The implementation of environmental health policies in health care facilities: The case of Malawi.

Establishing and maintaining safe and sufficient environmental health (EH) conditions in health care facilities (HCFs) is important to prevent and control infections. In 2018, the Government of Malawi finalized an environmental health policy that defines specific targets and programs for EH in healthcare settings. This and other related policies have been used since 2010 as a guide for EH practice in HCFs, but the implementation of these policies has been incomplete to-date. This study qualitatively examines the successes and shortcomings of implementing these policies in Malawi's public HCFs. Thematic analysis of interviews with 53 respondents from all levels of government was used to identify the successes of the policies and the barriers to effective implementation using Contextual Interaction Theory. The greatest identified strength lies in the design of the EH department and its ability to connect individual HCFs and EH actors directly to the policy-making level of government. Identified barriers to implementation include: insufficient financial support; lack of human resources; incomplete reporting; poor stakeholder coordination; and insufficient training of EH actors. We recommend refresher trainings for all EH actors, the establishment of a directorate level EH position, and strengthened coordination to improve the collection, analysis, and reporting of monitoring data to enable EH actors to advocate for the additional funding needed to develop programs for EH personnel and to apply effective EH interventions.

Subtalar joint motion and the relationship to lower extremity overuse injuries.

The purpose of this study was to determine if there was a difference between the subtalar joint ratio (transverse plane component to frontal plane component) in subjects with overuse symptoms in the foot compared with subjects with overuse symptoms in the leg and knee. Superior and posterior photographs were taken with the subtalar joint in pronation and supination while the subjects were in a seated position. The ratio of the transverse plane to frontal plane components of subtalar joint motion was calculated. A significant (p < 0.05) difference in the subtalar joint ratio existed between subjects with foot overuse symptoms and subjects with leg and knee overuse symptoms.

Biomechanical treatment of traumatic foot and ankle injuries with the use of foot orthotics.

Physical therapists commonly treat injuries that occur to the foot and ankle complex following trauma. The goals of rehabilitation typically focus on restoring motion and maximizing functional strength and proprioception. It is important to understand the normal biomechanics of the foot and ankle complex as well as the structural and biomechanical changes that occur following ankle fractures, calcaneal fractures, subtalar joint dislocations, and tarsometatarsal joint dislocations. The purpose of this paper is to provide a theoretical basis for the use of various types of foot orthotics in the biomechanical treatment of traumatic foot and ankle injuries.

Measurement of tibiofibular varum in subjects with unilateral overuse symptoms.

Lower extremity overuse injuries due to repeated microtrauma are often asymmetrical in nature. The purpose of this study was to determine if the amount of tibiofibular varum was asymmetrical in individuals with unilateral overuse injuries. The subjects were 20 patients who developed unilateral overuse symptoms of the leg and foot due to compensatory subtalar joint pronation. The distal one-third of the leg was bisected with the subjects standing in their normal base of support. The angle of this bisection to vertical was measured with a fluid inclinometer to determine the amount of tibiofibular varum. This measurement was performed in relaxed calcaneal stance and subtalar joint neutral stance. A single examiner performed all of the measurements and was blinded to the side of the subject's symptoms. A two-way analysis of variance for repeated measures was performed. There was a significant difference in the amount of tibiofibular varum between the injured and the uninjured extremities. There was also a significant difference between the measurements of tibiofibular varum when comparing the resting calcaneal stance and the subtalar joint neutral stance positions. This difference in tibiofibular varum between the injured and uninjured extremities may be one example of an asymmetry that can cause unilateral overuse symptoms.

The effects of foot orthotics on the EMG activity of selected leg muscles during gait.

Foot orthotics have been successfully used to treat muscular overuse leg injuries in athletes. The purpose of this study was to examine the effects of foot orthotics on the electromyographic (EMG) activity of the tibialis anterior, peroneus longus, and gastrocnemius muscles during walking. Ten volunteers with leg symptoms resulting from compensatory subtalar joint pronation were fitted with foot orthotics. The duration of tibialis anterior EMG activity following heel strike and the average EMG activity of the tibialis anterior, peroneus longus, and gastrocnemius muscles were collected with surface electrodes. Comparisons were made between the orthotic and nonorthotic conditions. A t-test for nonindependent samples with a significance level of p < 0.05 was used for data analysis. There was a statistically significant increase in the duration of tibialis anterior activity following heel strike in the orthotic condition. There were no significant differences in the average EMG activity for any of the three muscles between the orthotic and the nonorthotic conditions. This study suggests that foot orthotics had minimal effects on the muscles studied and that further research is necessary to determine the effectiveness of orthotics on the EMG activity of other leg muscles.

[Abortion trend and practice in 6 states in northern Mexico]. / Tendencias y practicas del aborto en los seis estados del norte de Mexico.

PIP: 10 socialworkers were recruited to identify and interview nonmedical abortion providers and clients in the northern Mexico states of Sonora, Tamaulipas, Chihuahua, Nuevo Leon, Coahuila, and Baja California for a 1979 study. Problems were encountered with wording of the questionnaire and the quality of the work of some of the social workers. 49 single clients aged 24.5 years on average and 29 married clients aged 29 years on average were interviewed. The married women appeared to be of slightly lower educational and social status than the single. Single women paid on average U. S. $91, $37 more than married women, but otained better service and had lower rates of complication. 65% of married women attempted to induced menstruation themselves before seeking abortions. Only 2 women, both married, waited more than 3 months to seek abortions, both because of lack of funds. Little relation was found between the cost, method, and quality of the abortions. Married women sought abortions typically for economic reasons, while single women did so for social reasons. The 11 female and 1 male nonmedical abortion providers were aged 32 to 53 years, 2 were nurses, and the rest had 6 or fewer years of education. 1 nurse performed D and Cs with local anesthesia, 7 used probes, 3 used herbal injections and 1 used an infusion of herbs. 5 had learned their techniques from medical personnel. Income from abortions was the major source of livelihood for 10 of the 12 but charges, volume of patients, and total income varied. The average provider had been performing abortions for over 10 years.^ieng