Risk Management and Healthcare Policy最新文献

Purpose: To explore the value of different inflammatory markers in predicting the severity of coronavirus disease 2019 (COVID-19) in patients with type 2 diabetes mellitus (T2DM).

Patients and methods: A total of 116 patients with COVID-19 in patients with T2DM were collected from December 2022 to March 2023 and were divided into a mild case group (77 cases) and a severe case group (39 cases). The ratio of neutrophil to lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil to lymphocyte × platelet ratio (NLPR), lymphocyte ratio to monocyte (LMR), systemic inflammatory response index (SIRI), systemic inflammatory index (SII), systemic inflammatory composite index (AISI), procalcitonin (PCT), C-reactive protein (CRP) and lactate dehydrogenase (LDH) were compared between the two groups. The screening effect of each variable on the progression of the disease was analyzed using receiver operating characteristic (ROC) curves.

Results: NLR, PLR, NLPR, MLR, SIRI, SII, AISI, LDH, CRP and PCT in severe case group were higher than those in mild case group (P<0.05), and LMR was lower than those in mild case group (P<0.05). ROC curve analysis further demonstrated the diagnostic performance of these biomarkers, with PCT having the largest area under the ROC curve (AUC^ROC) of 0.83.

Conclusion: NLR, PLR, NLPR, SIRI, SII, LDH, CRP and PCT demonstrate greater reliability in diagnostic value and clinical utility for predicting the severity of COVID-19 in patients with T2DM.

Purpose: This study aimed to identify distinct trends among Chinese residents based on their health-related quality of life (HR-QoL) outcomes and to analyze the demographic characteristics that contribute to these trends.

Materials and methods: The study conducted latent class analysis using baseline data obtained from a survey of health service utilization behaviors (from July to December 2016) among residents of Hubei Province, China (N = 1517). Latent classes were used to implement the HR-QoL grouping of different trends among the respondents. Multinomial logistic regression analysis was used to identify demographic characteristic factors affecting HR-QoL in the trend groups.

Results: A three-class model emerged as the most suitable grouping classification for HR-QoL among Chinese residents: the low HR-QoL class, exhibiting a downward trend (5.5%); the medium HR-QoL class, exhibiting an upward trend (12.1%); and the stable HR-QoL class, exhibiting high HR-QoL (82.4%). Participants in the medium class were more likely to be without chronic diseases, aged 45-64 years, and employed than those in the low class. Conversely, urban participants had a higher likelihood of belonging to the low class. Participants in the stable class were more likely to be without chronic diseases, aged 15-44 years or 45-64 years, and employed than those in the low class. Conversely, urban participants had a higher likelihood of belonging to the low class.

Conclusion: Three latent trend classes of HR-QoL were observed, which exhibited distinct characteristics. Residents without chronic diseases, residents under 65 years of age, and employed residents had better HR-QoL than individuals in other classes, while urban residents had poorer HR-QoL than individuals in other classes.

Background: Non-communicable diseases emerge as major public health challenges with increasing prevalence and mortality. The armed conflict in Sudan has resulted in the displacement of 6.8 million people, putting a significant strain on the health sector in the displacement areas. This study aimed to explore the prevalence of non-communicable diseases and access to healthcare services among internally displaced people in Northern Sudan.

Methods: A cross-sectional study was conducted among randomly selected internally displaced people in accommodation shelters at Dongola locality. Data were collected by face-to-face interviews using a questionnaire adapted from relevant studies. For data analysis descriptive statistics and chi-square tests were utilized using SPSS-27.

Results: 374 participated in the study with a 96.1% response rate. 70% of respondents were 18-49 years old. 70.9% of respondents were females, and 92.8% of them had no source of financial income. The prevalence of non-communicable diseases was 42.5%, with hypertension (44.7%), diabetes mellitus (24.7%), and thyroid disorders (15.2%) predominating. About 45.7% of patients interrupted their medication, and 38.6% could not access healthcare services, while 57.2% of respondents received free medical care. The study found a statistically significant association between the type of disease and age, gender, residence before displacement, and the Length of displacement.

Conclusion: 42.5% of the internally displaced suffer from non-communicable diseases, with hypertension, diabetes mellitus, and thyroid disorders predominating. About 45.3 and 38.6% of them respectively have interrupted their medications and lost regular follow up. The urgent need for improved healthcare services is recommended.

Background and objective: Concealed penis (CP) is a condition involving a congenital abnormality of the external genitalia, wherein the penile shaft is partially or completely obscured by surrounding skin tissues, negatively affecting the psychological and physical health of children. The guardians, who are primarily responsible for the daily care of children, play a crucial role in the early detection of this condition. Therefore, this study aims to explore knowledge, attitude, and practices (KAP) toward CP among guardians of young boys; results would provide a theoretical basis for the development of health education programs.

Methods: This web-based cross-sectional study was conducted among guardians of boys in the Department of Pediatric Surgery, local hospital between June 2023 and September 2023. A self-designed questionnaire was developed to collect demographic information of the guardians and to assess their knowledge, attitudes and practices toward CP.

Results: A total of 394 questionnaires were collected. Among the guardians, 143 (36.29%) of them were male, 375 (95.18%) were the parents of the children, 279 (70.81%) had a junior college or bachelor's degree, and 46 (11.68%) reported their children had CP. The knowledge, attitudes and practices scores were 4.00±2.00 (possible range: 0-7), 35.63±3.40 (possible range: 9-45), and 23.03±6.97 (possible range: 9-45), respectively. The structural equation model demonstrated that knowledge had direct effects on attitudes (β=0.63, p<0.001), and practices (β=0.81, p<0.001). Moreover, attitudes had direct effects on practices (β=0.43, p<0.001).

Conclusion: This study found insufficient knowledge, positive attitudes, but poor practices toward the CP in guardians of boys, especially among participants from rural areas of families with lower income. It is recommended to tailor educational initiatives and implement strategies to bridge the knowledge-practice gap toward concealed penis in boys.

Purpose: The most prevalent chronic liver disease in both developed and developing nations is Metabolic dysfunction-associated Steatotic Liver Disease (MASLD). The condition increases the risk of comorbidities and liver-related morbidity and mortality. The public's awareness and medical personnel's understanding are essential in creating countermeasures to stop the disease's spread; a positive attitude is essential for early screening. This study aimed to explore the knowledge and attitudes of Jordanians living in Amman toward MASLD to determine the public's awareness and medical personnel's understanding of the disease.

Materials and methods: A cross-sectional study was conducted using an online self-administered questionnaire that included 5 items for knowledge and 8 for attitude. Demographic questions were also included to further examine how demographic factors affected knowledge and attitude.

Results: Among 906 responders, (63.4%) were females, and (36.6%) were males. The majority age group was 18-30 (56.2%). Only 49.5% had previous knowledge of MASLD, (44.6%) believed they were at risk of developing it. There is a statistical significance between age, gender, educational level, and having a good knowledge of MASLD and a positive attitude towards it (p<0.05).

Conclusion: Generally, Jordan's population has a fair knowledge of MASLD and a positive attitude towards it. Warranting more research into the reasons behind it, and more awareness campaigns.

Aim: To investigate the emotional response of hospital staff to the Depression Anxiety Stress Scale-21 (DASS-21) over the COVID-19 pandemic and after the relaxation of prevention and control measures in Zhejiang Province, China, and identify influencing factors.

Design: Multicenter online cross-sectional design.

Methods: From January 10, 2023, to January 20, 2023, 1054 hospital employees in Zhejiang, China, were recruited using WeChat. Data was gathered via online, self-administered surveys. T-tests and one-way analyses of variance, Pearson's correlation analysis, and multiple linear stepwise regression analyses were used to examine the data.

Results: More than 90% of hospital employees were infected with COVID-19. Through regression analysis, the following variables were found to be independent predictors of emotional response to DASS-21: resilience (-13.346, P < 0.0001), sleep (14.689, P < 0.0001), friend support (-4.278, P < 0.0001), education level (2.699, P = 0.007), and marriage (-2.214, P = 0.027). The emotional responses were not as severe as predicted, but they were still well above the Chinese norm. A longitudinal comparison of DASS-21 emotional responses with similar studies showed a parabolic downward trend over time.

Conclusion: Our results identified education level, marriage, friend support, resilience, and sleep as independent predictors of emotional responses to the DASS-21 among hospital workers in this outbreak. Improving the mental resilience and sleep status of staff is a key target. Unmarried medical personnel with higher education should be given greater attention and support by management. In addition, there is still room for further improvement in the government and societal responses to similar outbreaks. The study also found a parabolic downward trend in DASS-21 emotional responses among hospital workers during the COVID-19 outbreak over time.

Objective: To analyze the current utilisation of delirium risk assessment and screening for older patients after hip fracture surgery in tertiary hospitals in Jiangsu Province, China.

Methods: This cross-sectional study was conducted from April 1 to April 30, 2023 among nurses working in orthopedics from Level III hospitals in Jiangsu Province, China. Data were collected using a self-designed questionnaire that focused on the utilisation of delirium risk assessment and prevention measures for older patients after hip fracture surgery. The questionnaire was administered through the online platform Questionnaire Star. Differences between data were analyzed using chi-square and rank-sum tests.

Results: A total of 616 nurses from 48 hospitals in Jiangsu province responded to the survey. Among them, 50.17% reported having no training in delirium management, 66.88% did not assess patients for delirium risk, and 73.21% did not screen patients for delirium in their clinical practice. It was observed that nurses with longer tenure, nurses specialising in orthopaedics, and nurses with ICU experience were more attentive to delirium risk assessment and delirium screening of patients (P<0.001).

Conclusion: Medical institutions must focus on strengthening nurses' training in delirium management for older patients after hip fracture surgery, improve their ability to undertake risk assessment and risk screening, unify delirium management norms, and ultimately improve nurses' delirium management ability.

Background and purpose: In public health emergencies, rapid perception and analysis of public demands are essential prerequisites for effective crisis communication. Public demands serve as the most instinctive response to the current state of a public health crisis. Therefore, the government must promptly grasp and leverage public demands information to enhance the effectiveness and efficiency of health emergency management, that is planned to better deal with the outbreak and meet the medical demands of the public.

Methods: This study employs dynamic topic mining and knowledge graph construction to analyze public demands, presenting a spatial-temporal evolution analysis method for emergencies based on EBU models. EBU models are three large language models, including ERNIE, BERTopic, and UIE.

Results: The data analysis of Shanghai's city closure and control during the COVID-19 epidemic has verified that this method can simplify the labeling and training process, and can use massive social media data to quickly, comprehensively, and accurately analyze public demands from both time and space dimensions. From the visual analysis, geographic information on public demands can be quickly obtained and areas with serious problems can be located. The classification of geographical information can help guide the formulation and implementation of government policies at different levels, and provide a basis for health emergency material dispatch.

Conclusion: This study extends the scope and depth of research on health emergency management, enriching subject categories and research methods in the context of public health emergencies. The use of social media data underscores its potential as a valuable tool for analyzing public demands. The method can provide rapid decision supports for decision-making for public services such as government departments, centers for disease control, medical emergency centers and transport authorities.

Background: Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe.

Methods: We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022.

Results: Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc.

Conclusion: Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.