A high rate of Human Immunodeficiency Virus infection among suspected Tuberculosis cases in Western Kenya

Background: Kenya is a high HIV/AIDS prevalence country and the epidemic has been declared a national disaster, and is at top of the government’s agenda. Objective: To determine the prevalence of HIV infection among suspected tuberculosis (TB) cases seeking healthcare at chest and paediatric clinics in Western Kenya. Methods: This cross-sectional study was done between 2007 and 2009. A total of 695 suspected TB cases (388 males and 312 females) were screened for HIV infection using Trinity Biotech Uni-Gold TM test and positives confirmed with the enzyme linked immunosorbent assay. A questionnaire was used to collect demographic data of the participants. Results: In total, 272 (39.1%) of the suspects were HIV infected 50.7% females and 48.3% males. Females were significantly affected than males [OR = 0.69; 95% CI: 0.51-0.94; P = 0.02]. The majority (39.3%) of the HIV cases were in the 25-34 age-group followed by the 35-44 (24.6%) and 15-24 (15.8%) age-groups respectively. Only 16.9% of HIV-infected cases were on antiretroviral therapy. Conclusions: The prevalence of HIV infection among suspected TB cases was 39.1%, which was relatively lower than 48%, 45% and 44% prevalence rates reported by Division of Leprosy Tuberculosis and Lung Disease (DLTLD) in the annual reports of 2007, 2008 and 2009, respectively. However, it was much higher the current national average HIV prevalence of 7.2%. Keywords: HIV prevalence; healthcare seekers; chest and paediatric clinics; suspected TB case

Tuberculose pulmonaire et cutanée chez un sujet VIH négatif antérieurement traité pour Histoplasmose cutanée : une observation clinique inhabituelle: Pulmonary and cutaneous tuberculosis in an HIV negative patient with a previous treatment for cutaneous histoplasmosis: an unusual report

The authors report through this clinical observation, a case of pulmonary and cutaneous tuberculosis in a 41 year old man with a previous history of treated and cured histoplasmosis. The presentation emphasizes the relevance of addressing immunosuppressive conditions other than HIV/AIDS in case of opportunistic infections affecting HIV-negative patients. Par cette observation de tuberculose multifocale sur terrain antérieurement traité pour histoplasmose cutanée, les auteurs attirent l’attention des prestataires sur l’occurrence possible d’affections rares, suggestives du VIH/SIDA, pouvant faire rechercher d’autres causes d’immunodépression chez les sujets VIH négatifs

New institutional setting, new organizational configurations: Redesigning the Danish emergency care system via a contingency approach

As a result of major administrative reform in 2007, the Danish emergency care system is undergoing the largest reorganization in decades (MHP, 2008; Vrangbaek, 2013). The number of acute hospitals has been reduced from more than 40 to 21 and new emergency departments (EDs) have been established (MHP, 2008; Wen et al., 2013, Mattsson, Mattsson & J\uf8rsboe, 2014). The EDs are the cornerstones of the Danish National Health System (NHS), as up to 70% of all acute care patients are evaluated there; they can be treated and discharged, or admitted for further care (MHP, 2008; Wen et al., 2013). The EDs therefore play a crucial role in determining the design of the overall healthcare, being a critical pathway for acute care and addressing hospital crowding. The Danish emergency care system represents an organizational field (DiMaggio & Powell, 1983) in which highly specialized healthcare actors, such as primary care physicians (PCPs), systems of out-of-hours care clinics, ambulance systems, and hospitals, have to coordinate their actions with the ultimate objective of providing a timely and appropriate response toward the collective. On the other hand, following the general reform of 2007, the National Board of Health in Denmark (NBHD) has recommended the delivery of emergency care through fewer, larger, and more centralized EDs. This was done to concentrate specialties and provide a higher level of care with greater efficiency in a system in which the patients\u2019 overall impression of hospitalization has traditionally been positive (MHP, 2008). Moreover, the overall reform generated (external) financial crunches for healthcare providers that predictably turned into internal pressures related to efficiency (e.g., Louis et al., 1999; Lega & DePietro, 2005; Reay & Hinings, 2005, 2009). The search for efficiency through the maximization of economies of scale, by concentrating specialized knowledge and equipment, is generating some symbiotic organizational effects. These can be studied at different levels of analysis (Hackman, 2003): a) at the macro level, through a general rationalization of public expense, in two ways: a.1) regions are in charge of the planning and delivery of healthcare, and new regional mechanisms for governance and funding, resulting in the diffusion of new performance appraisal approaches; a.2) positive operational spillovers are exploited amongst agents through coordination mechanisms based on healthcare networks, with several interdependent providers covering the various phases of emergency care; b) at the meso level, via the definition of structures, roles, and procedures of emergency care. In essence, each hospital designs its own ED, with different levels of managerial autonomy, human resource specialization, technological endowment, and design of internal processes. In short, the Danish emergency care system is trying to change toward a more cost-effective but also a more patient-oriented configuration; c) at the micro level, via the design of appropriate incentives for professionals. In Fearlie and Shortell\u2019s (2001) terms, \u201cA multilevel approach to change and the associated core properties can provide a framework for assessing progress on these and related issues over the next several years\u201d (p. 307). This paper presents the preliminary results of a larger research project called DESIGN-EM, aimed at designing effective and efficient EDs. In a dynamic environment, in which each of the 21 Danish hospitals is still configuring its own ED, this research project aims to determine if differences in organization designs affect efficiency, effectiveness, the quality of patient care, and resource utilization. It reports on the part of the project attempting to investigate the meso level of analysis (hospitals/EDs), and focuses on the research gap related to the adoption of the multi-contingency approach (Burton & Obel, 1988, 2004) in the design of emergency care, with a specific focus on the EDs (Table 1). Thus, this research addresses the following research question: How can hospitals design their EDs to adapt to institutional, technological, and clinical dynamics

Prevalence of overweight in 2 to 17 year-old children and adolescents whose parents live separately: a Nordic cross-sectional study

Background Comparative data of parental separation and childhood overweight has not been available before across the Nordic countries. The aim of this study was to examine the within-country prevalence and association between parental cohabitation and overweight in Nordic children. Methods A cross-sectional survey of 2-17-year-old children was conducted in 2011, titled: “NordChild”. A random sample of 3,200 parents in each of the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden were invited to participate in the study with parents of 6,609 children accepting to give answers about their children’s health and welfare including information on height and weight of each child and parental cohabitation (response rate 41.5%). The group differences in prevalence and adjusted odds ratio (OR) for overweight, with corresponding 95% confidence intervals (CI) were performed in children whose parents lived separately. Additionally, a missing data analysis was performed to determine whether the adjusted estimates might result from confounding or selection bias. Results A significant difference was observed in Iceland between children whose parents live separately compared to those who live with both parents (difference: 9.4%, 95% CI: 2.8; 15.9) but no such difference was observed in Denmark, Finland, Norway and Sweden. No significant odds of overweight were observed in children whose parents lived separately compared to children in normal weight at the time of study; Denmark: OR 1.03 (95% CI: 0.42; 2.53), Finland: OR 1.27 (95% CI: 0.74; 2.20), Iceland: OR 1.50 (95% CI: 0.79; 2.84), Norway: OR 1.46 (95% CI: 0.81; 2.62), and Sweden: 1.07 (95% CI: 0.61; 1.86). The missing data analysis indicated that the findings in Norway, Finland and Iceland were partly observed due to selection effects, whereas the adjustment in Denmark was due to confounding. The crude OR for overweight was higher in the 2-9-year-old group than in the 10-17-year-old group whose parents lived separately in Iceland, Norway and Sweden. Conclusions No association between parental cohabitation and overweight in Nordic children was found. Our finding of greater prevalence of overweight in Icelandic children whose parents live separately may be an indication that the welfare system in Iceland is separating from the other Nordic countries

Tension and Resistance to Change Organizational Climate: Managerial Implications for a Fast Paced World

Climate is the atmosphere of the organization, a “relatively enduring quality of the internal environment of an organization, which is experienced by its members and influences their behavior.” The organizational climate can be measured in terms of trust, morale, conflict, equity in rewards, leader credibility, resistance to change and scapegoating. Using a factor analysis, we found that the organizational climate can be described in two dimensions: “tension” and the resistance to change for a group of 245 Danish companies. High tension involves strained relationships, stress and a balance of the combined factors. High resistance to change is a preference for tomorrow to be like today. Change management has a long history and rests fundamentally upon Lewin’s three phases: unfreeze, change and re-freeze. More recently, change management is seen as sensemaking and the creation of an organizational reality in which change is more usual and continuous. Using the competing values framework, four organizational climates emerge: S internal process, which is high on tension and resistance to change, S rational goal, which is high on tension and low on resistance to change, S developmental, which is low on tension and low on resistance to change, and S group, which is low on tension and high on resistance to change. The managerial implications are complex For a fast paced world, the resistance to change must be low. Lewinian episodic change is difficult, slow and costly. Continuous change can be managed, where change becomes the norm of the organization. However, tension does not have to be low. Individuals may prefer a low tension organization, but it may not be necessary for a fast paced world. Further, since the two dimensions are independent, managers cannot reduce tension as a means to reduce the resistance to change

The association between preschool behavioural problems and internalizing difficulties at age 10-12 years

The aim was to study the association between preschool behavioural problems and emotional symptoms in 10- to 12-year-old children. The study was based on the Aarhus Birth cohort, Denmark, and included 1,336 children. Based on the parent-administered preschool behaviour questionnaire (PBQ), we identified three not mutually exclusive preschool behavioural categories: anxious–fearful (n = 146), hyperactive–distractible (n = 98), and hostile–aggressive (n = 170). Children without any known symptoms were considered well adjusted (n = 1,000). Borderline emotional (n = 105) and emotional difficulties (n = 136) were measured at age 10–12 years with the parent-administered strength and difficulties questionnaire (SDQ). Multinomial logistic regression analyses were used to adjust for potential confounding factors. We found that anxious–fearful behaviour and hostile–aggressive preschool behaviour were associated with twice the risk of school-age emotional difficulties. Comorbidity or confounding failed to explain these results. Hyperactive–distractible preschool behaviour was not associated with school-age emotional difficulties. Preschool anxious–fearful behaviour was associated with school-age emotional difficulties, suggesting internalizing symptom stability in some children from early childhood. Preschool hostile–aggressive behaviour was also associated with school-age emotional difficulties, which suggests transformation of one behavioural dimension into another through childhood, and the need to focus on both early internalizing difficulties and hostile–aggressive behaviour as risk factors for later internalizing difficulties

