Determining the cost of acute stroke care for a single stay at a tertiary care centre in Pakistan.

OBJECTIVE: To assess the economic burden of acute stroke, and to determine the average cost of acute stroke care for a single hospital stay in a public tertiary care hospital. METHODS: The cross-sectional study was conducted at the Medical Teaching Institute, Bacha Khan Medical Complex, Swabi, Pakistan, from May 16 to September 19, 2022, and comprised patients of either gender who were hospitalised with an acute stroke for the first time. All costs incurred during the care of the patients were measured using the micro-costing methodology, and the association of the cost with other variables was evaluated. Data was analysed using SPSS 24. RESULTS: Of the 34 patients, 24(70.6%) were males and 10(29.4%) were females. The overall mean age was 66+/-13.00 years. The mean length of hospital stay was 4+/-3.00 days. The mean total cost was 18,156+/-9,068 Pakistani rupees, which was the equivalent of 76.89+/-38.4 United States dollars. The cost of the first day of admission was the highest, declining per day as the stay progressed, and imaging/laboratory investigations formed the highest component of the overall cost (p<0.001). CONCLUSIONS: The cost of acute stroke care was found to be high even in a public hospital. The length of hospital stay was the most important determinant of the overall cost.

Occupational exposure to HIV among healthcare workers in PMTCT sites in Port Harcourt, Nigeria.

BACKGROUND: Rivers State is among the states with high HIV prevalence in Nigeria. Occupational exposure to HIV through blood or body fluids of HIV/AIDS patients is a recognised risk factor of HIV infections among healthcare workers. We identified the determinants of occupational exposures to HIV among healthcare workers in Prevention of Maternal to Child Transmission (PMTCT) sites within Port Harcourt metropolis in Rivers State. METHODS: A descriptive cross-sectional study was conducted and multi-stage sampling technique was used to select 341 healthcare providers from 22 public and 22 private health facilities in PMTCT sites in Port Harcourt metropolis. The data collected were analysed using descriptive statistics, Chi-square and logistic regression models (p-value = 0.05). RESULTS: Respondents' mean age was 35.9 ± SD8.4 years, 270 (80.1%) and 171(50.7%) were females, and from public health facilities respectively. Prevalence of occupational exposure of healthcare workers to HIV in the past 12 months was 153 (45.0%), and 96 (63.3%) experienced such exposure more than once. Contacts with potentially infectious body fluid accounted for the largest proportion 51 (33.3%); followed by needle stick prick 49 (32.6%). About 189 (56.1%) had safety information at their disposal and this serves as a reminder on safety precautions. The likelihood of occupational exposure was significantly higher among doctors (AOR = 2.22, 95% C.I = 1.16-4.25,) but lower among environmental health workers (AOR = 0.10, 95% C.I = 0.02-0.46,) than nurses/midwives when other factors were included in the model. CONCLUSION: Occupational exposure to blood and body fluids remains a frequent occurrence among healthcare workers; highest among doctors in PMTCT sites in the study area. Provision of protective safety materials, training and enforcement of adherence to universal precaution strategies are highly recommended.

Factors Contributing to the Self-Reported Prevalence of Multiple Chemical Sensitivity in Public Facility Workers and the General Population of Korea.

Multiple chemical sensitivity (MCS), an acquired disorder with multiple recurrent symptoms, has been studied for its association with diverse environmental factors. The present study investigated the factors associated with the self-reported prevalence of MCS in public facility workers and the general population in Korea. The Quick Environmental Exposure Sensitivity Inventory (QEESI) questionnaire was obtained from public facility workers (N=530) and the general population (N=500) to determine the prevalence of MCS and the degree of its risk. Information about demographic characteristics, subjective perceptions of sick building syndrome or sick house syndrome or allergy (SBS/SHS/Allergy), and certain home- or workplace-related events were also obtained. There was not a statistical difference between the public facility workers and the general population in the QEESI scores. The overall prevalence of MCS was 14.4% and there was no statistical difference between the two groups. Regarding the overall degree of risk of MCS, 21.8% of the study subjects were categorized as "very suggestive", and there was no significant difference between the two groups. Gender and the subjective perception of SBS/SHS/Allergy significantly affected the prevalence of MCS and the MCS risk criteria. Considering the absence of diagnostic criteria and/or treatment methods for MCS in Korea, these results can be utilized in establishing future strategies to manage MCS.

