Malgré les progrès dans la lutte contre le paludisme au Burkina Faso, il reste la plus importante maladie à transmission vectorielle dans le pays. P. falciparum est le plus répandu et le plus mortel au Burkina Faso. Les facteurs liés à ce fardeau élevé sont l’inaccessibilité (financière et géographique) aux soins de santé, l’insuffisance dans le diagnostic et la prise en charge adéquate et précoce des cas de paludisme. La réalisation de l'Objectif du Développement Durable 3 au Burkina Faso repose sur une mise en œuvre réussie d'un ensemble d'interventions de prévention, de gestion des cas et de surveillance épidémiologique du paludisme. L'objectif de réduire le taux de létalité lié au paludisme à 1 % en 2020 n'a pas été atteint, il est donc nécessaire de réaliser une évaluation de l’efficacité des programmes de lutte antipaludique (utilisation des MILDA, utilisation des CTA, la politique de gratuité des soins de santé) surtout au niveau infranational, utile pour orienter la prise de décision à des échelles géographiques plus petites. Les données cliniques sur le paludisme collectées en routine peuvent fournir des informations indispensables pour l’évaluation de la variation inter et intra mensuelle/annuelle de l’effet des interventions de lutte antipaludique et du risque de paludisme à l'échelle nationale et infranationale chez les enfants de moins de cinq ans. Au Burkina Faso, une quantité importante de données a été régulièrement collectée par le biais du système de transmission des données en ligne via le « District Health Information System 2 (DHIS2) ». Toutefois, leur utilisation pour évaluer l’effet des interventions de lutte sur la dynamique spatio-temporelle du risque de paludisme à l’échelle locale (district) reste limitée au Burkina Faso. Dans cette recherche, nous avons développé des modèles spatiaux et spatio-temporels implémentés dans un cadre hiérarchique bayésien pour (I) évaluer l’effet des interventions de lutte sur la dynamique spatio-temporelle de la morbidité et de la létalité dues au paludisme sur la période 2013-2018 chez les enfants de moins de 5 ans au Burkina Faso et (II) détecter les districts sanitaires (spatio-temporelle) qui ne parviennent pas à atteindre les objectifs du PNLP en termes de morbidité/létalité. Ces modèles utilisent l’Approximation Intégrée de la Laplace (INLA), un algorithme déterministe qui est une méthode appropriée pour analyser les données de routine du paludisme corrélées à la fois dans l’espace et dans le temps. Nous avons observé que la mise en œuvre de la politique de gratuité des soins de santé était significativement associée à une augmentation du nombre de cas rapportés de paludisme testés et confirmés par rapport à la période précédant sa mise en œuvre. Cet effet était cependant hétérogène dans les districts de santé. De plus, nous avons constaté que le taux mensuel de létalité du paludisme était en baisse au cours de la période 2013-2018. Cette réduction était significativement associée à la disponibilité des tests de diagnostic rapide du paludisme et du traitement. Aussi, nous avons observé que le risque de décéder du paludisme chez les enfants de moins de 5 ans était plus faible au cours de la période suivant la mise en œuvre de cette politique par rapport à la période précédente. Nous avons également identifié des districts sanitaires avec un taux de létalité du paludisme élevé dans les parties nord, nord-ouest et sud-ouest du pays. Nos résultats appellent à un effort soutenu et renforcé pour tester tous les cas suspects afin que, parallèlement à l’amélioration de la prise en charge précoce des cas, le fardeau du paludisme chez les enfants de moins de cinq ans soit connu avec précision (voir l'hippopotame presque entièrement). De plus, ils ont mis en évidence les districts sanitaires qui ont le plus besoin d'interventions ciblées et la nécessité de maintenir et de renforcer les programmes de santé en cours pour réduire davantage les décès dus au paludisme au Burkina Faso. / Despite progress in the fight against malaria in Burkina Faso, malaria remains the most important vector-borne disease in the country, and P. falciparum is the most widespread and deadly pathogen in the area. The factors linked to this high burden are the inaccessibility (financial and geographical) to health care, insufficient diagnoses, and inadequate/late management of malaria cases. The achievement of Sustainable Development Goal 3 in Burkina Faso is based on the successful implementation of a set of interventions for the prevention, case management, and epidemiological surveillance of malaria. The objective of reducing the case fatality