Population characteristics and geographic coverage of primary care facilities.

BACKGROUND: The location of General Practitioner (GP) facilities is an important aspect in the design of healthcare systems to ensure they are accessible by populations with healthcare needs. A key consideration in the facility location decision involves matching the population need for the services with the supply of healthcare resources. The literature points to several factors which may be important in the decision making process, such as deprivation, transportation, rurality, and population age. METHODS: This study uses two approaches to examine the factors associated with GP accessibility in Northern Ireland. The first uses multinomial regression to examine the factors associated with GP coverage, measured as the proportion of people who live within 1.5 km road network distance from the nearest GP practice. The second focuses on the factors associated with the average travel distance to the nearest GP practice, again measured using network distance. The empirical research is carried out using population and geospatial data from Northern Ireland, across 890 Super Output Areas and 343 GP practices. RESULTS: In 19% of Super Output Areas, all of the population live within 1.5 km of a GP practice, whilst in 24% none of the population live within 1.5 km. The regression results show that there are higher levels of population coverage in more deprived areas, smaller areas, and areas that have more elderly populations. Similarly, the average travel distance is related to deprivation, population age, and area size. CONCLUSIONS: The results indicate that GP practices are located in areas with higher levels of service need, but also that care needs to be taken to ensure rural populations have sufficient access to services, whether delivered through GP practices or through alternative services where GP practices are less accessible. The methodology and results should be considered by policy makers and healthcare managers when making decisions about GP facility location and service provision.

[Architectural modernization of psychiatric hospitals influences the use of coercive measures]. / Bauliche Modernisierungen in psychiatrischen Kliniken beeinflussen Zwangsmaßnahmen.

BACKGROUND: Coercive measures are widely applied in psychiatric hospitals as a last resort to prevent patients seriously harming themselves or others, with negative psychological and somatic consequences for those affected. OBJECTIVE: In a naturalistic observational study it was investigated whether relocation of the structural milieu of a psychiatric hospital to an architectonically improved new building influenced the application of coercive measures. MATERIAL AND METHODS: The frequency and duration of coercive measures (e.g. fixation, coercive medication and preventive restraints) were routinely documented and compared in the periods before and after the relocation. RESULTS: After the relocation the utilization of coercive measures was significantly reduced by 48-84 %. CONCLUSION: Despite the limitations of the study design the results suggest that the architectural improvements reduced the application of coercive measures. It is speculated that the positive structural milieu enhanced the well-being of patients and staff and their social relations, which in turn prevented coercive measures.

Consumers fueling outpatient construction.

Construction leaders continue to see their biggest opportunities in outpatient care, but providers still face challenges delivering levels of customer service that patients have come to expect.

Implications of construction method and spatial scale on measures of the built environment.

BACKGROUND: Research surrounding the built environment (BE) and health has resulted in inconsistent findings. Experts have identified the need to examine methodological choices, such as development and testing of BE indices at varying spatial scales. We sought to examine the impact of construction method and spatial scale on seven measures of the BE using data collected at two time points. METHODS: The Children's Environmental Health Initiative conducted parcel-level assessments of 57 BE variables in Durham, NC (parcel N = 30,319). Based on a priori defined variable groupings, we constructed seven mutually exclusive BE domains (housing damage, property disorder, territoriality, vacancy, public nuisances, crime, and tenancy). Domain-based indices were developed according to four different index construction methods that differentially account for number of parcels and parcel area. Indices were constructed at the census block level and two alternative spatial scales that better depict the larger neighborhood context experienced by local residents: the primary adjacency community and secondary adjacency community. Spearman's rank correlation was used to assess if indices and relationships among indices were preserved across methods. RESULTS: Territoriality, public nuisances, and tenancy were weakly to moderately preserved across methods at the block level while all other indices were well preserved. Except for the relationships between public nuisances and crime or tenancy, and crime and housing damage or territoriality, relationships among indices were poorly preserved across methods. The number of indices affected by construction method increased as spatial scale increased, while the impact of construction method on relationships among indices varied according to spatial scale. CONCLUSIONS: We found that the impact of construction method on BE measures was index and spatial scale specific. Operationalizing and developing BE measures using alternative methods at varying spatial scales before connecting to health outcomes allows researchers to better understand how methodological decisions may affect associations between health outcomes and BE measures. To ensure that associations between the BE and health outcomes are not artifacts of methodological decisions, researchers would be well-advised to conduct sensitivity analysis using different construction methods. This approach may lead to more robust results regarding the BE and health outcomes.

Access to dental public services by disabled persons.

BACKGROUND: According to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde--SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil. METHODS: A cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments. RESULTS: 43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers. CONCLUSIONS: While access to dental services has increased in Fortaleza, the lack of accessibility of health units and their surroundings does not promote the treatment of people with disabilities. Cultural, organizational, architectural, geographical, and communication barriers constrain the demand for and use of oral dental care services by this social segment.

[Sustainability and hygiene of building: future perspectives]. / La sostenibilità dell'ambiente costruito: attualità e prospettive.

OBJECTIVES: Multiple factors influence individuals' health status. Their impact is difficult to quantify as it is their interaction. Aim of the current work is to develop guidelines to support designers to promote health in the residential environment and to apply them through an evaluation system to certify the level of health performance. DESIGN: Politecnico di Milano, in collaboration with the Local Health Authorities of Milan and Empoli through analysis of needs performance and numerous multidisciplinary meetings, has produced a design guide (Healthy Design Guide - HeDe) and an evaluation system to certify the level of health performance. This system was tested on the Milan metropolitan area. SETTING: The experiment was carried out on a sample of 30 private residences, with an overall floor area ranging between 90 and 150 square meters, new or recently renovated. RESULTS: The tool works but at the same time it also shows that too often design choices are made for aesthetic or economic reasons rather than a real need for health and wellness. CONCLUSIONS: It is becoming increasingly important to strengthen synergies and multidisciplinary collaborations to achieve shared performance indications and to make a systematic review of the regulatory tools to protect public health.

Dementia special care units: a comparison with standard units regarding residents' profile and care features.

BACKGROUND: Unlike other countries, no data about residents and care features in Special Care Units (SCUs) in Spanish nursing homes have been reported to date. The present paper is the first to analyze the characteristics of residents with dementia and the features of provided care in SCUs in comparison to residents with dementia in standard beds, thus not receiving specialized care in nursing homes in Spain. METHODS: Data on residents with dementia were collected in 11 nursing homes. Residents with diagnosis of dementia and Mini-Mental State Examination scores of less than 27 were randomly selected in each center. Altogether 197 residents were assessed: 102 (52%) placed in SCUs, and 95 (48%) in standard beds. Analyses of the characteristics of residents in SCUs versus standard beds regarding socio-demographic and clinical variables, features of the care provided, and residents' quality of life (QoL) were performed using univariate and multivariate tests (binary logistic regression analysis). RESULTS: Residents in SCUs did not differ from those in standard beds in socio-demographic variables. Placement of residents in SCUs seemed to be related with the presence of severe cognitive and functional impairment and aggressive behaviors. Being in an SCU conveyed a higher probability of having individual bedroom and bathroom; nevertheless, there were no differences in the care provided in SCUs, considering use of nappies, and feeding and restraint systems. Patients in SCUs showed lower QoL reported by the staff. CONCLUSIONS: Although residents in SCUs present higher levels of impairment, there are no real differences in the care provided besides a higher probability of having individual rooms. Regulations on required features for SCUs in Spain are necessary to guarantee that care provided to residents is truly special.

Rebuilding a statewide network of community health centers for the medically underserved: a longitudinal assessment.

