Calidad del servicio de el examen visual realizado por Cruz Roja Nicaragüense para optar a la licencia de conducir, Managua, período enero-junio 2019

Objetivo: El presente estudio monográfico tuvo como objetivo, analizar la Calidad del servicio de el examen visual realizado por Cruz Roja Nicaragüense para optar a la licencia de conducir, Managua, período enero-junio 2019. Método: El estudio investigativo es mixto, de tipo observacional, descriptivo, correlacional, retrospectivo, transversal. La población en estudio fue de 377 personas que acudieron a realizarse el examen visual a la Sede Belmonte de Cruz Roja Nicaragüense, en la ciudad de Managua. Resultado: Los usuarios encuestados definieron como regular su grado de satisfacción en cuanto al examen visual que se realizaron en Cruz Roja Nicaragüense. Mediante pruebas de asociación se observó que existe una respuesta estadística significativa de p=.000 entre las variables de tiempo de espera, tiempo de realización de examen, trato de personal y presentación de las instalaciones físicas con el grado de satisfacción de los usuarios. De esta manera, se desarrolló un modelo de propuesta de protocolo clínico de atención visual con más pruebas optométricas complementarias para garantizar un examen visual completo que satisfaga las necesidades de los usuarios y garantice un chequeo visual óptimo. Conclusiones: La calidad de los servicios de atención para la salud va en dependencia de distintos factores, tal es el caso de una estructura de protocolo clínico de atención que valore completamente la capacidad visual del usuario y este quede satisfecho de la atención de dicho servicio. Palabras claves: Calidad, Calidad en Salud, Percepción, Examen visual, Optometrí

Eating, heating or taking the bus? Lived experiences at the intersection of energy and transport poverty

Experiences of poverty can manifest in multiple aspects of everyday life, often in interlinking ways. One example is ‘double energy vulnerability’, where a household faces both energy poverty and transport poverty simultaneously. This can result in trade-offs, where prioritising one essential need (e.g., transport) makes accessing another impossible (e.g., heating). Such decisions are not easily made, and they can have distinct spatio-temporal characteristics. They can vary between space and time and across different household members, and result in stark inter- as well as intra-household differences. People with socio-demographic and contextual vulnerabilities are particularly at risk of experiencing double energy vulnerability. Based on 59 household interviews across the four nations of the United Kingdom, we provide novel, multi-nation empirical evidence on the lived experiences of double energy vulnerability, drawing on our themes; ‘being locked into infrastructure’, ‘facing high costs and low incomes’, ‘choosing between energy and transport’, and ‘missing out’. A cross-national lived-experiences approach sheds light on double energy vulnerability as a relational, contingent and ongoing phenomena, attending to everyday experiences and capacities. We provide suggestions for further research, such as further study of double energy vulnerability amongst refugees and migrants. We also highlight that the study of lived experiences can aid the recognition of how different forms of poverty intersect and how they need to be taken into account in the design of Net Zero policies

Propuesta estratégica de mejora en la implementación de los estándares mínimos del Sistema de Gestión de la Seguridad y Salud en el Trabajo (SG-SST) en la Empresa Contactar para el año 2020.

La adopción de sistemas para la gestión de la salud y seguridad en el trabajo trata de responder a las demandas y presiones de los entes regulatorios, empleadores y trabajadores para garantizar un ambiente de trabajo seguro previniendo los accidentes y reduciendo el número de lesionados.The adoption of occupational health and safety management systems is a response to the demands and pressures of regulatory agencies, employers and workers to guarantee a safe work environment free that prevents accidents and reduces the number of people injured

Feasibility and willingness-to-pay for integrated community-based tuberculosis testing

BACKGROUND: Community-based screening for TB, combined with HIV and syphilis testing, faces a number of barriers. One significant barrier is the value that target communities place on such screening. METHODS: Integrated testing for TB, HIV, and syphilis was performed in neighborhoods identified using geographic information systems-based disease mapping. TB testing included skin testing and interferon gamma release assays. Subjects completed a survey describing disease risk factors, healthcare access, healthcare utilization, and willingness to pay for integrated testing. RESULTS: Behavioral and social risk factors among the 113 subjects were prevalent (71% prior incarceration, 27% prior or current crack cocaine use, 35% homelessness), and only 38% had a regular healthcare provider. The initial 24 subjects reported that they would be willing to pay a median $20 (IQR: 0-100) for HIV testing and$10 (IQR: 0-100) for TB testing when the question was asked in an open-ended fashion, but when the question was changed to a multiple-choice format, the next 89 subjects reported that they would pay a median $5 for testing, and 23$5 to get tested for TB, HIV, or syphilis. Among persons who received tuberculin skin testing, only 14/78 (18%) participants returned to have their skin tests read. Only 14/109 (13%) persons who underwent HIV testing returned to receive their HIV results. CONCLUSION: The relatively high-risk persons screened in this community outreach study placed low value on testing. Reported willingness to pay for such testing, while low, likely overestimated the true willingness to pay. Successful TB, HIV, and syphilis integrated testing programs in high risk populations will likely require one-visit diagnostic testing and incentives

Defining the museum of the 21st century: evolving multiculturalism in museums in the United States

This publication brings together a selection of papers presented at the online symposium organized by ICOFOM under the general theme Defining the Museum of the 21st Century, with Southern New Hampshire University in the United States on September 14, 2018.Chung, S.S.C., Leshchenko, A, & Soares, B.B. (Eds.). (2019). Defining the museum of the 21st century: evolving multiculturalism in museums in the United States. Retrieved from http://academicarchive.snhu.ed

Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15–19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.publishedVersio

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension