The modified slash Lindley-Weibull distribution with applications to nutrition data.

This work presents an extension of the slash Lindley-Weibull distribution, of which it can be considered a modification. The new family is obtained by using the quotient of two independent random variables: a two-parameter Lindley-Weibull distribution divided by a power of the exponential distribution with parameter equal to 2. We present the pdf and cdf of the new distribution, analyzing their risk functions. Some statistical properties are studied and the moments and coefficients of asymmetry and kurtosis are shown. The parameter estimation problem is carried out by the maximum likelihood method. The method is assessed by a Monte Carlo simulation study. We use nutrition data, which are characterized by high kurtosis, to illustrate the usefulness of the proposed model.

Perspectives, experiences, and opinions precepting advanced practice registered nurse students.

BACKGROUND: Significant growth in advanced practice registered nurse (APRN) student placements for clinical practicums have forced APRN preceptors, hospitals, and clinics to restrict the volume of APRN students they can accommodate. PURPOSE: Describe the experiences and opinions of APRNs regarding their precepting experiences of APRN students in three main areas; placement antecedents, placement postcedents, and preceptor incentives. METHODS: Quality improvement study conducted via electronic survey that contained quantitative short answer and a qualitative open-ended question of APRNs licensed in the State of REDACTED in June, 2019. FINDINGS: A total of 757 surveys were quantitatively analyzed. Qualitative thematic analysis resulted in identifying one overarching theme, the need for shared responsibility and accountability, and six unique primary themes. DISCUSSION: Our findings indicate that APRN preceptors recognize their critical role but lack support and preparation to fully execute academic and profession strategic goals and objectives. There is the need for academic and professional ownership of APRN education at every level.

Scope of Practice Barriers for Advanced Practice Registered Nurses: A State Task Force to Minimize Barriers.

Collegial relationships, administrative champions, and persistence are key components to breaking down barriers to advanced practice RN (APRN) practice. This article addresses how Iowa APRNs in a state-sanctioned task force identified barriers for practicing at the top of their licensure in a full practice authority state including defending the right to control the scope of nursing practice in court.

Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes.

In this study, researchers compare and contrast issues regarding diabetes self-management between persons in good versus poor glycemic control. The sample comprises low-income racially diverse adults with diabetes from four mid-western community health centers; 44 patients participated in eight focus groups divided by control status (HbA1c of > 9 [uncontrolled] or < 7 [controlled]). Themes common to both groups included the impact of dietary restrictions on social interactions, food cravings, the impact of mental health on self-management, and the importance of formal and informal (friends and family) support. Those in the uncontrolled groups described fear about being able to control their diabetes, confusion about self-management, and difficulty managing their diabetes while caring for family members. Although those in the controlled groups acknowledged difficulties, they discussed resisting cravings, making improvements with small changes, positive feelings about their ability to control their diabetes, and enjoying new foods and exercise. Interventions should include mental health support, incorporate formal and informal patient support structures, and address literacy issues. Health care providers and intervention personnel should be very concrete about how to do self-management tasks and guide patients on how to alter their diabetes regimens for social and other important life events.

The cancer pain practice index: a measure of evidence-based practice adherence for cancer pain management in older adults in hospice care.

Various clinical practice guidelines addressing pain assessment and management have been available for several years that pertain, at least to some extent, to older patients with cancer. Nonetheless, systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking. As part of a larger translating-research-into-practice pain improvement study involving older patients with cancer in hospice programs, we recognized the need to create a valid and reliable tool that can facilitate critical evaluation of hospice medical records for nurse and physician adherence to pain management guidelines to create a consolidated score for comparative and quality improvement purposes. We report the process used to create this tool, named the Cancer Pain Practice Index, and a guide to its use.

Implementing evidence-based practices: considerations for the hospice setting.

With increased regulation and scrutiny of outcomes, hospice programs are being challenged to consider the implementation of evidence-based practices (EBPs). This study reports findings from hospice director interviews and staff focus groups, which occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote evidence-based pain management practices. The purpose of this article is to provide background on the use of EBPs, to report facilitators and barriers to overall implementation of pain management EBPs in hospice, and to provide recommendations for hospices interested in increasing the use of EBPs. Three areas for evaluation prior to implementing an EBP initiative in hospices were identified: community, agency, and staff cultures. Recommendations for implementation of EBPs in hospices are provided.

Contribución a la ergonomia desde el análisis de la condición física en una muestra de trabajadores mineros con/sin síndrome de dolor lumbar (Región de Antofagasta, Chile) / Contribution to ergonomics from the analysis of physical condition in a sample of mine workers with and without lumbar pain (Region of Antofagasta, Chile)

Using a transversal design, we studied 40 male workers of a mining company in the north of Chile, in order to identify indicators of the physical conditions related to the syndrome of lumbar pain (SLP). The overall prevalence of SLP was 67.5%; the factors of physical condition, abdominal strength, fatigue of spinal erectors, general flexibility, lumbar flexibility and waist circumference were statistically associated with SLP. Although obesity and overweight were present in 65% of the studied sample, there was no statistical difference between the studied groups except for waist circumference. We conclude that ergonomics offers alternatives with scientific rigor which allow an adequate therapeutic and prophylactic management of this work-related pathology.

Determining Community Provider Practices in Hospices: The Challenges of Documentation.

Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage. This paper provides background on the importance of documentation, quality measures, outcomes of care, and regulatory imperatives in the hospice setting with specific observations from our research study and suggestions for changes in documentation practices.From our observations, we posit the necessity of pertinent outcome measures supported by standardized documentation processes in hospice. Uniformity in key practice indicators and patient outcome measures in documentation systems would advance the movement to improve quality and consistency of care in hospices. Standardization of documentation systems and language would also facilitate the conduct of research in the hospice setting, a population for which advancing knowledge is essential to assure quality care at the end of life.

Estimación de riesgo cardiovascular en trabajadores de una empresa molinera: Antofagasta, 2005 / Estimation of cardiovascular risk in workers of a mill company: Atofagasta 2005

In order to detect existence of cardiovascular risk associate to the work was examined 15 workers of a mill company of Antofagasta, having identified variable personal, environmental and procedural. The obtained results indicate that more than two thirds of the studied group it presented displayed overweight and obesity type 1, in addition to high and moderately high percentage of greasy mass with a positive variable of associated cardiovascular risk to the obesity and the excessive percentage of fat. In 12 cases an index was detected waist high and moderate hip, whereas 10 workers presented displayed arterial hypertension. The physiological service load described like moderate according to rate of pulse frequency, and like low according to the intraaural corporal temperature. Occupational heat exhibition the studied according to TGBH indicated absence of exhibition to physical risk according to law 16.744. The 1,867 kilocalories per day by food ingestion was calculated, situation that are not correlated with the high index of corporal mass, the percentage of greasy mass and the demanded physical loado An ergonomic strategy based on objective indicators sets out to orient the preventive management on the part of the company and continuous qualification of the workers in the matter of own health-care.

Para detectar existencia de riesgo cardiovascular asociado al trabajo se examinó 15 trabajadores de una empresa molinera de Antofagasta, identificando variables personales, ambientales y procedimentales. Se determinó sobrepeso y obesidad tipo 1 en más de dos tercios del grupo estudiado, además de porcentajes altos y moderadamente altos de masa grasa con una variable positiva de riesgo cardiovascular asociado a la obesidad y al porcentaje de grasa excesivo. En 12 casos se detectó un índice cintura cadera alto y moderado, en tanto que 10 trabajadores presentaron hipertensión arterial. La carga de trabajo fisiológico calificó como moderada según tasa de frecuencia de pulso, y como baja según la temperatura corporal intraaural. La exposición a calor ocupacional estudiada según temperatura de globo y bulbo húmedo indicó ausencia de exposición a riesgo físico según la ley 16.744. La ingesta de alimentos calculada fue de 1.867 kilocalorías por día, situación que no se correlaciona con el alto índice de masa corporal, el porcentaje de masa grasa y la carga física demandada.

Valoración de prueba de bioimpedanciometría en comparación con la de Skin Caliper para determinar prevalencia de obesidad y sobrepeso en trabajadores de la gran minería del Norte: Antofagasta, 2004 / Evaluation of the bioimpedanceometry test in comparison with the Kkin Caliper for determining the prevalence of obesity and overweight in workers from industrial mining operations in northern Chile: Antofagasta, 2004

Ergonomic measurements can have various orientations, one of which is evaluation and intervention related to excess weight and obesity of workers which may affect their health, quality-of-life, and productivity. In order to evaluate body composition it is necessary to have valid and instrumented tests applied in standard procedures in order to reasonably measure worker populations being surveyed. The present study used a screening, or population sweep technique, complemented with a prevalence or transverse design, which allowed determination of the sensitivity, predictive value, and probability ratio of the anthropometric technique of subcutaneous folds using the Skin Caliper, and comparing this with a bioinpedanceometry test as a reliability examination in order to determine the prevalence of obesity or excessive weight in the working population. The results indicated that about 67.0 percent of the population possessed moderate-to-high levels of body fat, indicating a high degree of cardiovascular risk. About 62.4 percent of this indicated a body mass index (IBM) representing overweight and obesity, inasmuch as 70.0 percent of the group studied was at cardiovascular risk based on the morbidity risk indicated by the waist/hip index (WHI). It was also shown that 100 percent of the workers in the study had lower than normal levels of body water content. Finally, the estimated energy consumption of the workers as determined by basal metabolism and daily work activity indicated excessive food intake. Using these results, an ergonomic program was designed which included training and education together with the plan of activities oriented towards controlling food intake and applied by the workers, involving each spouse. A single cohort as followed within which the incidence of obesity could be recorded longitudinally within the group using examination protocols which were identical with those used in the initial diagnosis of the group.