The Strategic Facility Improvement (SFI) initiative, has resulted in the replacement of 44 outpatient clinics and 28 clinic renovation capital improvement projects across Louisiana's 64 parishes. A total of $67.3 million has been invested in this effort to date. The goal of the SFI is to improve the health status of medically underserved patient populations. It remains the sole capital improvement effort of its kind and has been in continuous implementation since 1991. The SFI consists of predesign needs assessment, analysis of alternate site planning options, historic preservation options in the adaptation of noteworthy community civic resources to healthcare uses, and the postoccupancy assessment of completed capital improvements with the aim of learning positive lessons that can be carried into future efforts. It is based on advocacy and guided by a statewide public health agency. The discussion is centered on a status report on a 21-year period and is examined critically from the perspective of key stakeholders.

Is renovation riskier than new construction?: an observational comparison of risk factors for stepladder-related falls.

BACKGROUND: Stepladder-related injuries at construction sites have increased in recent years. We aimed to quantify the prevalence of stepladder-related fall hazards in general construction and to compare the risks on renovation worksites to new construction build sites. METHODS: Eighteen worksites were visited, resulting in the observation of 771 stepladders. Eight of the sites were new builds and ten were renovation projects. RESULTS: High compliance with best practices was not observed for several factors, including having hands free while climbing (46%) and using minimum forces (72%). There was a notable trend toward more hazards on renovation build projects than on new construction sites; however, these differences were not statistically significant. CONCLUSIONS: There was not sufficient evidence to show that stepladder fall hazards are more prevalent on renovation projects than on new build projects. Having hands free while climbing and using minimum forces were two practices needing more wide-scale adoption regardless of construction job type.

Evaluation of environmental management resources (ISO 14001) at civil engineering construction worksites: a case study of the community of Madrid.

In recent years, significant advances have been made in business organization and management. The growing demands of clients as well as the globalization of world markets are among the many factors that have led to the establishment of systems of quality control and environmental management as a competitive strategy for businesses. When compared to other professional sectors, the construction sector has been slower to respond to environmental problems and to adopt Environmental Management Systems (EMS). In the world today the ISO 14001 standard is currently the main frame of reference used by construction companies to implement this type of management system. This article presents the results of a general study regarding the evaluation of the application of the ISO 14001 standard at civil engineering construction worksites in the Community of Madrid (Spain), specifically pertaining to requirement 4.4.1, Resources, roles, responsibilities, and authority. According to requirement 4.4.1, company executives should appoint people responsible for implementing the EMS and also specify their responsibilities and functions. The personnel designated for supervising environmental work should also have sufficient authority to establish and maintain the EMS. The results obtained were the following: - EMS supervisors did not generally possess adequate training and solid experience in construction work and in the environment. Furthermore, supervisors were usually forced to combine their environmental work with other tasks, which made their job even more difficult. - Generally speaking, supervisors were not given sufficient authority and autonomy because productivity at the construction site had priority over environmental management. This was due to the fact that the company management did not have a respectful attitude toward the environment, nor was the management actively involved in the establishment of the EMS. - Insufficient resources were allocated to the Environmental Management Unit. As a result, the application of EMSs in construction projects often appeared to be more of a formality, which was merely a way of maintaining the certification of the Environmental Management System. It was more a means of meeting the requirements for submitting a tender to contracting organisms rather than an indicator of any real commitment to improving the environmental performance of construction companies.

Health sciences libraries building survey, 1999-2009.

OBJECTIVE: A survey was conducted of health sciences libraries to obtain information about newer buildings, additions, remodeling, and renovations. METHOD: An online survey was developed, and announcements of survey availability posted to three major email discussion lists: Medical Library Association (MLA), Association of Academic Health Sciences Libraries (AAHSL), and MEDLIB-L. Previous discussions of library building projects on email discussion lists, a literature review, personal communications, and the author's consulting experiences identified additional projects. RESULTS: Seventy-eight health sciences library building projects at seventy-three institutions are reported. Twenty-two are newer facilities built within the last ten years; two are space expansions; forty-five are renovation projects; and nine are combinations of new and renovated space. Six institutions report multiple or ongoing renovation projects during the last ten years. CONCLUSIONS: The survey results confirm a continuing migration from print-based to digitally based collections and reveal trends in library space design. Some health sciences libraries report loss of space as they move toward creating space for "community" building. Libraries are becoming more proactive in using or retooling space for concentration, collaboration, contemplation, communication, and socialization. All are moving toward a clearer operational vision of the library as the institution's information nexus and not merely as a physical location with print collections.

Improving patient access through office hysteroscopy clinic redesign.

BACKGROUND AND OBJECTIVE: Patients with abnormal uterine bleeding (AUB) often require hysteroscopy as part of the diagnostic workup. The purpose of this study was to improve efficiency by shortening the time to patient appointment for office hysteroscopy. INTERVENTIONS: Preintervention, nurse practitioners (NPs) and gynecologists saw patients with abnormal uterine bleeding (AUB) separately. This created inefficiency for the patients, frequently requiring second visits for hysteroscopy. A new hysteroscopy clinic was designed to increase practice efficiency. A collaborative team model was created including consecutive visits with NPs and gynecologists. Each patient with AUB was first evaluated by an NP, followed immediately by a shorter visit with a gynecologist for office hysteroscopy as indicated. NPs managed other diagnostic evaluation and bleeding treatment if hysteroscopy was not warranted. Collaborative clinic staffing consisted of two NPs seeing patients with AUB paired with one gynecologist for procedural support. MEASUREMENTS AND RESULTS: Electronic records of 393 patients scheduled for AUB visits from January to June 2015 were evaluated for preintervention data. Postintervention, 647 patient records were reviewed from January to June of 2016. During the preintervention period, 30% of patients had a hysteroscopy appointment scheduled within 0-13 days from the initial visit for AUB. Postintervention, the wait time for appointments decreased, with 63% of patients scheduled within 0-13 days. Clinic redesign also resulted in an increase of 57.5% in appointment slots. No-show rates and appointment fill rates were not adversely affected. CONCLUSIONS: A collaborative team-based care model using NPs and gynecologists improved efficiency and access to office hysteroscopy services.

Utilization and physical activity levels at renovated and unrenovated school playgrounds.

OBJECTIVE: This study examined utilization and physical activity levels at renovated compared to unrenovated school playgrounds. METHODS: Ten unrenovated and ten renovated school playgrounds (renovated at least a year prior) in Cleveland, OH were matched on school and neighborhood characteristics. Using direct observation (SOPLAY), the number of persons attending each playground and their physical activity levels were recorded using separate counts for girls, boys, men and women. Each school was observed ten times for 90 min each time outside of school hours in 2005. Paired t-tests, Wilcoxon Signed Ranks tests, and regression analyses were completed to examine differences across school pairs. RESULTS: More persons overall including adults and children utilized the renovated playgrounds compared to the unrenovated playgrounds. The proportion moderately-to-vigorously active was not different between renovated and unrenovated playgrounds although the proportion of children, in particular boys, who were vigorously active was greater at the renovated playgrounds. Although utilization was higher at the renovated playgrounds, absolute utilization was low across all playgrounds. CONCLUSIONS: This study suggests that playgrounds renovations may have the potential to increase the number of children utilizing the playground outside of school hours and may increase the proportion of children, especially boys, who are vigorously active.

Impact of work-related factors, lifestyle, and work ability on sickness absence among Dutch construction workers.

OBJECTIVE: The objective of this study was to evaluate the relative contribution of individual characteristics, lifestyle factors, work-related risk factors, and work ability on the occurrence of short (<2 weeks), moderate (2-12 weeks), and long (>12 weeks) durations of sickness absence. METHODS: Altogether 5867 Dutch construction workers with complete sick leave registration were followed from the day of their medical examination in 2005 until the end of 2006. The main outcome of the study was the duration of sickness absence, as registered by an occupational health service. Independent variables consisted of individual characteristics, lifestyle factors, work-related factors, and the work ability index. We used Poisson regression analyses with repeated occurrence of sick leave to calculate rate ratios (RR) and 95% confidence intervals of independent variables for the three categories of sick leave duration. RESULTS: Predictors for sick leave lasting 2-12 weeks and >12 weeks were: older age, obesity, smoking, manual materials handling, lack of job control, lung restriction, and a less than excellent work ability. For most predictors, higher RR values were observed with a longer duration of sickness absence. Obesity, smoking, manual materials handling, and lack of job control remained important risk factors for moderate and long durations of sick leave after adjusting for the strong effects of work ability on sickness absence. The highest population-attributable fractions were observed for: age over 50 years (18%), manual materials handling (20%), and good (18%), moderate (28%), and poor (2%) work ability. CONCLUSION: This study suggests that a variety of preventive measures targeted at smoking, obesity, physical load, psychosocial work factors as well as work ability will contribute to a reduction in the occurrence of sick leave.

