Public Health-related Problems Research Articles

Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project

PurposeThis study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.Design/methodology/approachThe authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.Originality/valueDMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

Quality assessment of raw and pasteurized milk in Gondar city, Northwest Ethiopia: A laboratory-based cross-sectional study

Milk is a complete and highly nutritious source of food for human beings. However, in many developing countries, including Ethiopia, the quality of milk products has become a major health concern for consumers, particularly for infants and children. Therefore, the aim of the present study was to assess the quality of raw and pasteurized milk marketed in Gondar city, Northwest Ethiopia. A laboratory-based cross-sectional study was conducted on 90 milk samples. The samples were chosen using a simple random sampling technique. For statistical analysis, ANOVA and the Pearson correlation coefficient were used. The specific gravity of pasteurized milk, farm milk, and milk vendors were found to be 1.021, 1.027, and 1.026, respectively. Farm milk, milk vendors, and pasteurized milk had fat contents of 3.38%, 3.22%, and 3.09%, respectively. The total bacterial count in pasteurized milk, farm milk, and milk vendors was found to be 7.08, 6.73, and 6.94 log10 CFU/mL, respectively. In raw milk, hydrogen peroxide (7.7%), formalin (7.7%), and water (3.8%) were found, whereas in pasteurized milk, hydrogen peroxide (50%), formalin (50%), and water (19.8%) were found. Based on the findings of this study, the quality of both raw and pasteurized milk was found to be poor as per the milk quality standards. This may cause significant public health-related problems. Therefore, an appropriate intervention should be conducted to improve the quality of milk.

Compliance to the Alcohol Law: Overserving to Obviously Intoxicated Visitors at Music Festivals.

Music festivals are often high-risk settings associated with large numbers of visitors and high alcohol intoxication levels, which contribute to a number of public health-related problems. According to the Swedish Alcohol Act, servers are responsible for not overserving alcohol to obviously intoxicated patrons. The aim of the current study was to examine compliance to the Swedish Alcohol Act at music festivals by assessing the rate of alcohol overserving to festival-goers. We conducted a study at a large music festival in Sweden hosting approximately 50,000 visitors. Professional actors, i.e., pseudo-patrons, enacted a standardized scene in which a highly intoxicated festival-goer attempted to buy beer at licensed premises inside the festival. Observers monitored each attempt. A total of 52 purchase attempts were conducted. The rate of overserving was 26.9% and was not influenced by the server’s gender, the number of servers, or the level of crowdedness at the bar area. Overserving differed between server age groups, which was not statistically significant when controlling for other factors. Compliance to the Alcohol Act at the festival can be improved. Intoxication levels and related problems can be reduced by implementing a multicomponent intervention including staff training, policy work, and improved enforcement.

The role of community pharmacists in public health and public health related problems which they encounter

Background and Aims: This study was conducted in order to identify the role of community pharmacists in public health and the public health related problems which are encountered. Methods: In this cross-sectional study, 87 community pharmacists answered a questionnaire form about sociodemographic characteristics, public health counseling roles and barriers. The data was summarized as mean ± standard deviation and percentage. Chi-square test was used to compare the categorical data. Results: 93.1% of the community pharmacists considered that they had an active role in the protection of public health, while the percentage of those who thought they were able to realized it was 78.2%. Limited authority (63.2%), insufficient time and workload (52.6%) were the leading causes of ineffectivity of the pharmacists in public health. The causes that prevented receiving consultancy services were shame (64.4%), the education level of the client (51.7%) and gender difference between the pharmacist and client (48.3%). The pharmacists thought that their professional reputation should be improved in order to improve their consulting role (35%). Conclusion: Although there are many occupational problems of pharmacists in Turkey, pharmacists voluntarily provide a consultacy service about many subjects for the protection of public health. Legal arrangements are needed to make pharmacies public health counseling centers.

Illicit Drugs in the Nightlife Setting: Changes in Employee Perceptions and Drug Use over a Fifteen-Year Period

Background Illicit drug use is common in nightlife settings and associated with various public health-related problems, making this an important arena for prevention. Purpose/objectives: To assess perceived prevalence of illicit drug use in the Stockholm nightlife setting, use of and attitudes toward illicit drugs among employees at licensed premises. Also, to make comparisons with two identical measurements from 2001 and 2007/08, and to explore potential differences related to own drug use, type of licensed premise, age or gender. Methods: Cross-sectional surveys were conducted at three time-points: 2001, 2007/08, and 2016/17, comprising employees at licensed premises in Stockholm participating in STAD’s Responsible Beverage Service training program. A total of 665 persons (mean age 28 years, 53% women) were included in the 2016/2017 measurement. Results: A majority of the respondents reported having observed patrons intoxicated by illicit drugs in the last six months, and agreed that patrons intoxicated by illicit drugs should be asked to leave licensed premises. The belief that one had observed patrons intoxicated by illicit drugs was more common among respondents who had themselves been using illicit drugs during the last year, and also among employees at nightclubs. Furthermore, comparisons with previous time-points showed a significant increase in the proportion of employees using illicit drugs. Almost half of the respondents in the youngest age group (18–24 years) reported illicit drug use during the last year. Conclusions/importance: Observation and use of illicit drugs are common among employees in the Stockholm nightlife setting and has increased significantly during the past decade.

