurses work and their working conditions. The purpose of this study was to compare nurse overtime and working conditions between states with and states without regulations limiting mandatory nurse overtime. Data were collected from registered nurses working in hospitals located in states with and without mandatory nurse overtime regulations; the final sample consisted of 219 nurses. No difference was found in overtime worked between nurses who worked in states with regulations or without. Those nurses working in states with regulations cared for more patients per shift and experienced more chronic nursing shortages on their nursing units than those working in states without regulation. Continuous efforts are needed to improve the implementation of regulations to reduce nurse mandatory overtime and long work hours. Copyright 2012, SLACK Incorporated.

How effective is mandatory building energy disclosure program in Australia?

NASA Astrophysics Data System (ADS)

Kim, S.; Lim, B. T. H.

2018-04-01

Mandatory green building regulations are often considered as the most effective tool to promote better energy efficiency and environmental protection. Nevertheless, its effectiveness compared to the voluntary counterpart has not been fully explored yet. In addressing this gap, this study aims to examine the environmental performance of green building stocks affected by the Australian mandatory building energy disclosure program. To this, this study analysed energy savings and carbon reduction efficiencies using the normalisation approach. The result shows that mandatory energy disclosure program did contribute to the reduction in energy usage and carbon emissions from the affected building stocks. More specifically, affected green building stocks showed a good efficiency especially in carbon reductions. The research results inform policymakers the possible improvement required for the mandatory disclosure program to increase the effectiveness towards dealing with the contemporary environmental issues aroused from the building sector, especially in energy savings perspective.

An evaluation of UK foundation trainee doctors' learning behaviours in a technology-enhanced learning environment.

PubMed

Brooks, Hannah L; Pontefract, Sarah K; Hodson, James; Blackwell, Nicholas; Hughes, Elizabeth; Marriott, John F; Coleman, Jamie J

2016-05-03

Technology-Enhanced Learning (TEL) can be used to educate Foundation Programme trainee (F1 and F2) doctors. Despite the advantages of TEL, learning behaviours may be exhibited that are not desired by system developers or educators. The aim of this evaluation was to investigate how learner behaviours (e.g. time spent on task) were affected by temporal (e.g. time of year), module (e.g. word count), and individual (e.g. knowledge) factors for 16 mandatory TEL modules related to prescribing and therapeutics. Data were extracted from the SCRIPT e-Learning platform for first year Foundation trainee (F1) doctors in the Health Education England's West Midland region from 1(st) August 2013 to 5(th) August 2014. Generalised Estimating Equation models were used to examine the relationship between time taken to complete modules, date modules were completed, pre- and post-test scores, and module factors. Over the time period examined, 688 F1 doctors interacted with the 16 compulsory modules 10,255 times. The geometric mean time taken to complete a module was 28.9 min (95% Confidence Interval: 28.4-29.5) and 1,075 (10.5%) modules were completed in less than 10 min. In February and June (prior to F1 progression reviews) peaks occurred in the number of modules completed and troughs in the time taken. Most modules were completed, and the greatest amount of time was spent on the learning on a Sunday. More time was taken by those doctors with greater pre-test scores and those with larger improvements in test scores. Foundation trainees are exhibiting unintended learning behaviours in this TEL environment, which may be attributed to several factors. These findings can help guide future developments of this TEL programme and the integration of other TEL programmes into curricula by raising awareness of potential behavioural issues that may arise.

41 CFR 301-70.704 - What expenses and/or classes of employees are exempt from the mandatory use of the Government...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Services exempts the following from the mandatory use of the Government contractor-issued travel charge...) Tips; (g) Meals (only when use of the card is impractical, i.e., group meals or the Government... classes of employees are exempt from the mandatory use of the Government contractor-issued travel charge...

41 CFR 301-70.704 - What expenses and/or classes of employees are exempt from the mandatory use of the Government...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Services exempts the following from the mandatory use of the Government contractor-issued travel charge...) Tips; (g) Meals (only when use of the card is impractical, i.e., group meals or the Government... classes of employees are exempt from the mandatory use of the Government contractor-issued travel charge...

Effectiveness of Alternative Desegregation Strategies: The Issue of Voluntary versus Mandatory Policies in Los Angeles. Part 1: 1979. Revised.

ERIC Educational Resources Information Center

Ross, J. Michael

A careful review of the literature and an examination of desegregation programs in Los Angeles, show that the claim that voluntary programs produce almost no desegregation, and certainly less than mandatory programs, is open to question. Most comparisons between voluntary and mandatory programs have been between cities and have not taken into…

Australian Undergraduate Primary School Student-Teachers' Responses to Child Sexual Abuse and Its Mandatory Reporting

ERIC Educational Resources Information Center

Goldman, Juliette D. G.

2010-01-01

This study aims to understand how primary school teachers, as mandatory reporters of child sexual abuse, are responding to child sexual abuse and its mandatory reporting, even though many teachers do not receive a compulsory course in Child Protection and its legal requirements in their pre-service university training. A cohort of 81 Australian…

29 CFR (non - mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 8 2011-07-01 2011-07-01 false mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations (Non Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Scaffolds Pt. 1926, Subpt. L, App. E (Non-mandatory)...

29 CFR (non - mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 8 2012-07-01 2012-07-01 false mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations (Non Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Scaffolds Pt. 1926, Subpt. L, App. E (Non-mandatory)...

29 CFR (non - mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 8 2013-07-01 2013-07-01 false mandatory) Appendix E to Subpart L of Part 1926-Drawings and Illustrations (Non Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Scaffolds Pt. 1926, Subpt. L, App. E (Non-mandatory)...

36 CFR 1260.62 - What is the appeal process when a mandatory review request for White House originated information...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What is the appeal process when a mandatory review request for White House originated information is denied? 1260.62 Section 1260... mandatory review request for White House originated information is denied? (a) When the Deputy Archivist of...

36 CFR 1260.62 - What is the appeal process when a mandatory review request for White House originated information...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false What is the appeal process when a mandatory review request for White House originated information is denied? 1260.62 Section 1260... mandatory review request for White House originated information is denied? (a) When the Deputy Archivist of...

Factors That Influence Mandatory Child Abuse Reporting Attitudes of Pediatric Nurses in Korea.

PubMed

Lee, In Sook; Kim, Kyoung Ja

This study aimed to identify knowledge of child abuse, awareness of child abuse reporting, factors that influence attitudes toward mandatory reporting, and professionalism among a sample of pediatric nurses in Korea. One hundred sixteen pediatric nurses working at two university hospitals in Korea took part in the study and completed self-administered questionnaires. The data were analyzed using descriptive statistics, t tests, analysis of variance, Pearson correlation coefficients, and hierarchical regression analysis. Knowledge of child abuse, awareness of child abuse reporting, and attitudes toward mandatory reporting were low. Regarding nursing professionalism, social perceptions had the lowest mean score and nursing autonomy had the highest mean score. Attitudes toward mandatory reporting significantly correlated with professionalism. In the hierarchical regression model, the influences of nursing autonomy and intentions to report child abuse on attitudes toward mandatory reporting were statistically significant (F = 2.176, p = .013), explaining 32% of the variation in attitudes toward mandatory reporting. The results of this study could be used to improve systems and policies addressing child abuse and to further develop reporting procedures for identifying children at risk of abuse, to ensure their protection as a professional responsibility.

Sources of Knowledge of Departmental Policy on Child Sexual Abuse and Mandatory Reporting Identified by Primary School Student-Teachers

ERIC Educational Resources Information Center

Goldman, Juliette D. G.; Grimbeek, Peter

2011-01-01

The introduction of a Department of Education policy on child sexual abuse and mandatory reporting is significant for school teachers. The mandatory reporting of child sexual abuse by school teachers carries wide-ranging and significant implications for the lives of school-aged children, and for the teachers who must implement the policy's…

41 CFR 301-51.3 - Who in my agency has the authority to grant exemptions from the mandatory use of the Government...

Code of Federal Regulations, 2010 CFR

2010-07-01

... authority to grant exemptions from the mandatory use of the Government contractor-issued travel charge card... REIMBURSEMENT 51-PAYING TRAVEL EXPENSES General § 301-51.3 Who in my agency has the authority to grant exemptions from the mandatory use of the Government contractor-issued travel charge card? The head of your...

49 CFR 1109.4 - Mandatory mediation in rate cases to be considered under the stand-alone cost methodology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Mandatory mediation in rate cases to be considered... § 1109.4 Mandatory mediation in rate cases to be considered under the stand-alone cost methodology. (a) A... methodology must engage in non-binding mediation of its dispute with the railroad upon filing a formal...

Redeeming Hollow Promises: The Case for Mandatory Spending on Health Care for American Indians and Alaska Natives

PubMed Central

Westmoreland, Timothy M.; Watson, Kathryn R.

2006-01-01

The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need. PMID:16507732

Decreases in Maximal Oxygen Uptake Among Army Reserve Officers’ Training Corps Cadets Following Three Months Without Mandatory Physical Training

PubMed Central

LIGUORI, GARY; KREBSBACH, KASSIE; SCHUNA, JOHN

2012-01-01

During the academic year, Army ROTC cadets are required to participate in mandatory physical training; however, during summer months training is not required. The purpose of this study was to determine if there is a change in cadet VO2max after the summer when training is not mandatory. Participants completed a graded exercise treadmill test to determine their VO2max in late spring of 2010 and again in early fall of 2010. Results indicated that over a three-month break from mandatory physical training, a significant decrease in VO2max was seen for both genders in ROTC cadets. PMID:27182392

Mandatory HIV testing in China: the perception of health-care providers.

PubMed

Li, Li; Wu, Zunyou; Wu, Sheng; Lee, Sung-Jae; Rotheram-Borus, Mary Jane; Detels, Roger; Jia, Manhong; Sun, Stephanie

2007-07-01

Health-care providers in China are facing an exponential increase in HIV testing and HIV-positive patients. A total of 1101 service providers were recruited to examine attitudes toward people living with HIV/AIDS (PLWHA) in China. Logistic regression models were used to assess factors associated with providers' attitudes toward mandatory HIV testing. Providers were most likely to endorse mandatory HIV testing for patients with high-risk behaviour and for all patients before surgery. Over 43% of providers endorsed mandatory testing for anyone admitted to hospital. Controlling for demographics, multivariate analyses indicated that providers with higher perceived risk of HIV infection at work, higher general prejudicial attitudes toward PLWHA, and previous contact with HIV patients were more likely to endorse mandatory HIV testing for anyone admitted to hospital. Results underscore the importance of implementing universal precautions in health-care settings and call attention to social and ethical issues associated with HIV/AIDS control and treatment in China.

Reactions to mandatory sentences in relation to the ethnic identity and criminal history of the offender.

PubMed

Feather, N T; Souter, Jacqueline

2002-08-01

This study investigated the responses of 181 participants (87 men, 94 women), from Adelaide, South Australia, to scenarios describing mandatory sentences for perpetrators of a property offense committed in the Northern Territory, Australia. Four scenarios that were randomly distributed varied ethnic identity (White Australian, Aboriginal Australian) and criminal history (first-time offender, third-time offender). Participants completed attitude measures for both mandatory sentencing and capital punishment, a right-wing authoritarianism scale, and a scale concerned with sentencing goals (retribution, deterrence, protection of society, and rehabilitation). Results showed strong effects of attitude toward mandatory sentencing on scenario responses for variables such as perceived responsibility, deservingness, leniency, seriousness, anger and pleasure, and weaker effects of ethnic identity and criminal history. Participants were generally more sympathetic when the offender was an Aboriginal Australian. Results of a multiple regression analysis showed that attitude toward mandatory sentence was predicted by right-wing authoritarianism and by sentencing goals relating to deterrence and the protection of society.

Should Lecture Recordings Be Mandated in Dental Schools? Two Viewpoints: Viewpoint 1: Lecture Recordings Should Be Mandatory in U.S. Dental Schools and Viewpoint 2: Lecture Recordings Should Not Be Mandatory in U.S. Dental Schools.

PubMed

Zandona, Andrea Ferreira; Kinney, Janet; Seong, WookJin; Kumar, Vandana; Bendayan, Alexander; Hewlett, Edmond

2016-12-01

Transcription or recording of lectures has been in use for many years, and with the availability of high-fidelity recording, the practice is now ubiquitous in higher education. Since technology has permeated education and today's tech-savvy students have expectations for on-demand learning, dental schools are motivated to record lectures, albeit with positive and negative implications. This Point/Counterpoint article addresses the question of whether lecture recording should be mandatory in U.S. dental schools. Viewpoint 1 supports the statement that lecture recording should be mandatory. Proponents of this viewpoint argue that the benefits-notably, student satisfaction and potential for improvement in student performance-outweigh concerns. Viewpoint 2 takes the opposite position, arguing that lecture recording decreases students' classroom attendance and adversely affects the morale of educators. Additional arguments against mandatory lecture recordings involve the expense of incorporating technology that requires ongoing support.

Attendance at NHS mandatory training sessions.

PubMed

Brand, Darren

2015-02-17

To identify factors that affect NHS healthcare professionals' attendance at mandatory training sessions. A quantitative approach was used, with a questionnaire sent to 400 randomly selected participants. A total of 122 responses were received, providing a mix of qualitative and quantitative data. Quantitative data were analysed using statistical methods. Open-ended responses were reviewed using thematic analysis. Clinical staff value mandatory training sessions highly. They are aware of the requirement to keep practice up-to-date and ensure patient safety remains a priority. However, changes to the delivery format of mandatory training sessions are required to enable staff to participate more easily, as staff are often unable to attend. The delivery of mandatory training should move from classroom-based sessions into the clinical area to maximise participation. Delivery should be assisted by local 'experts' who are able to customise course content to meet local requirements and the requirements of different staff groups. Improved arrangements to provide staff cover, for those attending training, would enable more staff to attend training sessions.

Views of practicing dentists regarding a mandatory fifth year of training.

PubMed

Lefever, Karen H; Atchison, Kathryn A; McCauley, Kevin R; Mito, Ronald D; Engelhardt, Rita

2003-03-01

As part of a U.S. Health Resources and Services Administration-funded evaluation of the impact of federal funding on postgraduate general dentistry programs, a random sample of 6,725 dentists graduating in 1989, 1993, and 1997 were surveyed regarding practice patterns, advanced training, populations served, services provided, and their position on a mandatory fifth year of training. Responses (1,965) showed 48 percent supporting a mandatory year and 52 percent not supportive. Open-ended comments were provided by 1,626 respondents. The main reasons for supporting a mandatory fifth year were the need for more instructional time and need for a transition year. Individual choice, no value in a fifth year of dental school, mentoring available elsewhere, and cost were cited in opposition. The following respondents were significantly more likely than other respondents to support a mandatory fifth year: individuals who had completed an AEGD, GPR, or specialty program; were Asian; held salaried positions in a community clinic, nursing home, or hospital; or described themselves as a consultant. Graduates in 1993 and 1997 were less supportive of a mandatory fifth year than were 1989 graduates. Significant differences in the reasons offered in support of respondents' positions on the issue were observed among AEGD, GPR, specialists, and nonspecialists and the three cohort years.

A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

PubMed

Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

2013-11-01

Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Adherence to medication under mandatory and voluntary mail benefit designs.

PubMed

Liberman, Joshua N; Hutchins, David S; Shrank, Will H; Slezak, Julie; Brennan, Troyen A

2011-07-01

To compare adherence rates under voluntary and mandatory mail benefit designs. Matched retrospective cohort. Adherence rates in the first year of therapy were compared between voluntary and mandatory mail cohorts composed of individuals who initiated statin, angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), platelet aggregation inhibitor, metformin, glitazone, or sulfonylurea therapy at a retail pharmacy between January 1 and March 31, 2009. Initiators in mandatory mail plans were matched on therapeutic class, age, sex, prospective risk, and cost of initial prescription with those in voluntary mail plans. Logistic regression models of optimal adherence were constructed to adjust for measured confounders. Persistence rates were similar through the first 60 days of therapy. The mandatory mail cohort had a notable drop in persistence by day 90 (63.3% vs 56.3%, P <.001), with a more pronounced drop among those without previous mail-service pharmacy use (50.5%). Median medication possession ratio (49.2% vs 57.4%) and optimal adherence (33.6% vs 36.1) were also lower. In the multivariable models, mandatory mail participants were less likely to achieve optimal adherence overall (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.67-0.74) and in the metformin (OR 0.55), sulfonylurea (OR 0.72), ACE inhibitor (OR 0.74), ARB (OR 0.69), and statin (OR 0.69) classes. Participants with no prior use of mail-service pharmacy had significantly lower odds of achieving optimal adherence in all therapeutic classes. Mandatory mail appears to cause some members to discontinue therapy prematurely, particularly those without previous mail service pharmacy experience.

Ethics of mandatory premarital HIV testing in Africa: the case of Goma, Democratic Republic of Congo.

PubMed

Rennie, Stuart; Mupenda, Bavon

2008-08-01

Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless they explicitly refuse ('opt out'). While these policies appear to increase uptake of testing, they raise a number of ethical concerns that have been debated in journals and at international AIDS conferences. However, one special form of 'provider-initiated' testing is being practiced and promoted in various parts of the world, and has advocates within international health agencies, but has received little attention in the bioethical literature: mandatory premarital HIV testing. This article analyses some of the key ethical issues related to mandatory premarital HIV testing in resource-poor settings with generalized HIV epidemics. We will first briefly mention some mandatory HIV premarital testing proposals, policies and practices worldwide, and offer a number of conceptual and factual distinctions to help distinguish different types of mandatory testing policies. Using premarital testing in Goma (Democratic Republic of Congo) as a point of departure, we will use influential public health ethics principles to evaluate different forms of mandatory testing. We conclude by making concrete recommendations concerning the place of mandatory premarital testing in the struggle against HIV/AIDS.

ETHICS OF MANDATORY PREMARITAL HIV TESTING IN AFRICA: THE CASE OF GOMA, DEMOCRATIC REPUBLIC OF CONGO

PubMed Central

RENNIE, STUART; MUPENDA, BAVON

2015-01-01

Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless they explicitly refuse (‘opt out’). While these policies appear to increase uptake of testing, they raise a number of ethical concerns that have been debated in journals and at international AIDS conferences. However, one special form of ‘provider-initiated’ testing is being practiced and promoted in various parts of the world, and has advocates within international health agencies, but has received little attention in the bioethical literature: mandatory premarital HIV testing. This article analyses some of the key ethical issues related to mandatory premarital HIV testing in resource-poor settings with generalized HIV epidemics. We will first briefly mention some mandatory HIV premarital testing proposals, policies and practices worldwide, and offer a number of conceptual and factual distinctions to help distinguish different types of mandatory testing policies. Using premarital testing in Goma (Democratic Republic of Congo) as a point of departure, we will use influential public health ethics principles to evaluate different forms of mandatory testing. We conclude by making concrete recommendations concerning the place of mandatory premarital testing in the struggle against HIV/AIDS. PMID:19143089

Population living in the Red Sea State of Sudan may need urgent intervention to correct the excess dietary iodine intake.

PubMed

Izzeldin, H S; Crawford, M A; Jooste, P L

2007-01-01

Both inadequate and high intakes of iodine are associated with thyroid disease and associated abnormalities. Consumption of foods deficient in iodine induces hypothyroidism. Conversely, excessive intake of the nutrient precipitates hyperthyroidism. Iodine deficiency causes impairment of thyroid hormonogenesis resulting in goiter (struma), cretinism which is associated with increased prenatal and infant mortality, deafness, motor disabilities and mental retardation due to damage during fetal and neonatal brain development. We have assessed the iodine status of school children from the locality of Port Sudan, Red Sea State of Eastern Sudan. The primary sources of iodine of the children are mainly iodized salt and rations supplied by local donors and various aid agencies operating in the Sudan. Male and female children (n=141), aged 6 to 12 years (median age 9.8 years), were selected for the survey using a multistage random sampling technique, between May 22 and August 25, 2006. All the children were assessed for urinary iodine and visible goiter. In addition, the iodine content of twenty salt samples was determined using the lodometric titration method and spot test kits. The components of other foods that are routinely consumed by the children and households were noted using a questionnaire form. Urinary iodine concentration exceeded 300 microg/l and 1000 microg/l in 65% and 9.9% of the children, respectively. The highest urinary iodine level was 1470 microg/l. The prevalence of visible goiter was 17%. All the salt samples collected from the schools had more than 150mg potassium iodate per kg of salt. The results of this pilot survey reveal that excessive intake of iodine in children exists in Port Sudan. Inappropriate and unregulated local fortification of salt and lack of monitoring of the imported and donated salt is the primary reason for the excessive intake. There is an urgent need for a regulatory mechanism during the process of iodine fortification and at the point of entry of imported and donated iodized salt as well as the mode of delivery in order to avoid hyperthyroidism and associated disorders. In addition, independent professionals should critically evaluate the health impact of excessive consumption of the nutrient.

Identification, toxicity and control of iodinated disinfection byproducts in cooking with simulated chlor(am)inated tap water and iodized table salt.

PubMed

Pan, Yang; Zhang, Xiangru; Li, Yu

2016-01-01

Chlorine/chloramine residuals are maintained in drinking water distribution systems to prevent microbial contamination and microorganism regrowth. During household cooking processes (e.g., soup making), the residual chlorine/chloramines in tap water may react with the iodide in iodized table salt to form hypoiodous acid, which could react with remaining natural organic matter in tap water and organic matter in food to generate iodinated disinfection byproducts (I-DBPs). However, I-DBPs formed during cooking with chloraminated/chlorinated tap water are almost completely new to researchers. In this work, by adopting precursor ion scan of m/z 127 using ultra performance liquid chromatography/electrospray ionization-triple quadrupole mass spectrometry, many new polar I-DBPs formed during cooking with chloraminated/chlorinated tap water were detected and proposed with structures, of which 3-iodo-4-hydroxybenzaldehyde, 3-iodo-4-hydroxybenzoic acid, 3-iodo-4-hydroxy-5-methylbenzoic acid, diiodoacetic acid, 3,5-diiodo-4-hydroxybenzaldehyde, 3,5-diiodo-4-hydroxybenzoic acid, 2,6-diiodo-4-nitrophenol, 2,4-diiodo-6-nitrophenol, and 2,4,6-triiodophenol were confirmed with standard compounds. With the aid of ultra fast liquid chromatography/ion trap-time of flight-mass spectrometry, molecular formula identification of five new I-DBPs (C8H5O4I, C7H4NO4I, C8H5O5I, C7H4NO5I, and C8H6O3I2) was achieved. A developmental toxicity with a recently developed sensitive bioassay was conducted for the newly identified I-DBPs, suggesting that phenolic I-DBPs (except for iodinated carboxyphenols) were about 50-200 times more developmentally toxic than aliphatic I-DBPs. The major I-DBPs in a baseline simulated cooking water sample were determined to be from 0.72 to 7.63 μg/L. Polar I-DBPs formed under various disinfection and cooking conditions were compared, and suggestions for controlling their formation were provided. Copyright © 2015 Elsevier Ltd. All rights reserved.

Eliminating Mandatory Retirement. A Report by the Chairman of the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Aging.

This document is a short report on issues related to eliminating mandatory retirement ages. H.R. 4154, Congressman Pepper's bill to legislate elimination of mandatory retirement by removing the maximum age limitation of the Age Discrimination in Employment Act of 1967, is included. The report includes the following sections: (1) questions and…

Chickenpox in Poland in 2014

PubMed

Korczyńska, Monika Roberta; Rogalska, Justyna

A large number of chickenpox cases, occurring especially in children between 0-14 years old and among those who are not vaccinated, indicates the rationale for the use of chickenpox vaccinations. In Poland since 2002, chickenpox vaccination is included in the National Immunisation Programme as recommended. AIM. To assess epidemiological situation of chickenpox in Poland in 2014 in comparison to previous years. To assess epidemiological situation of chickenpox in Poland in 2014 in comparison to previous years. The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins “Infectious diseases and poisonings in Poland in 2014” and “Vaccinations in Poland in 2014” (1;2). National Immunisation Programme for year 2014 was also used (3). In 2014, 221 628 cases of chickenpox were registered in Poland. The incidence was 575.9 and was lower than in 2013 (463.6). The highest number of cases was reported in mazowieckie voivodeship (35 321), the lowest in podlaskie voivodeship (5 346). The highest incidence was recorded in children aged 4 years. The chickenpox incidence among men was higher by 12.4% comparing to women (543.4). The incidence among rural residents (595.0) was higher by 9.8 % than among urban residents. Number of cases hospitalized due to mumps was 1 467. Number of people vaccinated against chickenpox was 63 608. In 2014, there was increase in the incidence of chickenpox in Poland. Since 2002 the number of people vaccinated against chickenpox increased. The increase in the number of people vaccinated against chickenpox would help maintain the downward trend in subsequent years.

Assessing the potential impacts of a revised set of on-farm nutrient and sediment 'basic' control measures for reducing agricultural diffuse pollution across England.

PubMed

Collins, A L; Newell Price, J P; Zhang, Y; Gooday, R; Naden, P S; Skirvin, D

2018-04-15

The need for improved abatement of agricultural diffuse water pollution represents cause for concern throughout the world. A critical aspect in the design of on-farm intervention programmes concerns the potential technical cost-effectiveness of packages of control measures. The European Union (EU) Water Framework Directive (WFD) calls for Programmes of Measures (PoMs) to protect freshwater environments and these comprise 'basic' (mandatory) and 'supplementary' (incentivised) options. Recent work has used measure review, elicitation of stakeholder attitudes and a process-based modelling framework to identify a new alternative set of 'basic' agricultural sector control measures for nutrient and sediment abatement across England. Following an initial scientific review of 708 measures, 90 were identified for further consideration at an industry workshop and 63 had industry support. Optimisation modelling was undertaken to identify a shortlist of measures using the Demonstration Test Catchments as sentinel agricultural landscapes. Optimisation selected 12 measures relevant to livestock or arable systems. Model simulations of 95% implementation of these 12 candidate 'basic' measures, in addition to business-as-usual, suggested reductions in the national agricultural nitrate load of 2.5%, whilst corresponding reductions in phosphorus and sediment were 11.9% and 5.6%, respectively. The total cost of applying the candidate 'basic' measures across the whole of England was estimated to be £450 million per annum, which is equivalent to £52 per hectare of agricultural land. This work contributed to a public consultation in 2016. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Evaluation of the mandatory construction induction training program in Western Australia: unanticipated consequences.

PubMed

Bahn, Susanne; Barratt-Pugh, Llandis

2012-08-01

Since January 1, 2007, Government legislation in Western Australia required all workers in construction to complete mandatory safety awareness training before they began work on site. During the implementation of this new legislation there was considerable resistance from the construction sector due to the mandatory nature of the training. The construction industry viewed this as an unnecessary impost as they considered that there was already sufficient safety training delivered through individual company and site inductions. In 2010, we evaluated the new Construction Induction Training (CIT) in the commercial construction sector in Western Australia to find that since 2007 there has been an unanticipated change in support for the mandatory training. The 2010 study shows a shift in the values of the safety culture for the commercial sector of the construction industry. In 2010, the industry not only supports the mandatory CIT, but is very vocal in its request to re-institute the refresher courses that were withdrawn in 2009. Indeed, 79% of respondents claimed there were measurable benefits to their business having their employees complete the CIT, while 96% claimed the CIT assisted in reducing accidents/incidents on their worksites. This 2010 study indicates that in this case, mandatory training has had a positive effect on safety culture change and gradually reduced work-related injury in the industry since 2007 to the present. The paper uses data from two studies conducted in 2006 and 2010 to highlight the unanticipated change in perception of the value of mandatory safety training in the WA construction industry to one which is positive and supportive. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons.

PubMed

Frederick, John; Brown, Alexandria C; Cummings, Derek A; Gaydos, Charlotte A; Gibert, Cynthia L; Gorse, Geoffrey J; Los, Jenna G; Nyquist, Ann-Christine; Perl, Trish M; Price, Connie S; Radonovich, Lewis J; Reich, Nicholas G; Rodriguez-Barradas, Maria C; Bessesen, Mary T; Simberkoff, Michael S

2018-04-01

OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.

Was mandatory quarantine necessary in China for controlling the 2009 H1N1 pandemic?

PubMed

Li, Xinhai; Geng, Wenjun; Tian, Huidong; Lai, Dejian

2013-09-30

The Chinese government enforced mandatory quarantine for 60 days (from 10 May to 8 July 2009) as a preventative strategy to control the spread of the 2009 H1N1 pandemic. Such a prevention strategy was stricter than other non-pharmaceutical interventions that were carried out in many other countries. We evaluated the effectiveness of the mandatory quarantine and provide suggestions for interventions against possible future influenza pandemics. We selected one city, Beijing, as the analysis target. We reviewed the epidemiologic dynamics of the 2009 H1N1 pandemic and the implementation of quarantine measures in Beijing. The infectious population was simulated under two scenarios (quarantined and not quarantined) using a deterministic Susceptible-Exposed-Infectious-Recovered (SEIR) model. The basic reproduction number R0 was adjusted to match the epidemic wave in Beijing. We found that mandatory quarantine served to postpone the spread of the 2009 H1N1 pandemic in Beijing by one and a half months. If mandatory quarantine was not enforced in Beijing, the infectious population could have reached 1,553 by 21 October, i.e., 5.6 times higher than the observed number. When the cost of quarantine is taken into account, mandatory quarantine was not an economically effective intervention approach against the 2009 H1N1 pandemic. We suggest adopting mitigation methods for an influenza pandemic with low mortality and morbidity.

Was Mandatory Quarantine Necessary in China for Controlling the 2009 H1N1 Pandemic?

PubMed Central

Li, Xinhai; Geng, Wenjun; Tian, Huidong; Lai, Dejian

2013-01-01

The Chinese government enforced mandatory quarantine for 60 days (from 10 May to 8 July 2009) as a preventative strategy to control the spread of the 2009 H1N1 pandemic. Such a prevention strategy was stricter than other non-pharmaceutical interventions that were carried out in many other countries. We evaluated the effectiveness of the mandatory quarantine and provide suggestions for interventions against possible future influenza pandemics. We selected one city, Beijing, as the analysis target. We reviewed the epidemiologic dynamics of the 2009 H1N1 pandemic and the implementation of quarantine measures in Beijing. The infectious population was simulated under two scenarios (quarantined and not quarantined) using a deterministic Susceptible-Exposed-Infectious-Recovered (SEIR) model. The basic reproduction number R0 was adjusted to match the epidemic wave in Beijing. We found that mandatory quarantine served to postpone the spread of the 2009 H1N1 pandemic in Beijing by one and a half months. If mandatory quarantine was not enforced in Beijing, the infectious population could have reached 1,553 by 21 October, i.e., 5.6 times higher than the observed number. When the cost of quarantine is taken into account, mandatory quarantine was not an economically effective intervention approach against the 2009 H1N1 pandemic. We suggest adopting mitigation methods for an influenza pandemic with low mortality and morbidity. PMID:24084677

Parents' and staff's support for a childcare agency employee mandatory vaccination policy or agency certification program.

