Health Quality Improvement Research Articles

Ozonoterapia: potenciador de la efectividad de la quimioterapia y reductor de reacciones adversas en cáncer epitelial

This study aimed to apply ozone therapy to increase chemotherapy effectiveness and reduce its adverse reactions, improving the patient's health quality. Through a quasi-experimental, longitudinal research, using methods of: comparative analysis, cause-effect relationship, and data triangulation. Data were collected by: Visual Analog Pain Scale (VAS), SAS, KPS, and direct observation. The diagnosis before ozone therapy showed signs of high metabolic grade tumor pathology in a solid peritoneal implant adhered to the sigmoid colon, lymphadenopathy versus peritoneal implants in the sigmoid mesocolon, lymphadenopathy of the left common iliac chain, left para-aortic retroperitoneal lymphadenopathy, and a sub-solid pulmonary nodule in the lateral segment of the right lower lobe. After ozone therapy, absence of moderate/high-grade metabolic tumor pathology was evidenced, disappearance of the pulmonary nodule in the right lower lobe, and complete response to chemotherapy of pelvic lymphadenopathies and pelvic peritoneal implants. It was demonstrated that ozone therapy enhances the effectiveness of chemotherapy and reduces its adverse reactions, improving the patient's health quality. It was shown that there is a correspondence between ozone therapy treatment and the increase in chemotherapy effectiveness, tumor pathology, and chemotherapy adverse reactions, obtaining an improvement in the patient's health quality.

Improving School Mental Health via National Learning Collaboratives With State and Local Teams: Components, Feasibility, and Initial Impacts.

School systems need practical and effective quality improvement strategies to advance school mental health promotion, prevention, and treatment services. Collectively, these efforts can be used to promote child and adolescent mental health, well-being, and academic success. The current study reports on the feasibility, initial impacts of, and recommendations from a national, multi-level learning collaborative conducted by the National Center for School Mental Health, University of Maryland School of Medicine and administered throughout the United States. The mixed-methods evaluation results support the feasibility of a learning collaborative and reinforce its positive initial impact on comprehensive school mental health system change. Participants indicated comprehensive school mental health quality improvements such as collaboration across diverse partners and spread of evidence-informed best practices that support high-quality services for students. The multi-level learning collaborative model is promising for future efforts to advance the dissemination of comprehensive school mental health systems and other state and local system change efforts. School mental health learning collaboratives may help address the ongoing youth mental health crisis by promoting high-quality mental health supports and services for youth.

Measuring Stakeholder Engagement in Statewide Primary Care Cardiovascular Health Improvement Cooperatives.

Cardiovascular disease (CVD) remains a major national health challenge with significant disparities linked to socioeconomic status, race, ethnicity, sex, and geography, prompting federal efforts to build statewide primary care quality improvement (QI) cooperatives to improve heart health. To be effective, cooperatives require high levels of member engagement and leaders need ways to assess engagement. The objective of this study was to develop and validate a novel Cooperative Member Survey to assess cooperative member engagement and assess the value of the cooperative to members across three statewide heart health QI cooperatives. The 14-item survey included fixed-response and open-ended questions and was developed through multiple iterative rounds across the three cooperatives to gain consensus on the wording of final items using a Delphi process. The survey then was administered to the key stakeholders in the three cooperatives. Findings from both the quantitative and qualitative items were analyzed and reported based on frequencies and emerging themes. The survey was then analyzed to determine factor structure and validity. Analysis revealed a two-factor structure which the research team identified as: (1) Cooperative Engagement, consisting of 11 items that measured how well the cooperative functioned overall, and (2) Cooperative Value, consisting of two items that assessed the perceived value of mutual learning and respect within the cooperative. This two-factor structure indicated that the Cooperative Member Survey successfully captured both the practical aspects of how the cooperative operates and the members' perceived benefits of their involvement. Successful QI cooperatives not only require efficient operations but also a sense of shared value among members. These findings suggest that cooperatives designed to improve public health outcomes may benefit from focusing not only on practical aspects of engagement but also on cultivating mutual respect and collective learning.

