Risk Management and Healthcare Policy最新文献

Objective: The aim of this review was to assess the factors influencing the occupational stress of state security forces during the COVID-19 pandemic.

Methods: We conducted a scoping review using the Pubmed, Scopus, and Web of Science databases, adhering to the PRISMA statement standards and the guidelines for narrative syntheses.

Results: We included a total of 26 studies. The prevalence of stress varied from 22% to 87.2%. Factors that may have influenced the stress levels of police officers during the pandemic include not having basic personal protective equipment, having little or no rest periods between tasks, long working hours, fear of contagion to themselves or others, pressure to maintain law and order, emotion regulation and preparedness, sex, marital status, work experience, age, presence of chronic underlying illnesses, family-work conflict, lack of psychological support, and others. The long working hours, the fear of infecting themselves or others, the pressure to maintain law and order, sex, and age are the six main factors evaluated for more studies.

Conclusion: Organisational, situational, and personal factors may have influenced the stress levels of police officers during the pandemic, and measures need to be taken to minimise their impact.

Purpose: Job satisfaction among faculty in standardized residency training programs has been underexplored. The objective of this study is to investigate job satisfaction among these faculty members and identify associated determinants.

Methods: An online cross-sectional survey was conducted with 4581 teachers in Heilongjiang Province from 18 to 30 May 2022, using a census method. The survey collected demographic information and assessed satisfaction using the Minnesota Satisfaction Questionnaire-Short Form. Predictors of job satisfaction were identified using multiple linear regression analysis in SPSS 24.0.

Results: The survey achieved a 91.12% response rate (4174/4581). The average satisfaction score of the respondents teachers was 4.30±0.70. The top three items with the highest satisfaction scores were "the chance to work alone on the job" (4.46±0.68), "the way my job provides for steady employment" (4.45±0.68), and "the freedom to use my own judgment" (4.43±0.69). The lowest-scoring items "the chances for advancement on this job" (4.02±1.03), "my pay and the amount of work I do" (4.08±0.96), and "the praise I get for doing a good job" (4.10±0.93). Multiple linear regression analysis revealed that geographical area, registered general subjects, age, administrative position, monthly income, daily working hours, and overtime frequency were significant factors influencing job satisfaction (P < 0.05).

Conclusion: The level of job satisfaction among standardized residency training faculty in Heilongjiang Province was generally high. High satisfaction was associated with residing in economically developed areas, having registered general subjects, holding administrative positions, earning high income, working shorter few hours daily and having a low frequency of overtime.

Background: The unique environment of high altitude can affect the work capacity of those not accustomed to it, and in some cases, it can even endanger their lives. Studying the effect of high-altitude exposure on work capacity is important. Still, there are few reviews on this topic. We aimed to summarize the parameters used to evaluate work capability in a high-altitude environment, the potential pathophysiological mechanisms, and the available pharmacological and non-pharmacological strategies for improvement.

Methods: We conducted searches on PubMed, Google Scholar, and China National Knowledge Infrastructure to explore the existing literature including basic and clinical studies from 1968 to 2023, using keywords such as "work capability/performance and high-altitude hypoxia" or "work/exercise at high altitude". Conference proceedings, notes, and case reports were excluded. The CiteSpace 6.1.R3 was used for de-duplication.

Results: A total of 727 papers were identified through search terms from the database. 486 papers were eliminated following the de-duplication process, lacking full text and deemed irrelevant to this article. Among the remaining 241 papers, 21 investigate the underlying mechanisms of reduced work capability due to altitude exposure, and 94 papers discuss measures to improve work capability when exposed to high altitudes.

Conclusion: In conclusion, this review summarizes the evaluation of indicators, pathomechanisms, and improvement measures for high-altitude exposure-related changes in work capability. More basic research on its mechanisms and large-sample, randomized controlled clinical studies to validate its effects are needed.

Objective: To assess the cost-effectiveness of adding daratumumab to carfilzomib and dexamethasone (KdD) in patients with relapsed or refractory multiple myeloma (RRMM).

Materials and methods: A Markov model was established to estimate health and economic outcomes of carfilzomib and dexamethasone (Kd) with or without daratumumab for RRMM patients over a lifetime horizon. The patients and intervention of the two arms were modeled according to the CANDOR trial. Costs were collected from the Chinese health system perspective. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of our conclusions.

Results: Compared with the Kd arm, KdD achieved an additional 0.537 quality-adjusted life-years (QALYs) at an incremental cost of $138,084, resulting in an incremental cost-utility ratios (ICURs) of $257,319 per QALY. Uncertainty analyses revealed that the model is robust to all the input parameters.

