Female genital cutting in the Gambia: can education of women bring change?

BACKGROUND: In the Gambia, three out of four women of reproductive age have undergone Female Genital Cutting (FGC). Many studies and policy advocates suggest that for such a practice that is deeply rooted in culture, a more holistic approach focusing on educating the population will have sustainable impact. This research examined whether educational level of women has an association with their attitude towards the practice of FGC. METHODS: Data from the 2013 Gambia Demographic Health Survey (GDHS) were analyzed. The sample included 6217 households: 10,233 females aged between 15 to 49 years and 3831 males between 15-59 years. This study focused only on women participants. The outcome variable was the attitude of women toward the practice of FGC. RESULTS: In multivariate regression model, women who were circumcised are found to have 80 times higher odds of supporting FGC [Odds Ratio = 80 (95% CI 50.93-124.4)] compared to uncircumcised women. Women with primary and secondary level education have lower odds of supporting FGC [OR = 0.73 (95% CI 0.915-0.007)) and those with higher education had the lowest odds [OR = 0.28 (95% CI 0.147-0.543)) of supporting FGC relative to women with no education at all. CONCLUSIONS: Education and awareness programs targeting women who are married and older, those with less education and those who are already circumcised can help change attitudes towards the practice of FGC.

Electronic medical orders for life-sustaining treatment in New York State: Length of stay, direct costs in an ICU setting.

OBJECTIVE: In the United States, approximately 20% patients die annually during a hospitalization with an intensive care unit (ICU) stay. Each year, critical care costs exceed $82 billion, accounting for 13% of all inpatient hospital costs. Treatment of sepsis is listed as the most expensive condition in US hospitals, costing more than $20 billion annually. Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is a standardized documentation process used in New York State to convey patients' wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments. No study to date has looked at the effect of eMOLST as an advance care planning tool on ICU and hospital costs using estimates of direct costs. The objective of our study was to investigate whether signing of eMOLST results in any reduction in length of stay and direct costs for a community-based hospital in New York State. METHOD: A retrospective chart review was conducted between July 2016 and July 2017. Primary outcome measures included length of hospital stay, ICU length of stay, total direct costs, and ICU costs. Inclusion criteria were patients ≥65 years of age and admitted into the ICU with a diagnosis of sepsis. An independent samples t test was used to test for significant differences between those who had or had not completed the eMOLST form. RESULT: There were no statistical differences for patients who completed or did not complete the eMOLST form on hospital's total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU. SIGNIFICANCE OF RESULTS: Completing an eMOLST form did not have any effect on reducing total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.

U.S. military service and the prevalence of metabolic syndrome: Findings from a cross-sectional analysis of the Cooper Center Longitudinal Study, 1979-2013.

U.S. military service confers both health benefits and risks potentially associated with a clustering of cardiovascular risk factors called metabolic syndrome. However, the association between prior military service and metabolic syndrome has not sufficiently been examined. The purpose of the study was to compare the prevalence of metabolic syndrome by prior military service status. Among 42,370 men (887 with prior military service) examined from 1979 to 2013 at the Cooper Clinic (Dallas, TX), we used a cross-sectional study design to examine the association between military service and metabolic syndrome. First, an unadjusted log binomial regression model was performed by regressing the prevalence of metabolic syndrome on prior service. This was followed by performing Kleinbaum's modeling strategy for assessing confounding. The same methodology was used to explore the association between individual metabolic syndrome risk factors and prior service. Prior military service was not significantly associated with the prevalence of metabolic syndrome (PR=0.98, 0.89-1.07). None of the variables explored were identified as confounders. Participants with prior military service had lower prevalence of both elevated levels of triglycerides (PR=0.89, 0.80-0.99) and low levels of high-density lipoprotein-cholesterol (PR=0.78, 0.70-0.88). They had a higher prevalence of elevated resting systolic blood pressure (PR=1.23, 1.12-1.35). However, none of these associations were significant after adjusting for identified confounders: age; cardiorespiratory fitness; and exam year. Study findings indicate that military service was not independently associated with the prevalence of metabolic syndrome or its components. Future research is warranted longitudinally assessing the impact of military service on long-term outcomes.

A cost-benefit analysis of peer coaching for overhead lift use in the long-term care sector in Canada.

