Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

Health systems are under pressure due to staffing shortages and retention challenges, exacerbated by COVID-19. Its negative impact on hospital staff's well-being, coupled with limited support, highlights the need for more innovative organizational solutions to improve retention. Recognizing this, an Ontario hospital became the first in Canada to employ a full-time facility dog to support hospital staff in distress. This qualitative study aimed to explore the experiences of hospital staff with a facility dog and its impact on the staff's perceived organizational support. One-on-one, semi-structured interviews were conducted with clinical, non-clinical and volunteer staff at the hospital. Data were audio-recorded, transcribed, de-identified, and then thematically analyzed. The sample comprised 27 participants, including 13 clinical and 12 non-clinical employees, and 2 volunteers, with the majority identifying as women (77.78%). The results revealed the following themes: (1) the facility dog offers a unique type of support that is distinct and innovative from currently available support; (2) the facility dog's presence has made positive organizational changes; (3) the facility dog provides a short-term relief that may be limited to some staff roles; (4) a sense of pride in being leaders by introducing such program to a Canadian hospital; (5) the need for organizational improvements beyond the facility dog. Participants perceived the facility dog as having a positive, although short-term, impact, particularly among non-clinical employees. The results suggest that while the dog can improve perceived organizational support, additional long-term initiatives are needed to maintain these perceptions and support over time.

Sleep quality is a critical component of student well-being and academic performance. This study aimed to examine the association between demographic characteristics, health and mental behaviors, smartphone usage, and sleep quality among undergraduate students at Jazan University in Saudi Arabia. A cross-sectional web-based survey was conducted between April and June 2023. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The questionnaire included demographic data, health behaviors (exercise, diet, stimulant intake, smoking, qat use), anxiety levels, and smartphone usage patterns. Data were analyzed using descriptive statistics, t-tests, ANOVA, and multivariable linear regression. A total of 1564 students participated. Demographic variables were not significantly associated with sleep quality. However, poor sleep quality was significantly associated with several factors. Students who exercised less (mean PSQI = 8.19 vs 7.67; P = .003) or followed an unhealthy diet (8.10 vs 7.33; P = .001) reported worse sleep. High intake of stimulants, such as coffee (>3 times/day: β = 1.08, P = .021), tea, and soft drinks, was also linked to poorer sleep. Anxiety showed a clear dose-response effect, with mild, moderate, and severe anxiety associated with PSQI increases of 0.89, 2.27, and 3.43 points, respectively (all P < .001). Evening (β = .52, P = .016) and bedtime (β = .42, P = .029) smartphone use further predicted worse sleep quality, independent of total usage time. Sleep quality among undergraduate students is primarily influenced by modifiable lifestyle and psychological factors. Interventions promoting healthier routines, reducing stimulant intake, managing anxiety, and improving digital habits are essential to support student well-being.

Post-traumatic stress disorder (PTSD) is often debilitating, with current treatments limited by low adherence, high costs, and accessibility issues. Innovative technologies such as virtual reality (VR), augmented reality (AR), and therapeutic video games provide immersive environments that may improve treatment outcomes. This systematic review and meta-analysis evaluated the efficacy of these approaches and explored their potential advantages over traditional methods. A comprehensive search of PubMed, PsycINFO, CINAHL, Web of Science, and Cochrane identified relevant studies. Two reviewers independently screened articles, extracted data, and assessed quality using the Mixed Methods Appraisal Tool (MMAT). A random-effects model was used to calculate pooled effect sizes (Hedges' g), and heterogeneity was evaluated with the Q test and I² statistic. Publication bias was examined with funnel plots, Egger's, and Begg's tests. Analyses were performed in Stata version 17.0. From 480 records, 21 studies were included in the review and 12 in the meta-analysis. VR-based treatments yielded a pooled effect size of -0.35 (95% CI [-0.57, -0.13]), indicating a small-to-moderate reduction in PTSD symptoms. The effect was statistically significant (z = -3.13, P < .01), with moderate heterogeneity (I² = 46.28%, P = .03). Funnel plots and statistical tests suggested minimal publication bias. Meta-regression showed no moderating effect of gender. Subgroup analyses indicated significant benefits in male-only samples, participants aged 20 to 30 and over 40, and studies with follow-up periods ≤7 months. Larger effects were observed in studies with 15 to 30 participants. VR, AR, and video game interventions significantly reduce PTSD symptoms and may enhance accessibility and engagement compared to traditional treatments. These findings support the integration of immersive technologies into therapeutic practice to improve outcomes for individuals with PTSD.

Robust predictive models are essential for preventing and mitigating risks associated with public drinking water systems (PWS), which pose significant public health threats and incur substantial medical costs. This study introduces a novel approach by comparing the performance of Logit, Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost) models in predicting risks based on PWS characteristics, community attributes, and regulatory developments, rather than relying on water quality and hydrological parameters. The study yields 3 key findings: (1) XGBoost outperforms Logit and SVM, though all models perform less effectively for predicting health-based risks; (2) community and regulatory characteristics exert a greater influence on risk predictions than PWS characteristics; and (3) XGBoost performs comparably to the water parameter-based prediction approach, with the added benefits of lower cost and suitability for long-term forecasting. This innovative approach offers substantial potential for residents, environmental advocates, and policymakers to better anticipate and address PWS risks by focusing on fundamental social determinants.

Extreme risk protection orders (ERPOs) are law in 22 states, the District of Columbia, and the U.S. Virgin Islands. ERPOs are an evidence-informed policy that allows for temporary removal of firearms when a judicial officer finds that individuals are at risk of harm to themselves and/or others. Illinois passed its ERPO law, called a firearm restraining order (FRO), in 2018. Additional implementation support is necessary for the law to be utilized. This paper discusses the process for planning an implementation site visit and the lessons learned from the site visit. Site visits serve as a valuable implementation tool to build connections, highlight opportunities for improvement in implementation, and coordinate effective policies to save lives. The site visit in Lake County, Illinois serves as an example of a successful site visit to further FRO implementation. ERPO site visits are dynamic meetings where best practices are shared, conversations with key implementers are facilitated, and challenges to ERPO implementation can be highlighted and overcome. Following the site visit to Lake County, Illinois, several lessons were learned: the importance of their Firearm Risk Reduction Coordinator, the challenge and need for standardized data collection, ongoing education and training needs, and the importance of partnership and connectivity. Following the site visit, Lake County, Illinois saw an increase in ERPO cases. Site visits are a useful tool to implement ERPO laws around the country. By bringing people together, ERPO implementers can coordinate services, highlight opportunities to improve implementation, and ensure coordination on firearm relinquishment.

In digital era, the self-concept clarity of college students is increasingly alarming in Chinese educational system. In view of this, the current study investigated the structural associations between smart-phone addiction, social anxiety, social withdrawal, and self-concept clarity among Chinese college students. A chain mediation model was employed in statistical analysis, and the participants were 891 college students selected from 2 universities in Shandong, China. The findings demonstrated that smart-phone addiction can not only directly and negatively influence self-concept clarity, but also indirectly and negatively affect self-concept clarity through the single mediation of social withdrawal as well as the chain mediation of social anxiety and social withdrawal. Besides, although the direct associations between smart-phone addiction and social anxiety and between social anxiety and self-concept clarity were significant, the indirect effect of smart-phone addiction on self-concept clarity via social anxiety was insignificant. Smart-phone addiction may lead to social anxiety and social withdrawal, whereby impairing the self-concept clarity of Chinese college students.

Patient satisfaction is a key indicator of healthcare quality, influencing patient adherence, health outcomes, and service utilization. This study evaluated patient-satisfaction in outpatient maternity and child hospitals, considering demographic factors such as age, gender, and regional differences. Findings were compared with international healthcare systems to identify strengths and areas for improvement. A cross-sectional survey was conducted using a validated electronic questionnaire distributed to patients attending outpatient maternal and child clinics. Data from 14 718 respondents were analyzed to assess satisfaction across service domains and identify demographic determinants. Statistical analyses included ANOVA, correlation, and regression to explore associations between satisfaction scores and gender, age, and regional differences. A total of 14 718 participant surveys were analyzed of which 72.8% were females. The mean age was 22.4 ± 16.5 years, with 46.4% aged ≤ 18 years, and 93.5% were Saudi nationals. The overall satisfaction score was 75.9 ± 26.4 with Pharmacy services (83.3%) and Laboratory services (82.5%) scoring highest and Moving Through (waiting times) the lowest (67.5%). Males reported higher satisfaction (77.9 ± 26.2%) compared to females (75.1 ± 26.4%; P < .0001). Elderly patients (≥65 years) had the highest satisfaction (82.6%), 13.9 points higher than young adults (P < .001). Regionally, the Central region had the highest satisfaction (80.6 ± 22.7%), outperforming the Northern region by 8.73 points (P < .001). The findings highlighted disparities in patient-satisfaction across different demographic and regional groups emphasizing the need to improve waiting times, communication, and digital services. Limitations included potential response bias and varying expectations. Future research should focus on digital transformation and policy reforms to support Vision-2030 goals and international standards.

Labor induction (IOL) is a common obstetric intervention to stimulate uterine contractions before the spontaneous onset of labor, with the goal of achieving vaginal delivery. It is indicated for various reasons, including post-term pregnancy, premature rupture of membranes (PROM), maternal medical conditions, and fetal growth restriction. This study aims to evaluate the prevalence of labor induction, its indications, and the associated maternal and fetal outcomes in Ethiopia. A comprehensive search for relevant articles was conducted using widely recognized databases such as Google Scholar, Cochrane, PubMed, HINARI, Web of Science, African Online, and institutional repositories from Ethiopian universities. Data were extracted using the standard format provided by the Joanna Briggs Institute. The Cochran Q test and I² statistics were employed to assess the heterogeneity of the studies. Publication bias was evaluated using a Funnel plot and Egger's test. A Forest plot was used to present the pooled prevalence of labor induction in Ethiopia. This systematic review and meta-analysis revealed that the overall pooled prevalence of induction of labor in Ethiopia was 14.4% (95% CI: 11.09-17.70; I² = 95.7%, P < .01). The primary indications for labor induction included premature rupture of membranes (33.91%), intrauterine fetal death (8.8%), intrauterine growth restriction (4.85%), post-term pregnancy (21.49%), oligohydramnios (12.2%), and hypertensive disorders (30.7%). Maternal complications related to induction of labor included postpartum hemorrhage (9.47%), cesarean section (28.68%), instrumental delivery (18.82%), and vaginal tears (14.45%). Adverse fetal outcomes included low Apgar scores at 1 min, fetal death, and neonatal intensive care unit (NICU) admission, with respective rates of 48.2%, 6.11%, and 15.5%. According to this systematic review and meta-analysis, the estimated overall prevalence of induction of labor in Ethiopia is 14.4%. The indications for induction of labor include premature rupture of membranes (PROM), intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), post-term pregnancy, oligohydramnios, and hypertensive disorders. Maternal complications of labor induction include postpartum hemorrhage (PPH), cesarean section, instrumental delivery, and vaginal tear. Adverse fetal outcomes associated with induction of labor include a low first-minute Apgar score, fetal death, and admission to the neonatal intensive care unit (NICU). Careful consideration and balancing of risks are essential when deciding to induce labor. Additionally, clear national protocols and follow-up on induction of labor are crucial to mitigate these risks. Registration number: reviewregistry2051.