Conclusion: From the Chinese healthcare system perspective, adding daratumumab to the Kd regimen for patients with RRMM appears to lack cost-effectiveness. Exploring alternative avenues such as negotiating for a more favorable price or introducing a financial assistance program dedicated to daratumumab and/or carfilzomib could prove to be an effective strategy in enhancing accessibility of this combination.

Purpose: This study explores regional differences, dynamic evolution, and influencing factors of medical service levels in Guangzhou under the Health China Strategy to provide a basis for improving service quality and reducing disparities.

Patients and methods: An evaluation system was constructed using the entropy weight TOPSIS method. The Dagum Gini coefficient analyzed regional differences, Kernel density estimation assessed service levels' distribution, and Tobit regression explored influencing factors. Data were collected from the "Guangzhou Statistical Yearbook", Guangzhou Health Commission reports, and government work reports from 2017 to 2022.

Results: The study shows that from 2017 to 2022, there were significant differences in medical service levels among different regions of Guangzhou, with higher service quality in central urban areas compared to remote and peripheral areas. The application of the entropy weight method revealed the importance of indicators such as medical business costs and the number of registered nurses per thousand population in evaluating service quality. According to the Dagum Gini coefficient decomposition method, regional differences in medical services in Guangzhou are the main factor causing uneven overall development quality. Kernel density estimation indicates a bimodal distribution of medical service quality, suggesting heterogeneity in service quality and an increasing trend in low-quality service areas. The Tobit model confirms that factors such as medical institution drug costs, bed occupancy rate, and medical human resources have a positive impact on improving service quality.

Conclusion: This study uniquely integrates the entropy weight TOPSIS method, Dagum Gini coefficient decomposition, and Kernel density estimation to dissect regional disparities in Guangzhou's medical services, offering a novel perspective on healthcare evolution under the Health China Strategy. The findings provide an innovative framework for optimizing resource allocation and enhancing service quality, guiding balanced development across regions.

Background: The objective of this study is to compare the measles immunoglobulin G (IgG) and rubella IgG levels in patient groups with mild and severe COVID-19 disease and reveal the possible relationship.

Methods: This study was conducted among COVID-19-confirmed patients over 18, under 65 years of age. This study involved 75 participants- divided into two groups. The first group usually comprised asymptomatic patients who did not require hospitalization (n=43), and the second group consisted of patients who had diffuse pneumonia on thoracic CT and required hospitalization (n=32).

Results: Anti-measles and anti-rubella IgG titers were detected to be higher in the group with severe disease compared to the group with mild disease (p=0.001 and p=0.001, respectively). The analyses were repeated by taking n=27 in Group 1 and n=27 in Group 2, which were similar in terms of age, gender and number. In the analysis performed without any age difference between the groups, no significant difference was found between the two groups in terms of Anti Measles IgG antibody titers (p=0.068). However, Anti Rubella antibody titers were found to be higher in the group with severe COVID-19 disease than in those with mild disease (p=0.03). Regardless of the severity of the disease, there was a positive correlation between Anti Rubella and Anti Measles IgG antibody titers and age (p=<0.001 Spearman's rho 0.517; p=0.008 Spearman's rho 0.304, respectively).

Conclusion: We believe that the pre-existing Anti-Rubella IgG antibodies in the patient may increase in parallel with the patient's viral load by recognizing the common macrodomain of SARS-CoV-2 and Rubella viruses. The common macrodomain of SARS-CoV-2 and Rubella viruses is also present in the attenuated rubella virus used in the MMR vaccine4. In this case, we predict that previously administered MMR vaccine may be protective for COVID-19 patients. disease compared to those with mild disease.

Governments worldwide have made significant efforts to combat the COVID-19 pandemic. Nonetheless, measures against the COVID-19 outbreak have raised concerns relating to the measures that can affect health and endanger the lives of patients not related to COVID-19 but needing emergency treatments. For instance, ambulances were sometimes unable to access restricted zones for patients in urgent situations, and emergency departments were closed or refused urgent cases due to healthcare policies during the pandemic. To prevent such issues in future public health emergencies, changes to existing pandemic prevention measures are necessary. This article, through narrative review, intends to find a better healthcare policy during pandemic to protect proportionally public health and simultaneously guarantee the health and lives of non-COVID-19 patients needing emergency care. For this purpose, it provides three suggestions: ensuring ambulance access to confined areas, strengthening emergency department capabilities, and finding a balance between pandemic control and respect for patient rights. These suggestions are paramount to safeguard public health while securing the health and living for those needing urgent medical care.

Introduction: Unused and/or expired pharmaceuticals stored in households are potential health and environment hazards that require safe disposal. In Eritrea, there has not been a proper household medicines disposal system and pharmaceutical wastes had been disposed of irrationally. The study was therefore conducted to assess community's understanding and disposal practices of unused/expired medications and willingness to participate in a household medicines take-back system.