The effects of Omega-3 fatty acids and vitamin D supplementation on the quality of life and blood inflammation markers in newly diagnosed breast cancer women: An open-labelled randomised controlled trial

Background and aimsNutritional intervention is one of the primary steps to improvement of health status and quality of life (QoL) in patients with cancer treated by chemotherapy. There is limited evidence on the potential nutritional intervention to complement active oncological treatment strategies in breast cancer (BC) patients in developing countries. The aim of the present study was to assess the effects of omega-3 fatty acids (ω3) and vitamin D3 (VitD) supplementations on the QoL and blood inflammation markers of tumor necrosis factor-alpha (TNF-α) and high-sensitive C-reactive protein (hsCRP) assessed among women newly diagnosed with BC in the Gaza Strip, Palestine MethodsA total of 88 BC women were randomly assigned into one of four groups: i) omega-3 fatty acid (ω3) group; ii) vitamin D (VitD) group; iii) ω3+VitD group, and iv) the control. Participants were received either two 300mg ω3 capsules daily, or one 50,000IU VitD tablet weekly, or both supplementation for 9-weeks. The QoL status was assessed by the European Organization for Research and Treatment of Cancer (EORTC) instruments of QLQ-C30 and QLQ-BR23 tools, while blood inflammatory markers of TNF-α hsCRP were used. All measurements were taken from baseline to the end of the intervention period. The detailed procedures of the present study were registered on ClinicalTrial.gov with the identifier NCT05331807. ResultsAt the end of the trial, participants in the ω3+VitD group showed a significant increase in overall global health status (p <0.01) compared to other groups. Additionally, this group showed significantly higher functional scores (all p <0.05) and lower scores for fatigue (p <0.01), nausea and vomiting, pain, and appetite loss (all p <0.05) at the end of the trial compared to baseline. Furthermore, comparisons between the intervention groups revealed a significant difference in blood concentrations of TNF-α and hsCRP (p <0.05). These significant differences were identified in hsCRP between ω3 and control groups (p <0.01). The ω3+VitD group demonstrated a significant reduction in both hsCRP and TNF-α levels (both p <0.05) from baseline. No significant changes in blood inflammatory markers were observed within the ω3 or VitD groups alone. ConclusionParticipants receiving daily ω3 and weekly VitD supplementation for 9 weeks showed a significant improved in QoL and blood inflammation markers among the newly diagnosed BC during their chemotherapy treatment.

State of the health workforce in the WHO African Region: decade review of progress and opportunities for policy reforms and investments

IntroductionAn adequate health workforce is one of the cornerstones of a healthy nation. Over the last two decades, Africa has gained momentum in mitigating critical health workforce gaps, but urgent...

Treatment Outcomes of Four-Implant-Retained Maxillary Palateless Overdenture: A 5-Year Observational Study.

Palateless overdentures (PLODs) provide advantages of improved taste perception and retention over conventional dentures. We aimed to evaluate 5-year outcomes of four implant maxillary PLODs. In this prospective observational study, edentulous participants were enrolled. A new conventional maxillary denture was prepared followed by implant placement and insertion of four implant retained maxillary PLOD. Oral health quality of life was assessed using the 49-item Oral Health Impact Profile (OHIP-49) at multiple intervals over 5 years along with biological and mechanical outcomes. Nine patients were evaluated at year 5. The mean age was 68 years, and six of the nine patients were males. The cumulative survival rate of implants was 100% while the implant success rate was 86%. Nylon retentive replacement was the most common encountered complication noted approximately four times per patient over 5 years. From a mean OHIP-49 severity score of 71.2 at baseline, severity scores decreased to 23.9 (p < 0.001) at year 1, denoting a clinically meaningful and statistically significant improvement in oral health quality of life. The lowered OHIP-49 severity scores remained stable throughout 5 years of follow-up. Four implant supported maxillary overdenture appears to have good patient perceived, biological and mechanical outcomes over 5 years. Fully powered studies are needed to replicate these findings.

Automated mental health screening in pediatric lupus: associations with disease features and treatment.

