Education Program for Critical Care Nurses on Preventing Catheter-Associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles\u27s adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses\u27 knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p \u3c .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses\u27 knowledge of evidence-based practices to prevent CAUTIs. Improving nurses\u27 knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses

Education Program for Critical Care Nurses on Preventing Catheter-Associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles\u27s adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses\u27 knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p \u3c .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses\u27 knowledge of evidence-based practices to prevent CAUTIs. Improving nurses\u27 knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses

HCME: An Environment-Friendly I.C. Engine Fuel

The study revealed that Hura crepitans oil is a good candidate for Hura crepitans methyl ester (HCME) production. Two steps (esterification and transesterification) production stages influenced the high yield of HCME. Three possible experimental runs were performed in each step, the best of the three conditions were 1.45 (% v/v) for H2SO4 conc., 5:1 for methanol/oil molar ratio, 40 min for reaction time which gave 1.06 % for FFA in the first step, in the second step, 92.70 %(w/w) of HCME was obtained at 0.55% KOH, 5:1 methanol/oil molar ratio, 60 oC temperature and 30 min reaction time. The produced HCME had fuel properties which satisfied both ASTME D6751 and EN 1424 standards. The fatty acid profile of the HCME revealed the dominant fatty acids were linoleic (64.50%), oleic (17.54%) and palmitic (12.70%). Exhaust emissions from an internal combustion (I.C.) engine revealed that there is 60% decreased in CO, 58% decreased in NOx, 60% decreased in HC, 39% decrease in smoke opacity and 42% decreased in BSFC at B20, respectively. Flue gas temperature increased by 12% at B20, 45% increased in BTE at B50 when compared to pure diesel (AGO). Hence, it can be concluded that B20 (20% HCME + 80% AGO) will provides the best emission reduction at the lowest cost

Factors Influencing Cervical Intraepithelial Neoplasia and Cervical Cancer Development among Women in Lokoja, North Central Nigeria

Cervical cancer is increasingly becoming a high cause of cancer deaths in Nigeria; it has a high prevalence in Nigeria, as it is the case in most developing countries. This study was aimed at screening for Cervical Intraepithelial Neoplasia (CIN) using Papanicolaou screening procedure, and identifying the influencing factors amongst women in Lokoja, North central Nigeria. This was a cross sectional study involving women between the ages of 16-65 years, selected through convenience sampling of patients and staff that attended the Federal Medical Centre. Interviewer- administered questionnaire and clinical report form were also used to collect data, and data was analyzed using correlational analysis. Results showed that of the 203 women in the study, 193 (95.07%) had normal cytology (they were negative for intraepithelial lesion or malignancy), while 10 (4.93%) women had CIN. Socio-demographic characteristics showed that there were significant relationships between the age of the correspondents and the development of CIN (p = 0.015), significant association was also obtained between male partner circumcision (p=0.0262), coitarche (p=0.0046), parity (p=0.0019), alcohol usage (p=0.0026), age of first pregnancy (p=0.0326), use of steroid contraceptive (p=0.0104), number of sexual partners (p=0.0001) and the development of CIN. CIN present were low grade squamous intraepithelial lesions, atypical squamous cell of uncertain significance, and squamous cell carcinoma. The major risk factors associated with cervical intraepithelial neoplasia development indicated in this study include; parity, alcohol usage and multiple sexual partners

Biting on human body parts of Simulium vectors and its implication for the manifestation of Onchocerca nodules along Osun River, southwestern Nigeria