A multi-scale approach mapping spatial equality of urban public facilities for urban design.

Spatial equality analysis is useful for urban designers and policy makers to produce and/or adapt urban services provision, while supporting the pursuit of the public interest in the urban design process. This research focuses on urban public facilities (UPFs), the most relevant physical elements serving the public interest, and proposes a multi-scale methodology from a practical perspective to understand and foster the spatial equality of UPFs. Using Shenzhen to test the approach, this research first investigates the density and aggregation of UPFs at the district level to recognize how developing differentiations and social context act on the spatial patterns in UPFs. Second, the accessibility of different types of UPF are measured at the sub-district level which emphasizes the spatial impedance between demand and supply and the availability of services. Then, we draw location-specific design strategies for better spatial equality at a site scale. The results show "cross-district impact" plays an important role in influencing overall spatial equality. Also, sufficient transportation networks, road configurations, and the diversity of UPFs could significantly improve service capacity and impact the achievement of spatial equality. This paper draws attention to the improvement of spatial equality and can contribute new insights to the interpretation and measurement of the spatial equality in urban design debates.

Health facility utilization and Healthcare-seeking behaviour of the elderly population in India.

Background: The increasing elderly population in India has generated an unmet need for healthcare services concerning them. To address some of those needs, the study aims to provide the current status of health facility utilization, health-seeking behaviour (HSB), and factors influencing them. Methodology: Data from the Longitudinal Ageing Study in India (LASI)-Wave I was used to conduct multivariate analysis to assess the association between health facility utilization (inpatient and outpatient) and HSB across all age groups of the elderly. Results: The likelihood of utilizing public health facilities increased with age for OPD and decreased with age for IPD. HSB was 23% less in the 80 years and above elderly as compared to other age groups. Healthcare service uptake was higher in the elderly with health insurance in a public health facility. Conclusion: Improving health insurance coverage among the Indian elderly may potentially improve healthcare service uptake in public health facilities.

An Early SARS-CoV-2 Omicron Outbreak in a Dormitory in Saint Petersburg, Russia.

The Omicron variant of SARS-CoV-2 rapidly spread worldwide in late 2021-early 2022, displacing the previously prevalent Delta variant. Before 16 December 2021, community transmission had already been observed in tens of countries globally. However, in Russia, the majority of reported cases at that time had been sporadic and associated with travel. Here, we report an Omicron outbreak at a student dormitory in Saint Petersburg between 16-29 December 2021, which was the earliest known instance of a large-scale community transmission in Russia. Out of the 465 sampled residents of the dormitory, 180 (38.7%) tested PCR-positive. Among the 118 residents for whom the variant had been tested by whole-genome sequencing, 111 (94.1%) were found to carry the Omicron variant. Among these 111 residents, 60 (54.1%) were vaccinated or had reported a previous infection of COVID-19. Phylogenetic analysis confirmed that the outbreak was caused by a single introduction of the BA.1.1 sub-lineage of the Omicron variant. The dormitory-derived clade constituted a significant proportion of BA.1.1 samples in Saint Petersburg and has spread to other regions of Russia and even to other countries. The rapid spread of the Omicron variant in a population with preexisting immunity to previous variants underlines its propensity for immune evasion.

Sagittal spine disposition and pelvic tilt during outdoor fitness equipment use and their associations with kinanthropometry proportions in middle-aged and older adults.

