Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis

Limited studies had investigated the potential benefits of workplace-based hypertension management programs on long-term blood pressure (BP) control and health outcomes. This study used the propensity score matching to examine the effectiveness of a workplace-based hypertension management program on BP control and risks of major adverse cardiovascular events and all-cause mortality. Within the Kailuan study, a workplace-based hypertension management program was initiated in 2009 among men with hypertension, which included regular BP measuring (twice a month), free antihypertensive medications, and individualized health consultation. Participants were followed until loss to follow-up, death, or December 31, 2019. Among 17 724 male hypertensives aged 18 to 60 years, 6400 participated in the program. The propensity score matching yielded 6120 participants in the management group and 6120 participants in the control group. Both systolic and diastolic BPs were significantly lower in the management group than in the control group over follow-up, and the mean between-group difference at the 10th year was −7.83 (95% CI, −9.06 to −6.62) mm Hg for systolic BP and −4.72 (95% CI, −5.46 to −3.97) mm Hg for diastolic BP. Participants in the program were more likely to achieve BP control (odds ratio, 1.70 [95% CI, 1.41–2.06]) and had significantly lower risks of major adverse cardiovascular events (hazard ratio, 0.83 [95% CI, 0.72–0.94]) and all-cause mortality (hazard ratio, 0.71 [95% CI, 0.58–0.86]), compared with those who were not in the program. A workplace-based hypertension management program was related to reduced BP levels and lower risks of major adverse cardiovascular events and mortality in Chinese men with hypertension.

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

<b><i>Introduction:</i></b> The aim of this study is to evaluate the outcome of pregnancies complicated by monochorionic monoamniotic twin reversed arterial perfusion sequence (MOMA TRAP) diagnosed in the first trimester. <b><i>Methods:</i></b> All patients diagnosed with MOMA TRAP sequence &#x3c;14.0 weeks of gestation in a 10-year study period were retrospectively analyzed for intrauterine course and outcome. All patients were offered either expectant management or intrauterine intervention. Adverse outcome was defined as either intrauterine death (IUD), neonatal death or preterm birth &#x3c;34.0 weeks of gestation. <b><i>Results:</i></b> In the study period, 17 cases with MOMA TRAP sequence were diagnosed. Of these, 2 couples opted for termination of pregnancy. The remaining 15 were divided into 2 groups depending on the management: group A (<i>n</i> = 8) with expectant management and group B (<i>n</i> = 7) with intrauterine intervention. All fetuses in group A died before 20 weeks. Survival in group B was significantly better with 4/7 (57.1%) life births at a median of 39.6 weeks of gestation (<i>p</i> = 0.0256). The reasons for IUD in the 3 cases in group B were hemodynamic, strangulation, and bleeding complications during intervention. <b><i>Conclusions:</i></b> Intrauterine intervention in MOMA TRAP pregnancies significantly improves neonatal survival, although it is still associated with a substantial risk for IUD by hemodynamic complications or entanglement.

Tools Rekayasa Perangkat Lunak dalam Membuat Pemodelan Desain Menggunakan Unified Modeling Language (UML)

Pengembangan Rekayasa Perangkat Lunak berorientasi Objek, saat ini menggunakan tools pemodelan desain yang sesuai dengan model perancangan aplikasi sistem berorientasi objek. Dalam membangun suatu aplikasi sistem berorientasi objek atau berorientasi langsung dengan para pengguna (Users), maka tools yang tepat untuk di gunakan sebagai tools perancangan aplikasi sistem berorientasi objek yang dapat menggambarkan model proses (blueprint) dari suatu Rekayasa Perangkat Lunak Berorientasi Objek ialah Unified Modeling Language (UML). Unified Modelling Language (UML) adalah suatu metode dalam pemodelan secara visual yang digunakan sebagai sarana perancangan sistem berorientasi objek. Awal mulanya, UML diciptakan oleh Object Management Group dengan versi awal 1.0 pada bulan Januari 1997 [13]. Pada September 1997 lahirlah Unified Modeling Language (UML) versi 1.1 dengan 8 buah diagram, Pada tahun 1999 lahirlah Unified Modeling Language (UML) versi 1.3, menjadi 9 buah diagram, dengan penambahan “Business use case Diagram”, Pada bulan Mei 2001 lahirlah Unified Modeling Language (UML) versi 1.4, menjadi 10 buah diagram, dengan penambahan “Object Diagram”, Pada tahun 2002 lahirlah Unified Modeling Language (UML) versi 2.0, menjadi 13 buah diagram, dengan penambahan menjadi 13 buah diagram [1]-[3]. Model diagram proses yang dapat di kembangkan atau dibangun menggunakan Unified Modeling Language (UML) ialah Use Case Diagram, Business Use Case Diagram, Activity Diagram, Sequence Diagram, Object Diagram, Class Diagram, StateChart Diagram, Collaboration Diagram, Component Diagram, Deployment Diagram, Composite Structure Diagram, Interaction Overview Diagram, Package Diagram, Timing Diagram. Unified Modeling Language (UML) diharapkan mampu mempermudah pengembangan perangkat lunak serta memenuhi semua kebutuhan pengguna dengan efektif, lengkap, dan tepat. Hal itu termasuk faktor-faktor scalability, robustness, security. Adapun tujuan dan fungsi perlu adanya Unified Modeling Language (UML) yakni (1) Dapat memberikan bahasa pemodelan visual atau gambar kepada para pengguna dari berbagai macam pemrograman maupun proses umum rekayasa, (2) Menyatukan informasi-informasi terbaik yang ada dalam pemodelan, (3) Memberikan suatu gambaran model atau sebagai bahasa pemodelan visual yang ekspresif dalam pengembangan sistem, (4) Tidak hanya menggambarkan model sistem software saja, namun dapat memodelkan sistem berorientasi objek, (5) Mempermudah pengguna untuk membaca suatu sistem. Dan Unified Modeling Language (UML) berguna sebagai blueprint dalam perancangan berupa coding suatu program. Software yang dapat menggambarkan Unified Modeling Language (UML) ialah Aplikasi StarUML. Aplikasi StarUML dapat digunakan untuk membuat suatu alur atau proses dari suatu prosedur program yang ingin dibuat dengan cara menggambarkan model perangkatnya. Didalam StarUML terdapat beberapa bagian utama dari Unified Modeling Language (UML) yaitu view, diagram, model element, dan general mechanism.

Structural Relationship of Factors Affecting PMO Implementation in the Construction Industry

This paper focused on studying the factors affecting PMO implementation in the construction industry. A PLS-SEM model was developed for achieving this objective. The model used 171 survey data sets consisting the model was developed and evaluated using SmartPLS software. Model evaluation at the measurement level found that it has achieved the convergent and discriminant validity thresholds. While at the structural level, the model has reached its criterion fitness values. For the hypothesis testing, it was found that all three paths of factors have a significant relationship to the PMO implementation in the construction industry. From this validated model, the most dominant factors affecting PMO implementation are Resistance to change for organizational culture group; Additional administrative workload for project management group, and Inexperience PMO leadership for the resource management group. These findings will help construction practitioners in understanding the importance of PMO implementation in the construction industry. Doi: 10.28991/cej-2021-03091781 Full Text: PDF

Effectiveness of group guidance using Expressive Arts Therapy in improving self management of sexual harassment among vocational high school students in city of Pinang

The case of sexual harassment are more and more extends, spread, and found a lot in several areas, the city, even among all these villages not only the community but also in the world of education in indonesia. Sexual harassment case it is becoming even diverse and no longer eat his victims who are in the age range of adult , but those who are in the age range of teenagers even children very much a victim or an offender sexual harassment. Sexual harassment that occured in schools happened because of incompetence students in regulating and manage himself with good. One of the efforts was to enhance the capacity of students in regulating and manage himself in do sexual harassment is to hold guidance services use the art of expressive of group. The sample as many as 13 students for the experiments on class, X, XI and 13, students to the control group the sample used are proportionate stratified random sampling. Statistical analysis of data used in this research are nonparametrik statistics. Instruments gather data using the model scale likert, data analyzed using wilcoxon signed ranks kolmogorov-smirnov test and with the help of two independent sampels spss 20. Version. The findings of this study are: 1) there is a significant differences self management group experiment before and after given guidance services group use an expressive art therapy, 2) there is a significant differences self management control group before and after the guidance given services without special treatment, 3) there is a differences self management group experiment given guidance services group use an expressive art therapy to the control group given guidance services group about self management without special treatment , this was apparent from the score average postest group experiment rise higher than the average posttest score control group.

A Cross-Provider Health Care Management Program for Musculoskeletal Disorders: Results of a Randomized Controlled Trial in 22 German Companies

Musculoskeletal disorders (MSDs) are among the most common cause for reduced work capacity and sick leave. Workplace health promotion programs are often neither tailored to the workplace nor the individual needs of the employees. To counteract lacking intersectional care, this four-year randomized controlled trial (RCT) aimed to investigate the effects of modular coordinating case management (treatment group) compared to supported self-management (control group) on MSD specific sick leave days (routine data), workability (WAI), self-efficacy (self-efficacy scale), and pain (German pain questionnaire, GPQ). The study network comprised 22 companies, 15 company health insurance funds, and 12 pension funds in Germany. Overall, 852 participants (Module A/early intervention: n = 651, Module B/rehabilitation: n = 190, Module C/reintegration: n = 10) participated. Both groups achieved fewer sick leave days, higher workability, and less pain (p < 0.0001) at follow-up compared to baseline. At follow-up, the coordinating case management group showed fewer disability days (GPQ), lower disability scores (GPQ), and lower pain intensities (GPQ) than the supported self-management group (p < 0.05), but no superiority regarding MSD specific sick leave days, workability, nor self-efficacy. Module A showed more comprehensive differences. The accompanying process evaluation shows barriers and facilitators for the implementation of the program, especially in a RCT setting.

