[Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]. / Utilisation en soins primaires d'un outil de repérage des troubles du neurodéveloppement : étude multicentrique observationnelle.

INTRODUCTION: Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years. METHOD: This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid. RESULTS: Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]). CONCLUSION: This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.

An Integrated and Multivariate Model along with Designing Experiments Approach for Assessment of Micro- and Macro- Ergonomic Factors: The Case of a Gas Refinery.

BACKGROUND: The objectives of this paper are three folds. First, an integrated framework for designing and development of the integrated health, safety and environment (HSE) model is presented. Second, it is implemented and tested for a large gas refinery in Iran. Third, it is shown whether the total ergonomics model is superior to the conventional ergonomics approach. This study is among the first to examine total ergonomics components in a manufacturing system. METHODS: This study was conducted in Sarkhoon & Qeshm Gas refinery- Iran in 2006. To achieve the above objectives, an integrated approach based on total ergonomics factors was developed. Second, it is applied to the refinery and the advantages of total ergonomics approach are discussed. Third, the impacts of total ergonomics factors on local factors are examined through non-parametric statistical analysis. RESULTS: It was shown that total ergonomics model is much more beneficial than conventional approach. It should be noted that the traditional ergonomics methodology is not capable of locating the findings of total ergonomics model. CONCLUSION: The distinguished aspect of this study is the employment of a total system approach based on integration of the conventional ergonomics factors with HSE factors.

Quality Management in Health Systems of Developed and Developing Countries: Which Approaches and Models are Appropriate?

BACKGROUND: Quality Management is one of the most effective strategies for improving the health systems performance in developed and developing countries. The main goal of this study was identifying the most important aspects of quality management and preparing an appropriate model for health system. METHOD: This research was a comparative study on quality management models in the health systems of different countries. We have selected, as a sample, different countries in Asia, Africa, North America, Europe, and South America having a background in using various samples of total quality models in their health units. The studies also included the experiences of World Health Organization in different countries. RESULTS: The main goals for promoting quality in the countries are being studied includes service efficiency increase, promoting services delivery, promoting quality of working life, and changing organizational culture. Total approaches used for the countries studied include quality Assurance, Cultural change, ISO 9001, TQM and improving services quality. There are not generally outcomes criteria in 22 cases of the studies done in the developing countries. The most important problems revealed in establishing the quality management, organizational resistance against the change, lack of senior management commitments, lack of strategic planning and lack of required resources. CONCLUSION: The models for quality management should pay attention to the cultural change strategies, staff participation, strategic vision and Strategic planning. Strategic total quality management is the appropriate model in this regard.