OBJECTIVES: To evaluate whether a peer-coaching programme for patient lift use in British Columbia, Canada, was effective and cost-beneficial. METHODS: We used monthly panel data from 15 long-term care facilities from 2004 to 2011 to estimate the number of patient-handling injuries averted by the peer-coaching programme using a generalised estimating equation model. Facilities that had not yet introduced the programme served as concurrent controls. Accepted lost-time claim counts related to patient handling were the outcome of interest with a denominator of full-time equivalents of nursing staff. A cost-benefit approach was used to estimate the net monetary gains at the system level. RESULTS: The coaching programme was found to be associated with a reduction in the injury rate of 34% during the programme and 56% after the programme concluded with an estimated 62 lost-time injury claims averted. 2 other factors were associated with changes in injury rates: larger facilities had a lower injury rate, and the more care hours per bed the lower the injury rate. We calculated monetary benefits to the system of $748 431 and costs of $894 000 (both in 2006 Canadian dollars) with a benefit-to-cost ratio of 0.84. The benefit-to-cost ratio was -0.05 in the worst case scenario and 2.31 in the best case scenario. The largest cost item was peer coaches' time. A simulation of the programme continuing for 5 years with the same coaching intensity would result in a benefit-to-cost ratio of 0.63. CONCLUSIONS: A peer-coaching programme to increase effective use of overhead lifts prevented additional patient-handling injuries but added modest incremental cost to the system.

The prevalence and risk factors of Post-Traumatic Stress Disorder among workers injured in Rana Plaza building collapse in Bangladesh.

OBJECTIVES: Prevalence and risk factors of PTSD among injured garment workers who survived a major factory collapse. METHODS: Survivors receiving treatment or rehabilitation care at one year post event were surveyed, which included Post Traumatic Stress Disorder Checklist Specific version. RESULTS: The respondents consisted of 181 people with a mean age of 27.8 years and a majority had less than high school education (91.2%). Multivariable logistic regression found that the odds of having PTSD was higher among married (OR: 3.2 [95% CI: 1.3-8.0]), those who used to work more than 70 hr/week (OR: 2.4 [1.1-5.3]), workers who used to hold higher job positions (OR: 2.6 [1.2-5.6]) or who had a concussion injury (OR: 3.7 [1.4-9.8]). Among the respondents, 83.4% remained unemployed, and only 57.3% (63 people) reported receiving a quarter or less of what they were promised as compensation. CONCLUSIONS: Probable PTSD was prevalent among surviving workers of the Rana Plaza building collapse in Bangladesh.

Investigation of Pertussis Cases in a Texas County, 2008-2012.

OBJECTIVES: Within the past 25 years, there has been a dramatic increase in the incidence of pertussis cases in the United States. As such, this investigation reports on the high-risk groups and describes risk factors of pertussis cases in a large Texas county. METHODS: This study was a cross-sectional analysis of data collected by health department employees using the Texas Department of State Health Service's Pertussis Case Track Record, which is the standard investigation form for collecting vital information on pertussis cases. We extracted and analyzed county-level data for a 5-year period (2008-2012). The study population at risk included all current residents in this county, and cases included all who were clinically diagnosed as having confirmed or probable pertussis cases that were reported to the health department according to the Centers for Disease Control and Prevention case definition. The vaccination status of a case was defined as fully vaccinated, partially vaccinated, or not vaccinated. RESULTS: A total of 198 probable and confirmed pertussis cases were included in this analysis. Most of the cases were infants younger than 1 year old (n = 107). The largest category of cases was not vaccinated and of the rest, 32.8% were partially vaccinated, 17.2% had unknown vaccination status, and 13.1% were fully vaccinated. Only 48 (24.2%) sources of exposure were identified and they included fathers (14.6%), sisters (14.6%), brothers (14.6%), other children (14.6%), and mothers (12.5%). Many sources of exposure (n = 26, 54.1%) were unaware of their vaccination history. Hispanics accounted for 84.5% of cases in the younger than 1 year old group and 88.9% of cases were in the 1 to 2 years old group. With respect to race/ethnicity and vaccination status of the cases, 39.46% of Hispanics, 32% of whites, and 50% of blacks were reported to be unvaccinated. CONCLUSIONS: Increasing pertussis vaccination coverage among children, as well as providing booster shots to adults with special attention on the Hispanic population, may prove to be an effective strategy for health departments.

Epidemiology of falls in older adults in Texas.

