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1.
Environ Pollut ; 292(Pt A): 118298, 2021 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-34626702

RESUMEN

There are large knowledge gaps concerning environmental levels and fate of many organic pollutants, particularly for chemicals of emerging concern in tropical regions of the Global South. In this study, we investigated the levels of chlorinated paraffins (CPs) and dechloranes in air and soil in rural, suburban, and urban regions in and around Dar es Salaam, Tanzania. Samples were also collected near the city's main municipal waste dumpsite and an electronic waste (e-waste) handling facility. In passive air samples, short chain CPs (SCCPs) dominated, with an average estimated concentration of 22 ng/m3, while medium chain CPs (MCCPs) had an average estimated concentration of 9 ng/m3. The average estimated air concentration of ∑dechloranes (Dechlorane Plus (DP) + Dechlorane 602 + Dechlorane 603) was three to four orders of magnitudes lower, 2 pg/m3. In soil samples, MCCPs dominated with an average concentration of 640 ng/g dw, followed by SCCPs with an average concentration of 330 ng/g dw, and ∑dechloranes with an average concentration of 0.9 ng/g dw. In both air and soil, DP was the dominating dechlorane compound. Urban pulses were observed for CPs and dechloranes in air and soil. CPs were in addition found in elevated levels at the municipal waste dumpsite and the e-waste handling facility, while DPs were found in elevated levels at the e-waste handling facility. This suggests that waste handling sites represent important emission sources for these pollutants. Investigations into seasonal trends and environmental fate of CPs and dechloranes showed that monsoonal rain patterns play a major role in governing air concentrations and mobility, particularly for the less volatile MCCPs and dechloranes. This study is the first to report levels of CPs in air from sub-Saharan Africa, and DP, Dechlorane 602, and Dechlorane 603 in soil from sub-Saharan Africa.

2.
Infect Chemother ; 53(3): 421-435, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34623776

RESUMEN

Antimicrobial resistance has emerged as a serious global public health threat. One of the countermeasures to increased antibiotic-resistant bacterial infections is the use of an integrative intervention strategy for the selection and administration of appropriate antibiotics and for the monitoring of antibiotic use, collectively known as "Antimicrobial Stewardship Programs" (ASPs). However, since the medical environment and policies vary by country and medical facilities, ASPs also need to be applied to each facility and condition accordingly. The United States Centers for Disease Control and Prevention announced the core elements for hospital ASPs, which outlines the specific structural and procedural components required to implement ASPs in 2014. As multidrug-resistant bacterial infections and use of broad-spectrum antibiotics in Korea are on the rise, ASPs must be urgently applied to medical facilities for appropriate management of antibiotic use. However, there is an ongoing limitation to the immediate adoption and application of ASPs in Korean medical facilities due to the lack of medical workforce and related financial resources. To address this issue, efforts of medical professionals and government are required, and core elements that match the characteristics and circumstances of Korean medical facilities must be urgently developed.

3.
Environ Monit Assess ; 193(10): 682, 2021 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-34595610

RESUMEN

Local primary emissions of air pollutants are responsible for public health, decreasing productivity, and cultural activities in local residential areas. In this study, an integrated air quality observation and modeling system with a geographical information system (GIS) was developed to characterize the air pollution caused by local primary emission sources. This integrated system could provide air quality monitoring, data analysis, and visualization results that reflect air pollutant concentration data in a study area containing a local rural village (LRV) and an asphalt manufacturing facility (AMF). Additionally, the model was used to estimate the contributions of air quality from an emission source at the receptor and determine the control factor for the emission rate or meteorological changes. From the forward and backward modeling results, we found that the concentrations of particulate matter smaller than 2.5 µm (PM2.5) concentrations in the village were affected by the unique meteorological and emission conditions. The PM2.5 concentration was significantly increased for the cases with a slow wind speed of 1 m/s or high wind speed of 3 m/s, with an emission rate of 10 g/s. The contribution of AMF emissions was explained by contribution factor analysis. During the study period of December 2014-December 2015, the incoming contribution of PM2.5 at the LRV measurement station was approximately 47.6%. These results suggest that the proposed method can be useful for understanding adverse air quality conditions and estimating the emissions of air pollutants from primary sources for local environmental and public health authorities.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Monitoreo del Ambiente , Sistemas de Información Geográfica , Material Particulado/análisis
4.
Reprod Health ; 18(1): 188, 2021 Sep 22.
Artículo en Inglés | MEDLINE | ID: mdl-34551794

RESUMEN

BACKGROUND: Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services. METHODS: A qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were analysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation. RESULTS: Key factors that influenced the implementation of the community-based interventions were the community readiness to adopt the interventions and effective local administrative systems. Stakeholders' engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions. CONCLUSION: This study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members' reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions.


Asunto(s)
Atención Prenatal , Femenino , Grupos Focales , Humanos , Embarazo , Investigación Cualitativa , Tanzanía
5.
Environ Toxicol Chem ; 2021 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-34529856

RESUMEN

The presence of pharmaceutically active compounds (PACs) in the environment and their associated hazards is a major global health concern; however, data on these compounds are scarce in developing nations. In the present study, the existence of 39 non-antimicrobial PACs and six of their metabolites in wastewater from hospitals and adjacent surface waters in Sri Lanka was investigated from 2016-2018. The highest amount of the measured chemicals, including the highest concentrations of atorvastatin (14,620 ng/L) and two metabolites, mefenamic acid (12,120 ng/L) and o-desmethyl tramadol (8,700 ng/L), were detected in wastewater from the largest facility. Mefenamic acid, gemfibrozil, losartan, cetirizine, carbamazepine, and phenytoin were detected in all the samples. The removal rates in wastewater treatment were 100% for zolpidem, norsertaline, quetiapine, chlorpromazine, and alprazolam. There was substantial variation in removal rates of PACs among facilities, and the overall data suggest that treatment processes in facilities were ineffective and that some PAC concentrations in the effluents were increased. The estimated risk quotients revealed that 14 PACs detected in water samples could pose low to high ecological risk to various aquatic organisms. Compounds such as ibuprofen, tramadol, and chlorpromazine detected in untreated and treated wastewater at these facilities pose a high risk to several aquatic organisms. This study provides novel monitoring data for non-antimicrobial PAC abundance and the associated potential ecological risk related to hospitals and urban surface waters in Sri Lanka and further offers invaluable information on pre-COVID-19 era PAC distribution in the country. This article is protected by copyright. All rights reserved.

6.
Ann Med Surg (Lond) ; : 102763, 2021 Aug 26.
Artículo en Inglés | MEDLINE | ID: mdl-34462651

RESUMEN

Background: The outbreak of coronavirus disease (COVID-19) highlights the global health emergency. To limit the rate of COVID-19 transmission to health care workers, adequate personal protective equipment's (PPE's) are required. Emerging reports indicate that the widespread usage of PPE during the COVID-19 outbreak has exacerbated plastic contamination in the ocean. Purpose: This paper attempts to understand the influence of practice, benefits, and impact of personal protective equipment (PPE) during the COVID-19 crisis on clean water sanitation, life below water, and life on land (SDGs 6, 14, and 15 respectively) in Fiji and assess the effectiveness of measurements taken to deal with this crisis. Fiji is a small Pacific Island Country (PIC) and the global crisis of COVID-19 entered the Fijian border on 19th, March 2020. Sadly, the second wave of COVID-19 was reported on 18th, April 2021, which began at a managed quarantine facility after contact between a couple returning from India to Fiji and a soldier. Since then the number of cases have been increasing daily and posing a risk to the public. Materials and method: A personal observations were made to collect the PPE pollution on the streets, near roads, car parks, markets, and towns. Results: The widespread PPE pollution was noticed, the common PPE found in the Vesivesi road of Suva, Fiji was facemask (61.36%) and hand gloves (38.64%), as it is mostly used by the general public, police offices, municipal waste management, shopping malls works, and medical care workers. Face shield littering was limited due to fewer users. Conclusions: In response to the COVID-19 pandemic, this study stresses a great concern on enabling SDGs 6, 14, and 15 and how the use of PPEs during COVID-19 has impacted the natural environment. It is critical to remember that managing PPE waste during a contagious pandemic should be treated as an emergency and handled quickly.