Patients with childhood-onset systemic lupus erythematosus (c-SLE) have higher rates of depression than their peers, which has been associated with worse medical outcomes. Therefore, it is imperative that their mental health be addressed. We utilized quality improvement (QI) methodology to automate mental health screening for patients with lupus within a pediatric rheumatology clinic. The retrospective cohort study aims to evaluate the association between mental health screening outcomes and demographics, medications, and disease activity measures in patients with childhood lupus. The mental health QI team at a quaternary pediatric rheumatology center implemented an automated process for mental health screening in patients with c-SLE. Patients seen between 2017 and June 2023 with a diagnosis of c-SLE were identified using International Classification of Disease -Clinical Modification (ICD-CM) codes. Disease activity was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K). Medications were identified on outpatient and inpatient orders for conventional synthetic and biologic disease-modifying anti-rheumatic drugs, hydroxychloroquine, corticosteroids, and aspirin. Mental health screening was accomplished with the Patient Health Questionnaire (PHQ). Descriptive statistics, univariate and multivariate linear regression were used. Between January 2017 and June 2023, 117 patients with c-SLE (41% with lupus nephritis) completed 534 total screenings. Each patient completed PHQ screenings, a median of 5 [interquartile range 2, 6] times. Screening increased when the screening process was automated. Those who were Black, female, or prescribed leflunomide, mycophenolate, and corticosteroids had higher PHQ scores. Mental health support is essential for patients with chronic rheumatologic diseases such as SLE. Sustainable processes for quickly identifying depression are needed for optimal care of patients with SLE. Our process of automated, streamlined mental health screening successfully increased the screening of patients with SLE at every visit and led to timely interventions for positive PHQ scores. Higher PHQ scores were correlated with patients on leflunomide, mycophenolate, and corticosteroids. Future research should identify modifiable risk factors for high PHQ scores that the medical team can target.

Creating scalable health equity and quality improvement frameworks: Evaluating the impact of a cancer screening awareness campaign for reducing disparities in Black and Hispanic women.

75 Background: Cancer disparities persist for Black and Hispanic women. Quantifiable learnings from early detection efforts may help inform future health equity initiatives and improve patient outcomes. This study describes survey results measuring the effectiveness of Love Letters for Cancer Screening for Women of Color, an awareness campaign using representative artwork and letters created “for the community, by the community,” within a quality improvement framework. Methods: Genentech and IQVIA deployed a survey at community health events hosted by partner organizations Weill Cornell Medicine and the American Cancer Society. The survey (fielded in English and Spanish) evaluated the impact of this health equity campaign on perceptions of cultural representation, cancer screening awareness, and motivation to act. In-person responses were compared with responses from an online control group in the broader NY metro area. Participants gave informed consent, and modest compensation was provided upon survey completion. This study was not powered for statistical significance. Results: Responses from 317 participants (117 in person; 200 online) showed that this campaign successfully resonated with target demographics of Black and Hispanic women both in person and online, demonstrating the positive impact of this community-based campaign. The campaign was effective at motivating Black and Hispanic respondents to act, with 74% reporting they would schedule a cancer screening, and 75% reporting they would talk to friends or family. Among respondents with self-reported low health literacy, 85% reported feeling more knowledgeable. Overall, in-person engagement was more meaningful than online engagement, highlighting the importance of partnering with community organizations for live events. Conclusions: Partnerships across patient, community, industry,and provider organizations are key to advancing cancer health equity and overcoming health disparities in historically marginalized, underserved populations. These survey results support cocreation and co-implementation of culturally tailored awareness campaigns with measurement frameworks to achieve quality improvement and health equity goals. Respondents who “agreed” or “completely agreed”. The campaign respects/reflects my culture and community Felt inspired to act around cancer screening for myself/my loved ones Will share information and/or materials about campaign with others Will talk to family and/or friends about cancer screenings Will speak to my HCP about cancer screenings Will schedule a cancer screening appointment for myself Black In-person (n=64) 75% 89% 77% 80% 77% 75% Online (n=20) 65% 75% 50% 70% 60% 60% Hispanic In-person (n=28) 82% 86% 79% 82% 75% 82% Online (n=20) 70% 70% 60% 70% 60% 65%

Sex and Gender Variables in Data Set Creation and Data Cleaning for Inclusive and Accurate Reproductive Health Research and Quality Improvement.