Las intervenciones ergonómicas pueden tener diversas orientaciones, siendo una de ellas la valoración e intervención relacionada al sobrepeso y obesidad de trabajadores lo que influye sobre su salud, calidad de vida y productividad, propósitos de la ergonomía. Para valorar la composición corporal es necesario disponer de pruebas validadas e instrumentales y de procedimientos estandarizados para intervenir racionalmente las poblaciones laborales en vigilancia. En este trabajo se utilizó un diseño de tamizaje o barrido poblacional, complementado con un diseño de prevalencia o transversal, lo que permitió determinar la sensibilidad, valor predictivo y razón de probabilidades de la técnica antropométrica de pliegues subcutáneos mediante Skin Caliper comparándola con la prueba de Bioimpedanciometría como examen de certeza y posteriormente se estableció la prevalencia en población laboral. Los resultaron indicaron que un 67,0 por ciento de la población estudiada califica con niveles de grasa corporal moderado-alto, lo que indica un alto riesgo cardiovascular. El 62,4 por ciento de ella posee un índice de masa corporal (IMC) compatible con sobrepeso y obesidad, en tanto que el 70,0 por ciento del grupo estudiado está en riesgo cardiovascular en razón de la comorbilidad asociada al índice cintura cadera (ICC). También se comprobó que el 100 por ciento de los trabajadores en estudio se encuentra bajo los niveles normales de agua corporal total. Finalmente, estimado el gasto energético de los trabajadores según metabolismo basal y actividades diarias en el desempeño, se identificó la condición de sobre ingesta alimentaria. Con estos resultados se diseñó un programa de ergonomía que contempla capacitación y educación junto a un plan de actividades orientado a controlar la ingesta y el gasto de los trabajadores, incorporando al cónyuge, e iniciando una cohorte única cuya incidencia será controlada longitudinalmente con protocolos de examinación idénticos a...

Suicidio en la Región de Antofagasta 1989-1999: ¿existe una tendencia creciente? / Suicide in the Región de Antofagasta 1989-1999: is there a increasing trend?

Introducción: La revisión de la literatura publicada revela que existe un incremento en la frecuencia, morbilidad y mortalidad por suicidios en población joven en distintos países. El presente es un estudio descriptivo destinado a determinar la incidencia de suicidios en la región de Antofagasta entre los años 1989-1999, y conocer la tendencia observada en ese lapso de tiempo. Material y Método. Se revisó la totalidad de los certificados de defunción del período. Se diseño un instrumento de recolección de información que fue aplicada a cada caso. Los datos fueron ingresados al programa Exel. Para el análisis estadístico se utilizó el programa Statgraphics. Resultados. Se encontró un total de 319 muertes, de las cuales 275 fueron hombres y 44 mujeres. Relación Hombre/Mujer de 5,4/1. Em ambos sexos más de dos tercios de los casos ocurrieron en menores de 45 años. Se confirmo el efecto de edad descrito en otros estudios. En hombres se observaron tasas elevadas en la región de Antofagasta y en especial en la comuna de Calama. En las mujeres se observa una tendencia decreciente de suicidios. Comparados los períodos 1989-95 con 1996-99, se observó un incremento de 34,5 por ciento en las tasas de los hombres menores de 45 años y una reducción de 35,9 por ciento en las tasas de las mujeres en ese grupo de edad. Conclusión. Se observó una tendencia creciente del suicidio en el sexo masculino en población joven en edad productiva. Se enfatiza la necesidad de mirar este fenómeno como un problema de salud pública y la necesidad de implementar un programa de monitoreo e intervención en esta materia

Epidemiología del suicidio en la segunda región de Chile / Epidemiology of suicide at the second region of Chile

Como problema de salud pública el suicidio ha adquirido especial relevancia estas últimas décadas. El los países occidentales ocupa las primeras cinco a diez causas de muerte. Desde un punto de vista epidemiológico el estudio de los patrones de muerte por suicidio podría arrojar luz sobre acciones que pudieran ser preventivas y por lo tanto salvadores de vidas. El presente es un estudio descriptivo destinado a conocer las características epidemiológicas del suicidio en la II Región, en el período comprendido entre los años 1989-1995. Se utilizó como metodología la revisión de la totalidad de los certificados de defunción que resume la mortalidad general de la Región en el período antes citado. Para recolectar la información se confeccionó un instrumento especialmente diseñado para este efecto. Se encontró un total de 194 casos: 161 hombres y 33 mujeres (relación H/M de 4,8-1). El promedio de edad de los hombres fue 39,05 y de las mujeres 43,12 años. A diferencia de otros estudios no se observó el efecto edad, ya que la población afectada es esencialmente joven en edad productiva. Las estaciones de mayor frecuencia de suicidio en los hombres son el invierno y el verano. No se encontró tendencia alguna respecto de los días de la semana. A partir de 1991 se observó un alza importante de suicidios en la Región (aumentó 14,6 por ciento) a expensas de los hombres, lo cual se reveló en lastasas que muestran valores altos comparados con el resto del país y Santiago. En las mujeres, a pesar de que no se observó alza en el suicidio, las tasas son igualmente elevadas hecha la comparación anterior. Se concluye la necesidad de efectuar otros estudios destinados a clarificar este problema