Baggrunden er de mange forebyggelige indlæggelser, der kan mindskes ved tidlig opsporing og intervention i primær sektor Formål:Atafprøve udvalgte værktøjer i et design, som vil udgøre en effektiv metode til at lave tidlig opsporing af udsatte borgere i primær sektor, der viser tegn på begyndende sygdom som kan forebygges. Dernæstatudvikle og testeet IT-system til attriagere og risikovurderedisse borgere, samt et nyt spørgeskemaredskab til at vurdere forandringenaf den sundhedsfagligepraksis. Metode: Mikset metodologi anvendesfor atbesvare forskningsspørgsmåleneog formålet. Først testesi klinisk praksiset nyt sæt af metoder til tidligopsporing med efterfølgende triage og risiko-scoring af borgerne og dernæst afprøves en nyudviklet IT-platformhertil.Metoderne som afprøves er: Ændrings-skemaet med triage og TOBS (Tidlig Opsporingaf Begyndende Sygdom). Endeligpilottestes et nyt spørge-skema til at undersøge forandringen i den sundhedsfaglige praksis. Hovedresultater: Det er lykkedes at afprøve Ændringsskemaet med triage i trepleje-grupper (n=105)–således at alle borgeres habitualtilstand registreres og triageres. Alle borgere var ved testperiodens slutning monitoreret påoversigtstavler i plejegrupperne. Man havde fundet de kategorier som havde mindrefunktionstab og sygdomstegn(12,4%)og dem som var i risiko for forværring eller indlæggelse(8,6%). Der var iværksat opfølgende handling og forebyggende indsatser i forholdtil disse borgere.TOBS måling af vitale værdier (Puls, vejrtrækningsfrekvens, temperatur, bevidsthedsniveau og systolisk blodtryk) er introduceret og afprøvet på udvalgte risiko patienter –men der var ikke tilstrækkelig systematisk registrering af den analoge deli alle testgrupperne endnu. Testentyder dog på, at det godt kan kombineres med Ændrings-skemaet til at få systematiserede målinger af vitale værdier og opfølgning på deudsatte borgere.Der er udviklet en tilpasset IT-platform med Ændringskemaet, triage og TOBS til at få plejepersonalet til at lave tidlig opsporing af borgere med begyndende sygdomstegn. Endelig er der lavet et spørgeskema, der kan bruges til at undersøge oplevelsen af forandringer i den sundhedsfaglige praksis i forbindelse med indsatsen for tidlig opsporing og det er pilottestet i to plejegrupper (n=45). Der er ikke fundet tegn på systematisk bortfald på enkelte items, men der var for stort generelt bortfald i den sidste testgruppe til at opnå en fuld repræsentativitet i forhold til deres besvarelser. Konklusion: Tidlig opsporing i primær sektor, kræver enklemetoder tilpasset praksis ogfaggrupperne. Der er testet og fundet et virksomtmetodisk designtil tidlig opsporing i primær sektor, et tilpasset IT-redskabtil at understøtte udførelsen afÆndringsskemaet med triage og TOBS måling af borgere i risikozonen. Endvidere erpilottestet etnytspørgeskematil at undersøge forandringen af den sundhedsfaglige praksis, som den opleves af de involverede fagpersoner / Background.New methods and interventions in the primary sector can increase early disease detection and avoid unnecessary hospitalization. Aim:This study aimed to test a powerful set of early detection methods for vulnerable citizens who exhibit signs of incipient disease or preventable deterioration, including (i) an IT system customized to perform triage, (ii) Timely Observation of Beginning Sickness (TOBS) to measure at-risk citizens, and (iii) a questionaire that assesses change in healthcare practice. Methods. The mixed methods in this study included clinical testing, a triaged changing table, TOBS, risk scoring, and a new IT platform. We also pilot-tested a new questionnaire to investigate change in the healthcare practice. Main Results: After testing the triaged changing table in three healthcare groups (n=105), we registered citizens according to risk. Information boards allowed care groups to identify patients who experienced less loss of function and fewer signs of disease (12.4%); others experienced several major changes and were at risk of deterioration or hospitalization (8.6%). We initiated follow up and preventive measures to care for these citizens. TOBS included measurement of vital signs (i.e., heart and breathing rate, temperature, level of consciousness and systolic blood pressure) in selected risk patients, providing systematic risk scoring and suggestions for actions. Finally, we developed and pilot-tested (in two care groups, n = 45) a simple questionnaire that can prospectively examine change in healthcare practices. There are no signs of systematic errors on single items but in the last test group there was too large a general lapse of answers to achieve a full representation in relation to their responses. Conclusion: Early detection of preventable diseases in the primary sector requires methods that are adapted to the clinical setting and professional groups. Our results suggest that combining TOBS with the changing table may enable systematic measurement in vulnerable citizens detected and a quick follow up with preventive measures to care for these citizens. A well-customized IT platform will help healthcare providers detect early signs of disease. Using data entered during patient visits, the system can perform an online triage, create summaries of categorized citizens, and provide reminders of important follow up / <p>ISBN 978-91-86739-80-5</p>

Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

Abstract Background Measles is a serious infectious disease that contributes significantly to the burden of disease in many developing countries. In most developed nations, such as Canada, endemic transmission of measles has been declared eliminated thanks to rigorous vaccination programs, but isolated outbreaks of the disease continue to happen. Therefore, a thorough understanding of the factors contributing to these outbreaks is necessary. Objectives There were two main objectives of this thesis. The first objective was to assess the geospatial distribution of reported measles cases in Ontario with a goal of identifying clusters of reported measles. For this objective, the main hypothesis was that measles cases would not be randomly distributed across Ontario and instead would cluster in certain regions. The second objective was to explore some of the factors that may be associated with measles clusters. For this objective, the main hypothesis was that the proportion of immigrants, population density, low-income prevalence and education level would be associated with measles clusters. Methods The first objective was achieved through a thorough geospatial analysis using SaTScan and R. Individual forward sortation areas were used as the spatial unit of analysis. The analysis leveraged data from multiple sources: 2016 Census data, Ontario measles cases data from iPHIS from 2008 to 2019, a shapefile of all forward sortation areas in Canada from Statistics Canada and centroid coordinates of forward sortation areas that were obtained using web scrapping techniques on the geolocation service of Natural Resources Canada. The maximal window size of the geospatial analysis was chosen using the maximum clustering heterogeneous set-proportion technique. The geospatial analysis was run with 99,999 Monte Carlo repetitions under a Poisson distribution using the purely spatial analysis. The Ontario population from the 2016 Census was used as the population at risk. Any cluster with a p ≤ 0.05 was deemed statistically significant. The second objective was achieved through a case-control study: Forward sortation areas that were within statistically significant measles clusters were considered as cases and the rest of the forward sortation areas were considered as controls. Demographic data necessary to assess the factors of interest were extracted from the 2016 Census. A univariable logistic regression model was run to compute the odds ratio and test the association between the factors of interest and measles clusters. 95% confidence intervals were computed for each odds ratio. Data-curation techniques and data analysis were performed in R 4.0.4. Results From 2008 through 2019, 178 measles cases were identified. 82% of cases lacked necessary vaccination or vaccination records against measles, 35% of cases were linked to traveling outside of Ontario, 20% of cases reported being in contact with a known case, and 72% of cases were less than 5 years old or older than 21. Ten measles clusters were identified of which six were deemed statistically significant. These six significant clusters represented 7% of the population at risk but contained nearly 40% of all reported measles cases between 2008 and 2019. Measles clusters had a strong association with the proportion of immigrants living within them, population density and prevalence of low-income. No association was found between education level and measles clusters. Conclusion The results indicate that most measles cases in Ontario are unvaccinated or lack proof of vaccination; arise through secondary transmission within the province; arise from undetected transmission; and are adults or infants. Additionally, it is possible to see that the risk of reported measles cases is not randomly distributed across the province, but instead measles cases tend to cluster in certain regions. Such clusters tend to be characterized by specific population-level factors that may be contributing to the risk of reported measles. Targeted and equitable interventions are needed as we continue on the path to eradication.

No description available.