OBJECTIVES: The expected increase in the US older adult population implies an increased risk of fall-related injury among these individuals. We describe the epidemiology of fall morbidity among older adults in Texas, a large US state with a diverse population base. METHODS: Texas Behavioral Risk Factor Surveillance System 2010 data were analyzed. The falls outcome was defined as falling: any fall in the past 3 months and a serious fall: a fall resulting in limited activities for at least 1 day or requiring medical attention. RESULTS: A total of 5996 subjects were included in this analysis; 17.6% (n = 1055) reported falling 1 to 5 times in the previous 3 months, and 361 (6%) experienced serious falls. Risk of falling had a significant positive association among respondents who rated their general health as fair to poor (relative risk [RR] 2.39, 95% confidence interval [CI] 1.55-3.68) and a negative association for those who reported regular physical activity (RR 0.59, 95% CI 0.42-0.82). A similar model examined the risk of serious falls and found statistically positive associations in respondents who reported fair or poor general health (RR 3.29, 95% CI 2.00-5.43). Negative associations were found for those who reported regular physical activity (RR 0.56, 95% CI 0.38-0.83) and for men (RR 0.62, 95% CI 0.39-0.98). No statistically significant correlations for either of the fall outcomes were found with residence, obesity, education, income, age, ethnicity, employment, marital status, diabetes mellitus, or cardiovascular disease. CONCLUSIONS: Interventions aimed at the prevention of falls should focus on maintaining and improving general health and promoting physical activity among older adults.

Developing and Implementing a Citywide Asthma Action Plan: A Community Collaborative Partnership.

OBJECTIVES: Asthma affects 1 in 10 children in the United States, with higher prevalence among children living in poverty. Organizations in San Antonio, Texas, partnered to design and implement a uniform, citywide asthma action plan to improve asthma management capacity in schools. METHODS: The asthma action plan template was modified from that of the Global Initiative for Asthma. School personnel were trained in symptom recognition, actions to take, and use of equipment before the asthma action plan implementation. The annual Asthma Action Plan Summit was organized as a forum for school nurses, healthcare providers, and members of the community to exchange ideas and strategies on implementation, as well as to revise the plan. RESULTS: The asthma action plan was implemented in all 16 local school districts. Feedback received from school nurses suggests that the citywide asthma action plan resulted in improved asthma management and student health at schools. CONCLUSIONS: The evidence in this study suggests that community organizations can successfully collaborate to implement a citywide health initiative similar to the asthma action plan.

Trends in fall-related injuries among older adults treated in emergency departments in the USA.

To examine national trends in fall-related injuries among older adults treated in emergency departments (ED) and project these injuries until the year 2030. The Web-based Injury Statistics Query and Reporting System was used to generate data on fall-related injuries treated in ED. Joinpoint regression analysis was used to examine the average annual change in injury rates over time. Fall-related injury and hospitalisation rates increased on average by 2% (95% CI 1.5% to 2.7%) and by 4% (95% CI 2.9% to 5.0%) per year, respectively. Assuming the increase in fall-related injury rates remains unchanged, the number of fall-related injuries may increase to 5.7 million by the year 2030. Fall-related injuries among older adults treated in ED increased in the USA during the study period. Moreover, a marked increase in the number of these injuries may occur over the next decades.

Analysis of fall injuries by body mass index.

OBJECTIVE: To examine the association of body mass index (BMI) and fall injuries. METHODS: Data were derived from the 2010 Behavioral Risk Factor Surveillance System and included subjects aged 45 years and older from Texas. The outcome was self-reported falls that resulted in injury to the respondents. Analysis of fall injuries by BMI was conducted and standard errors, 95% confidence intervals (CIs), and coefficients of variation were reported. Complex sample multivariate Poisson regression was used to examine the association of BMI and fall injuries. RESULTS: A total of 18,077 subjects were surveyed in 2010, and 13,235 subjects were aged 45 years old and older. The mean BMI was higher (29.94 vs 28.32 kg/m(2)) among those who reported fall injuries compared with those who did not. The fall injuries reported by obese respondents (relative risk [RR] 1.67) were found to be significantly (P = 0.031) higher compared with normal-weight respondents in the multivariate regression. Other risk factors that had significant association with fall injuries (when adjusted for BMI) were activity limitations (RR 5.00, 95% CI 3.36-7.46) compared with no limitations, and not having formal employment (homemaker: RR 2.68, 95% CI 1.33-5.37; unable to work: RR 5.01, 95% CI 1.87-13.29; out of work and students: RR 3.21, 95% CI 1.41-7.29) compared with the employed population. CONCLUSIONS: There is a significant association between obesity and fall injuries in adults aged 45 years old and older in Texas. Interventions in fall prevention, although generally targeted at present to older adults, also should take into account the weight status of the subjects.

Noise exposure and serious injury to active sawmill workers in British Columbia.