An Organizational Change Perspective

We present the concept of organizational misfit as a complement to multi-contingency theory fit concepts for organizational performance. Firms with misfits have opportunity losses that firms without misfits do not suffer. Using data from 232 small and medium sized Danish firms, we confirm the hypotheses that firms with either or both situational and contingency misfits have lower performance increases than firms without misfits. Further, a firm may not obtain increased performance from the elimination of misfits piecemeal, but will obtain significant nonlinear positive increases when misfits are fixed within a holistic or systems approach

Misdiagnosis and clinical significance of non-tuberculous mycobacteria in Western Kenya in the era of human immunodeficiency virus epidemic

Objectives: To determine and document the role of non-tuberculous mycobacteria (NTM) in TB-like disease morbidity and demonstrate the confusion they cause in the diagnosis of TB in western Kenya.Design: A cross-sectional study.Setting: One provincial and nine District hospitals in western Kenya.Subjects: Tuberculosis suspects.Interventions: Sputa from 872 tuberculosis suspects underwent microscopy and culture on solid and liquid media. The growth was identified using the Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. Consenting clients were screened for HIV infection using Trinity Biotech Uni-GoldTM test and positive cases were confirmed with the enzyme linked immunosorbent assay. A questionnaire was used to obtain demographic data.Main outcome measures: ZN smear positivity / negativity; Culture positivity or negativity; Mycobacterium species isolates (tuberculous or non-tuberculous); HIV status.                                                      Results: Sputa from 39.1% (341/872) of the participants were ZN smear positive, of these 53.1% (181/341) were culture positive. Only 3.8% (20/531) of the ZN smear negatives were culture positive. In total 41.4% (361/872) participants were infected with mycobacteria, of which 44.3% (160/361) were culture negative and 55.7% (201/361) were culture positive. The culture positives yielded 92.5% M. tuberculosis complexand 7.5% NTM. The overall prevalence of the NTM disease was 1.72% (15/872).                                                                            Conclusion: A low prevalence of NT M pulmonary disease in western Kenya is reported in this study, but some the NTM disease cases could have been misdiagnosed as TB cases

Mboga za Watu wa Pwani: Kilifi Utamaduni Conservation Group

Vegetables of the Coast People of Kenya No region in Kenya boasts of a greater variety of vegetables than the coastal area. Over 100 species are used by the nine linguistically-related groups living here, the Mijikenda. Just as rich is the knowledge associated with these vegetables as seen in the variety of mixtures that may be formed in a single preparation and the delicate art of balancing the quantities of each. This book makes available information on this rich vegetable culture. It provides local names of the vegetables in the different dialects (Mijikenda groups), scientific names, ecological and production information, method of preparation and mixtures involved. Eight plates with over 100 photographs as well as over 60 illustrations are provided for easy identification of the species. This book will be valuable for people interested in Mijikenda vegetables and traditions, scientists, development workers as well as extension agents working in the field of agriculture, anthropology, food and nutrition and ethnobotany, among several others. Maelezo Mboga za Watu wa Pwani Hamna sehemu ya Kenya inayojivunia aina nyingi za mboga kuliko Pwani. Zaidi ya aina mia moja hutumiwa na wakaaji wa sehemu hii waitwao WaMijikenda. Vile kuna wingi wa aina za mboga, ndivyo pia kuna wingi wa ujuzi unaoambatana na hizi mboga. Huu ujuzi tunaushuhudia wakati mboga aina tofauti zinapochangnywa kwa umakini na kupikwa pamoja. Kitabu hiki kinasimulia utamaduni wa kipekee wa mboga za Wamijikenda. Kinaelezea maumbile ya hizi mboga, majina ya mboga kwa lugha za waMijikenda na ya kisayanzi, mazingira ambamo mboga inamea, ukuzaji, utayarishaji na ‘visanganyo’ vinavyotumiwa. Kwa jumla, zimo kurasa nane zilio na zaidi ya picha mia moja na pia kuna zaidi ya michoro sitini, ili kumsaidia msomaji kuzitambua hizi mboga kwa urahisi. Hiki kitabu kitakuwa cha manufaa kwa wale wanaotaka kufahamu utamaduni wa waMijikenda kuhusu mboga, na pia kwa wanasayanzi na wanaoendeleza miradi vijijini hasa katika nyanja za kilimo, mila na desturi, lishe bora pamoja na wanaosoma manufaa ya mimea kwa binadamu na wengine