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Regular Sputum Check-Up for Early Diagnosis of Tuberculosis after Exposure in Healthcare Facilities.

Regular Sputum Check-Up for Early Diagnosis of Tuberculosis after Exposure in Healthcare Facilities.

Adequate sputum sampling is the basis of diagnosing TB [21], and sufficient training to obtain adequate sputum samples is particularly crucial for patients with mental illness [35]. Sputum induction has been proven be a well-tolerated, low-cost technique with a similar diag- nostic yield to bronchoscopy in the diagnosis of smear-negative pulmonary TB [36]. Adequate sputum sampling to allow for the early diagnosis of new TB cases is considered to be critical to prevent TB transmission in the beginning of an outbreak since latent TB treatment is infeasible. Indeed, to treat contact subjects with latent TB infection is an effective strategy to stop further transmission of TB in the management of TB outbreak in healthcare facilities [1], while to stop the transmission of TB is particularly critical if latent TB screening and treatment is infeasible. The results of this study provide clinical evidence of using regular sputum check-ups via induc- tion for all contact subjects to early diagnose subjects of TB with minimal lung lesions, and this strategy may be considered to be one of the strategies in stopping further transmission of TB. Our data show that regular sputum check-ups for all high-risk contact participants for up to 4 years were an effective and necessary strategy for the early identification of new TB cases. The use of sputum induction and thorough training for how to obtain sputum samples may at least partly explain the detection of TB patients with minimal lung lesions in this study. However, unlike regular CXR follow-up, continuous regular sputum smear and culture check-ups as in the follow-up protocol used in this study is quite resource-intensive. We thus used our data to analyze the efficacy of focusing resources on high-risk subjects after a two-year regular sputum check-ups, which might be a potential alternative approach in resource-limited set- tings. Our data showed that 68.8% (11/16) of the TB cases were diagnosed within the first 2 (1–2) years, with the other 31.2% (5/16) of TB cases diagnosed in the next 2 (3–4) years. It is worth noting that all of the cases diagnosed in the 3–4 year period were high-risk patients, of whom 80% (4/5) had a long duration of contact (5.5 ± 1.6 months) and 20% (1/5) had a low BMI (20.0 kg/m 2 ) (Table 3). Therefore, regular sputum check-ups for all contact participants for the first 2 years while reserving regular sputum check-ups only for high-risk participants may be a reasonable and resource-saving strategy in clinical practice.
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A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

This study provides the following insights. Firstly, most primary healthcare facilities in Nigeria are unable to adequately provide basic EmOC services or meet an increasing demand for obstetric care. To put this proper perspective, consider the following: of the 20,000 or so registered healthcare facilities in Nigeria (both public and private), about 80% are primary healthcare facilities, less than 1% are tertiary [3,17] and referral facilities can seldom be found in rural areas (which harbor two thirds of the population) [18]. Even as the newly introduced Midwifery Service Scheme (MSS) has increased the availability of nurses and midwives in primary healthcare centers, service provision still remains low [19]. While most women will experience normal delivery, it is well document- ed that all women are at risk for pregnancy-related complications and resultant morbidity and mortality. It is for this very reason that primary healthcare centers accessible to all women are necessary but not sufficient to reduce maternal mortality. These facilities also Quality of Obstetric Care in Nigerian Hospitals
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Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010.

Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010.

The primary goal of our study was not to compare different surveillance system performance for DENV detection. However, accurate DENV case finding required the combination of two electronic biosurveillance systems (ESSENCE and BioSense), as well as infection preventionist manual surveillance efforts at VA facilities. These electronic biosurveillance systems currently rely on outpatient diagnostic encounter codes, ICD-9, which can be searched by syndrome or individual codes. ICD-9 coding for outpatient visits in VA may not be completely accurate, and likely underestimates the true number of cases, particularly in those cases where confirmatory laboratory testing was not obtained, or was obtained and results were not available at the time of encounter close-out. Syndromic surveillance includes additional, non-specific ICD-9 codes (i.e., fever and rash), which can further reduce the specificity of the diagnosis. In addition, DENV or syndrome ICD-9 codes could reflect prior outpatient encounters for DENV disease, and contribute to an overestimation of the number of cases. Infection preventionists can access multiple data domains in the EMR (including history, laboratory data, and treatment), which help refine whether a potential DENV case is likely to be a confirmed or probable case. In addition, infection preventionists can help facilitate obtaining convalescent blood samples to further help confirm diagnoses. As demonstrated in Figure 3 no system of identifying cases was perfect, both infection preventionists and BioSense were able to identify 9 out of the 12 confirmed/probable cases. ESSENCE was able to capture all 12 cases, however, misidentified 3 cases. Because of the reduced specificity of electronic biosurveillance systems, VA is enhancing VA’s ESSENCE system by including vital signs (temperature), laboratory orders and results, inpatient admission data, outpatient encounter severity codes, telephone care encounter data, and pharmacy prescription data, in addition to ICD-9 encounter codes, which will improve specificity and automate much of what infection preventionists currently must review by hand. Until our enhanced system is available, utilization of an electronic surveillance system in addition to manual surveillance by infection preventionists will remain important.
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Better antiretroviral therapy outcomes at primary healthcare facilities: an evaluation of three tiers of ART services in four South African provinces.

Better antiretroviral therapy outcomes at primary healthcare facilities: an evaluation of three tiers of ART services in four South African provinces.

Methodology/Principal Findings: A retrospective cohort study was conducted including ART-naı¨ve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models and logistic regression were used to compare death, loss to follow-up (LTFU) and virological suppression (VS) between PHC, district and regional hospitals. 29 203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1% (95% CI: 79.3%–80.8%), 71.5% (95% CI: 69.1%–73.8%) and 68.7% (95% CI: 67.0%–69.7%) at PHC, district and regional hospitals respectively, after 24 months of treatment (P,0.0001). In adjusted regression analyses, LTFU was independently increased at regional hospitals (aHR 2.19; 95% CI: 1.9422.47) and mortality was independently elevated at district hospitals (aHR 1.60; 95% CI: 1.3021.99) compared to PHC facilities after 12 months of ART. District and regional hospital patients had independently reduced probabilities of VS, aOR 0.76 (95% CI: 0.5920.97) and 0.64 (95% CI: 0.5620.75) respectively compared to PHC facilities over 24 months of treatment.
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Unequal access to public healthcare facilities: theory and measurement revisited

Unequal access to public healthcare facilities: theory and measurement revisited

The paper is organized as follows. Section 2 sets off by examining healthcare service accessibility, through a commonly used functional equation which assumes monotonic strictly concave utility relative to healthcare service complexity weighted against hospital distances. Complementing the analysis, the Appendix puts forward an alternative utility specification, which accounts for increasing marginal disutility beyond a safety threshold, and infers its implications for elasticity of marginal disu- tility with respect to hospital distance, and social distribution weights for hospital in- frastructure investments (see Note 1 in Section 5). By partly drawing on this frame- work (relative to safety threshold and ‘best practice’ distances), a stochastic frontier hurdle model is formulated with an endogenously determined distance threshold, be- yond which distances from hospitals are influenced by frontier-location factors and inefficiency effects. Results of an application to pooled biennial (2000-03) commune- level data for Chile are presented in section 3. Accessibility is measured in terms of physical distances of communal administrative centres from reference/emergency hospitals. Conclusions are drawn in section 4.
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Rev. bras. epidemiol.  vol.13 número2

Rev. bras. epidemiol. vol.13 número2

In the multivariate model for a joint association test of the variables related to the use of healthcare facilities and IPV, a polynomial logistic regression analysis was performed, using the Stata 10.0 statistical suite. The reference variable was never having experienced any IPV. Independent variables that presented a p<0.20 in the uni- variate analysis (chi-square) were selected for the multiple model to ind the odds ratio. The analysis model tested the association of IPV with the use of healthcare services, including other predictor (independent) variables for the adjustment effect, but without going into much detail about their speciic associations. The choice for this type of modeling, which we call “conirma- tive type”, is due to the fact that we tried to highlight (conirm) the relevance of violence as a factor of impact on the frequency of use of healthcare services and on the repetition of complaints or diagnoses, emphasizing the association to remain.
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Rev. Saúde Pública  vol.38 número6

Rev. Saúde Pública vol.38 número6

The study was conducted in Ribeirão Preto, southeastern Brazil. World Health Organization drug use indicators were used as a methodological basis. Our sample comprised 10 healthcare facilities, with 6,692 prescriptions written by clinicians and pediatricians for the analysis of prescription indicators and 30 patients of each facility for the analysis of patient care indicators. The number of facilities varied according to each indicator. We used statistical tests for the comparison of proportions. Results

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Planning and Analysis of an Arched Indoor Stadium