Risk-adjustment schemes are used to monitor hospital performance, on the assumption that excess mortality not explained by case mix is largely attributable to suboptimal care. We have developed a model to estimate the proportion of the variation in standardised mortality ratios (SMRs) that can be accounted for by variation in preventable mortality. The model was populated with values from the literature to estimate a predictive value of the SMR in this context-specifically the proportion of those hospitals with SMRs among the highest 2.5% that fall among the worst 2.5% for preventable mortality. The extent to which SMRs reflect preventable mortality rates is highly sensitive to the proportion of deaths that are preventable. If 6% of hospital deaths are preventable (as suggested by the literature), the predictive value of the SMR can be no greater than 9%. This value could rise to 30%, if 15% of deaths are preventable. The model offers a 'reality check' for case mix adjustment schemes designed to isolate the preventable component of any outcome rate.

In 2012, 48,277 cases of pertussis were diagnosed in the United States. Pertussis, otherwise known as whooping cough, is a highly contagious, often debilitating, sometimes deadly, vaccine-preventable disease with an increasing incidence and death rate in the U.S, which may be due to vaccine exemptions. The purpose of this project was to determine if a relationship exists between immunization policies and immunization exemption rates, immunization exemption rates and pertussis rates, and immunization policies and pertussis rates in each state. Bronfenbrenner's bio-ecological framework was used to guide the project. Publically available data from the Centers for Disease Control and Prevention (CDC), schools of public health, state health departments, and public health officials were retrieved for this cross-sectional, ecological comparison study. Spearman's r product-moment correlation coefficient was used to investigate the relationship between the variables. States with lenient vaccine laws had higher exemption rates (r = .359, p < .01), and states with higher exemption rates had higher pertussis rates (r = .470, p < .01). Finally, states with lenient vaccine laws had higher pertussis rates (r = .111, p = 0.439). This project should be added to the literature used to inform and educate the public as well as influence policy makers. As a result of this study, arguments for eliminating non-medical vaccine exemptions should be strengthened. As policies are changed, social change should follow in the form of decreased immunization exemption rates and decreased pertussis rates.

<p><a>The primary goal of this research was to summarize the occupational farm-related fatalities of Indiana farmers 55 years and older and to recommend evidence-based intervention strategies targeting older farmers who perform activities that involve the cutting and trimming of trees. The primary activities consisted of (1) preparing a summary of occupational farm-related fatalities of farmers who were 55 years and older, (2) preparing a summary of occupational farm-related fatalities of older farmers who were performing activities in a woodlot setting or that included the occasional cutting and trimming of trees, and finally (3) the development of recommendations for evidence-based injury prevention strategies targeting older farmers who conduct occasional woodcutting activities. </a></p> <p>The summary of older Indiana farmer fatalities identified a total of 388 fatalities reported between 1988 and 2017 with an increase in the number of reported fatalities over the period of 2012-2017. Tractors were identified as the most common source of injury (40.5%) with tractor overturns involved in no fewer than 86 cases or 22.2% of all cases. Older farmer fatalities for occasional woodcutters accounted for 40 fatalities with the cutting and trimming of trees to be the most common cause of injury (67.5%). </p> <p>Core desired safety competencies were identified that were used to develop injury prevention strategies based upon the summary of injuries, areas of concerns reported in the review of literature and the results gathered from the summaries of Indiana older farmers killed while performing woodcutting activities. A pilot evidence-based intervention instructional presentation was developed with the assistance of a panel of experts to be used by Extension Educators to increase awareness of the target population of current safety practices relating to woodlot activities. </p>

The present study aimed to analyze the applicability of legal theories ImprevisÃo and avoidable damage in minimizing the effects of uncertainty in the agribusiness contracts. To examine such application, first, secondary data extracted from time series database of IBGE and IPEA-DATA in the estimation of an econometric model, where methods of time series, unit root test, test were employed were worked co-integration Johansen model vector error correction and variance decomposition of forecast errors. This econometric procedure aims to demonstrate margins of errors in the prognosis of future data. The sample period covers January 2007 to December 2011. As an additional function was taken concomitantly, a research field whose basic aim was to characterize the contractual relationship of an agribusiness production chain. The supply chain was chosen the culture of cashew in the state of CearÃ. The set of results in a systemic way, demonstrates that despite all the caring of economic agents in running a successful strategic planning within their productive activity, there is always a "gray area", under the impenetrable human perspective, imbued with extraordinary facts and unpredictable that when they occur, cause imbalance in contracts. This means that the fatality not envisioned by econometric methods, the legal instruments supplementing them in order to adjust the contracts, rebalancing them again. / O presente trabalho se propÃs analisar a aplicabilidade das teorias jurÃdicas da ImprevisÃo e dos Danos evitÃveis na minimizaÃÃo dos efeitos da incerteza no contratos de agronegÃcio. Para examinar referida aplicaÃÃo, primeiramente, foram trabalhados dados secundÃrios extraÃdos de sÃries histÃricas do banco de dados do IBGE e IPEA-DATA na estimaÃÃo de um modelo economÃtrico, onde foram empregados mÃtodos de sÃries de tempo, teste de raiz unitÃria, teste de co-integraÃÃo de Johansen, modelo de vetor de correÃÃo de erros e decomposiÃÃo da variÃncia de erros de previsÃo. Tal procedimento economÃtrico tem o objetivo de demonstrar margens de erros no prognostico de dados futuros. O perÃodo analisado abrange janeiro de 2007 a dezembro de 2011. Em uma funÃÃo suplementar foi feita, concomitantemente, uma pesquisa de campo cujo intuito basilar foi caracterizar a relaÃÃo contratual de uma cadeia produtiva do agronegÃcio. A cadeia produtiva escolhida foi a cultura da castanha de caju no Estado do CearÃ. O conjunto de resultados, de forma sistÃmica, demonstra que, apesar de todo zelo dos agentes econÃmicos em executar um bom planejamento estratÃgico dentro de sua atividade produtiva, sempre hà uma âzona obscuraâ, impenetrÃvel sob a Ãtica humana, impregnada de fatos extraordinÃrios e imprevisÃveis que, quando de sua ocorrÃncia, causam desequilÃbrio nos contratos. Isso significa que, na fatalidade nÃo antevista pelos mÃtodos economÃtricos, os instrumentos jurÃdicos suplementando-os, de forma a reajustar os contratos, reequilibrando-os novamente.

Research has shown that 400,000 people die every year due to preventable medical errors. Medical error reporting and safety is a responsibility of all members of a health care organization. Creating an environment that addresses and prevents potential or actual safety problems can help reduce the incidence of medical errors made by nurses in the workplace. The purpose of this quantitative research study was to determine if nurses' perceptions of safety problems and error-preventing procedures and systems affected their comfort in reporting safety problems and intent to leave. High-reliability theory was the theoretical foundation for this study. Data were obtained from 1,171 surveys completed by newly licensed registered nurses located in 51 different metropolitan statistical areas and 9 counties. SPSS Version 25 was used to conduct a secondary data analysis including descriptive statistics, bivariate analysis, and multiple logistic regression for each variable. Themes that emerged from the data analysis included the importance of education on safety protocols and improving nurse satisfaction and nurse retention. The findings of the study might contribute to social change by creating an increased awareness for nurse leaders, managers, and newly licensed registered nurses in ensuring that there is improved comfort of reporting and appropriate error-preventing procedures and system in the health care environment. Increased awareness will allow for action and improved protocols to enhance the overall safety and quality of care for nurses and their patients.

The ever-increasing prevalence of diabetes mellitus and its associated healthcare costs in the United States has led to our healthcare system's need for cost-effective health resources and chronic disease management. The interventions of Community Health Workers (CHWs) can cost-effectively improve population health and prevent the unnecessary utilization of some medical services especially in rural, low-income, minority populations, where there is often limited access to healthcare. The purpose of this study is to investigate the relationship between the number of total CHWs in rural counties and the mean diabetes-related preventable hospitalization rates in Latino patients diagnosed with diabetes in those rural counties. The main goal of this research study is to contribute to the existing literature about the importance of CHWs especially in rural counties and the effect their presence has on diabetes-related preventable hospitalizations. Quantitative rural county data sets were analyzed to determine the correlation between the number of CHWs per rural county and the rate of diabetes-related preventable hospitalizations per rural county. Due to the COVID-19 pandemic outbreak, this research project was modified to be completed in a timely manner. A statistically insignificant moderately negative linear relationship was found between the two variables. Therefore, there was not enough statistical evidence in the sample to say that this correlation exists in the rural America population. Future research is needed to investigate this relationship more thoroughly.