A Survey of the Mobile Phone-Based Interventions for Violence Prevention Among Women

Information Communication Technologies (ICT), particularly mobile phone technology, has increased the propinquity between individuals by enhancing their ability to frequently communicate with one another through different mediums, like text, audio, video, and emojis. Cell phone technology is being used to combat various social issues, including several public health-related problems such as violence against women. Over the past two decades several cellphone-based apps, including Circle of 6, MyPlan, Panic Button, and Aspire News have been developed in several countries to prevent violence against women. Anecdotal evidence suggests that these apps are effective both as violence prevention and as an intervention tool in public as well as private spaces. However, very little awareness exists among social workers about these mobile phone applications (apps), particularly the capabilities and limitations of these apps. Based on a brief survey and classification of the existing mobile phone apps designed to prevent violence against women, this paper aims to explain how these apps work, and point out their capabilities and limitations so that social workers and public health professionals can better guide their clients in using these technology-based services. It is highly recommended that social workers evaluate how their clients are affected by the use or non-use of violence prevention apps and advocate for their client’s right to digital literacy and internet access.

Physical activity in children and adolescents with type 1 diabetes and contem-porary methods of its assessment.

Exercise is a determinant of people's well-being, and it contributes to the prevention and treatment of numerous diseases of affluence, e.g. diabetes and obesity. The rapid pace of economic development is affecting human functioning to such a degree that the need for physical activity, which has always been recognised as a biological and natural need, has been significantly reduced. Consequently, to-day public health related problems occurring globally are connected with the increasing incidence of cardiovascular, neoplastic, and met-abolic diseases. These problems are manifested not only in adults, but they also increasingly affect children and adolescents worldwide. In the case of children with type 1 diabetes, physical activity is of particular importance because it contributes to the child's normal de-velopment and to positive effects of therapies. The paper discusses health-related benefits of physical activity in children and adolescents with type 1 diabetes, it presents recommendations related to physical activity published in Poland and abroad, and reviews contemporary methods of its assessment.

Close Together, Far Apart: an Assessment of the Public Health Needs of Three Geographically Proximate Communities in Central Haiti.

Haiti, a country marked by extreme poverty and poor health, is also an active site for thousands of non-governmental organizations. The community needs assessment is an important tool that allows aid organizations to understand better community perspectives regarding health. In this study, 84 community members were interviewed across three geographically proximate communities in the Arcahaie region of Haiti to identify similarities and differences in community needs. Overall, the most important public health-related problems included access to clean water, sanitation, health care, and education. In discussing these topics, similarities were observed in drinking water source and relative lack of water treatment. Significant differences were noted between the communities in health care source. There were no significant differences in school enrollment patterns across communities, but there were differences in gendered enrollment. This broad survey affirms the importance of understanding the needs of individual communities in order to implement effective public health interventions.

MODELING BARRIERS OF SOLID WASTE TO ENERGY PRACTICES: AN INDIAN PERSPECTIVE

In recent years managing solid wastes has been one of the burning problems in front of state and local municipal authorities. This is mainly due to scarcity of lands for landfill sites. In this context experts suggest that conversion of solid waste to energy and useful component is the best approach to reduce space and public health related problems. The entire process has to be managed by technologies that prevent pollution and protect the environment and at the same time minimize the cost through recovery of energy. Energy recovery in the form of electricity, heat and fuel from the waste using different technologies is possible through a variety of processes, including incineration, gasification, pyrolysis and anaerobic digestion. These processes are often grouped under “Waste to Energy technologies”. The objective of the study is twofold. First authors assessed the current status of solid waste management practices in India. Secondly the leading barriers are identified and Interpretive structural modeling technique and MICMAC analysis is performed to identify the contextual interrelationships between leading barriers influencing the solid waste to energy programs in the country. Finally the conclusions are drawn which will assist policy makers in designing sustainable waste management programs.