Planning and Analysis of an Arched Indoor Stadium

In Kerala there is no Olympic standard swimming pools and table tennis courts. The best sports centre in Kerala is Regional Sports Centre Kadavantra, which leads the development of elite sport in Cochin city. The existing swimming pool in RSC is not of Olympic standards. For National Games, Sports Council of India had proposed a new Multipurpose Indoor Stadium to improve the facilities. The newly proposed stadium replaces the existing swimming pool and basketball court there. The multilevel stadium has more relevance in this scenario, because of lack of space for construction. The stadium consists of basement parking facilities, Olympic standard swimming pool, Table tennis room and Residential and other facilities for athletes. The indoor stadium is designed as a zero energy building. That is the total energy input and output is zero. Also the usage and wastage of energy during construction is minimized. This is very important aspect due to acute energy shortage faced by our country today. The materials for the construction are chosen so as to have a minimum carbon di-oxide foot print.
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Cystic fibrosis, are we missing in India?

Cystic fibrosis, are we missing in India?

Results: 92.5% agreed that Cystic fibrosis (CF), is now a pan ethnic disease. 100% accepted that the factors that are associated with decreased survival in CF patients from developing countries are early age of onset of symptoms, severe malnutrition at the time of diagnosis and frequent episodes of pneumonia. Severe malnutrition, not responding to nutritional therapy , neonatal meconium ileus and recurrent pneumonia , 87.5% 100% and 85% suspect cystic fibrosis respectively. 90% do not have facilities for diagnosis of cystic fibrosis like sweat chloride test and 87.5% felt absence of facilities makes the diagnosis of cystic fibrosis difficult. 90% agreed that the education of pediatricians about the disease, can improve the quality of life and survival in CF. Conclusion: Inadequacy of diagnostic services for CF may be reason for missing CF cases in India and we need to sensitize the health professionals for CF diagnosis and develop better diagnostic and patient support services for CF.
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A contribuição do BIM para gestão de facilities na construção civil / BIM contribution to facilities management in civil construction

A contribuição do BIM para gestão de facilities na construção civil / BIM contribution to facilities management in civil construction

Coordenar a infraestrutura de uma empresa é uma tarefa árdua, dada a quantidade de variáveis que ela inclui. São ferramentas, equipamentos e recursos humanos que precisam trabalhar em harmonia, para assegurar a produtividade e o bem-estar nos ambientes de trabalho. Para manter o bom funcionamento de todos estes aspectos, as empresas passaram a adotar a gestão de facilities, também conhecida como facilities management. Manter os elevadores funcionando, o ar- condicionado na temperatura ideal, a limpeza sempre em dia, a gestão de dados e informações com grande segurança, entre várias outras questões, é tarefa para o Facilities. Esse setor é responsável pela administração, gestão e manutenção de empresas dos mais diversos setores, não importa o tamanho.
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Measures to reduce the impact of anti-icing agents on the environment and on the work of wastewater treatment facilities

Measures to reduce the impact of anti-icing agents on the environment and on the work of wastewater treatment facilities

This article analyses the impact of the excess of chemical agents in the snow on the environment and on the working waste water treatment facilities. The article presents some suggestions for improvement of regulatory require- ments concerning design engineering of snow melting facilities in the water disposal system. This suggestion was substantiated to assess snow as waste disposed from road surface, and to register snow mass delivered to snow melting facilities in equivalent units. It is assumed that snow melting stations are facilities designed for waste treatment, and this is why the project documenta- tion for construction of these facilities has to undergo a state expertise for En- vironmental Impact Assessment.
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Lean healthcare no bloco operatório

Lean healthcare no bloco operatório

Quando, finalmente, se reconhece que a melhoria no desempenho operacional é o pré- requisito chave para a sustentabilidade e crescimento das organizações, o Lean Manufactorin[r]

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CE128.R9: Framework convention on tobacco control

CE128.R9: Framework convention on tobacco control

(c) protect all nonsmokers, in particular children and pregnant women, from exposure to second-hand smoke through elimination of smoking in government facilities, health care facilities, and educational institutions as a priority, and through the creation of smoke-free environments in workplaces and public places as soon as possible, recognizing that smoke-free environments also promote cessation and prevent initiation of tobacco use;

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Prevalence of mental health problems in children and adolescents from the outskirts of São Paulo City: treatment needs and service capacity evaluation

Prevalence of mental health problems in children and adolescents from the outskirts of São Paulo City: treatment needs and service capacity evaluation

In Embu's public service system, we identified 12 facilities providing mental health treatment for children and adolescents aged 6 and 17 years. These facilities belonged to different se[r]

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Agile healthcare solution : nursing

Agile healthcare solution : nursing

Salienta-se ainda que muitas organizações de saúde começaram a ter alguma independên- cia relativamente à adopção dos seus sistemas de informação há apenas alguns anos atrás. Deste modo, a desmaterialização do processo clínico passou a se possível em muitas insti- tuições hospitalares através de sistemas informatizados tais como o Paper Free Healthcare da ALERT® ou o HCIS (Healthcare Information System) da HP (Hewlett-Packard). Seja qual for a solução escolhida, um dos maiores desafios para o sucesso de uma implementa- ção nestas organizações é a integração com outros sistemas existentes, uma vez que, boa parte dos mesmos, são centrais e antigos e continuam a ser insubstituíveis e indispensáveis ao funcionamento das instituições. No entanto, estas soluções limitam a autonomia dos serviços de informação das mesmas. Tal como pode ser verifica no Anexo II, muitas dessas aplicações foram desenvolvidas pelo IGIF (Instituto de Gestão Informática e Financeira da saúde), actual ACSS (Administração Central de Sistemas de Saúde). São exemplos dessas aplicações o RHV (Recursos Humanos e Vencimentos), o SINUS (Sistema de INformação para Unidades de Saúde) que é uma aplicação direccionada gestão de doentes dos centros de saúde, o SONHO (Sistema de gestão de doentes hospitalares), o SApE (Sistema de Apoio ao enfermeiro) e o SAM (Sistema de Apoio Médico). Para além dessas aplicações existem muitas outras direccionadas à gestão financeira, ao aprovisionamento, à logística, ao trabalho de backoffice, ao apoio à decisão, entre outras áreas que podem, igualmente, ter de ser integradas no sistema informático da instituição. O aumento da autonomia financeira das organizações conduz ao acréscimo de obrigações de prestação de contas e à necessida- de de ter acesso a informação consolidada, fiável e atempada com a possibilidade de efec- tuar cruzamento de dados que permita agir em prol das boas práticas de gestão e da melhor prestação de cuidados de saúde.
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Biological hazards for healthcare workers

Biological hazards for healthcare workers

Salmonella spp., Shigella spp., Campylobacter jejuni/ coli, Yersinia enterocolitica, enteropathogenic Escherichia coli, enterohemorrhagic Escherichia coli, rotaviruses, Clos- tridium difficile, and Vibrio cholerae are among the most serious agents that can be transmitted to healthcare work- ers by the fecal-oral route [4]. Skin infection agents, such as scabies agent or herpes simplex virus 1 or 2, are trans- mitted by contact and they often infect healthcare work- ers. Enterococcus faecium, Staphylococcus aureus, Klebsi- ella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. can be transmitted by contact too, but usually they do not cause infection in healthy people. Nevertheless, in some circumstances, they can cause serious health problems, namely pneumonia or infecting wounds. On the other hand, as healthcare work- ers become colonized with these agents, they can act as a
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MAINTENANCE EXPENSES PREDICTION OF TRANSPORTATION FACILITIES

MAINTENANCE EXPENSES PREDICTION OF TRANSPORTATION FACILITIES

To predict maintenance expenses of transportation facilities it is necessary to consider con- ditions of its operation and age as well as drivers proficiency.. Key words: transportation[r]

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Absenteeism and presenteeism costs from occupational accidents with WRMSDs in a Portuguese hospital

Absenteeism and presenteeism costs from occupational accidents with WRMSDs in a Portuguese hospital

Data collection was first performed in the “human resources department” in the hospital to identify the work accident cases and consequent WRMSDs. We then sent a questionnaire to each healthcare worker that included a socio demographic characterization and identified lost productivity by asking the following two questions (i) the number of days lost due to sick leave with work-related musculoskeletal disorders resulting from work accidents (absenteeism) and (ii) the level of presenteeism, which was assessed using the Work Limitations Questionnaire (reduced - 8 issues ) - WLQ
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CD10.R11: Minimum sanitation standard for hotels, restaurants, transportation facilities, and tourist centers

CD10.R11: Minimum sanitation standard for hotels, restaurants, transportation facilities, and tourist centers

recommended for application in hotels, restaurants, transportation facilities, and tourist centers.[r]

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Planning of hospitals and health facilities

Planning of hospitals and health facilities

A close look at Resolution XXV, as was said in Part I of this report, shows how broad in scope it is. Its stated principles imply the following considerations: Orderly incorpor[r]

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