Methods: A cross-sectional study was conducted from January to February 2023 in randomly selected households of Asmara. The study participants were selected using a multi-stage-cluster sampling. Data, collected through face-to-face interview using a structured questionnaire, were double entered using CSPro version 7.3 software package and analyzed using SPSS version 26.

Results: A total of 327 participants were enrolled in the study with a predominance of female respondents (84%). The most commonly used disposal practices were throwing with household garbage (65.6%), followed by dumping under soil (38.7%) and flushing down the toilet/sink (15.2%). Around three-quarters (70.5%) of the households had unused/expired medicines stored at home during the data collection period with intention to use being the most common reason for storage (83.9%). Analgesics and anti-infectives were the most commonly stored classes of medicines, and more than half of the anti-infectives were stored for future use. The mean knowledge score of participants was 7.31/11 (95% CI: 7.09-7.52). Moreover, participants had a satisfactory willingness to participate in a household medicines take-back system, with a mean attitude score of 16.89/20 (95% CI: 16.45-17.29). Lack of awareness, negligence, time/health constraints, fear of accountability/stigma, accessibility and reluctance were reported as possible challenges in establishing a household medicines take-back system.

Conclusion: Unnecessary storage and improper disposal of household unused/expired medicines along with inadequate knowledge on disposal mechanisms were common in households of Asmara. Hence, public education on proper disposal as well as coordinated efforts for the establishment of safe disposal mechanisms are recommended.

Objective: The aim of this study is to assess the impact of educational interventions on knowledge and attitudes toward HIV/AIDS, with the goal of reducing stigma.

Methods: A cross-sectional epidemiological study was conducted. This intervention study assessed knowledge and attitudes about HIV/AIDS using a 5-point Likert scale. Participants, selected by convenience sampling method, included patients, their relatives, and healthcare providers at a University Hospital, excluding those with HIV/AIDS. After completing a pre-test questionnaire, participants received written information from an infectious disease specialist on HIV/AIDS, covering prevalence, transmission, prevention, and treatment per WHO guidelines. A post-test was then administered to evaluate changes in knowledge and attitudes. The study used a validated Turkish attitude scale. Statistical analysis was performed using SPSS 23.0. Continuous variables were presented as mean ± standard deviation or median and range. Correlation analysis examined the relationship between HIV/AIDS knowledge and stigmatizing attitudes.

Results: In the study conducted with 388 participants, the mean age was 34, with 48.7% male and 51.3% female. Education significantly increased HIV/AIDS knowledge and improved empathetic, accepting attitudes toward individuals living with HIV (p<0.05).

Conclusion: These results suggest that educational interventions should be implemented widely, especially in healthcare settings, to combat stigma. Future actions could include integrating similar programs into routine training for healthcare workers, patient education initiatives, and community outreach. Expanding the approach to other regions and monitoring long-term effects would further support stigma reduction.

Objective: To investigate the epidemiology, and hospitalization of tetanus in Suzhou, Jiangsu Province, China, focusing on the severity of the disease, treatment, outcomes and hospitalization costs, and to explore the risk factors for severe tetanus.

Methods: This retrospective, multicenter observational study analyzed tetanus patients admitted to various medical institutions between 2013 and 2023. Patients were classified into two groups as severe or non-severe, using the Ablett classification. Differences between the two groups were compared using the Chi-squared test, Fisher's exact test and Mann-Whitney U-test. Binary logistic regression analysis was used to evaluate potential risk factors for severe disease.

Results: A total of 63 patients with tetanus were included in this study. The median age of the patients was 57.0 (48.0-74.0) years, with a predominance of males (65.1%). There was an overall increasing trend in the rate of severe illness in tetanus patients from 2013-2023 (P<0.001). The proportion of patients admitted to the hospital was highest (39.7%) in summer (June-August) (P=0.001). The rate of severe tetanus was significantly higher in patients aged ≥65 years than in those aged 0-40 years and 41-64 years (P=0.019). The incubation period was 8.0(5.0-11.0) days for severe tetanus patients and 11.0 (8.0-18.0) days for non-severe patients (P=0.005). Compared to the non-severe group, the severe group shouldered a higher hospitalization cost, with total costs amounting to US $19062.8(4675.4-29,385.4) and US $4291.1(1356.6-19,635.4), respectively. Binary logistic regression analysis revealed that patients aged 65 years and above significantly increased the risk of developing severe disease (OR = 3.345, 95% CI: 1.039-10.770).

Conclusion: Tetanus occurs primarily in the summer in Suzhou City, Jiangsu Province, China. The incubation period is shorter in patients with severe tetanus. The elderly are the main affected population, with the risk of developing severe disease escalating with advancing age. Knowledge of tetanus immunoprophylaxis should be strengthened to further reduce morbidity and mortality.