The Challenges of Managing Water for Wetland Ecology, Flood Mitigation and Agriculture in the Upper Lunan Water, an Intensive Arable Catchment in Scotland

The “Water for All” project has aimed to develop a multi-disciplinary science case for adaptive management through a Payment for Ecosystem Services (PES) scheme in the Lunan Water, a lowland catchment in Scotland. Management needs for high and low flows, standing water levels and flow routing to/from high nature value mesotrophic wetlands were appraised. A key part has been the development of a real time hydrological-hydraulic model of the upper Lunan Water as an aid to management and scenario analysis especially with respect to existing and potential hydraulic structures. This provides better working knowledge and forecast-based simulations of high or low flow situations for catchment management planners, farmers, riparian owners and other local stakeholders. Engagement with local users and residents has included surveying Willingness To Pay (WTP) for hydraulic management as a function of governance mechanisms, development of a catchment management group , and interviews and workshops with riparian and other land-users. The work has highlighted the joys and sorrows of seeking to develop a PES approach and lessons to be learnt in project management, promotion of multiple benefits, catchment-scale water governance and the vices and virtues of “benign neglect”.

267. Therapeutic Management of Bacterial Brain Abscess: An Overview of Diagnosis and Outcomes

Background We describe and compare the clinical, diagnostic evaluation and outcomes of patients who underwent therapeutic management for pyogenic brain abscess. Methods We retrospectively reviewed adults who presented with pyogenic brain abscess from January 1, 2009 through June 30, 2020. Results 231 patients were identified during the study period. Sixty-one (26.4%) patients received antibiotic therapy alone, and 170 (73.6%) had a combination of antibiotic therapy and surgical intervention. The median age for the medical and combined therapy group was 59 years and 58 years, respectively. Patients who received medical treatment had a higher prevalence of infective endocarditis than those who received combined therapy (6.6% vs. 0.6%; P=0.005). The medical therapy group was more likely to have brain MRI and cranial CT than the patients with combined therapy (75.4% vs. 63.5%; P=0.041). Midline shift (11.5% vs. 31.2%; P=0.002), a single (21% vs. 83%; P=0.001) and greater size (1.4 cm vs. 2.5 cm; P=0.007) brain abscess was significant when comparing medical vs. surgically managed abscess. Stereotactic surgical technique was the preferred diagnostic approach for the medical group (65.6% vs. 46.5%; P=0.010), and excision/craniotomy for the combined group (31.1% vs. 53.5%; P=0.002). Streptococcus viridans group was the predominant organism (32.8% and 25.9%; P=0.30). Compared to those who received combined therapy, patients with medical therapy alone were most likely to receive cephalosporin (72.1% vs. 41.2%; P=&lt; 0.0001), vancomycin (23% vs. 12.4%; P=0.047) and metronidazole (27.9% vs. 14.7%; P=0.022). In both groups, median duration of antimicrobial therapy was 42 days (P=0.12). Patients with medical therapy alone had a higher mortality rate (18% vs. 7.1%; p=0.014) but less neurologic sequelae (21.3% vs. 30.6%; P=0.16) compared with combined therapy. Medical Management. Organism isolated in the medical management group Combined Management. Organism isolated in the combined management group Demographic and Clinical Characteristics of Patients with Brain Abscess who Underwent Therapeutic Management Conclusion Most patients with pyogenic brain abscess had no identified risk factors, and brain MRI and cranial CT were the diagnostic imaging modalities of choice. Compared to those who received medical therapy alone, patients with combined treatment had a single and greater size fluid collection with the presence of midline shift. A prompt combined surgical and medical approach with prolonged antimicrobial therapy can cure the infection. Outcomes of Patients with Bacterial Brain Abscess Radiologic and Surgical Diagnosis of Patient with Brain Abscess who Underwent Therapeutic Management Disclosures John C. O’Horo, Sr., MD, MPH, Bates College and Elsevier Inc (Consultant) M. Rizwan Sohail, MD, Medtronic Inc., Philips, and Aziyo Biologics, Inc (Consultant) M. Rizwan Sohail, MD, Aziyo Biologics (Individual(s) Involved: Self): Consultant; Philips (Individual(s) Involved: Self): Consultant