7.
PLoS One ; 16(8): e0256904, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34464423

RESUMEN

The 15-minute community life circle (15min-CLC) strategy is one of Shanghai's important methods for building a global city and facing a society with a more diverse population structure in the future. In the existing research, the balance between the construction of the life circle and the needs of the people in the life circle still needs to be further fulfilled. This paper is based on the city's multi-source large data set including 2018 AutoNavi POI (Point of Interests), OSM (OpenStreetMap) road network data and LandScan population data set, and evaluates the current status of Shanghai's 15min-CLC through the fusion of kernel density estimation, service area analysis and other statistical models and proposes relevant optimization suggestions. The results show that there are the following shortcomings: (1) From the perspective of different types of infrastructure service facilities, the spatial construction of Shanghai's overall life service facilities and shopping service facilities needs to be optimized. (2) From the perspective of comprehensive evaluation, the comprehensive service convenience of infrastructure service facilities in the downtown area is relatively high, while the comprehensive service convenience of urban infrastructure service facilities in the suburbs and outer suburbs is relatively low; The diversity of basic service facilities in the 15min-CLC in the downtown area is more consistent with the population distribution; However, in the peripheral areas of the urban area, too many infrastructure service facilities have been constructed. Based on the above shortcomings and the perspective of supply and demand matching, relevant optimization strategies are proposed in different regions and different types of infrastructure service facilities: (1) focus on the construction of basic service facilities in the urban fringe and urban-rural areas, improve the full coverage of the basic service facilities, and appropriately reduce the number of basic service facilities in the downtown area. (2) The development of community business models can be used to promote the development of new life service facilities and shopping service facilities. (3) Improve community medical institutions through facility function conversion, merger and reconstruction, etc. (4) Optimize the hierarchical basic service facility system and improve the population supporting facilities of basic service facilities in the 15min-CLC. This paper incorporates people's needs and concerns on the living environment into the 15min-CLC evaluation model, and uses Shanghai as an example to conduct research, summarizes the existing shortcomings, and proposes corresponding optimization strategies based on the matching of supply and demand. This article attempts to explore a replicable 15min-CLC planning model, so that it can be extended to the Yangtze River Delta urban agglomeration, to provide reference for further research on the 15min-CLC, and to promote urban construction under the concept of sustainable development.

8.
Infect Dis Clin North Am ; 35(3): 697-716, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34362539

RESUMEN

The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.


Asunto(s)
COVID-19 , Defensa Civil , Instituciones de Salud/tendencias , Control de Infecciones , Administración de la Seguridad/organización & administración , COVID-19/epidemiología , COVID-19/prevención & control , Defensa Civil/métodos , Defensa Civil/organización & administración , Ambiente Controlado , Arquitectura y Construcción de Hospitales/métodos , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , SARS-CoV-2
9.
PLoS One ; 16(7): e0254083, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34234372

RESUMEN

BACKGROUND: Malawi has halved the neonatal mortality rate between 1990-2018, however, is not on track to achieve the Sustainable Development Goal 12 per 1,000 live births. Despite a high facility birth rate (91%), mother-newborn dyads may not remain in facilities long enough to receive recommended care and quality of care improvements are needed to reach global targets. Physical access and distance to health facilities remain barriers to quality postnatal care. METHODS: Using data We used individual data from the 2015-16 Malawi Demographic and Health Survey and facility data from the 2013-14 Malawi Service Provision Assessment, linking households to all health facilities within specified distances and travel times. We calculated service readiness scores for facilities to measure their capacity to provide birth/newborn care services. We fitted multi-level regression models to evaluate the association between the service readiness and appropriate newborn care (receiving at least five of six interventions). RESULTS: Households with recent births (n = 6010) linked to a median of two birth facilities within 5-10 km and one facility within a two-hour walk. The maximum service environment scores for linked facilities median was 77.5 for facilities within 5-10 km and 75.5 for facilities within a two-hour walk. While linking to one or more facilities within 5-10km or a two-hour walk was not associated with appropriate newborn care, higher levels of service readiness in nearby facilities was associated with an increased risk of appropriate newborn care. CONCLUSIONS: Women's choice of nearby facilities and quality facilities is limited. High quality newborn care is sub-optimal despite high coverage of facility birth and some newborn care interventions. While we did not find proximity to more facilities was associated with increased risk of appropriate care, high levels of service readiness was, showing facility birth and improved access to well-prepared facilities are important for improving newborn care.

10.
J Food Prot ; 2021 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-34265068

RESUMEN

The COVID-19 pandemic has greatly impacted the US food supply and consumer behavior. Food production and processing are being disrupted as illnesses, proactive quarantines, and government-mandated movement restrictions cause labor shortages. In this environment, the food industry has been required to adopt new, additional practices to minimize the risk of COVID-19 cases and outbreaks among its workforce. Successfully overcoming these challenges requires a comprehensive approach that addresses COVID-19 transmission both within and outside the facility; possible interventions include strategies to (i) vaccinate employees, (ii) assure that employees practice social distancing, (iii) assure that employees wear face coverings, (iv) screen employees for COVID-19 (v) assure that employees practice frequent handwashing and avoid touching their faces, (vi) clean frequently touched surfaces, and (vii) assure proper ventilation. Compliance with these control strategies needs to be verified and an overall "COVID-19 control culture" needs to be established to facilitate an effective program. Despite some public misperceptions about SARS-CoV-2 presence on foods or food packaging representing a public health risk, it is important to note that both the virus' biology and epidemiological data clearly support a negligible risk of COVID-19 transmission through food and food packing. However, COVID-19 pandemic related supply chain and workforce disruptions, as well as the shift in resources to protect food industry employees from COVID-19 may increase the actual food safety risks. The goal of this paper is to review the COVID-19 mitigation practices adopted by the food industry, and the potential impact of these practices and COVID-19 related disruptions on the industry's food safety mission. A review of these impacts is necessary to ensure that the food industry is prepared to maintain a safe and nutritious food supply in the face of future global disruptions.

11.
Bioinformatics ; 2021 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-34117876

RESUMEN

MOTIVATION: ITSoneWB (ITSone WorkBench) is a Galaxy-based bioinformatic environment where comprehensive and high-quality reference data are connected with established pipelines and new tools in an automated and easy-to-use service targeted at global taxonomic analysis of eukaryotic communities based on Internal Transcribed Spacer 1 variants high-throughput sequencing. AVAILABILITY: ITSoneWB has been deployed on the INFN-Bari ReCaS cloud facility and is freely available on the web at http://itsonewb.cloud.ba.infn.it/galaxy. SUPPLEMENTARY INFORMATION: Supplementary data are available at https://github.com/ibiom-cnr/itsonewb/wiki.

12.
Infect Dis Now ; 51(5): 424-428, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34157429

RESUMEN

OBJECTIVES: Even though SARS Cov2 outbreak management has been well-described, scant information is available in military settings. We aimed to describe a SARS Cov2 outbreak and its management on the Dixmude, a French landing helicopter dock. PATIENTS AND METHODS: We performed an observational retrospective and monocentric study in a ship. Role 1 was reinforced by additional roles 1 and 2. Our analysis included all infected crew personnel. We described demographic data, outbreak course, and biological samples including Covid-19 diagnosis. All infected patients were monitored for 10 days. RESULTS: Between February 16th 2021 and March 12th 2021, 54 patients (10% of the entire crew) were included. No patient had previously been vaccinated against SARS Cov2. The global mission was maintained. The crew members were healthy, male, and young (median age 28 years) with no medical history. Ranks of every status were concerned. Covid-19 disease was mainly diagnosed by real-time reverse-transcriptase polymerase chain reaction (rt-PCR). Thirty-two patients (59%) were symptomatic, four (8%) were presymptomatic and 18 (33%) remained asymptomatic. CONCLUSIONS: The present work describes specific SARS Cov2 outbreak management in an austere military environment. Early individual and global measures were set and implemented on board.