rate linked to malaria to 1% by 2020 has not been reached. It is, therefore, necessary to carry out an evaluation of the effectiveness of malaria control programs (the use of long-lasting insecticidal nets, the use of Artemisinin-based combination therapy, and free health care policies), especially at the sub-national level, which will be useful for guiding decision-making at smaller geographic scales. Routinely collected clinical data on malaria can provide essential information for the assessment of inter- and intra-monthly/annual variation in the effects of malaria control interventions and the risk of malaria at the national and subnational levels among children under five. In Burkina Faso, a significant amount of data is regularly collected through the online data transmission system via the “District Health Information System 2 (DHIS2)”. However, the use of these data to assess the effects of control interventions on the spatio-temporal dynamics of malaria risk at the local (district) level remains limited in Burkina Faso. In this research, we developed spatial and spatio-temporal models implemented in a Bayesian hierarchical framework to (i) assess the effects of control interventions on the spatio-temporal dynamics of morbidity and lethality due to malaria in the period of 2013–2018 in children under 5 in Burkina Faso and (ii) detect health districts (spatio-temporal) that fail to achieve the PNLP objectives in terms of morbidity/lethality. These models use Laplace Integrated Approximation (INLA), a deterministic algorithm that provides an appropriate method for analyzing routine malaria data correlated in both space and time. We observed that the implementation of the free health care policy was significantly associated with an increase in the number of reported cases of malaria tested and confirmed compared to the period before its implementation. This effect was, however, heterogeneous in the health districts. In addition, we found that the monthly malaria case fatality rate declined during the period of 2013–2018. This reduction was significantly associated with the availability of rapid diagnostic tests for malaria and treatments. We also observed that the risk of dying from malaria in children under 5 years old was lower during the period following the implementation of this policy compared to the previous period and identified health districts with a high case fatality rate from malaria in the northern, northwestern, and southwestern parts of the country. Our results call for a sustained and strengthened effort to test all suspected cases so that, along with improving early case management, the burden of malaria in children under five can be known with precision. In addition, our results highlight the health districts in greatest need of targeted interventions, as well as the need to maintain and strengthen ongoing health programs to further reduce malaria deaths in Burkina Faso. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

Thesis (M.Med. (Forensic Pathology)) -- University of Limpopo, 2022 / Introduction and background: Road traffic fatalities remain a worldwide burden with more than half of those fatalities comprising of vulnerable road users (pedestrians, cyclists and motorcyclists). This prompted the World Health Organization and United Nations to establish Sustainable Developmental Goals aimed at reducing road traffic crashes. The study explored factors relating to pedestrian fatalities on the R71 road, which may inform future interventions to enhance pedestrian safety. Aim: The study aimed at profiling pedestrian road traffic crash fatalities on the R71 road admitted at Polokwane Forensic Pathology Services. Methodology: A quantitative descriptive study utilising total population purposive sampling of pedestrians that demised because of R71 road traffic crashes over a 3-year period was done. There were 65 cases studied. Results: The study revealed that the fatalities were more male adult pedestrians than females, who were between 20 -39 years old. Majority of those pedestrians were wearing dark coloured clothing with no reflectors on. The pedestrian fatalities were mostly seen over the weekend and between evening and midnight. The fatalities peaked in December and February (summer season). The common locality of the pedestrian fatalities was Mankweng and Mentz village (Area 3). Most of those pedestrians sustained head injuries. Conclusion: Contributory factors and injuries of those pedestrian fatalities that demised because of R71 road traffic crashes were identified, which some were similar to those already highlighted in literature.

Tesis por compendio / [ES] El brote de Coronavirus SARS-CoV-2 representó un reto para la economía, la vida social y los servicios sanitarios. Justo cuando más se necesitaba la información para la planificación económica, los servicios de vigilancia y notificación no fueron capaces de ofrecer, a pesar de esfuerzos extraordinarios, datos consistentes, como así reconocieron los propios orga-nismos gubernamentales. Esta tesis incluye tres artículos publicados durante los brotes de COVID-19 y una investi-gación adicional fuera del conjunto de publicaciones. La investigación tiene como objetivo general proporcionar información a través de estimaciones alternativas. Para ello se han utilizado varias metodologías, entre ellas los modelos matemáticos de predicción epidemio-lógica, el Mejor Ajuste de Valores Relacionados (BARV), los análisis de diferentes encues-tas y la metodología bibliométrica, aprovechando u ofreciendo alternativas a los métodos bayesianos más complejos, las simulaciones de Monte Carlo o las cadenas de Markov, aun-que algunos datos obtenidos se apoyan parcialmente en estas metodologías. Cada artículo aborda un tema esencial relacionado con la pandemia COVID-19. La primera publicación se centra en los datos epidemiológicos básicos. Se refiere al primer brote de COVID-19, estimando su duración, incidencia, prevalencia, tasa de fallecimientos sobre infectados (IFR) y tasa de fallecimientos sobre casos (confirmados) (CFR). Como dato destacado de este trabajo, se previó que la seroprevalencia era demasiado baja para que la inmunidad de rebaño desempeñara algún papel. Aunque el valor obtenido fue aproxima-damente un 2% inferior al que demostró posteriormente un estudio poblacional (Instituto Carlos III), la conclusión sobre la inmunidad de rebaño no cambió, y los resultados confir-maron la idoneidad del enfoque. La segunda publicación se centró en las cuestiones legales y las noticias falsas, analizando la reticencia de la población a vacunarse, el impacto de las falsas noticas en estos comporta-mientos, las posibilidades legales de hacer obligatoria la vacuna y las posibles acciones contra los profesionales de la salud que publican noticias falsas. La principal conclusión fue que, aunque se podría encontrar una vía legal para la obligatoriedad de la vacunación, y para la persecución gubernamental de las noticias falsas, la opinión ciudadana parece prefe-rir que la administración no tome la iniciativa, por lo que se recomienda promover y fomen-tar la concienciación ciudadana. La tercera publicación presentó un modelo matemático simplificado para la estimación del coste-efectividad de la vacuna contra la COVID-19. Se actualizan los datos de dos fechas para la estimación de los costes directos para el sistema sanitario debidos a la COVID-19, computando el coste por ciudadano y por Producto Interior Bruto (PIB), así como el coste-efectividad de la vacuna. La estimó razón de coste-efectividad incremental (RCEI) para dos dosis por persona a un coste de 30 euros cada dosis (incluida la administración). Asumien-do al 70% de efectividad y con el 70% de la población vacunada resultó ser de 5.132 euros (4.926 - 5.276) por año de vida ajustado a calidad (AVAC) ganado (a 17 de febrero de 2021). Una cifra que desciende cada día de pandemia activa. Se incluyó una investigación adicional, no incorporada en el conjunto de artículos, centrada en los recursos humanos y la educación. Se analizaron los temas preocupan al personal de primera línea, es decir, a la enfermería, y cómo la pandemia ha afectado a sus publicaciones científicas, como índice de los cambios en el clima laboral que sufre este colectivo. Median-te un estudio bibliométrico comparativo entre las publicaciones de 2019 y 2020, se analizó el cambio de temas y ámbitos como reflejo del impacto del COVID-19 en el personal de enfermería. Así se comprobó que, en los ámbitos de enfermería de atención especializada, y sobre todo e / [CA] El brot de Coronavirus SARS-CoV-2 va representar un repte per a l'economia, la vida soci-al i els serveis sanitaris. Quan més es necessitava la informació per a la planificació econò-mica, malgrat esforços extraordinaris, els serveis de vigilància i notificació no van ser capa-ços d'oferir dades consistents, com així van reconèixer els mateixos organismes governa-mentals. Aquesta tesi inclou tres articles publicats durant els brots de COVID-19 i una investigació addicional fora del conjunt de publicacions. La investigació té com a objectiu general pro-porcionar informació a través d'estimacions alternatives. Per a això s'han utilitzat diverses metodologies, entre elles els models matemàtics de predicció epidemiològica, el Millor Ajust de Valors Relacionats (BARV), les anàlisis de diferents enquestes i la metodologia bibliomètrica, aprofitant o oferint opcions alternatives als mètodes bayesians més comple-xos, les simulacions de Montecarlo o les cadenes de Markov, tot i que algunes dades obtin-gudes es recolzen parcialment en aquestes metodologies. Cada article aborda un tema essen-cial relacionat amb la pandèmia COVID-19. La primera publicació se centra en