The Relationship Service Quality to the Satisfaction of “Mandiri Inhealth” Health Insurance Users Visited to Kediri Service Office

Background: Service quality can mean a simple way to achieve desired goals in the most efficient and effective way, with an emphasis on satisfying the consumer. By knowing the level of customer satisfaction, health insurance can improve service quality. This study aims to determine the relationship of service quality to the satisfaction of health insurance users of Inhealth Mandiri who visited the Kediri Service Office. The method of this research is analytic correlation with cross sectional model. The population used by all Mandiri Inhealth health insurance users visited Kediri Kediri Service Office on average in May, June, July 2017. Methods: The sampling technique used simple random sampling of 68 respondents. The independent variable of service quality and dependent variable is the satisfaction of health insurance user of Mandiri Inhealth who visited Kediri Service Office. Technique of collecting data using questioner then in test with rank spearman with significant level 5%. Results: The results showed that most respondents (60%) said the quality of good service as many as 41 people and got the majority of respondents (56%) satisfaction level is very satisfied sebnyak 38 people. Based on spearman rank test, the value of r (0,000) <α (0,05) hence Ho's denotes that there is relation to the satisfaction of health insurance user of Mandiri Inhealth who visited Kediri Service Office. Conclusion: Better to maintain and improve the quality of service so that the health insurance user is very satisfied with the quality of service that has been provided by regularly evaluating the quality of service and the returning customer will be given a checklist of the services provided

Lifestyle related fertility disorders in North Jordan: Potential for improvement

Objectives: To explore the prevalence rates of lifestyle practices linked to fertility disorders. Materials and Methods: A cross-sectional descriptive study, using a validated questionnaire, was conducted among sub-fertile couples attending the fertility center at Jordan University of Science and Technology between February 2013 and August 2014. Results: A total of 126 couples took part in the study. The average length of sub-fertility was 4.2 years. The mean age of the women was 31 years, of whom 70% were <35 years of age. Over 6% engaged in regular sporting activity. Less than 1% of women smoked more than 5 cigarettes per day. For male partners, the mean age was 36 years, of whom 85.7% were <45 years of age. Over 22% engaged in regular sporting activity. None were taking anabolic steroids on a regular basis. Almost 39% of men smoked more than 5 cigarettes per day. The percentage of patients that took advantage of the woman’s “fertile days” on 6 occasions over the preceding 6 months was 29.37%. Low stress was encountered in 24.21%, intermediate stress in 40.08%, and high stress in 34.52% of couples. The most frequent cause of stress was delay in achieving pregnancy. Almost 4% of women displayed 2 or more risk factors, compared to 11.1% in their male counterparts. Conclusion: Behavior-related fertility disorders are common in Jordan. Modifying lifestyle factors for better reproductive health is highly recommended

Capabilities and Impact on Wind Analyses of the Hurricane Imaging Radiometer (HIRAD)

The Hurricane Imaging Radiometer (HIRAD) is a new airborne microwave remote sensor for hurricane observations that is currently under development by NASA Marshall Space Flight Center in partnership with the NOAA Atlantic Oceanographic and Meteorological Laboratory/Hurricane Research Division, the University of Central Florida, the University of Michigan, and the University of Alabama in Huntsville. The instrument is being test flown in January and is expected to participate in or collaborate with the tropical cyclone experiment GRIP (Genesis and Rapid Intensification Processes) in the 2010 season. HIRAD is designed to study the wind field in some detail within strong hurricanes and to enhance the real-time airborne ocean surface winds observation capabilities of NOAA and USAF Weather Squadron hurricane hunter aircraft currently using the operational Stepped Frequency Microwave Radiometer (SFMR). Unlike SFMR, which measures wind speed and rain rate along the ground track at a single point directly beneath the aircraft, HIRAD will provide images of the surface wind and rain field over a wide swath (approx.3 x the aircraft altitude) with approx.2 km resolution. See Figure 1, which depicts a simulated HIRAD swath versus the line of data obtained by SFMR

Development, Capabilities, and Impact on Wind Analyses of the Hurricane Imaging Radiometer (HIRAD)

The Hurricane Imaging Radiometer (HIRAD) is a new airborne microwave remote sensor for hurricane observations that is currently under development by NASA Marshall Space Flight Center in partnership with the NOAA Atlantic Oceanographic and Meteorological Laboratory/Hurricane Research Division, the University of Central Florida, the University of Michigan, and the University of Alabama in Huntsville. The instrument is being test flown in January and is expected to participate in the tropical cyclone experiment GRIP (Genesis and Rapid Intensification Processes) in the 2010 season. HIRAD is being designed to study the wind field in some detail within strong hurricanes and to enhance the real-time airborne ocean surface winds observation capabilities of NOAA and USAF Weather Squadron hurricane hunter aircraft currently using the operational Stepped Frequency Microwave Radiometer (SFMR). Unlike SFMR, which measures wind speed and rain rate along the ground track at a single point directly beneath the aircraft, HIRAD will provide images of the surface wind and rain field over a wide swath (approximately 3 x the aircraft altitude) with approximately 2 km resolution. This paper describes the HIRAD instrument and the physical basis for its operations, including chamber test data from the instrument. The potential value of future HIRAD observations will be illustrated with a summary of Observing System Simulation Experiments (OSSEs) in which measurements from the new instrument as well as those from existing instruments (air, surface, and space-based) are simulated from the output of a detailed numerical model, and those results are used to construct simulated H*Wind analyses. Evaluations will be presented on the impact on H*Wind analyses of using the HIRAD instrument observations to replace those of the SFMR instrument, and also on the impact of a future satellite-based HIRAD in comparison to instruments with more limited capabilities for observing strong winds through heavy rain. Potential impact on numerical prediction of hurricane intensity will also be discussed

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Micronutrient fortification of food and its impact on woman and child health: A systematic review

Background: Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies.Methods: A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1.Results: Our systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children.Conclusion: Fortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Placebo-controlled efficacy of percutaneous coronary intervention for focal and diffuse patterns of stable coronary artery disease

Background: Physiological assessment with pressure wire pullback can characterize coronary artery disease (CAD) with a focal or diffuse pattern. However, the clinical relevance of this distinction is unknown. We use data from the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) to test if the pattern of CAD predicts the placebo-controlled efficacy of percutaneous coronary intervention (PCI) on stress echocardiography ischemia and symptom end points. Methods: One hundred sixty-four patients in ORBITA underwent blinded instantaneous wave-free ratio (iFR) pullback assessment before randomization. Focal disease was defined as a ≥0.03 iFR unit drop within 15 mm, rather than over a longer distance. Analyses were performed using regression modeling. Results: In the PCI arm (n=85), 48 were focal and 37 were diffuse. In the placebo arm (n=79), 35 were focal and 44 were diffuse. Focal stenoses were associated with significantly lower fractional flow reserve (FFR) and iFR values than diffusely diseased vessels (mean FFR and iFR, focal 0.60±0.15 and 0.65±0.24, diffuse 0.78±0.10 and 0.88±0.08, respectively, P<0.0001). With adjustment for this difference, PCI for focal stenoses resulted in significantly greater reduction in stress echo ischemia than PCI for diffuse disease (P<0.05). The effect of PCI on between-arm pre-randomization adjusted exercise time was 9.32 seconds (95% CI, −17.1 to 35.7 seconds; P=0.487). When stratified for pattern of disease, there was no detectable difference between focal and diffuse CAD (Pinteraction=0.700). PCI improved Seattle Angina Questionnaire angina frequency score and freedom from angina more than placebo (P=0.034; P=0.0035). However, there was no evidence of interaction between the physiological pattern of CAD and these effects (Pinteraction=0.436; Pinteraction=0.908). Conclusions: PCI achieved significantly greater reduction of stress echocardiography ischemia in focal compared with diffuse CAD. However, for symptom end points, no such difference was observed

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030