Existing data is often used for reproductive research and quality improvement. Electronic health records (EHRs) with a single data field for sex and gender conflate sex assigned at birth, genotype, gender identity, and the presence of anatomic tissue and organs. This is problematic for inclusion of transgender and gender-diverse populations in research. This article discusses considerations with a single-item sex and gender variable drawn from EHR records and describes an audit to determine variable validity as a criterion for inclusion or exclusion in perinatal research. Individuals with a live birth at a large academic medical center from 2010 to 2022 were identified via electronic query, and records with male demographic information were reviewed to validate (1) the patient's date of birth and delivery date in the EHR matched the medical record number, (2) male sex and gender demographic information, and (3) male gender terms in EHR notes. All health records of male birthing individuals (n = 8) had EHR evidence of giving birth within the health system during the timeframe, and the date of birth matched the medical record number of the EHR. All had male gender in the EHR demographic information. Six patients did not have any male gender terms in available EHR notes, only female gender terms. Two records had recent notes using male gender terms. Current EHRs may not have reliable data on the gender and sex of gender-diverse individuals. A single sex and gender variable drawn from EHRs should not be used as inclusion or exclusion criteria for health research or quality improvement without additional record review. EHRs can be updated to collect more data on sex, gender identity, and other relevant variables to improve research and quality improvement.

Changing practice in cystic fibrosis: Implementing objective medication adherence data at every consultation, a learning health system and quality improvement collaborative

AbstractBackgroundMedication adherence data are an important quality indicator in cystic fibrosis (CF) care, yet real‐time objective data are not routinely available. An online application (CFHealthHub) has been designed to deliver these data to people with CF and their clinical team. Adoption of this innovation is the focus of an National Health Service England‐funded learning health system and Quality Improvement Collaborative (QIC). This study applies the capability, opportunity, and motivation model of behavior change to assess whether the QIC had supported healthcare professionals' uptake of accessing patient adherence data.MethodThis was a mixed‐method study, treating each multidisciplinary team as an individual case. Click analytic data from CFHealthHub were collected between January 1, 2018, and September 22, 2019. Thirteen healthcare practitioners participated in semi‐structured interviews, before and after establishing the QIC. Qualitative data were analyzed using the behavior change model.ResultsThe cases showed varied improvement trajectories. While two cases reported reduced barriers, one faced persistent challenges. Participation in the QIC led to enhanced confidence in the platform's utility. Reduced capability, opportunity, and motivation barriers correlated with increased uptake, demonstrating value in integrating behavior change theory into QICs.ConclusionQICs can successfully reduce barriers and enable uptake of e‐health innovations such as adherence monitoring technology. However, ongoing multi‐level strategies are needed to embed changes. Further research should explore sustainability mechanisms and their impact on patient outcomes.

Abstract P114: Reducing Racial Disparities in Hypertension Control using Multicomponent, Equity-Centered Approach

Background: Black Americans have the highest prevalence of hypertension among all racial or ethnic groups in the United States and are five times more likely to die from hypertension compared to non-Hispanic whites. Perceived discrimination in healthcare, clinician and institutional bias, and socioeconomic and environmental inequities contribute to uncontrolled hypertension in this population. Multilevel, multicomponent interventions have effectively improved blood pressure control among Black Americans but remain inadequately implemented in the clinical setting. An integrated nursing/public health quality improvement study was designed to address this gap between evidence and integration into clinical practice. Methods: Using a one group pre/posttest design, we examined the effect of a 12-week intervention on blood pressure among Black Americans with uncontrolled hypertension aged 18 and older in the primary care setting. Intervention components included remote blood pressure monitoring, weekly phone coaching with culturally congruent care, medication intensification, and a standardized hypertension protocol. Results: The average age of the participants (n=35) was 64 years, and two thirds (n=23) were female (66%). The mean difference in both systolic and diastolic blood pressure decreased significantly (23 mmHg and 11mmHg, t-test –9.736 and –5.502, p-value &lt;.001). At 12 weeks, 87% of participants had achieved blood pressure control. The intervention also significantly improved medication adherence and hypertension knowledge (p-value &lt;.001). Conclusion: A multicomponent, culturally congruent quality improvement intervention significantly improved blood pressure among Black Americans. Implications: Scaled up implementation of multicomponent, equity-centered, culturally congruent approaches are needed to reduce racial disparities in hypertension control.

Applying models of co-production in the context of health and well-being. A narrative review to guide future practice.

Recent years have seen a dramatic growth in interest in the nature and extent of co-production in the health and social care sectors. Due to the proliferation of work on co-production, there is variation in practice in how co-production is defined, understood, and used in practice. We conducted a narrative review to explore, and provide an overview of, which models of health and social care co-production have been developed, applied, and critiqued over recent decades. Seventy-three peer-reviewed articles met our inclusion criteria. In this set of articles, we identified three broad types of models: conceptual/theoretical, practice-oriented, and presenting a typology. We found that practice-oriented models, predominantly from the Health Services Research and Quality Improvement literature, had largely not drawn on conceptual/theoretical models from the disciplinary fields of Public Administration & Management and Sociology. In particular, they have largely neglected theoretical perspectives on relationships and power and agency in co-production work. The concepts of Service-Dominant Logic and Public Service-Dominant Logic as ways to think about the joint, collaborative process of producing new value, particularly in the context of the use of a service, have also been neglected. Our review has identified distinct literatures which have contributed a variety of models of health and social care co-production. Our findings highlight under-explored dimensions of co-production that merit greater attention in the health and social care contexts. The overview of models of co-production we provide aims to offer a useful platform for the integration of different perspectives on co-production in future research and practice in health and social care.

Use of an electronic wellness instrument in the integrated health and social care of older adults: a group concept mapping study

BackgroundHealth system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada.MethodsGroup concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan.ResultsForty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument’s ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance.ConclusionsMany person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.

Drivers of High Concentration and Dispersal of PM10 and PM2.5 in the Eastern Part of Chhota Nagpur Plateau, India, Investigated Through HYSPLIT Model and Improvement of Environmental Health Quality

ABSTRACTThe ambient air quality is continuously declining especially in emerging countries because of rapid rate of urbanization, industrialization, and allied activities. Thus, the principal objective of this research is to inspect the spatiotemporal variation of particulate matters and to identify the drivers of pollutant dispersal. The month‐wise PM10 and PM2.5 data of 2022 and 2023 were obtained from the West Bengal Pollution Control Board. Meteorological datasets such as wind speed (m/s) and wind direction (degree) were collected from the NASA power access website. The HYSPLIT (Hybrid Single‐Particle Lagrangian Integrated Trajectory) model was applied to identify the pollutant's trajectories. Results showed that Purulia station stood highest in case of absolute AQI 715 (23‐1‐2022 at 7 a.m.), PM2.5 483.47 µg/m3 (23‐1‐2022 at 8 a.m.), and PM10 682.28 µg/m3 (23‐1‐2022 at 7 a.m.), respectively. During winter, the vertical expansion of particles was within the 100‐m boundary layer while during summer, it dispersed vertically and crossed 2000 m above the ground surface due to the combined effect of atmospheric conditions such as wind speed, wind direction, air pressure, and temperature. Moreover, the industrial outputs of Jharkhand and West Bengal play a significant role in elevating the pollution level. Plantation of suitable pollution‐resistant plants including Banyan (Ficus bengalensis), Mango (Mangifera indica), Peepul (Ficus religiosa), Guava (Psidium guajava), Kadam (Neolamarkia cadamba), Neem (Azadirachta indica) is a suitable management technique against pollution in this region.

Development of the “Digihet” Multimedia Education Program to Improve Health Quality in the Setara Community Group

The digital divide and low health quality are challenges faced by the Setara South Sempaja community group. The impact of flooding is a health problem frequently experienced by this community group. The Technology and Health Education Program (Digihet) is designed to address this issue by providing education on the use of digital technology and clean and healthy living patterns to vulnerable groups affected by health problems. This study aims to develop and evaluate the effectiveness of the Digihet program in improving digital literacy, specifically in clean and healthy living patterns, and the quality of life of the community. The Digihet program is developed using multimedia development techniques, starting from the concept design stage to distribution. The Digihet program teaches about 10 clean and healthy living skills for households, including childbirth assisted by healthcare professionals, exclusive breastfeeding for babies, weighing babies and toddlers, using clean water, washing hands with clean water and soap, using healthy latrines, eradicating mosquito larvae at home, eating fruits and vegetables every day, engaging in physical activity every day, and not smoking indoors. Data were collected through beta testing, and the research results showed that the Digihet program is effective in increasing digital literacy in forming clean and healthy living patterns. The results of this study are expected to serve as a basis for developing multimedia health education programs and contribute to enhancing the understanding of the relationship between digital literacy, public health, and information technology in the context of household health quality.

Developing a Maternal Health Worker Training Program in Rural Mississippi [ID 2683576

INTRODUCTION: Mississippi faces the highest infant mortality rate and maternal mortality rate in the United States, with rates for Black women four times higher than for White women. Using community maternal health workers (MHWs) to support patients during pregnancy and postpartum has proven beneficial in other locations and could be transformative in rural Mississippi. We aimed to identify key patient needs to create a MHW training program in the rural Mississippi Delta, as a component of a broader maternal health quality improvement project. METHODS: We conducted quality improvement interviews with 18 obstetric patients (10 prenatal, 8 postpartum) at Delta Health Center, a federally qualified health center in Mound Bayou, Mississippi. We queried patients about strengths and gaps in their prenatal care and their opinions on MHWs. We also queried the obstetrics and gynecology and pediatrics teams at Delta Health Center to identify key pregnancy, postpartum, and infant care and development topics needed for MHW training. RESULTS: 17/18 (94%) of the patients interviewed were in support of the MHW program. The following themes emerged in patient interviews: desire for psychologic support, connection to community resources, and help managing high-risk pregnancy conditions. We designed a 2-week training for MHWs that covers: MHW Responsibilities, Pregnancy Care, Childbirth, Postpartum Care, and Newborn Care and Infant Development. Based on patient feedback, the training prioritizes content related to psychological support and high-risk pregnancy care. CONCLUSION: Patients expect MHWs to be valuable assets for their care. Maternal health workers have the potential to support pregnant women in rural health care settings, ultimately enhancing maternal–fetal health outcomes.

482 Improvement of health outcomes and quality of life of Hispanic older adults in Puerto Rico through participation in a Physical Activity (PA) Community-based Program

OBJECTIVES/GOALS: The proposed study aims to improve physical and mental health outcomes among Hispanic older adults who live alone in a low-income San Juan, Puerto Rico community through weekly PA groups. Specific outcomes include measures of loneliness, social isolation, depression, physical mobility, metabolic indicators, and other health indicators. METHODS/STUDY POPULATION: Data will be collected at three time points: Pre (Week 1), Mid (Week 6), and Post (Week 12) intervention. Currently, the community has 50 residents over 65 years old who live under the poverty index and receive multiple social benefits. Various tools will be implemented to measure loneliness (University of California Los Angeles – Loneliness Scale-10 items), social isolation (Lubben Social Network Scale-6 items), depression (Geriatric Depression Scale-10 items), physical mobility (Time Up and Go Test), metabolic health indicators (hemoglobin A1c and glucose) and other health indicators (i.e., blood pressure, cholesterol, as well as body mass index (BMI)). These measurements will determine if participation in PA groups is associated with improvement of the variables measured. RESULTS/ANTICIPATED RESULTS: It is expected that the baseline scores of older Hispanic adults in terms of loneliness, social isolation, depression, physical mobility, metabolic indicators (i.e., cholesterol level and hemoglobin A1c), and other health indicators (blood pressure or BP and BMI) will be lower compared to those after participation in the Physical Activity Program. More frequent participation will be associated with more significant improvement in measured variables. DISCUSSION/SIGNIFICANCE: Results from this study will determine the effectiveness of community-based PA interventions in addressing loneliness, social isolation, depression, physical mobility, and metabolic factors (hemoglobin A1c and glucose) in elderly minority Hispanic populations as a means of improving their health outcomes and quality of life.