les dades epidemiològiques bàsiques. Es refereix al pri-mer brot de COVID-19, calculant la seua durada, incidència, prevalença, taxa de defuncions sobre infectats (IFR) i taxa de defuncions sobre casos (confirmats) (CFR). Com a dada des-tacada d'aquest treball, es va preveure que la seroprevalença era massa baixa perquè la im-munitat de ramat exercirà algun paper. Tot i que el valor obtingut va ser aproximadament un 2% inferior al demostrat posteriorment en un estudi poblacional (Institut Carles III), la conclusió sobre la immunitat de ramat no va canviar, i els resultats van confirmar la idoneï-tat de l'enfocament. La segona publicació es va centrar en les qüestions legals i les notícies falses, analitzant la reticència de la població a vacunar-se, l'impacte de les falses notícies en aquests comporta-ments, les possibilitats legals de fer obligatòria la vacuna i les possibles accions contra els professionals de la salut que publiquen notícies falses. La principal conclusió va ser que, tot i que es podria trobar una via legal per l'obligatorietat de la vacunació, i per la persecució governamental de les notícies falses, l'opinió ciutadana sembla preferir que l'administració no prenga la iniciativa, per la qual cosa es recomana promoure i fomentar la conscienciació ciutadana. La tercera publicació va presentar un model matemàtic simplificat per a l'estimació del cost-efectivitat de la vacuna contra la COVID-19. S'actualitzen les dades de dues dates per a l'estimació dels costos directes per al sistema sanitari deguts a la COVID-19, computant el cost per ciutadà i per Producte Interior Brut (PIB), així com el cost-efectivitat de la vacuna. La va estimar raó de cost-efectivitat incremental (RCEI) per dues dosis per persona a un cost de 30 euros cada dosi (inclosa l'administració). Assumint al 70% d'efectivitat i amb el 70% de la població vacunada va resultar ser de 5.132 euros (4.926 - 5.276) per any de vida ajustat a qualitat (AVAQ) (a 17 de febrer de 2021). Una xifra que descendeix cada dia de pandèmia activa. Es va afegir una investigació addicional, no inclosa en el conjunt d'articles, centrada en els recursos humans i l'educació. Es van analitzar els temes que preocupen al personal de pri-mera línia, és a dir, a la infermeria, i com la pandèmia ha afectat les seues publicacions cien-tífiques, com a índex dels canvis en el clima laboral que pateix aquest col·lectiu. Mitjançant un estudi bibliomètric comparatiu entre les publicacions de 2019 i 2020, es va analitzar el canvi de temes i camps com a reflex de l'impacte del COVID-19 en el personal d'infermeria. Així es va comprovar que en els àmbits d'infermeria d'atenció especialitzada, i sobretot en atenció primària, els principals problemes detectat / [EN] The SARS-CoV-2 Coronavirus outbreak has posed a challenge to the economy, social life, and health services. Just when information was most needed for economic planning, moni-toring, and reporting services were unable, despite extraordinary efforts to provide con-sistent data, as government agencies themselves acknowledged. This thesis includes three articles published during the COVID-19 outbreaks and additional research outside the publication set. The overall aim of the research is to provide infor-mation through alternative estimates. Several methodologies have been used, including mathematical models for epidemiological prediction, Best Adjustment of Related Values (BARV), analyses of different surveys and bibliometric methodology, taking advantage of or offering an alternative to, more complex options such as Bayesian methods, Monte Carlo simulations or Markov chains, although some data obtained are partially supported by these methodologies. Each article addresses a key issue related to the COVID-19 pandemic. The first publication focuses on basic epidemiological data. It refers to the first outbreak of COVID-19, estimating its duration, incidence, prevalence, Infection Fatality Rate (IFR) and Case Fatality Rate (CFR). As a highlight of this work, the seroprevalence was anticipated to be too low for herd immunity to play a role. Although the value obtained was approximate-ly 2% lower than that subsequently demonstrated by a population-based study (Instituto Carlos III), the conclusion on herd immunity remained unchanged, and the results con-firmed the appropriateness of the approach. The second publication focuses on legal issues and fake news, analysing reluctance to be vaccinated in the population, the impact of fake news on these behaviours, the legal possi-bilities of making vaccination mandatory, and possible actions against health professionals who publish fake news. The main conclusion was that, although a legal avenue could be found for mandatory vaccination and for governmental prosecution of fake news, public opinion seems to prefer that the authorities do not take the initiative, therefore it recom-mends promoting and encouraging public awareness. The third publication presented a simplified mathematical model for estimating the cost-effectiveness of the COVID-19 vaccine. Data from two dates were obtained for the