Background: The biting preference of Simulium vectors has been known to influence the distribution ofOnchocerca nodules and microfilariae in human body. There is, however, variation in biting pattern of Simuliumflies in different geographical locations. This study investigates the biting pattern on human parts by Simuliumvectors along Osun river system where Simulium soubrense Beffa form has been implicated as the dominantvector and its possible implication on the distribution of Onchocerca nodules on human body along the river.Methods: Flies were collected by consented fly capturers on exposed human parts namely head/neck region,arms, upper limb and lower limb in Osun Eleja and Osun Budepo along Osun river in the wet season (August–September) and the dry season (November–December) in 2008. The residents of the communities were alsoscreened for palpable Onchocerca nodules.Results: The results showed that number of flies collected below the ankle region was significantly higher thanthe number collected on other exposed parts (p <0.05) while the least was collected on head/neck region in bothseasons. The lower trunk was the most common site (60%) for nodule location at Osun Eleja followed by uppertrunk (40%). Nodules were not found in the head and limb regions. At Osun Budepo, the upper trunk was themost common site of the nodule location (53.8%) followed by the lower trunk (38.5%) and head region (7.7%).Conclusion: Though, most of the flies were caught at the ankle region, the biting of other parts coupled with thepresence of nodules at the head and upper trunk regions showed that Simulium vectors could obtain microfilariaefrom any part of the body, thus increasing the risk of onchocerciasis transmission

Occurrence of PAHs in water samples of the Diep River, South Africa

Occurrence of polycyclic aromatic hydrocarbons (PAHs) in freshwater may aggravate the water crisis currently being experienced in the Western Cape Province of South Africa. However, there is dearth of data on the levels of PAHs, which is necessary for effective assessment of water quality as well as remediation strategies. This study therefore assessed levels of PAHs in the Diep River freshwater system of Western Cape Province, South Africa. A liquid-liquid extraction solid-phase extraction gas chromatography flame ionisation detection (LLE-SPEGC-FID) method was developed to simultaneously determine the 16 United States Environmental Protection Agency (USEPA) listed priority PAHs in water samples. The SPE-GC-FID method allowed an acceptable linearity (R2 &gt; 0.999) within the calibration range of 1 to 50 μg/mL. Instrument detection limits ranged between 0.02 and 0.04 μg/mL and instrument quantification limits between 0.06 and 0.13 μg/mL. Recovery study results were also acceptable (83.69–96.44%) except for naphthalene, which had recovery of 60.05% in spiked water matrix. The seasonal averages of individual PAH detected at the studied sites ranged between not detected (nd) and 72.38 ± 9.58 μg/L in water samples.Keywords: PAHs, Diep River, GC-FID, freshwate

Places Nigerians visited during COVID-19 government stay-home policy: evidence from secondary analysis of data collected during the lockdown

Introduction. Compliance with the Government’s lockdown policy is required to curtail community transmission of Covid-19 infection. The objective of this research was to identify places Nigerians visited during the lockdown to help prepare for a response towards future infectious diseases of public health importance similar to Covid-19 Methods. This was a secondary analysis of unconventional data collected using Google Forms and online social media platforms during the COVID-19 lockdown between April and June 2020 in Nigeria. Two datasets from: i) partnership for evidence-based response to COVID-19 (PERC) wave-1 and ii) College of Medicine, University of Lagos perception of and compliance with physical distancing survey (PCSH) were used. Data on places that people visited during the lockdown were extracted and compared with the sociodemographic characteristics of the respondents. Descriptive statistics were calculated for all independent variables and focused on frequencies and percentages. Chi-squared test was used to determine the significance between sociodemographic variables and places visited during the lockdown. Statistical significance was determined by P<0.05. All statistical analyses were carried out using SPSS version 22. Results. There were 1304 and 879 participants in the PERC wave-1 and PCSH datasets, respectively. The mean age of PERC wave-1 and PCSH survey respondents was 31.8 [standard deviation (SD)=8.5] and 33.1 (SD=8.3) years, respectively. In the PCSH survey, 55.9% and 44.1% of respondents lived in locations with partial and complete covid-19 lockdowns, respectively. Irrespective of the type of lockdown, the most common place visited during the lockdown was the market (shopping); reported by 73% of respondents in states with partial lockdown and by 68% of respondents in states with the complete lockdown. Visits to families and friends happened more in states with complete (16.1%) than in states with partial (8.4%) lockdowns. Conclusions. Markets (shopping) were the main places visited during the lockdown compared to visiting friends/family, places of worship, gyms, and workplaces. It is important in the future for the Government to plan how citizens can safely access markets and get other household items during lockdowns for better adherence to stay-at-home directives for future infectious disease epidemics

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

© 2020 Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill & Melinda Gates Foundation

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations