Stronger together: midwifery twinning between Tanzania and Canada

This article describes a twinning relationship between the Canadian Association of Midwives (CAM) and the Tanzania Midwives Association (TAMA). It argues that the twinning relationship strengthened both associations. The article briefly reviews the existing literature on professional associations and association strengthening to demonstrate that professional associations are a vital tool for improving the performance of healthcare workers and increasing their capacity to contribute to national and international policy-making. It then suggests that midwifery associations are particularly significant given the frequent professional marginalization of midwives. The article then describes in depth the relationship between CAM and TAMA, highlighting the accomplishments of the twinned partners, and analyzing the factors that contributed to the success of the relationship. The findings demonstrate that twinning can successfully strengthen associations, increasing their ability to support their membership, care for the public, and shape national policy-making. The article therefore proposes twinning as a successful and cost-effective model for encouraging the growth of the midwifery profession.     

Prevalence of hidden carbon monoxide poisoning in auto service workers; a prospective cohort study

Background

Carbon monoxide (CO) is formed as a result of the incomplete burning of hydrocarbon-containing fuels such as natural gas, coal, liquid petroleum gas, and wood. CO is a colorless, odorless, and poisonous gas that produces various acute and chronic effects in CO-exposed people. In this study, we aimed to measure CO levels in auto care repairmen with chronic CO-related illnesses using a serial, non-invasive method.A prospective cohort study.

Methods

A total of 99 people from six different auto-repair services were included in the study. Carboxyhemoglobin (COHb) levels were measured at four different times with 2-hour intervals starting at 08:00 AM. Data concerning employees’ ages, working hours, smoking statuses, and types of home heating fuel were collected. A control group of 100 cases was created based on this data. The measurements were done on the control group in the morning with a Masimo Rad-57 CO-oximeter.

Results

The highest mean (± SD) COHb value was 7.04%?±?3.32% after the third measurement. The mean value for the control group was 1.61%?±?1.43%. A statistically significant difference between the groups was found for each value.

Discussion

We determined that the risk of being affected by CO is high in buildings in which the auto services were located. The effects of chronic or prolonged exposure to low amounts of CO were found to be ambiguous. However, in some studies, it was found that low-grade CO exposure could lead to coronary artery disease and some neurological complications. Therefore, it is necessary to be careful about the health of employees who have been exposed to CO.

Conclusions

We concluded that there is a need for more detailed studies concerning chronic CO poisoning. Also, in workplaces in which there is high exposure to CO, proper workplace safety measures should be taken to reduce this gas’s harmful effects to employees.

     

Leadership position and physician visits – results of a nationally representative longitudinal study in Germany

Background

So far, studies within the occupational field have largely concentrated on working conditions and job stressors and staff members’ or subordinate health. Only a few have focused on managers in this context, but studies are missing that explicitly look at the relation between leadership position and health care use (HCU). Thus, the purpose of this study was to examine the potential effects of a change in leadership position on HCU in women and men longitudinally.

Methods

Data were drawn from a nationally representative longitudinal study in Germany (German Socio-Economic Panel, GSOEP). Data from 2009 and 2013 were used. Leadership position was divided into (i) top management, (ii) middle management, (iii) lower management, and (iv) a highly qualified specialist position. The number of physician visits in the preceding 3 months were used to quantify HCU (n?=?2140 observations in regression analysis; 69% male).

Results

Adjusting for various potential confounders (e.g., age, self-rated health, chronic conditions, and personality factors), Poisson FE regression analysis revealed that changes from a highly qualified specialist position to the top management were associated with a decrease in the number of physician visits in men (β?=?.47, p?<?.05), but not in women. Gender differences (gender x leadership position) were significant.

Conclusions

Findings of this study emphasize the impact of leadership positions on the number of physician visits in men. Further study is required to elucidate the underlying mechanisms.

     

Rehabilitation bei Kindern und Jugendlichen mit Diabetes mellitus

Background

Medical rehabilitation plays a special role in the treatment of children and adolescents with diabetes mellitus: services which are difficult to implement in an out-patient or an acute in-patient setting can be provided. The study analyzed changes over a period of 12 years.