estimation of the direct costs to the health system due to COVID-19, computing the cost per citizen and per Gross Domestic Product (GDP), as well as the cost-effectiveness of the vaccine. The estimated incremental cost-effectiveness ratio (ICER) was calculated for two doses per person at a cost of 30 euros per dose (including administration). Assuming 70% effectiveness and with 70% of the population vaccinated, it was found to be 5,132 euros (4,926 - 5,276) per quality-adjusted life year (QALY) gained (as of 17 February 2021). The figure decreases with each day of the active pandemic. Additional research not included in the set of articles focuses on human resources and education. It analyses the concerns of frontline staff, i.e., nurses, and how the pandemic has affected their scientific publications, as an index of the changes in the work climate experienced by this group. Through a comparative bibliometric study of publications in 2019 and 2020, the change in topics and fields was analysed, as a reflection of the impact of COVID-19 on nursing staff. It was found that in the fields of specialised care nursing and above all in primary care, the main problems detected are those related to protective measures and psychological factors, while the publications of nursing staff in nursing homes showed an increase in topics related to management and organisation. Finally, some aspects of the implementation of telecommuting and distance learning have been reviewed. Some of the boosts in this field resulting from the pandemic could be very useful and remain in the future, such as the incorporation of telewo / Marco Franco, JE. (2021). What have we learned from the economic impact of the Covid-19 outbreak? Critical analysis of economic factors and recommendations for the future [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/174883 / TESIS / Compendio

Abortion and severe pre-eclampsia/eclampsia remain the major causes of maternal mortality in Zimbabwe. Based on this problem, factors associated with maternal mortality due to abortion and severe pre-eclampsia/eclampsia were investigated to improve pregnancy outcomes. Cases and controls were selected from 4895 abortion and 318 severe preeclampsia/ eclampsia obstetric records to conduct a retrospective case-control study. Significant risk factors identified for reducing maternal mortality due to postabortion complications included the administration of oxytocic drugs and evacuations of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. No significant factors could be identified which influenced maternal deaths among women suffering from severe pre-eclampsia/eclampsia. Magnesium sulphate was not routinely administered, as recommended internationally. In both groups, cases apparently received better reported quantitative care than controls. Recommendations based on this research report include improved midwifery education and in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

The intense economic growth that Brazil has experienced in recent decades and its consequent explosive motorization process have resulted in an undesirable impact: the continuously increasing trend in traffic fatality numbers. This study presents a research on indicators and indexes with the objective of delivering both overall and disaggregated evidence about the road safety performance and targets in fatality reduction in Brazil at the state level taking the exposure into account. The intention is to support road safety strategic analysis in the country and to contribute to improve this critical scene. The methodological structure of this thesis consists of the following three main parts: (I) diagnosing the road safety situation at the state level using final outcome related information, in particular traffic fatality risk data; (II) setting a target number of traffic fatalities based on the relationship between the exposure level and the number of traffic fatalities in each state; and (III) suggesting domains for improvements based on the research of safety performance indicators representing three domains (road user, environment and vehicle) throughout the states. From a benchmarking point of view, we divided the Brazilian states into three separate clusters in order to provide more realistic state performance comparisons. After a data collection and indicators selection step, Data Envelopment Analysis (DEA) was the method used for executing the different steps, with the application of four different types of models specially developed for the identified research purposes. In addition, by means of bootstrapping the DEA scores we measured the sensitivity of the results to possible variations in the input data, for example concerning data quality and availability. As a result, we provided a road safety diagnosis per state as well as traffic fatality targets according to different perspectives: the entire group of road users (motorized and nonmotorized ones), motor vehicle occupants, and finally a disaggregated performance evaluation by running four separate DEA models (for motorcycle, car, truck and