BACKGROUND: Outdoor fitness training has become popular as a tool for improving the health, especially middle-aged and older adults. For this purpose, outdoor fitness equipment (OFE) have been installed in public areas. However, their safety and effectiveness are still unknown. The aim of the present research was to analyze the sagittal disposition of the spine and pelvic tilt during the use of OFE, and to determine the influence of anthropometric variables on these factors in middle-aged and older adults. METHODS: Seventy healthy volunteers, 56 women and 14 men (age: 63.14 ± 8.19 years) participated in the study. Sagittal spine disposition and pelvic tilt were measured using a Spinal Mouse®, in the relaxed standing position, and during the use of the OFE. In addition, kinanthropometry variables were also measured according to the guidelines of the International Society for the Advancement of Kinanthropometry. RESULTS: Regarding thoracic kyphosis, a significant decrease was found in thoracic kyphosis in the initial position (IP) in single bonny rider (SBR) (p = 0.006) and row (p = 0.046), and a significant increase in the final position (FP) in the row (p = 0.011), surfboard (p < 0.001) and air walker (p = 0.027) machines. In relation to the lumbar curvature and pelvic tilt, a significant decrease in lumbar lordosis and a decrease in pelvic anteversion were observed in the IP and FP in SBR and row; and in the bike (p < 0.001) machine. In the surfboard machine, a significant decrease in lumbar lordosis was found (p = 0.002), with no changes in pelvic tilt. According to the multiple linear regression analysis, the subjects with a higher cormic index and height were more at risk of increasing their thoracic kyphosis, decreasing lumbar lordosis and/or decreasing pelvic anteversion towards pelvic retroversion. CONCLUSIONS: Middle-aged and older adults show spinal misalignments when using the OFE with respect to the standing position, showing a decrease in the thoracic kyphosis in IP of SBR and ROW, and a significant increase in the surfboard and air walker, and in the FP of Row, in the lumbar lordosis in all the OFE in sitting and some in standing, and in the pelvic anteversion in all the OFE in sitting. The variables height and the cormic index explained most of the changes in sagittal spine disposition.

Research on the site selection of watershed public facilities as multi-use detention basin: an environmental efficiency perspective.

With the climate change and the acceleration of urbanization, urban flood disaster is becoming increasingly frequent, leading to more severe impact than in the past. The traditional disaster alleviation strategies have gradually expanded to non-engineering disaster reduction strategies. As urban public property, public facility is more available than private land, making it the preferred strategy of site selection for urban land flood diversion. However, due to the limited government finance, how to select public facilities as the multi-use detention basin to maximize the disaster reduction and external benefits is an issue that needs to be considered before planning and decision-making. This study builds an operable decision model of site selection of urban public facilities as multi-use detention basin from the perspective of environmental efficiency. The decision model analyzes the expected costs and benefits of the multi-use detention basin based on data envelopment analysis (DEA) and cross-efficiency analysis, so as to establish the optimal combination of alternative schemes of site selection. It further compares with the traditional detention basin considering only disaster reduction efficiency to summarize how to improve the strategy of selecting multi-use detention basin site within the watershed in the future. This paper uses the watershed of Dajiaxi as a case study, and finds that (I) there is a certain trade-off relationship between the optimized schemes established from the perspective of environmental efficiency and disaster reduction efficiency evaluation. The scheme with the highest disaster reduction efficiency does not necessarily increase the external benefit significantly; (II) for the inefficient schemes, the difference between the site selection schemes and the ideal efficiency value can be measured through slack variable analysis.

The Distribution and Accessibility of Urban Parks in Beijing, China: Implications of Social Equity.

As public service facilities, urban parks offer many benefits for daily life and social activities for residents. However, the accessibility of public parks to urban residents is often unevenly distributed in spaces that cannot be utilized fully. Here, we used the urban parks in Beijing, China as a case study and examined the relationship between urban park accessibility and population distribution at different administrative levels. Gini coefficient and Lorenz curve were used to evaluate the social equity of urban park accessibility, and the location quotient was used to identify the spatial difference between urban parks and resident population. The results of our study show that the urban park accessibility varies at district and subdistrict levels and that places with more urban parks usually have higher accessibility. Very importantly, the spatial equity is different from the social equity, a mismatch exists between the spatial distribution of urban parks and population, particularly for the elderly residents. These results generate valuable insights, as, in China and many developing countries, current urban public green space planning only uses the ratio of public green space to urban construction land and the per capita public green area.

Cumplimiento de los protocolos de prevención de la legionelosis en edificios públicos / Legionnaires' disease prevention protocol performance in public buildings

Objetivo Investigar la relación entre el cumplimiento del Real Decreto 865/2003 y el Decreto 287/2002, por los que se establecen los criterios higiénico-sanitarios para la prevención y control de la legionelosis, y el riesgo debido a un deficiente mantenimiento higiénico- preventivo de las instalaciones de agua. Métodos Estudio descriptivo realizado en la provincia de Málaga (España) sobre una muestra correspondiente a 214 edificios públicos, 83 variables e interpretación sobre el porcentaje de cumplimiento de la normativa. Medida del riesgo, definición de clusters (tipificación del riesgo), estimadores clásicos y robustos, estimación jackknife e intervalos de confianza bootstrap . Resultados Riesgo por incumplimiento parcial entre el 11,1 (riego, Centros Privados de ESO) y 85,7 por ciento (AFS, Institutos de Educación Secundaria). La normativa se cumple en 82 edificios, 130 la incumplen y 2 no presentan instalaciones de riesgo. Cumplimiento total 38 por ciento. Estimación para el cumplimiento parámetros de localización 0,33-0,36 (33-36 por ciento) y de escala 0,11-0,16. Estimador jackknife del sesgo reducido 0,35071 (estimación media). Intervalos de confianza bootstrap con extremos [0.26, 0.47]. Conclusión El menor riesgo por incumplimiento parcial corresponde a Institutos de Educación Secundaria y el mayor por distribución a los hoteles de cuatro y tres estrellas. Selección del parámetro de localización estimador de Huber y de escala NMAD . Atendiendo al parámetro "razón poblacional" y estimador "razón muestral", el estimador jackknife del sesgo reducido es insesgado. Intervalos de confianza basados en las técnicas bootstrap , partiendo de la media 0,2- recortada muestral y coeficiente de confianza 0,95, muy aproximados.

Objective Studying the relationship between fulfilment of royal decree 865/2003 and decree 287/2002 (establishing hygienic-sanitary criteria for preventing and controlling Legionnaires' disease) and risk arising from deficient preventative-hygienic water facility maintenance. Methods This was a descriptive study carried out in the province of Málaga (Spain) on a sample of 214 public buildings using 83 variables and interpreting legislation fulfilment percentages. Risks were measured, clusters defined (related to risk typification) and classic and robust estimators, jack-knife estimation and bootstrap confidence intervals were calculated. Results 11.1 percent (irrigation, ESO private centres) and 85.7 percent (AFS, secondary education institutions) partial non-fulfilment/breach risks were found. Eighty-two buildings complied with current standards, 130 failed to fulfil them and 2 did not display risk facilities. There was 38 percent overall compliance with established norms. Location parameter fulfilment was estimated as being 0.33-0.36 (3336 percent) and scale as 0.110.16. Reduced bias jack-knife estimator was 0.35071 (average estimation). Bootstrap confidence interval extremes were 0.26 and 0.47. Conclusion Secondary education institutions represented the least risk due to partial noncompliance and four- and three-star hotels the greatest. Huber estimator was selected as location parameter and NMAD as scale parameter. Regarding the population ratio parameter and sample ratio estimator, it was considered that the jack-knife estimator of reduced bias was unbiased. Confidence intervals based on bootstrap techniques (starting from 0.2trimmed mean sample and a 0.95 confidence coefficient) were very approximate.