The entwined circles of quality improvement & advocacy

Health policy and quality improvement initiatives exist symbiotically. Quality projects can be spurred by policy decisions, such as the creation of financial incentives for high-value care. Then, advocacy can streamline high-value care, offering opportunities for quality improvement scholars to create projects consistent with evidenced-based care. Thirdly, as pediatrics and neonatology reconcile with value-based payment structures, successful quality initiatives may serve as demonstration projects, illustrating to policy-makers how best to allocate and incentivize resources that optimize newborn health. And finally, quality improvement (QI) can provide an essential link between broad reaching advocacy principles and boots-on-the-ground local or regional efforts to implement good ideas in ways that work practically in particular environments. In this paper, we provide examples of how national legislation elevated the importance of QI, by penalizing hospitals for low quality care. Using Medicaid coverage of pasteurized human donor milk as an example, we discuss how advocacy improved cost-effectiveness of treatments used as tools for quality projects related to reduction of necrotizing enterocolitis and improved growth. We discuss how the future of QI work will assist in informing the agenda as neonatology transitions to value-based care. Finally, we consider how important local and regional QI work is in bringing good ideas to the bedside and the community.

Welding room development for simultaneous improvement of welder health and weld quality of gas metals arc welded aluminum AA5083-H112

This study investigated the weld joint mechanical properties and welding fume exposure associated with Gas Metal Arc Welding of aluminum AA5083-H112 in 27 different welding room environment conditions. These conditions consist of variation in temperature, as well as intake and exhaust wind velocities. The temperature varies as 19 °C, 27 °C and 35 °C. Both the intake and exhaust velocity vary as 0 m/s, 3.1 m/s and 5.5 m/s. The experimental findings underscore the pronounced influence of these factors on both weld quality and welder exposure to fumes. Notably, intake wind velocity emerges as the most critical factor, contributing significantly to 47.68 % in weld joint tensile strength. The temperature emerges as the least critical factor with 12.02 % of contribution. However, temperature became the most critical factor on weld joint impact energy with 54.89 % of contribution while exhaust wind velocity became the least with 3.89 %. Air quality monitoring highlights the importance of optimal intake and exhaust fan configuration to effectively reduce fume exposure. All examined welding room environment condition are deemed safe for the welder, as they do not exceed the Treshold Limit Value (TLV), except the condition where the welding room lacks of air circulation in intake and exhaust wind velocity of 0 m/s. The identified optimal welding room condition exerts a temperature of 27 °C, intake and exhaust wind velocity of 0 m/s and 3.1 m/s respectively. This condition not only achieves established weld quality standards but also ensures compliance with fume exposure regulation. This research provides valuable insights for optimizing welding room environment to simultaneously maintain weld quality and safeguard the well-being of welders

Investigation of cost and availability of gluten-free food in Jeddah, KSA

ObjectiveThe prevalence of celiac disease (CD) in KSA is progressively increasing. Consistent adherence to a gluten-free (GF) diet is the only effective CD treatment. The availability and cost of GF food are important factors in adherence to a GFD. The objective of this study was to investigate the cost and availability of GF food in a sample of local stores and supermarkets across Jeddah province in KSA. MethodEleven supermarkets in Jeddah, KSA, ranging from high budget/quality supermarkets to low-budget stores, were visited. Eight food categories were evaluated, including flour, breakfast cereals, breads, pastas, and snacks (e.g., biscuits, cookies, snack bars, and chips). The availability and cost of GF and gluten containing (GC) items within these food categories were recorded. Each item included in these food categories was counted, and the overall average price was calculated. ResultsA total of 233 GF and 24 GC products were found. Supermarket 1 had the highest availability of GF foods (n = 90), followed by supermarket 2 (n = 34), supermarket 3 (n = 30), supermarket 4 (n = 23), supermarket 5 (n = 21), supermarket 6 (n = 18), supermarket 7 (n = 9), and supermarket 8 (n = 8). The median price per 100 g was significantly greater for GF than GC products (p < 0.05). The cost of GF products was significantly higher than that of GC products (p < 0.05); consequently, GF foods were twice as expensive as their GC counterparts. ConclusionThe availability of GF products was limited, and GF products were more expensive than standard GC products. High cost and limited availability are major roadblocks to GFD adherence among people with CD. Governmental organizations must cooperate with healthcare providers and food industries to ensure that GF foods are widely available and affordable for people with CD, to minimize financial pressure and improve health quality.