bus). Moreover, the SPI research including a hierarchy of 27 safety performance indicators expressed the states relative performance on the main road safety domains. Lastly, state profiles compiling all this information summarized the \"per state\" findings. / O intenso crescimento econômico que o Brasil tem experimentado nas últimas décadas e seu consequente explosivo processo de motorização resultaram em um impacto indesejado: a tendência contínua do aumento do número de mortes no trânsito. Este estudo apresenta uma pesquisa acerca de índices e indicadores com o objetivo de fornecer evidências gerais e desagregadas sobre o desempenho da segurança viária e metas de redução no número de mortes no Brasil no âmbito estadual, levando a exposição em consideração. A intenção é embasar uma análise estratégica da segurança viária no país e contribuir para melhorar este cenário crítico. A estrutura metodológica desta tese consiste das seguintes três partes principais: (I) diagnóstico da situação da segurança viária no nível estadual utilizando informações relacionadas ao resultado final, em particular dados de risco de morte no trânsito; (II) estabelecer uma meta para o número de mortes no trânsito para cada estado; e (III) sugerir domínios para melhorias baseado em pesquisa de indicadores de desempenho da segurança viária voltada a três domínios (usuário da via, ambiente e veículo). Sob a ótica do benchmarking, dividiram-se os estados brasileiros em três clusters para proporcionar comparações mais realistas dos desempenhos estaduais. Após uma etapa de coleta e seleção de indicadores, utilizou-se o método de Data Envelopment Analyis (DEA) para executar as diferentes etapas, com a aplicação de quatro tipos distintos de modelos especialmente desenvolvidos para os propósitos da pesquisa. Além disso, por meio de bootstrapping dos escores obtidos com a DEA, mediu-se a sensibilidade dos resultados a possíveis variações nos dados de entrada, no que diz respeito a, por exemplo, qualidade e disponibilidade dos dados. Como resultado, propicia-se, a partir de diferentes perspectivas, um diagnóstico da segurança viária por estado, assim como metas no número de mortes: para todo o grupo de usuários (motorizados e não-motorizados), ocupantes de veículos motorizados, e finalmente uma avaliação desagregada por meio de quatro modelos separados (para motocicletas, automóveis, caminhões e ônibus). Adicionalmente, a pesquisa de indicadores de desempenho da segurança considerando a hierarquia de 27 indicadores expressou os desempenhos relativos dos estados nos principais domínios da segurança viária. Por fim, perfis estaduais compilando todas estas informações resumem os resultados para os estados.

The intense economic growth that Brazil has experienced in recent decades and its consequent explosive motorization process have resulted in an undesirable impact: the continuously increasing trend in traffic fatality numbers. This study presents a research on indicators and indexes with the objective of delivering both overall and disaggregated evidence about the road safety performance and targets in fatality reduction in Brazil at the state level taking the exposure into account. The intention is to support road safety strategic analysis in the country and to contribute to improve this critical scene. The methodological structure of this thesis consists of the following three main parts: (I) diagnosing the road safety situation at the state level using final outcome related information, in particular traffic fatality risk data; (II) setting a target number of traffic fatalities based on the relationship between the exposure level and the number of traffic fatalities in each state; and (III) suggesting domains for improvements based on the research of safety performance indicators representing three domains (road user, environment and vehicle) throughout the states. From a benchmarking point of view, we divided the Brazilian states into three separate clusters in order to provide more realistic state performance comparisons. After a data collection and indicators selection step, Data Envelopment Analysis (DEA) was the method used for executing the different steps, with the application of four different types of models specially developed for the identified research purposes. In addition, by means of bootstrapping the DEA scores we measured the sensitivity of the results to possible variations in the input data, for example concerning data quality and availability. As a result, we provided a road safety diagnosis per state as well as traffic fatality targets according to different perspectives: the entire group of road users (motorized and nonmotorized ones), motor vehicle occupants, and finally a disaggregated performance evaluation by running four separate DEA models (for motorcycle, car, truck and bus). Moreover, the SPI research including a hierarchy of 27 safety performance indicators expressed the states relative performance on the main road safety domains. Lastly, state profiles compiling all this information summarized the \"per state\" findings. / O intenso crescimento econômico que o Brasil tem experimentado nas últimas décadas e seu consequente explosivo processo de motorização resultaram em um impacto indesejado: a tendência contínua do aumento do número de mortes no trânsito. Este estudo apresenta uma pesquisa acerca de índices e indicadores com o objetivo de fornecer evidências gerais e desagregadas sobre o desempenho da segurança viária e metas de redução no número de mortes no Brasil no âmbito estadual, levando a exposição em consideração. A intenção é embasar uma análise estratégica da segurança viária no país e contribuir para melhorar este cenário crítico. A estrutura metodológica desta tese consiste das seguintes três partes principais: (I) diagnóstico da situação da segurança viária no nível estadual utilizando informações relacionadas ao resultado final, em particular dados de risco de morte no trânsito; (II) estabelecer uma meta para o número de mortes no trânsito para cada estado; e (III) sugerir domínios para melhorias baseado em pesquisa de indicadores de desempenho da segurança viária voltada a três domínios (usuário da via, ambiente e veículo). Sob a ótica do benchmarking, dividiram-se os estados brasileiros em três clusters para proporcionar comparações mais realistas dos desempenhos estaduais. Após uma etapa de coleta e seleção de indicadores, utilizou-se o método de Data Envelopment Analyis (DEA) para executar as diferentes etapas, com a aplicação de quatro tipos distintos de modelos especialmente desenvolvidos para os propósitos da pesquisa. Além disso, por meio de bootstrapping dos escores obtidos com a DEA, mediu-se a sensibilidade dos resultados a possíveis variações nos dados de entrada, no que diz respeito a, por exemplo, qualidade e disponibilidade dos dados. Como resultado, propicia-se, a partir de diferentes perspectivas, um diagnóstico da segurança viária por estado, assim como metas no número de mortes: para todo o grupo de usuários (motorizados e não-motorizados), ocupantes de veículos motorizados, e finalmente uma avaliação desagregada por meio de quatro modelos separados (para motocicletas, automóveis, caminhões e ônibus). Adicionalmente, a pesquisa de indicadores de desempenho da segurança considerando a hierarquia de 27 indicadores expressou os desempenhos relativos dos estados nos principais domínios da segurança viária. Por fim, perfis estaduais compilando todas estas informações resumem os resultados para os estados.

Abortion and severe pre-eclampsia/eclampsia remain the major causes of maternal mortality in Zimbabwe. Based on this problem, factors associated with maternal mortality due to abortion and severe pre-eclampsia/eclampsia were investigated to improve pregnancy outcomes. Cases and controls were selected from 4895 abortion and 318 severe preeclampsia/ eclampsia obstetric records to conduct a retrospective case-control study. Significant risk factors identified for reducing maternal mortality due to postabortion complications included the administration of oxytocic drugs and evacuations of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. No significant factors could be identified which influenced maternal deaths among women suffering from severe pre-eclampsia/eclampsia. Magnesium sulphate was not routinely administered, as recommended internationally. In both groups, cases apparently received better reported quantitative care than controls. Recommendations based on this research report include improved midwifery education and in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

Introduction: Ventricular arrhythmias (VAs) are common after an acute coronary syndrome (ACS) and are associated with worse clinical outcomes. However, little is known about recent trends in their occurrence, their association with serum glucose levels, and their psychological impact in ACS setting. Methods: We examined 25-year (1986-2011) trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of VAs, and the association between serum glucose levels and VAs in patients with an acute myocardial infarction (AMI) in the Worcester Heart Attack Study. Lastly, we examined the relationship between in-hospital occurrence of VAs and 12-month progression of depression and anxiety among hospital survivors of an ACS in the longitudinal TRACE-CORE study. Results: We found the IRs declined for several major VAs between 1986 and 2011while the hospital CFRs declined in both patients with and without VAs over this period. Elevated serum glucose levels at hospital admission were associated with a higher risk of developing in-hospital VAs. Occurrence of VAs, however, was not associated with worsening progression of symptoms of depression and/or anxiety over a 12-month follow-up period in patients discharged after an ACS. Conclusions: The burden and impact of VAs in patients with an AMI has declined over time. Elevated serum glucose levels at hospital admission may serve as a predictor for in-hospital occurrence of serious cardiac arrhythmias. In-hospital occurrence of VAs may not be associated with worsening progression of symptoms of depression and anxiety in patients with an ACS.

<p dir="ltr"><a href="" target="_blank">ABSTRACT</a></p><p dir="ltr">A literature review was conducted, to determine and gain a better understanding of the environmental, technological, physiological, and psychological issues that lone agricultural workers potentially face in the event they are involved in an emergency. An investigation was conducted of communication devices used in other industries where working alone was common, to monitor for and detect incident occurrences. An assessment of currently available emergency alert software and sensing technology for <a href="" target="_blank">communication </a><a href="#_msocom_1" target="_blank">[AE1]</a> devices was also undertaken in this review.</p><p dir="ltr">Three hundred and sixty-eight U.S. cases of fatalities or injuries were analyzed in which working alone was identified as a contributing factor. Cases included lone agricultural workers, between the ages 15-64, who were identified from a convenient sample of incident reports from <a href="" target="_blank">2016-2021</a><a href="#_msocom_2" target="_blank">[AE2]</a> . Of the 368 lone agricultural worker incidents analyzed, 38% (140) were caused by tractor rollover or tractor runover, and ATV/ UTV rollovers. Grain bin entrapments accounted for 13% (48) of all identified cases, of which 86% (42) were fatal. Thirty-three percent (121) of the identified incidents involved equipment roll over (not including runovers), and 50% of identified victims, when age was known, were 57 years of age or older. In 11 cases (3%), the victim was under 15 years old and active in agricultural-related tasks at the time of incident occurrence.</p><p dir="ltr">Geospatial Information Systems (GIS) tools were used to identify the proximity of Emergency Medical Service (EMS) facilities and cellular towers from a convenient sample of 29 fatal and serious agricultural related injuries from 2016-2021, occurring in the state of Indiana. This analysis found that there were substantially fewer EMS facilities within close proximity to documented rural incident locations compared to injuries or fatalities occurring closer to a populated area. There were also fewer cellular towers within close proximity of incidents located primarily on or near rural agricultural land. More densely populated areas tended to have a greater density of EMS and cellular tower locations, with, most likely, more favorable outcomes from injuries due to shorter <a href="" target="_blank">response times.</a><a href="#_msocom_3" target="_blank">[AE3]</a></p><p dir="ltr">An investigation of the physical and operational impact that agricultural equipment would have on the efficacy of commercially available wearable technologies was undertaken, to detect the potential injury-causing agricultural incident. Five experiments were conducted to test the feasibility of these selected wearable devices in detecting agricultural-related incidents with the potential of causing serious injuries. Only one <a href="" target="_blank">simulated agricultural incident</a> <a href="#_msocom_4" target="_blank">[AE4]</a> successfully triggered incident detection. <a href="" target="_blank">Incidents successfully triggered incident detection on one wearable device, the Garmin Vivoactive 4 smartwatch. </a><a href="#_msocom_5" target="_blank">[AE5]</a></p><p dir="ltr">Recommendations included greater emphasis on the hazards associated with lone workers assigned agricultural workplaces, development of new, evidence-based educational resources to incorporate in current prevention strategies directed at farmers, ranchers, and agricultural workers, enhanced supervision of young agricultural workers and compliance with existing child labor regulations, equipping lone workers with appropriate cellphones and/ or wearable technologies to be carried in their vehicles, agricultural equipment, or on their person, use of electronic surveillance or monitoring equipment, written policies and procedures that enhance awareness of worker locations and conditions on a regular basis, and adherence to existing federal and state workplace safety and health regulations related to lone workers.</p><p><br></p><p dir="ltr"><a href="#_msoanchor_1" target="_blank">[AE1]</a>Changed</p><p dir="ltr"><a href="#_msoanchor_2" target="_blank">[AE2]</a>Fixed</p><p dir="ltr"><a href="#_msoanchor_3" target="_blank">[AE3]</a>I’m not sure how to address that more rural people are dying, given the limited scope and criteria for selection of the incidents selected in this study.</p><p dir="ltr"><a href="#_msoanchor_4" target="_blank">[AE4]</a>Not sure if this Is the best way to say it. I may end up cutting this part. I’ll pair the abstract down to ~250 words. For whatever reason, I thought the intro chapter abstract needed to be longer for a dissertation.</p><p dir="ltr"><a href="#_msoanchor_5" target="_blank">[AE5]</a>Shortened this paragraph and removed unnecessary detail, for clarity.</p>