Risk Management and Healthcare Policy最新文献

Purpose: To examine the associations between baseline frailty, longitudinal changes in frailty status, and the risk of incident arthritis in older adults across diverse international populations.

Methods: We analyzed harmonized longitudinal data from four large ageing cohorts: CHARLS (China), ELSA (England), SHARE (Europe), and MHAS (Mexico). A total of 48,480 participants aged 45 years and older were included in the baseline analysis, among whom 18,820 were included in the longitudinal frailty change analysis. Frailty was assessed using a standardized frailty index. We employed Cox proportional hazards models to estimate the associations of baseline frailty and frailty transitions over two years with subsequent incident arthritis, adjusting for sociodemographic and lifestyle covariates.

Results: Higher baseline frailty levels were prospectively associated with an increased risk of incident arthritis, with Hazard Ratios (HRs) for the highest versus lowest frailty tertiles ranging from 1.26 (95% CI 1.10-1.44) to 1.71 (95% CI 1.31-2.23) across the cohorts. Regarding dynamic changes, worsening frailty was associated with a significantly elevated risk; specifically, transitioning from pre-frail to frail was associated with HRs ranging from 1.45 (95% CI 1.08-1.95) in SHARE to 2.06 (95% CI 1.42-2.98) in MHAS. In contrast, improvement in frailty status was not associated with a significant reduction in arthritis risk in any cohort.

Conclusion: The relationship between frailty and arthritis risk is markedly asymmetric. While frailty progression significantly elevates risk, restoring a robust state does not immediately reverse this vulnerability. This suggests that preventing decline is far more effective than attempting to reverse risk once damage has occurred.

Objective: To identify risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) and to develop and internally validate a nomogram.

Methods: This retrospective, single-center study included 607 patients who underwent PELD between January 2018 and December 2023. Thirty candidate predictors were collected. Predictor selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression. A nomogram was constructed in accordance with the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) recommendations. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC); for a binary outcome, the concordance index (C-index) is numerically equivalent to the AUC and was therefore reported for internal validation. Calibration was evaluated using the Hosmer-Lemeshow test and calibration curves. Internal validation was conducted using bootstrap resampling (1,000 iterations) and 10-fold cross-validation. Decision curve analysis (DCA) was applied to evaluate clinical utility.

Results: During follow-up, 70 of 607 patients (11.5%) developed rLDH. Seven independent predictors were identified: postoperative activity, body mass index (BMI), smoking, ligamentum flavum (LF) thickness, sagittal range of motion (sROM), Modic change, and Pfirrmann grade. The nomogram achieved an AUC of 0.793 (95% CI: 0.736-0.850) and good calibration (Hosmer-Lemeshow P = 0.668). Internal validation showed a C-index of 0.763 (95% CI: 0.682-0.844) in bootstrap resampling and 0.775 in 10-fold cross-validation. The calibration curve showed close alignment with the ideal curve. DCA demonstrated favorable clinical utility of the model.

Conclusion: This internally validated nomogram integrates clinical and imaging predictors to provide individualized rLDH risk prediction after PELD. It may assist in identifying patients at higher risk of recurrence who could benefit from closer postoperative surveillance and individualized decision-making. External validation is warranted before broad clinical implementation.

Background: In patients ≥60 years with hypertension and type 2 diabetes mellitus, triglyceride-glucose index (TyG), TyG-BMI, uric acid to high-density lipoprotein cholesterol ratio (UHR), atherogenic index of plasma (AIP), single point insulin sensitivity estimator (SPISE Index) and their cumulative averages are linked to rapid kidney function decline (RD). This study aimed to identify the parameter most strongly independently associated with RD.

Methods: A retrospective cohort study used electronic records from Shanghai Chuansha Huaxia Community Health Service Center. Consecutive patients ≥60 years with both diseases (January 2020-December 2023) were enrolled and divided into RD (n=151) and Non-RD (n=499) groups based on 4-year eGFR trajectory.

Results: RD group had higher age, cum TyG, UHR, cum UHR, and cum AIP (all P<0.05). Multivariable logistic regression showed UHR, cum UHR, and cum AIP were independently associated with RD (P<0.001, P<0.001, P=0.015). Cum UHR had the strongest association (AUC=0.724, 95% CI 0.675-0.773) and non-linear relations with incident RD and absolute eGFR decline.

Conclusion: Elevated cum UHR is significantly associated with RD in these patients and may serve as a valuable biomarker for high-risk individual identification.

Purpose: This study aims to assess mental health literacy (MHL) in Guangxi, a border province in China with one of the largest ethnic minority populations, and to analyze its influencing factors.

Methods: This cross-sectional study used a multistage stratified cluster sampling approach to conduct face-to-face interviews with 9,744 residents aged 18 years and older in Guangxi. Guided by the socio-ecological model (SEM), we evaluated individual, interpersonal, community, and structural variables. Binary logistic regression and optimal scaling regression were used to identify independent factors associated with MHL and their relative importance.

Results: Of the 9,444 residents included, the overall MHL attainment rate was 12.7%; attainment in the mental health knowledge dimension was 16.6%. Recognition rates were 27.4% for depression and 46.2% for social anxiety disorder. MHL scores were significantly lower in rural ethnic minority areas than in urban areas (P < 0.05). Regression analyses showed that older age, being from the Dong ethnic group, lower education, a history of psychological treatment, and poor self-reported health were risk factors for low MHL. In contrast, male gender, employment in healthcare or technical professions, higher income, and daily internet use of less than three hours were protective factors.

Conclusion: MHL levels in Guangxi are suboptimal, particularly for recognizing depression and social anxiety disorder, with insufficient mental health knowledge emerging as a key barrier. Digital access and socio-economic advantages play a pivotal role in enhancing MHL. Strengthening mental health education in ethnic minority regions through culturally tailored, internet-based interventions and prioritizing high-risk groups, such as older adults, individuals with lower education or income, and those in rural Dong communities, may help reduce mental health inequalities.

Background: Cost-related medication nonadherence (CRNA), whereby patients do not take medications as prescribed due to their cost, negatively affects health outcomes. While patients' experiences with CRNA have been characterized, studies have not explored providers' perspectives. Our objective was to explore the experiences and perspectives of providers caring for patients facing CRNA.

Methods: We conducted a qualitative research study involving one-on-one interviews with individuals 18 years or older and work as health or allied health professionals in Metro Vancouver from August 2023 to April 2024. Interviews were transcribed verbatim and thematic analysis was applied which involved: data familiarization (reviewing transcripts, cross-checking with audio for accuracy); initial coding (labelling concepts in the transcripts); and theme formation (grouping similar codes to capture broader experiences).

Results: Altogether 16 providers participated (12 women, 3 men, 1 non-binary) from diverse disciplines. Thematic analysis led to three themes. The first theme, "how CRNA shapes practice" indicates that providers frequently deal with patients experiencing CRNA which is then associated with significant increases in workload. The second theme, "barriers to supporting patients through CRNA" suggests that most providers have no formal training to help them navigate CRNA and face time constraints in busy practices. The third theme, "making sense of CRNA within practice" highlights how providers conceptualize CRNA and how this then influences their responses to medication affordability challenges. Provider recommendations for addressing CRNA, included access to short-term funds, increased educational resources, and systemic organizational changes to increase provider supports.

Conclusion: CRNA affects not just patients, but also providers who care for them, revealing significant gaps in current systems of support. These insights underscore the need for coordinated policy action on medication affordability and the integration of structured resources within clinical settings to better equip providers to respond to CRNA.

Purpose: To examine the relationship of personality traits, lifestyle factors, and geriatric syndromes-including frailty, malnutrition, depression, cognitive status, fall risk, and sleep quality-in individuals aged 95 years and over.

Patients and methods: This cross-sectional study included 148 individuals (≥95 years) registered at three YAŞAM (Healthy Aging Center) polyclinics in Türkiye between February and October 2025. Data were collected via face-to-face interviews using sociodemographic questionnaires alongside the Katz ADL, Clinical Frailty Scale (CFS), ITAKI Fall Risk Scale, MUST, GDS-SF, PSQI, Mini-Cog, and Charlson Comorbidity Index (CCI).

Results: The mean age was 97.09±2.63 years (range: 95-109); 74.3% were women and 85.8% were widowed. Earlier regular exercise (reported by 26.4%) was significantly associated with longer functional independence, higher Katz ADL and Mini-Cog scores, lower fall risk (ITAKI), and lower frequencies of diabetes and incontinence. Frailty was prevalent among those with moderate-high comorbidity burden, while optimism and a calm temperament were associated with lower frailty, better cognitive status, and superior sleep quality. Depression and high fall risk were frequent, particularly among women and those with poor perceived health.

Conclusion: Psychological resilience (optimism) and lifelong physical activity appear to protect cognitive function, independence, and sleep quality in the oldest-old, whereas depression and inactivity are linked to frailty. These findings suggest that psychosocial factors and healthy lifestyle behaviors are critical components of longevity and should be integrated into geriatric care models and healthy aging policies.

Purpose: Climate extremes are a catastrophic manifestation of climate change. Motorcycle ambulances are an emerging sort of vehicle that is intended to offer quick access in large cities. This study evaluated the effect of extreme weather events on the accessibility of emergency motorcycle ambulance services.

Patients and methods: We conducted a retrospective analysis of motorcycle ambulance operation data from January 2020 to December 2024. Data on motorcycle ambulance operating times, rainfall levels in the operational area, and ground temperatures at the Emergency medical services (EMS) unit were collected. Continuous data were presented as means and standard deviations (SD), while categorical data were reported as frequencies and percentages. Associations between categorical variables were evaluated using the chi-square test. A two-tailed p-value of less than 0.05 was considered statistically significant.

Results: With a total of 569 operations documented over the five years, services were postponed during rainy weather and when ground temperatures exceeded 40°C. The availability of operational motorcycle ambulances declined from 81.28% to 34.03%. Increased rainfall (hours lost increased from 1065.1 to 2711.7; p<0.001) and rising temperatures exceeding 40°C (hours lost increased from 574.9 to 3067.3; p<0.001) were the main causes of service interruptions. This occurred despite increased utilization of motorcycle ambulances for emergency responses (65 to 165 operations annually; p=0.022) and a growing use of AED-equipped units for cardiac emergencies (4.6% to 23.6% of operations; p=0.014).

Conclusion: This quantitative evidence of the impact of climate extremes on emergency healthcare access due to reduced motorcycle ambulance availability. The gradual reduction in operational hours was caused by rising rainfall and elevated temperatures.

Background: Launched in 2009, China's National Essential Public Health Services Program (NEPHSP) has been broadly implemented throughout the country. However, rigorous evaluations of its impact on chronic disease outcomes remain limited. Hypertension, being one of the major noncommunicable diseases targeted by the program, provides an important case study for assessing its effectiveness.

Methods: We used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 to evaluate the impact of receiving NEPHSP-covered services (from 2015 onward) on hypertension management. A difference-in-difference approach with two-way fixed effects was used on a cohort of 774 hypertensive adults to estimate changes in health and socioeconomic outcomes associated with NEPHSP coverage.

Results: NEPHSP participation contributed to significant increases in hypertension control (9.8%; 95% CI: 2.7-16.9%; p<0.01) and treatment rates (9.9%; 95% CI: 3.8-16.1%; p<0.01). It also increased inpatient admissions by 0.17 per year (95% CI: 0.03-0.31; p<0.05). No significant effect was found on outpatient visits. In addition to clinical benefits, involvement in NEPHSP was linked to a 5.4% reduction in the Engel coefficient (95% CI: 1.2-9.6%; p<0.05), indicating improved household economic well-being. These impacts were more pronounced among younger adults and urban residents, highlighting disparities across subpopulations.

Conclusion: The findings provide evidence that NEPHSP has improved hypertension management and household economic well-being. To further maximize these gains, future policy refinements should focus on adapting services to the specific needs of older age groups and other less-responsive subpopulations to ensure universal health equity.

Objective: This study aims to analyze global trends and disparities in the incidence and burden of intraocular foreign bodies (IOFBs) from 1990 to 2021 across 204 countries and territories, stratified by region, age, sex, socio-demographic index (SDI) and human development index (HDI), while assessing the impact of the COVID-19 pandemic.

Methods: Utilizing data from the Global Burden of Disease Study 2021 (GBD 2021), we extracted the age-standardized incidence rates (ASIR), years lived with disability (YLDs), and the number of cases of IOFBs. Estimated annual percentage changes (EAPC) were calculated to evaluate trends.

Results: Globally, the number of IOFB cases increased by 33% (21.59 to 28.67 million) from 1990 to 2021. While ASIR declined overall (EAPC: -0.99), an upward trend emerged post-2010. High-SDI regions and very high HDI countries exhibited the highest ASIR, whereas low-SDI regions saw the largest case growth (129%). Males aged 25-54 years comprised the majority of cases. COVID-19 altered injury patterns, shifting incidents to domestic settings. Regions like East Asia and Brazil demonstrated significant ASIR reductions, while Central Latin America experienced rising trends. Similarly, regions and countries such as East Asia and Brazil showed significant decreases in YLDs rate, while Southeast Asia and the Philippines showed a slight upward trend.

Conclusion: Despite the current decline in ASIR from 30 years ago, it has shown an upward trend since 2010, indicating that IOFBs is an ongoing public health challenge. Disparities due to socioeconomic development, occupational risks, demographic factors, and epidemics necessitate targeted interventions. In the future, strengthening occupational regulations, healthcare capacity, and data-driven prevention strategies appear quite necessary.

Objective: To explore the application of Healthcare Failure Mode and Effect Analysis (HFMEA) in optimizing the operational workflow of oncology day wards.

Methods: A retrospective controlled study was conducted with 658 patients treated in our day ward from August 2021 to March 2022. The control group (n=344, August to November 2021) received standard care, while the experimental group (n=314, December 2021 to March 2022) underwent HFMEA-based process redesign. Key interventions included establishing a multidisciplinary team, developing a patient admission assessment tool, optimizing infusion chair allocation, creating a WeChat-based communication platform, and implementing electronic health education. Risk Priority Numbers (RPNs) were calculated using a severity-occurrence matrix. Primary outcomes included RPN reduction rates, treatment waiting times, and patient satisfaction scores.

Results: Compared with the control group, the experimental group showed significant improvements in several key metrics. The RPN improvement rates for the treatment, evaluation, and treatment processes were 48.01%, 52.94%, and 61.59%, respectively. The experimental group also demonstrated higher satisfaction scores from 3 to 4 points in waiting time, infusion process, health education, service attitude aspects. Additionally, the median waiting time decreased from 16 minutes to 7 minutes (P<0.05). However, there was no statistically significant difference between the two groups in patients' satisfaction with the admission process, diagnosis and treatment technology, technical operation, treatment environment, and discharge environment (P>0.05).

Conclusion: The optimized day ward operation process based on HFMEA has demonstrated significant benefits in reducing medical risks, shortening patient treatment waiting time, and improving patient satisfaction. These improvements are particularly relevant for healthcare institutions facing similar challenges.