Methods

In a monocentric, retrospective cross-sectional analysis, all (n = 2001) children and adolescents with diabetes (52% girls, age 12.6 ± 4.9 years) who were admitted to a specialist clinic for rehabilitation during the period 01/2004–12/2016 were examined.

Results

The duration of medical rehabilitation was 27.3 ± 6.1 days. In all, 1980 of 2001 (98.9%) children and adolescents had type 1 diabetes, while 21 of 2001 (1.1%) had type 2 diabetes. Mean HbA1c was 7.87 ± 1.47%. Overall, 1897 of 2001 (95%) patients had an intensified insulin therapy, of which 633 (32%) used insulin pumps (CSII). They injected 0.86 ± 0.47?I.?U. insulin/kg body weight/day and performed 37.6 ± 11.4 blood glucose self-tests/week. The number of patients who participated in medical rehabilitation decreased: In 2016 it was 68% lower than in 2007, the year of the highest number of patients (p < 0.05). Parameters of metabolic control hardly changed. The proportion of patients with CSII increased (p < 0.05). In particular, young children used CSII more frequently (59% in <4 year olds vs 24% in 16–17 year olds, p < 0.05). Changes also occurred in cultural status: The percentage of patients from German families decreased (p < 0.05); the proportion of patients from mixed-cultural families increased (p < 0.05). The number of patients living together with both parents also decreased (p < 0.05 for the tendency); the number of patients living with single parents increased (p < 0.05 for the tendency). In young children, HbA1c values were the lowest. From the beginning of puberty (about 10 years), HbA1c increased (8.5 ± 1.9% in 16–17 year olds). There were no correlations/associations between metabolic control and the incidences of hypoglycemia/ketoacidoses.

Conclusions

There has been a change in medical rehabilitation: The number of patients has decreased, the proportion of patients using CSII has increased, the number of patients living with single parents and the percentage of patients from a culturally mixed families has also increased. Thus, there are new challenges in medical rehabilitation.

     

PM<Subscript>10</Subscript> concentration in relation to clinic visits for anxiety disorders: a population-based study of a high river-dust episode region in Taiwan

PM₁₀ exposure has been found to have significant effects on a variety of physical conditions. However, whether it acts on psychopathology remains unclear. This study used 8-year data to examine the relationship between PM₁₀ concentration and daily clinic visits of anxiety disorders. All residents of Yunlin County, Taiwan, which is a high river-dust exposure area, were selected as subjects. Data from the Taiwan National Health Insurance Research Database (NHIRD), 2002–2009, were analyzed. Individuals with any ICD code of 300.0 and 300.2 were categorized as with anxiety disorders. PM₁₀ data were based on the Lunbei station (located at Yunlin County) of EPA, Taiwan. Time-series analysis showed that, during the observed 8 years, the number of daily clinic visits for anxiety disorders increased with PM₁₀ levels, and the relationship remained significant after unemployment rate, and the Weighted Price Index of Taiwan Stock Exchange in the same period were controlled for. In particular, we found that there is a linear dose-response effect between daily clinic visits and PM₁₀ levels when PM₁₀ <?300 μg/m³; whereas a dramatically elevated daily clinic visits of anxiety disorders was found when PM₁₀ >?300 μg/m³. Findings from this study highlight that high level of PM₁₀ exposure derived from severe weather or environment condition may affect the occurrence of anxiety disorders. In addition, there seems to have a threshold of PM₁₀ in elevating the risk of anxiety disorders.     

Pflegeschulungen für Angehörige mit Migrationshintergrund und Kompetenzbildungen für professionell Pflegende

Background

The proportion of people in need of care with a migration background and therefore the demand for qualified nursing staff will increase. So far, however, considerations and concepts aiming to improve the care situation (including cultural sensitivity) for people in need of care with a migration background are lacking.

Objective

The following questions are addressed on the basis of care training for relatives with migration background and competence development for health care professionals: What content should the care training/competence development take into account? What are the limits regarding planning and implementation, and what are the suggestions for improvements?

Materials and methods

The development of care training and competence development was based on a needs and resources assessment (in the form of a systematic literature review, an expert workshop, semistructured interviews with relatives with migration background who are providing nursing care). A training manual that has been published includes research results and findings and is applicable to other target groups and settings.

Results and discussion

A transcultural training manual was developed and tested for use in outpatient care. It consists of two parts: training for relatives providing nursing care and competency training for health care specialists. It enables the planning, preparation, and implementation of training courses and includes theoretical background knowledge, practical exercises, and didactic advice. When using the manual, however, the target group should be planned at an early stage and individual needs and resources of course participants should be taken into account.

     

Change in quality of malnutrition surveys between 1986 and 2015

Background

Representative surveys collecting weight, height and MUAC are used to estimate the prevalence of acute malnutrition. The results are then used to assess the scale of malnutrition in a population and type of nutritional intervention required. There have been changes in methodology over recent decades; the objective of this study was to determine if these have resulted in higher quality surveys.

Methods

In order to examine the change in reliability of such surveys we have analysed the statistical distributions of the derived anthropometric parameters from 1843 surveys conducted by 19 agencies between 1986 and 2015.

Results

With the introduction of standardised guidelines and software by 2003 and their more general application from 2007 the mean standard deviation, kurtosis and skewness of the parameters used to assess nutritional status have each moved to now approximate the distribution of the WHO standards when the exclusion of outliers from analysis is based upon SMART flagging procedure. Where WHO flags, that only exclude data incompatible with life, are used the quality of anthropometric surveys has improved and the results now approach those seen with SMART flags and the WHO standards distribution. Agencies vary in their uptake and adherence to standard guidelines. Those agencies that fully implement the guidelines achieve the most consistently reliable results.

Conclusions

Standard methods should be universally used to produce reliable data and tests of data quality and SMART type flagging procedures should be applied and reported to ensure that the data are credible and therefore inform appropriate intervention. Use of SMART guidelines has coincided with reliable anthropometric data since 2007.

     

Indoor air quality index for preoccupancy assessment

The purpose of this study is to document the potential impacts on indoor air quality associated with different types of building materials (wall and floor finishes) through the development of an Indoor Air Quality index. The study first identifies pollutant sources and their corresponding health impacts due to short-term and long-term exposures. The study also quantifies levels of certain pollutants within a steady-state controlled environment, comparing the results of this study with previous studies conducted in different regions. It also proposes an IAQ index as an assessment tool which can be utilized preoccupancy. The field studies were conducted in residential buildings during January and February in Cairo to monitor volatile organic compounds (VOCs), formaldehyde (HCHO), ammonia (NH₃), radon gas, and particulate matter (PM). The indoor air was monitored in nine locations: four during the construction process and five following completion of construction. For this investigation, three rooms under construction within a Cairene building site were utilized to test the finishing materials. Chemical analysis and direct reading devices were used for air sampling and monitoring. The results revealed that the concentration of some pollutants decreased within the first year of construction, while others remained above target limits. The results of this study offer recommendations for engineers regarding the selection of appropriate materials through the implementation of source control strategies and an IAQ index which can be used as an assessment tool to ensure that the Indoor Air Quality meets recommended standards. Based on the conclusions and limitations of this study, recommendations for future work are documented such as the screening of materials and monitoring of Indoor Air Quality.     

Multi-level policies for air quality: implications of national and sub-national emission reductions on population exposure

Poor air quality and related health impacts are still an issue in many cities and regions worldwide. Integrated assessment models (IAMs) can support the design of measures to reduce the emissions of precursors affecting air pollution. In this study, we apply the SHERPA (screening for high emission reduction potentials for air quality) model to compare spatial and sectoral emission reductions, given country-scale emission targets. Different approaches are tested: (a) country ”uniform” emission reductions, (b) emission reductions targeting urban areas, (c) emission reductions targeting preferential sectors. As a case study, we apply the approaches to the implementation of the National Emission Ceiling Directive. Results are evaluated in terms of the reduction in average population exposure to PM_2.5 overall in a country and in its main cities. Results indicate that the reduction of population exposure to PM_2.5 highly depends on the way emission reductions are implemented. This work also shows the usefulness of the SHERPA model to support national authorities implementing national emission reduction targets while, at the same time, addressing their local air quality issues.