Evaluation of nutritional quality, contamination, adulteration and preservative quality of different sources of milk

The present study was conducted at Dairy Science laboratory of Chittagong Veterinary and Animal Sciences University to evaluate nutritional quality, contamination, adulteration and preservative status of different sources of fluid milk. Milk samples were collected from farm, vendors and departmental stores. Test performed to evaluate the milk samples were chemical (% of butter fat, solids-not-fat and protein), added preservatives, adulteration status and microbial population (standard plate count, coliform and salmonella count). Results indicate that available market milk irrespective of brand maintaining the Bangladesh Standard Testing Institute (BSTI) standards as far as butter fat, solids- not-fat, protein and microbial quality is concerned. The nutritional and microbial quality of farm produced milk (FPM) was good except high coliform count. The nutritional and chemical quality of FPM and market milk (MM) of all five brands were satisfactory but vendors supplied milk was below standard due to water adulteration. Microbial quality of MM of all five brands was very safe for human consumption. High fat content even after watering and presence of formalin in 8% samples of vendor supplied rural milk (VSRM) indicates evening milk of previous day might be mixed with morning milk of next day. It may be concluded that these adulterants and preservatives in milk may cause severe public health related problems.

A Spatial Conceptual Data Model For Public Health In Nigeria

Sub Saharan Africa region is synonymous with various health problems ranging from diseases (such as malaria, measles, and tuberculosis), environmental to other public health related problems. In the region, most of the diseases and health related problems are as a result of environmental problems. Despite all the health problems, sub Saharan Africa most especially Nigeria lacks national health database. In the country, there is inadequate health care delivery system and patchy epidemiological data couple with the fact that there is no reliable method of epidemiological data collections. In order to solve these problems, this paper proposed a well organised conceptual public health data model for Nigeria, which addresses all the health problems and their causes. The proposed data model could be used to develop any health related system such as national public health database system, and disease surveillance system, which we intend to develop from this, proposed data model. The model is motivated by an interoperable disease surveillance and prediction system in Nigeria. We started with review of the existing health data models which include disease surveillance data models developed for Nigeria and Kenya which we modified and extended to develop a spatial conceptual public health data model in Nigeria. The proposed data model contributed to the existing health data models with its environmental health feature, which makes the model to be unique from other existing health data models. The model is developed using unified modelling language. We intend to make the model and health related systems that would be developed from the proposed data model open so as to allow other researchers most especially from sub Saharan Africa region and those that are interested in the region to contribute to the maintenance of the public health data model. The systems that would be developed from the proposed data model would make use of web feature services technology and allow interoperability with other health related systems. The proposed system would be able to capture, store, query, retrieve, and generate reports on any disease and the environmental problems that caused such health related problems among other things.

Making endoscopy mobile: a novel initiative for public healthcare

Public healthcare has progressed immensely in the past few decades. However, the rural masses in the developing and underdeveloped countries very often have limited access to the advanced healthcare technology. At the Asian Institute of Gastroenterology, Hyderabad, India, the Rural Health Care Project has been initiated in an attempt to provide cost-effective gastrointestinal care to the rural population. The Project was implemented by traveling to remote rural areas in a bus that had been converted into a mobile hospital and equipped with basic diagnostic facilities including a custom-made endoscopy unit. The mobile hospital and endoscopy unit is accompanied by a telemedicine vehicle that transmits all procedures and data to the main telemedicine center at the parent institute in Hyderabad. Our efforts have resulted in cost-effective management and robust data collection of several common gastrointestinal illnesses in remote rural areas of the Indian state of Andhra Pradesh. To date, 32756 endoscopic procedures have been carried out in a population of over 10 million people spanning 4837 villages. Overall, 72% of the population has had a positive finding on upper gastrointestinal endoscopy (primarily related to acid peptic diseases). Interestingly, <1% of the population have had colonic polyps on screening colonoscopy, whereas the prevalence of infective colitis has been high. This whole exercise has produced a high level of satisfaction among both beneficiaries and care-givers; it has also offered doctors in training the opportunity to encounter and manage common public health-related problems. This program is funded by philanthropic donations.

An assessment of the strengths and weaknesses of current veterinary systems in the developing world.

The changes that veterinary services have undergone in the developing world over the last two decades are expected to continue and result in the further privatisation of selected tasks, the decentralisation of decision-making and a move towards more focus on public goods service delivery by State veterinary units. At the same time, global food consumption patterns are changing in numerous ways, which will certainly affect veterinary services delivery systems. These changes include a trend towards increasing globalisation, rapidly escalating consumer demand for animal protein, intensification of livestock production into larger units and growth of the trade of livestock and livestock products. Intensification of livestock production into larger units and global trade will increase the challenges resulting from the resurgence of serious animal diseases, food safety hazards and veterinary public health-related problems. Facing and managing these challenges raises issues related to animal health delivery systems and national policies that will have to be addressed. Strengthening the capacity of State veterinary units to respond to regulatory responsibilities dictated by national laws and international World Trade Organization and OIE (World organisation for animal health) health standards will be at the centre of animal health policies in most developing countries. Creating an environment which facilitates privatised service delivery and supports subcontracting is likely to contribute to improving economic efficiency and providing wider access to veterinary services. Equally important is the issue of professional development, which must be addressed by refocusing veterinary curricula and improving professional standards. The profession will then be in a better position to serve the needs of increasing numbers of consumers.