Predictors of hearing protection use in construction workers.

OBJECTIVES: Although noise-induced hearing loss is completely preventable, it remains highly prevalent among construction workers. Hearing protection devices (HPDs) are commonly relied upon for exposure reduction in construction, but their use is complicated by intermittent and highly variable noise, inadequate industry support for hearing conservation, and lax regulatory enforcement. METHODS: As part of an intervention study designed to promote HPD use in the construction industry, we enrolled a cohort of 268 construction workers from a variety of trades at eight sites and evaluated their use of HPDs at baseline. We measured HPD use with two instruments, a questionnaire survey and a validated combination of activity logs with simultaneous dosimetry measurements. With these measurements, we evaluated potential predictors of HPD use based on components of Pender's revised health promotion model (HPM) and safety climate factors. RESULTS: Observed full-shift equivalent noise levels were above recommended limits, with a mean of 89.8 +/- 4.9 dBA, and workers spent an average of 32.4 +/- 18.6% of time in each shift above 85 dBA. We observed a bimodal distribution of HPD use from the activity card/dosimetry measures, with nearly 80% of workers reporting either almost never or almost always using HPDs. Fair agreement (kappa = 0.38) was found between the survey and activity card/dosimetry HPD use measures. Logistic regression models identified site, trade, education level, years in construction, percent of shift in high noise, and five HPM components as important predictors of HPD use at the individual level. Site safety climate factors were also predictors at the group level. CONCLUSIONS: Full-shift equivalent noise levels on the construction sites assessed were well above the level at which HPDs are required, but usage rates were quite low. Understanding and predicting HPD use differs by methods used to assess use (survey versus activity card/dosimetry). Site, trade, and the belief that wearing HPD is not time consuming were the only predictors of HPD use common to both measures on an individual level. At the group level, perceived support for site safety and HPD use proved to be predictive of HPD use.

Reliability and validity testing of the SF-36 questionnaire for the evaluation of the quality of life of Chinese urban construction workers.

The quality of life (QOL) of the Chinese 'floating' migrant population is of growing concern. Urban construction workers are the main migrant population in China, but there is little published research on their QOL. The reliability and validity of the 36-Item Short Form Health Survey (SF-36) questionnaire were assessed by conducting a population-based study of migrant construction workers in Shenyang, China. Two construction sites were randomly selected from each of the five districts of Shenyang City and 1200 copies of the questionnaire were distributed to rurally-registered, non-Shenyang workers aged > or = 16 years at these sites. A total of 1125 questionnaires were evaluated. The overall Cronbach's alpha coefficient of the SF-36 questionnaire was 0.821 while the respective Cronbach's alpha coefficient for each dimension was > 0.70. Results showed that the SF-36 questionnaire demonstrated good reliability and validity, and that it can be used to measure QOL among Chinese migrant urban construction workers.

Safety and ergonomic considerations for an aging workforce in the US construction industry.

The US construction workforce is aging as millions of baby boomers move toward retirement age. Older workers make a substantial contribution to construction in terms of skills and experience. However, construction is still one of the most physically demanding occupations, hence the health implications for older workers. Descriptions of injuries, illnesses and fatalities among older workers in the US construction industry from recent literature are presented along with the practical health and safety interventions that have been proposed including: ergonomic interventions, wellness programs, worksite housekeeping, training, and safety climate. Understanding the risks and hazards in specific industries could help identify training and intervention requirements to meet the challenges facing aging workers in these occupational groups.