BACKGROUND: Occupational noise might increase the risk of workplace injury through a variety of mechanisms, including interference with communication and increased stress. OBJECTIVES: The purpose of this study was to assess the effect of chronic noise exposure on serious workplace injury, and how the timing of exposure influenced risk. METHODS: The authors examined a cohort of 26 000 workers, who worked between 1950 and 1989. Cases were those hospitalised for a work-related injury (ICD-9 codes 800-999, and E codes E800-E999), from April 1989 to December 1998. Cumulative exposure levels were estimated for subjects based on a quantitative retrospective exposure assessment. An internal comparison of cumulative noise exposure and subchronic durations of noise exposure and injury was conducted using Poisson regression. There were 163 cases for the cumulative and 161 cases for the subchronic analysis. RESULTS: Cumulative noise exposure were associated with a decreased risk for injuries, with the risk generally decreasing as cumulative noise levels increased, while most durations of subchronic exposure were associated with an increased risk for injury. An inverse U-shaped trend was observed with the time period of 90 days to 1 year demonstrating the most elevated RR compared with 0-1 days of exposure. CONCLUSIONS: Workers highly exposed to noise, or exposed for long periods of time, might develop effective methods of communicating the risk and preventing injuries when exposed to noise.

Peer coaching and mentoring: a new model of educational intervention for safe patient handling in health care.

BACKGROUND: To reduce the risk of patient handling-related musculoskeletal injury, overhead ceiling lifts have been installed in health care facilities. To increase ceiling lift usage for a variety of patient handling tasks, a peer coaching and mentoring program was implemented among the direct care staff in the long-term care subsector in British Columbia, Canada. They received a 4-day training program on body mechanics, ergonomics, patient-handling techniques, ceiling lift usage, in addition to coaching skills. METHODS: A questionnaire was administered among staff before and after the intervention to evaluate the program's effectiveness. RESULTS: There were 403 and 200 respondents to the pre-intervention and post-intervention questionnaires. In general, staff perceived the peer-coaching program to be effective. The number of staff who reported to be using ceiling lifts "often and always" went higher from 64.5% to 80.5% (<0.001) after coaching program implementation. Furthermore, staff reported that they were using the ceiling lifts for more types of tasks post-intervention. Staff reported that the peer coaching program has increased their safety awareness at work and confidence in using the ceiling lifts. CONCLUSIONS: The findings suggest that this educational model can increase the uptake of mechanical interventions for occupational health and safety initiatives. It appears that the training led to a greater awareness of the availability of or increased perceptions of the number of ceiling lifts, presumably through coaches advocating their use.

How are the surviving workers of the Rana Plaza factory collapse in Bangladesh doing: quality of life, participation restriction, income and occupation.

PURPOSE: On April 24, 2013 a building called "Rana Plaza" that housed several garment factories collapsed in Bangladesh. Around 1134 people died and more than 2500 sustained serious injuries. This study evaluates the change in income and occupation of the Rana Plaza survivors as well as their level of community participation and quality of life two years after the incident. It also aimed to gain insight into these survivors' success or failure in economic reintegration. METHODS: A cross-sectional survey collected data from the injured garment workers using convenience sampling method. The Short Form 36 Items Questionnaire measured their quality of life, and the Participation Scale measured their community participation restriction level. Poor economic reintegration was defined when a survivor was not working or had an income less than 3000 Taka [US$36]/month. RESULTS: Data were collected from 338 Rana Plaza survivors all of who were previously garment workers. Their income decreased substantially after the disaster. The majority were now engaged in earning livelihood from retail shop management and animal husbandry. A total of 124 survivors (36.6%) were found to be poorly economically reintegrated; females were found to be at greater odds (twice) of poor economic reintegration than males. Those with severe participation restriction scores had four times greater odds and who reported moderate restriction had two times greater odds of poor economic reintegration compared to those with no restriction. CONCLUSIONS: Survivors of Rana Plaza factory disaster were facing many health and economic challenges two years after the event. Implications for rehabilitation Rehabilitation service providers should document and describe the health status correctly to understand the burden and monitor the effectiveness of their intervention. Government needs to develop and strengthen rehabilitation capacity as more workers will be injured as the country rapidly industrializes. Factory owners should create light duty work opportunities and provide other workplace modification for injured workers to re-enter the workforce.

Occupational and environmental risk factors for falls among workers in the healthcare sector.

Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004-2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56-8.69)) and community health workers (6.58 (3.76-11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January-March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions. STATEMENT OF RELEVANCE: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions.

Characterisation of persons with lower limb amputation who attended a tertiary rehabilitation centre in Bangladesh.

Objective: We aimed to describe the causes, types, and consequences of lower limb amputation and the demographics of subjects with such amputation who attended a tertiary rehabilitation center in Bangladesh, Centre for the Rehabilitation of the Paralysed.Methods: Cross-sectional data were collected from subjects with lower limb amputation who attended a specialized rehabilitation center between January 2014 and August 2016. Telephone interviews were conducted using a structured questionnaire. Descriptive analysis, paired t-test, and Fisher's exact test were conducted as well as a regression analysis was performed.Results: A total of 332 respondents, aged 5 to 76 years (mean 37.5± SD 13.8), with lower limb amputation participated in the study. Of the respondents, the majority were male (87.7%) and lived in rural areas (64.8%). Road traffic accidents were the leading cause (58.7%) of amputation followed by peripheral vascular diseases (7.5%) and hit by sharp objects (7.2%). Age (odds ratio: 0.9) and driving as occupation (odds ratio: 7.3) were found to be statistically significant covariates for amputation from road traffic accidents. The mean duration between having an amputation and receiving the first prosthetic fitting was 6.4 years (±8.9). Among the study participants, 30.7% lost their jobs after amputation and their mean monthly income reduced significantly (p < 0.01) from US$119.9 (±421.5) to US$45.8 (±63.1).Conclusion: Majority of the lower limb amputations resulted from traumatic road traffic accidents. Younger males and drivers were found to be more prone to amputation from road traffic accidents. Lower limb amputation creates great health and economic disparity in the amputee's lives.Implications for rehabilitationMajority of the lower limb amputation cases in Bangladesh were attributable to road traffic accidents-a largely preventable cause.The mean time between amputation and prosthetic fitting was more than 6 years which implies lack of awareness and inaccessibility of prosthetic management.Policymakers, regulators, law enforcement, and traffic safety advocates should take urgent actions to prevent road traffic accidents and raise awareness about and improve availability of prosthetic rehabilitation in Bangladesh.

Near miss and minor occupational injury: Does it share a common causal pathway with major injury?

BACKGROUND: An essential assumption of injury prevention programs is the common cause hypothesis that the causal pathways of near misses and minor injuries are similar to those of major injuries. METHODS: The rates of near miss, minor injury and major injury of all reported incidents and musculoskeletal incidents (MSIs) were calculated for three health regions using information from a surveillance database and productive hours from payroll data. The relative distribution of individual causes and activities involved in near miss, minor injury and major injury were then compared. RESULTS: For all reported incidents, there were significant differences in the relative distribution of causes for near miss, minor, and major injury. However, the relative distribution of causes and activities involved in minor and major MSIs were similar. The top causes and activities involved were the same across near miss, minor, and major injury. CONCLUSIONS: Finding from this study support the use of near miss and minor injury data as potential outcome measures for injury prevention programs.

Are female healthcare workers at higher risk of occupational injury?

BACKGROUND: Differential risks of occupational injuries by gender have been examined across various industries. With the number of employees in healthcare rising and an overwhelming proportion of this workforce being female, it is important to address this issue in this growing sector. AIMS: To determine whether compensated work-related injuries among females are higher than their male colleagues in the British Columbia healthcare sector. METHODS: Incidents of occupational injury resulting in compensated days lost from work over a 1-year period for all healthcare workers were extracted from a standardized operational database and the numbers of productive hours were obtained from payroll data. Injuries were grouped into all injuries and musculoskeletal injuries (MSIs). Detailed analysis was conducted using Poisson regression modelling. RESULTS: A total of 42 332 employees were included in the study of whom 11% were male and 89% female. When adjusted for age, occupation, sub-sector, employment category, health region and facility, female workers had significantly higher risk of all injuries [rate ratio (95% CI) = 1.58 (1.24-2.01)] and MSIs [1.43 (1.11-1.85)] compared to their male colleagues. CONCLUSIONS: Occupational health and safety initiatives should be gender sensitive and developed accordingly.

Evaluation of ceiling lifts in health care settings: patient outcome and perceptions.

Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the "year" variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation.

Geospatial Analysis of Refugee Access to Primary Care Physicians in San Antonio, Texas.

This study investigated refugee access to primary care physicians (PCP) in San Antonio, Texas. Catholic Charities of San Antonio (CCSA) is the primary agency responsible for connecting refugees to a PCP. Data on refugees were collected from CCSA between May to September 2013 (N = 547). PCPs information was accessed at the Texas Medicaid and Healthcare Partnership (TMHP) website. The 2SFCA method was used in geographic information systems (GIS) to analyze the ratio of healthcare providers relative to refugees within varying walking distances. The highest concentration of accessibility was at 20 min distance in the Medical Center area. The highest concentration of accessibility at all walking distances were also in the Medical Center area. The univariate and multivariate analyses did not result in significant findings for the association between demographic variables and the accessibility scores. These findings recommend building new and more relationships with healthcare providers where PCPs access is low.