Asunto(s)
COVID-19/epidemiología , Brotes de Enfermedades , Adulto , Aeronaves , COVID-19/terapia , Femenino , Francia/epidemiología , Humanos , Masculino , Instalaciones Militares , Estudios Retrospectivos , Adulto Joven
13.
Complement Ther Clin Pract ; 44: 101395, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33991958

RESUMEN

INTRODUCTION: For some time, Residential Aged Care Facilities (RACF) have incorporated animals into their environment to relieve loneliness and isolation for aged-care residents. However, research examining this practice is not as developed. This paper aims to identify the policies and practices influencing the conduct of Animal-Assisted Activities (AAA) in RACF focusing on the Australian context. METHODS: Peer-reviewed and gray literature were searched using an array of databases including CINAHL; Embase; Medline; Pubmed; Scopus and Web of Science; Google Scholar; PROSPERO, Proquest Dissertations; Theses Global; Animal Studies Repository; Medicine and Health Science Commons; Open Gray and a targeted Google search for relevant Australian Guidelines. Database searches had no time limits. Nine documents published between 1990 and 2018 were identified, appraised and subsequently included in the analysis. RESULTS: Facilities have not developed or implemented core policies; instead, there appears to be a reliance on AAA providers ensuring resident safety. Animal welfare is also identified as an emerging area, warranting further action and policy development. CONCLUSION: The requirement for effective AAA policies for RACF staff continues to be an area of need. Over the last 30 years, the development of policies guiding the provision of animal activities within RACFs has been inconsistent in both content and application, including the implementation of basic hygiene policies. If the international situation is indicative, further work is needed in Australia to develop and enforce infection control, risk management and animal welfare policies in RACF and AAA organizations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration # CRD42020150440.


Asunto(s)
Políticas , Anciano , Animales , Australia , Humanos
14.
Lancet Glob Health ; 9(8): e1101-e1109, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34051180

RESUMEN

BACKGROUND: Global reports have described inequalities in coverage of reproductive, maternal, newborn, and child health (RMNCH) interventions, but little is known about how socioeconomic inequality in intervention coverage varies across multiple low-income and middle-income countries (LMICs). We aimed to assess the association between wealth-related inequalities in coverage of RMNCH interventions. METHODS: In this cross-sectional study, we identified publicly available Demographic Health Surveys and Multiple Indicator Cluster Surveys from LMICs containing information on household characteristics, reproductive health, women's and children's health, nutrition, and mortality. We identified the most recent survey from the period 2010-19 for 36 countries that contained data for our preselected set of 18 RMNCH interventions. 21 countries also had information on two common malaria interventions. We classified interventions into four groups according to their predominant delivery channels: health facility based, community based, environmental, and culturally driven (including breastfeeding practices). Within each country, we derived wealth quintiles from information on household asset indices. We studied two summary measures of within-country wealth-related inequality: absolute inequalities (akin to coverage differences among children from wealthy and poor households) using the slope index of inequality (SII), and relative inequalities (akin to the ratio of coverage levels for wealthy and poor children) using the concentration index (CIX). Pro-poor inequalities are present when intervention coverage decreased with increasing household wealth, and pro-rich inequalities are present when intervention coverage increased as household wealth increased. FINDINGS: Across the 36 LMICs included in our analyses, coverage of most interventions had pro-rich patterns in most countries, except for two breastfeeding indicators that mostly had higher coverage among poor women, children and households than wealthy women, children, and households. Environmental interventions were the most unequal, particularly use of clean fuels, which had median levels of SII of 48·8 (8·6-85·7) and CIX of 67·0 (45·0-85·8). Interventions primarily delivered in health facilities-namely institutional childbirth (median SII 46·7 [23·1-63·3] and CIX 11·4 [4·5-23·4]) and antenatal care (median SII 26·7 [17·0-47·2] and CIX 10·0 [4·2-17·1])-also usually had pro-rich patterns. By comparison, primarily community-based interventions, including those against malaria, were more equitably distributed-eg, oral rehydration therapy (median SII 9·4 [2·9-19·0] and CIX 3·4 [1·3-25·0]) and polio immunisation (SII 12·1 [2·3-25·0] and CIX 3·1 [0·5-7·1]). Differences across the four types of delivery channels in terms of both inequality indices were significant (SII p=0·0052; CIX p=0·0048). INTERPRETATION: Interventions that are often delivered at community level are usually more equitably distributed than those primarily delivered in fixed facilities or those that require changes in the home environment. Policy makers need to learn from community delivery channels to promote more equitable access to all RMNCH interventions. FUNDING: Bill & Melinda Gates Foundation and Wellcome Trust. TRANSLATIONS: For the French, Portuguese and Spanish translations of the abstract see Supplementary Materials section.


Asunto(s)
Países en Desarrollo , Disparidades en Atención de Salud/economía , Servicios de Salud Materno-Infantil/organización & administración , Servicios de Salud Materno-Infantil/estadística & datos numéricos , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/estadística & datos numéricos , Niño , Estudios Transversales , Femenino , Humanos , Recién Nacido , Embarazo , Factores Socioeconómicos
15.
Environ Sci Pollut Res Int ; 28(33): 45029-45040, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33860420

RESUMEN

The establishment of landfill covers consumes substantial amounts of fuels and materials that contribute to greenhouse gas emissions and fossil fuel depletion (FFD). This study compared the global warming impact (GWI) and FFD of a shrub willow evapotranspiration (ET), conventional clay, and geosynthetic cover using life cycle assessment (LCA). The willow ET cover is a carbon-negative system with a total GWI of -13,206 kgCO2eq ha-1 over 30 years, while the GWI of clay (194,916 kgCO2eq ha-1) and geosynthetic covers (260,212 kgCO2eq ha-1) were substantial. Willow's ability to store carbon in coarse roots and stools creates the opportunity for negative carbon emissions. The FFD impact of the willow ET cover (75,303 MJ surplus ha-1) is 4.7 times lower than the clay cover and 7.7 times lower than the geosynthetic cover. Sensitivity and uncertainty analyses indicated that the GWI of the willow ET cover was less than zero for all scenarios, and the GWI and FFD of the geosynthetic cover were the highest. Willow ET covers can protect human health and the environment, reduce greenhouse gas emissions by sequestering carbon, and provide a source of wood chips that could be used for renewable energy or other applications.


Asunto(s)
Salix , Animales , Arcilla , Humanos , Estadios del Ciclo de Vida , New York , Instalaciones de Eliminación de Residuos
16.
JBI Evid Synth ; 19(10): 2659-2694, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33896907

RESUMEN

OBJECTIVE: This review examined the effectiveness of telemonitoring versus usual care on self-care behaviors among community-dwelling adults with heart failure. INTRODUCTION: Heart failure is a global health crisis. There is a body of high-level evidence demonstrating that telemonitoring is an appropriate and effective therapy for many chronic conditions, including heart failure. The focus has been on traditional measures such as rehospitalizations, length of stay, cost analyses, patient satisfaction, quality of life, and death rates. What has not been systematically evaluated is the effectiveness of telemonitoring on self-care behaviors. Involving patients in self-care is an important heart failure management strategy. INCLUSION CRITERIA: This review included studies on adult participants (18 years and older), diagnosed with heart failure (New York Heart Association Class I - IV), who used telemonitoring in the ambulatory setting. Studies among pediatric patients with heart failure, adult patients with heart failure in acute care settings, or those residing in a care facility were excluded. METHODS: Eight databases, including CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Epistemonikos, ProQuest Dissertations and Theses, PsycINFO, and Web of Science were systematically searched for English-language studies between 1997 and 2019. Studies selected for retrieval were assessed by two independent reviewers for methodological quality using critical appraisal checklists appropriate to the study design. Those meeting a priori quality standards of medium or high quality were included in the review. RESULTS: Twelve publications were included in this review (N = 1923). Nine of the 12 studies were randomized controlled trials and three were quasi-experimental studies. Based on appropriate JBI critical appraisal tools, the quality of included studies was deemed moderate to high. In a majority of the studies, a potential source of bias was related to lack of blinding of treatment assignment. Telemonitoring programs ranged from telephone-based support, interactive websites, and mobile apps to remote monitoring systems and devices. Self-care outcomes were measured with the European Heart Failure Self-care Behaviour Scale in nine studies and with the Self-care of Heart Failure Index in three studies. Telemonitoring improved self-care behaviors across 10 of these studies, achieving statistical significance. Clinical significance was also observed in nine of the 12 studies. All studies utilized one of two validated instruments that specifically measure self-care behaviors among patients with heart failure. However, in some studies, variation in interpretation and reporting was observed in the use of one instrument. CONCLUSIONS: Overall, telemonitoring had a positive effect on self-care behavior among adult, community-dwelling patients with heart failure; however, there is insufficient and conflicting evidence to determine how long the effectiveness lasts. Longitudinal studies are needed to determine the sustained effect of telemonitoring on self-care behaviors. In addition, the limitations of the current studies (eg, inadequate sample size, study design, incomplete statistical reporting, self-report bias) should be taken into account when designing future studies. This review provides evidence for the use of telemonitoring, which is poised for dramatic expansion given the current clinical environment encouraging reduced face-to-face visits. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019131852.

17.
Clin Nurse Spec ; 35(3): 138-146, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33793176

RESUMEN

PURPOSE: The COVID-19 pandemic has significantly challenged healthcare organizations across the globe, forcing innovation, resourcefulness, and flexibility. The purpose of this article is to describe the impact of clinical nurse specialist practice on COVID-19 preparation at a military hospital. ENVIRONMENT OF CARE CHANGES: The pandemic required facilities to develop expansion plans to facilitate a potential surge of COVID-19 patients. Clinical nurse specialists collaborated to develop a plan to expand care capacity and streamline testing while designating specific critical care and medical-surgical areas for COVID-19 patients. STAFFING CONSIDERATIONS: To capitalize on the expanded bed capacity, clinical nurse specialists identified and trained outpatient nursing staff to serve as nurse extenders. DISCUSSION: Early in the pandemic, a lack of strong evidence-based interventions to mitigate transmission and treatment necessitated the development of innovative solutions. The clinical nurse specialist team established designated transport routes for COVID-19 patients, leveraged technology to improve methods of care, and cultivated a culture of innovation by providing on-the-spot meaningful recognition to staff. CONCLUSION: As leaders in healthcare, clinical nurse specialists are change agents that work to maintain high-quality, safe patient care even during a global pandemic.


Asunto(s)
COVID-19/enfermería , Hospitales Militares/organización & administración , Enfermeras Clínicas/organización & administración , COVID-19/epidemiología , Humanos , Liderazgo , Investigación en Evaluación de Enfermería , Estados Unidos/epidemiología
18.
J Clin Nurs ; 30(13-14): 1990-2000, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33756003

RESUMEN

AIMS AND OBJECTIVES: This study aimed to compare anxiety, resilience, and depression between COVID-19 unit (confirmed patients and suspected patients) and non-COVID-19 unit nurses and assess their effects on depression. BACKGROUND: Nurses working during the global pandemic are known to be physically and psychologically exhausted, and experience severe anxiety and depression. However, there is a lack of studies comparing anxiety and depression between COVID-19 and non-COVID-19 unit nurses. DESIGN: Descriptive research study. METHODS: This study was conducted on 64 nurses who directly worked for more than a month in a COVID-19 unit of a general hospital with nationally designated negative-pressure isolation beds and 64 nurses working in a non-COVID-19 unit. Data were collected through questionnaires and were analysed using SPSS 25.0. Reporting of this research adheres to the STROBE guidelines. RESULTS: Anxiety and depression were significantly higher in nurses working with patients suspected to have COVID-19 rather than nurses working with confirmed COVID-19 patients and non-COVID-19 patients. Resilience was significantly lower in suspected patient unit nurses than in COVID-19 unit nurses. Anxiety was the major factor predicting depression in both COVID-19 unit (confirmed patients and suspected patients) and non-COVID-19 unit nurses with 76.6%, 80.7%, and 63.6% explanatory power, respectively. CONCLUSIONS: Among nurses working in COVID-19 units, suspected patients unit nurses had higher depression than confirmed patients unit nurses due to an unsafe facility environment, insufficient personal protective equipment, and unknown conditions of the patients. Thus, interventions which have a high impact on depression need to be provided to relieve anxiety. RELEVANCE TO CLINICAL PRACTICE: The nursing organisation must provide comprehensive support including coordinated shifts, internal motivation, incentives, up-to-date information, and clear infection prevention guidelines to relieve anxiety caused by exhaustive workload, uncertainty of infectious diseases, and lack of human and material resources.


Asunto(s)
Ansiedad/epidemiología , COVID-19/psicología , Depresión/epidemiología , Enfermeras y Enfermeros/psicología , Resiliencia Psicológica , Hospitales , Humanos
19.
Environ Health ; 20(1): 28, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33722240

RESUMEN

BACKGROUND: To examine the influence of solar cycle and geomagnetic effects on SLE disease activity. METHODS: The data used for the analysis consisted of 327 observations of 27-day Physician Global Assessment (PGA) averages from January 1996 to February 2020. The considered geomagnetic indices were the AP index (a daily average level for geomagnetic activity), sunspot number index R (measure of the area of solar surface covered by spots), the F10.7 index (measure of the noise level generated by the sun at a wavelength of 10.7 cm at the earth's orbit), the AU index (upper auroral electrojet index), and high energy (> 60 Mev) proton flux events. Geomagnetic data were obtained from the Goddard Space Flight Center Space Physics Data Facility. A time series decomposition of the PGA averages was performed as the first step. The linear relationships between the PGA and the geomagnetic indices were examined using parametric statistical methods such as Pearson correlation and linear regression, while the nonlinear relationships were examined using nonparametric statistical methods such as Spearman's rho and Kernel regression. RESULTS: After time series deconstruction of PGA averages, the seasonality explained a significant fraction of the variance of the time series (R2 = 38.7%) with one cycle completed every 16 years. The analysis of the short-term (27-day) relationships indicated that increases in geomagnetic activity Ap index (p < 0.1) and high energy proton fluxes (> 60 Mev) (p < 0.05) were associated with decreases in SLE disease activity, while increases in the sunspot number index R anticipated decreases in the SLE disease activity expressed as PGA (p < 0.05). The short-term correlations became statistically insignificant after adjusting for multiple comparisons using Bonferroni correction. The analysis of the long-term (297 day) relationships indicated stronger negative association between changes in the PGA and changes in the sunspot number index R (p < 0.01), AP index (p < 0.01), and the F10.7 index (p < 0.01). The long-term correlations remained statistically significant after adjusting for multiple comparisons using Bonferroni correction. CONCLUSION: The seasonality of the PGA averages (one cycle every 16 years) explains a significant fraction of the variance of the time series. Geomagnetic disturbances, including the level of geomagnetic activity, sunspot numbers, and high proton flux events may influence SLE disease activity. Studies of other geographic locales are needed to validate these findings.


Asunto(s)
Fenómenos Geológicos , Lupus Eritematoso Sistémico , Fenómenos Magnéticos , Humanos , Protones , Índice de Severidad de la Enfermedad , Actividad Solar
20.
Emerg Med J ; 38(5): 373-378, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33771818

RESUMEN

Anticipating the need for a COVID-19 treatment centre in Israel, a designated facility was established at Sheba Medical Center-a quaternary referral centre. The goals were diagnosis and treatment of patients with COVID-19 while protecting patients and staff from infection and ensuring operational continuity and treatment of patients with non-COVID. Options considered included adaptation of existing wards, building a tented facility and converting a non-medical structure. The option chosen was a non-medical structure converted to a hospitalisation facility suited for COVID-19 with appropriate logistic and organisational adaptations. Operational principles included patient isolation, unidirectional workflow from clean to contaminated zones and minimising direct contact between patients and caregivers using personal protection equipment (PPE) and a multimodal telemedicine system. The ED was modified to enable triage and treatment of patients with COVID-19 while maintaining a COVID-19-free environment in the main campus. This system enabled treatment of patients with COVID-19 while maintaining staff safety and conserving the operational continuity and the ability to continue delivery of treatment to patients with non-COVID-19.


Asunto(s)
COVID-19/epidemiología , COVID-19/terapia , Servicio de Urgencia en Hospital/organización & administración , Hospitales Especializados/organización & administración , Control de Infecciones/organización & administración , Servicio de Urgencia en Hospital/normas , Humanos , Control de Infecciones/normas , Israel/epidemiología , Equipo de Protección Personal/normas , Equipo de Protección Personal/provisión & distribución , SARS-CoV-2 , Telemedicina , Triaje/organización & administración , Flujo de Trabajo
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