A Cross-Sectional Survey on the Impact of Irrelevant Speech Noise on Annoyance, Mental Health and Well-being, Performance and Occupants' Behavior in Shared and Open-Plan Offices.

This cross-sectional survey has compared subjective outcomes obtained from workers in shared (2⁻5 occupants) and open-plan (+5 occupants) offices, related to irrelevant speech, which is the noise that is generated from conversations between colleagues, telephone calls and laughter. Answers from 1078 subjects (55% in shared offices and 45% in open-plan offices) have shown that irrelevant speech increases noise annoyance, decreases work performance, and increases symptoms related to mental health and well-being more in open-plan than in shared offices. Workers often use headphones with music to contrast irrelevant speech in open-plan offices, while they take a break, change their working space, close the door or work from home in shared offices. Being female, when there are more than 20 occupants, and working in southern cities without acoustic treatments in the office, make it more likely for the occupants to be annoyed by irrelevant speech noise in open-plan offices. While, working in southern cities and with acoustic treatments in the office makes it more likely that noise annoyance will be reported in shared offices. Finally, more than 70% of the interviewed in open-plan offices were willing to reduce their voice volumes when advised by a noise monitoring system with a lighting feedback.

Safety assessment in plant layout design using indexing approach: implementing inherent safety perspective. Part 2-Domino Hazard Index and case study.

The design of layout plans requires adequate assessment tools for the quantification of safety performance. The general focus of the present work is to introduce an inherent safety perspective at different points of the layout design process. In particular, index approaches for safety assessment and decision-making in the early stages of layout design are developed and discussed in this two-part contribution. Part 1 (accompanying paper) of the current work presents an integrated index approach for safety assessment of early plant layout. In the present paper (Part 2), an index for evaluation of the hazard related to the potential of domino effects is developed. The index considers the actual consequences of possible escalation scenarios and scores or ranks the subsequent accident propagation potential. The effects of inherent and passive protection measures are also assessed. The result is a rapid quantification of domino hazard potential that can provide substantial support for choices in the early stages of layout design. Additionally, a case study concerning selection among various layout options is presented and analyzed. The case study demonstrates the use and applicability of the indices developed in both parts of the current work and highlights the value of introducing inherent safety features early in layout design.

[Injury rates and severity during the construction of High Speed Train Track Torino-Novara: which are the expected risks?]. / Frequenza e gravità infortunistiche nei cantieri dell'alta velocità Torino-Novara: qual e il rischio infortunistico atteso?

BACKGROUND: Construction of the Torino-Novara High Speed Train Track (TAV) provided a unique opportunity to describe the magnitude of accidents on a major construction project for which complete data were available for 123 companies with over 10,000 employees. OBJECTIVES: To describe the rate and severity of accidents during the construction of TAV and to compare this with national indexes. The limits and critical points of the national surveillance system are discussed and solutions for responding to public occupational safety and health service needs are proposed. METHODS: 1,691 injuries with more than 3 lost work days were recorded between 2003 and 2005 by the TAV Surveillance System (Orme-TAV). Accident rate and severity indexes (Orme indexes) by year and occupation, were compared with indexes for Piedmont and Italy for the period 2002-04 provided by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) for the Construction sector and the Road and Railway Construction sub-sector. A comparison with the accident rate of the same 123 firms calculated for all construction yards in Italy in 2003-04 (national indexes) was also made. RESULTS: Accident rates decreased from 152 in 2003 to 72 in 2005 per 1,000 workers, but were higher than the national indexes (the Orme indexes/national indexes ratio was 1.75 in 2003 and 1.67 in 2004). Accident severity indexes were lower than the national figures. DISCUSSION: Complete reporting, facilitated by the existence of a Surveillance System, yielded accident rates that were more reliable than those previously reported. Data suggest that the discrepancy is due to both underreporting and exposed worker assessment difficulties. The burden of on-site work-related accidents in the construction sector appears to be higher and more costly than what has been desumed from national data.