PubMed

Rebmann, Terri; Wang, Jing; Wilson, Kristin D; Gilbertson, Philip G; Wakefield, Mary

2016-07-01

Vaccine-preventable diseases pose a significant risk to children in childcare. However, few regulations exist regarding childcare staff vaccination. This study aimed to assess support for a childcare agency staff mandatory vaccination policy. Surveys were distributed to staff and parents at 23 St Louis, Mo, childcare agencies during fall 2014. Staff and parents' support for a mandatory vaccination and/or agency certification program were compared using χ(2) tests. Multivariate logistic regression was conducted using a 2-level nested design and controlling for gender, race, age, and income to determine predictive models for support for a mandatory staff vaccination policy and/or agency certification program. Overall, 354 parents and staff participated (response rate, 32%). Most supported a mandatory staff vaccination policy (80.0%; n = 280) or agency certification program (81.2%; n = 285), and there were no differences between parents versus staff. Determinants of support for a mandatory policy included willingness to receive influenza vaccine annually, belief that vaccines are safe and effective, and support for the policy only if there were no costs. There is strong support for some type of childcare agency staff vaccination policy. Implementing such a policy/program should be a collaborative endeavor that addresses vaccine cost and access. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

45 CFR 400.105 - Mandatory services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Refugee Medical Assistance Scope of Medical Services § 400.105 Mandatory services. In providing refugee medical assistance to...

Impact of States’ Nurse Work Hour Regulations on Overtime Practices and Work Hours among Registered Nurses

PubMed Central

Bae, Sung-Heui; Yoon, Jangho

2014-01-01

Objectives To examine the degree to which states’ work hour regulations for nurses—policies regarding mandatory overtime and consecutive work hours—decrease mandatory overtime practice and hours of work among registered nurses. Methods We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. Principal Findings The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. Conclusions State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses. PMID:24779701

Impact of states' nurse work hour regulations on overtime practices and work hours among registered nurses.

PubMed

Bae, Sung-Heui; Yoon, Jangho

2014-10-01

To examine the degree to which states' work hour regulations for nurses-policies regarding mandatory overtime and consecutive work hours-decrease mandatory overtime practice and hours of work among registered nurses. We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses. © Health Research and Educational Trust.

49 CFR 220.61 - Radio transmission of mandatory directives.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures... the duration of the train crew's work assignment. (ii) For on-track equipment, before a mandatory...

Effectiveness and acceptance of a health care-based mandatory vaccination program.

PubMed

Leibu, Rachel; Maslow, Joel

2015-01-01

To decrease the risk of transmission of hospital-associated transmission of influenza and pertussis through mandatory vaccination of staff. A mandatory influenza and toxoid-diphtheria toxoid-acellular pertussis program was implemented systemwide. A structured vaccine exemption program was implemented for those requesting a medical and/or religious/moral/ethical exemption. Systemwide influenza vaccination rates increased from 67% historically, 76.2% in the 2012 to 2013 influenza season, to 94.7% in 2013 to 2014 with an overall compliance rate of 97.8%. Toxoid-diphtheria toxoid-acellular pertussis vaccination rates systemwide reached 94.9%, with an overall compliance rate of 98%. Higher rates were experienced at individual hospital facilities compared with the corporate location. Successful vaccination campaign outcomes can be achieved through diligent enforcement of mandatory vaccination, masking, and other infection prevention procedures.

Evaluation of efficacy of iodine prophylaxis in Poland based on the examination of schoolchildren living in Opoczno Town (Lodz Voivodship).

PubMed

Zygmunt, Arkadiusz; Adamczewski, Zbigniew; Wojciechowska-Durczyńska, Katarzyna; Cyniak-Magierska, Anna; Krawczyk-Rusiecka, Kinga; Zygmunt, Agnieszka; Karbownik-Lewińska, Małgorzata; Lewiński, Andrzej

2012-12-22

In 1997 a currently obligatory model of iodine prophylaxis, based on mandatory iodization of household salt with 30 mg KI/kg, was introduced. The aim of our study was to assess the iodine intake among school-age children living in Opoczno in 3 subsequent time points - in 1994, before establishment of currently operating model of iodine prophylaxis, in 1999 - 2 years after implementation of iodine prophylaxis and in 2010, - 14 years after its implementation. We assessed goitre incidence and urine iodine concentration (UIC) in 104 children in 1994, 207 children in 1999 and 174 children in 2012. Age of examined children ranged from 6 to 15 years. The thyroid volumes evaluated by ultrasound were compared to reference values for thyroid volume proposed by Zimmermann at al. Moreover, we have introduced a new index - V/BSA ratio (comparison of thyroid volume to the body surface area), which to our belief allows for more accurate assessment of thyroid volume. The median of UICs was 45.5 μg/L (1994), 101.1 μg/L (1999) and 100.6 μg/L (2010). The distribution of obtained results has changed as well - iodine concentrations below 50 μg/L were present in 59.1% children in 1994, in 12.6% children - in 1999 and in 7.1% children - in 2010.Although a significant decrease in goitre incidence with regard to age - 92.6% (1994) vs 18.5% (1999) and 15.8% (2010), as well as with regard to BSA - 95.4% (1994) vs 15.2% (1999) and 11.6% (2010) was observed, it still points to the iodine deficiency, which is in contradiction with UICs as they are within normal limits. V/BSA ratio avoids such discrepancy. The values of ratio V/BSA were higher in 1994 (7.079 ± 2.775) than in 1999 (2.935 ± 1.112) (p<0.05) and in 2010 (2.846 ± 1.029) (p<0.05). Hitherto model of iodine prophylaxis has proved to be effective in eliminating the iodine deficiency. The iodine intake is now more even, homogenous, which translates into smaller scatter of UICs and less percentage of children, in whom UIC is less than 50 μg/L. However, the iodine intake only slightly exceeds the recommended values, so median of UICs oscillates around the lower limit of references values.

Evaluation of efficacy of iodine prophylaxis in Poland based on the examination of schoolchildren living in Opoczno Town (Lodz Voivodship)

PubMed Central

2012-01-01

Background In 1997 a currently obligatory model of iodine prophylaxis, based on mandatory iodization of household salt with 30 mg KI/kg, was introduced. The aim of our study was to assess the iodine intake among school-age children living in Opoczno in 3 subsequent time points – in 1994, before establishment of currently operating model of iodine prophylaxis, in 1999 – 2 years after implementation of iodine prophylaxis and in 2010, – 14 years after its implementation. Methods We assessed goitre incidence and urine iodine concentration (UIC) in 104 children in 1994, 207 children in 1999 and 174 children in 2012. Age of examined children ranged from 6 to 15 years. The thyroid volumes evaluated by ultrasound were compared to reference values for thyroid volume proposed by Zimmermann at al. Moreover, we have introduced a new index – V/BSA ratio (comparison of thyroid volume to the body surface area), which to our belief allows for more accurate assessment of thyroid volume. Results The median of UICs was 45.5 μg/L (1994), 101.1 μg/L (1999) and 100.6 μg/L (2010). The distribution of obtained results has changed as well – iodine concentrations below 50 μg/L were present in 59.1% children in 1994, in 12.6% children – in 1999 and in 7.1% children – in 2010. Although a significant decrease in goitre incidence with regard to age – 92.6% (1994) vs 18.5% (1999) and 15.8% (2010), as well as with regard to BSA – 95.4% (1994) vs 15.2% (1999) and 11.6% (2010) was observed, it still points to the iodine deficiency, which is in contradiction with UICs as they are within normal limits. V/BSA ratio avoids such discrepancy. The values of ratio V/BSA were higher in 1994 (7.079 ± 2.775) than in 1999 (2.935 ± 1.112) (p<0.05) and in 2010 (2.846 ± 1.029) (p<0.05). Conclusions Hitherto model of iodine prophylaxis has proved to be effective in eliminating the iodine deficiency. The iodine intake is now more even, homogenous, which translates into smaller scatter of UICs and less percentage of children, in whom UIC is less than 50 μg/L. However, the iodine intake only slightly exceeds the recommended values, so median of UICs oscillates around the lower limit of references values. PMID:23259538

Spatial variability of drinking water iodine in Denmark: implications for future policy making

NASA Astrophysics Data System (ADS)

Voutchkova, Denitza; Ernstsen, Vibeke; Kristiansen, Søren; Hansen, Birgitte

2014-05-01

The iodine-an essential component of human thyroid hormones-is provided to our organisms naturally from the food and water and/or is added artificially to the diet. One of the major natural contributors to the dietary iodine intake in Denmark is the drinking water. Both insufficient or excessive iodine intake can cause health problems however the attention falls mainly on the iodine deficiency (ID). Denmark is classified to have mild ID, which is based on sub-national data only. On a bigger scale, in Europe, about 40% of the general population is estimated to suffer from insufficient iodine intake (based on recent update on the iodine status worldwide). A mandatory addition of iodine to the salt was introduced in 2001 in Denmark to address the population's mild deficiency. One of the components of the Danish monitoring program investigating the effect of the salt iodizing (DanThyr) was based on the geographical variation of drinking water iodine levels. More specifically, the location of the two DanThyr cohort studies was chosen to reflect the low concentrations in the western part of Denmark and higher concentration in the eastern part. However, the knowledge about the spatial variability of iodine in Danish ground- and drinking water at that time was quite limited and misrepresentation of the natural variability is suspected. The presented sampling campaign was completed in 2013, and includes 144 waterworks with annual abstraction of about 175 mio m3 groundwater (~45% of the total groundwater abstraction by all active public and private Danish waterworks). The results show a surprisingly complex spatial pattern concerning both the iodine concentrations and speciation. By estimating the dietary iodine intake from water and comparing it to the WHO recommendations, it becomes possible to recognize potentially deficient/excessive geographical areas. Moreover, it is demonstrated that drinking water iodine levels (major dietary iodine contributor in Denmark) can be used as a proxy for the ID status of the population in countries such Denmark, where there is no recent nationwide survey or monitoring program following up the population's iodine status on a national level. Not only can the outcome of this project facilitate the design of future epidemiological studies, but also support policy making in the area of ID prevention and water management as it fills a knowledge gap for drinking water iodine speciation and variation in connection to both spatial distribution and human health.

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DTIC Science & Technology

1993-01-01

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28 CFR 544.43 - Incentives.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Mandatory English-as-a-Second Language Program (ESL) § 544.43 Incentives. The Warden or designee shall establish a system of incentives to encourage an inmate to meet the mandatory ESL program requirements. ...