Risk Management and Healthcare Policy最新文献

Background: The physical activity level of Maintenance Hemodialysis (MHD) patients is closely associated with prognosis and quality of life. This study aimed to investigate the exercise status and influencing factors among MHD patients in the Nantong region.

Methods: A cross-sectional study was conducted among 227 MHD patients from three hospitals in Nantong, China, between June 2024 and February 2025. The Physical Activity Stage of Change Scale was used to assess exercise behavior stage; the Dialysis Patient Exercise Benefits/Barriers Scale was used to evaluate exercise cognition; and the Perceived Social Support Scale was used to assess perceived social support. Patients were divided into regular exercise and non-regular exercise groups based on behavior stage. Influencing factors were analyzed using univariate and multivariate methods.

Results: Among 227 patients, 83 (36.56%) engaged in regular exercise, while 144 (63.44%) did not. Univariate analysis showed that age, marital status, education level, exercise cognition, and social support differed significantly between the two groups (P<0.05). Multivariate logistic regression revealed that marital status, exercise cognition, and social support were independent influencing factors of regular exercise behavior.

Conclusion: Exercise participation among MHD patients in Nantong remains insufficient. Targeted interventions addressing exercise cognition and social support should be adopted to promote regular physical activity in this population.

Keywords: Maintenance Hemodialysis; Physical Activity; Cross-sectional Study; Social Support; Exercise Cognition.

The evolution of digital media over recent decades has fundamentally reshaped how health crises are communicated and managed, significantly influencing medical policy reforms. The increasing prominence of social media platforms has created new opportunities and challenges in health crisis management. This review examines how online discourse surrounding health crises, including both accurate information and misinformation, has shaped public health policy by influencing public trust and complicating policy implementation. Through an analysis of case studies and crisis communication literature, this review identifies the key factors driving policy changes in response to digital public opinion. The role of misinformation, viral content, and digital activism in driving or hindering health policy reforms is discussed, with a focus on how governments and health agencies have adapted their communication strategies to maintain public trust and ensure effective policy implementation. Notable examples include South Korea's digital health initiatives during the COVID-19 pandemic and the United States responses to vaccine eligibility confusion, which illustrate the dynamic relationship between digital mobilisation and policy shifts. The review advocates for the integration of digital engagement strategies into health policy development, emphasising transparency, real-time feedback, and active stakeholder participation. Best practices in digital crisis management, such as social media monitoring, data-informed decision-making, and transparent communication, are highlighted. As digital media continues to shape public opinion, agile, transparent, and responsive communication has become critical. Policymakers must now consider digital engagement not only as a tool for crisis management but as an essential component of the policymaking process.

Purpose: Studying abroad represents a significant risk factor for diminished health and well-being due to cultural, environmental, and psychosocial challenges. This study aimed to explore international students' perceptions of well-being and examine the factors contributing to their well-being while living and studying abroad.

Methods: We used an exploratory sequential mixed-methods study design. The first part of the research involved a qualitative study conducted through in-depth interviews and focus group discussions. We analyzed the data using thematic analysis. We used the results from the first stage to develop the quantitative part of the study. Multiple regression was used to analyze the factors contributing to international students' perceived well-being.

Results: The qualitative study identified four main factors: academic life, health, social connectedness, and environmental factors. The quantitative study found that faculty and student status significantly affected well-being.

Conclusion: Universities and those managing international student affairs should develop pre-arrival plans for incoming students, considering their diverse backgrounds and perspectives on well-being. Student well-being positively influences academic results by enhancing cognitive function, motivation, social engagement, and resilience while reducing risks of stress, burnout, and dropout rates.

Background: The COVID-19 pandemic has brought about substantial changes in lifestyles, highlighting the importance of online nutritional counseling as a viable strategy to enhance knowledge and promote healthier lifestyles. This approach serves as an alternative means to prevent non-communicable diseases and strengthen immune function. This study aimed to assess the impact of nutritional tele-counseling on knowledge levels and lifestyle habits related to immunity among university staff members in Lima, Peru.

Methods: A quasi-experimental analytical study was conducted, using a non-probabilistic convenience sampling method to select a sample of 35 participants aged between 30 and 59 years. The study was conducted via the Zoom platform. A pre-test was administered, followed by a two-month counseling program that included sessions on nutrition and lifestyle-related topics. A post-test was administered at the conclusion of the intervention. Data analysis was conducted using the McNemar test for categorical variables and the Wilcoxon signed-rank test for quantitative variables, with a statistical significance level set at p < 0.05. All analyses were performed using SPSS version 17.

Results: The knowledge score related to immunity-enhancing foods and nutrients showed a significant increase, with the mean score rising from 3.3 ± 1.9 to 7.1 ± 1.5 (p < 0.001). Similarly, following the intervention, a significant improvement in lifestyle scores was observed, with the mean score increasing from 4.3 ± 1.8 to 11.3 ± 1.6 (p < 0.001).

Conclusion: These results demonstrate the effectiveness of the nutritional tele-counseling program in significantly enhancing both nutritional knowledge and lifestyle practices.

Objective: This study aims to analyze the service supply challenges for Family Physicians during public health emergencies through the lens of street-level bureaucracy.

Methods: Guided by street-level bureaucracy theory within a three-tier analytical framework (micro-, meso-, and macro-levels), this qualitative study employed semi-structured interviews with 36 Family Physicians in Shanghai regarding their responses to a public health emergency. Interviews were recorded, transcribed verbatim using "iFlytek Hearing" software, manually reviewed, and analyzed thematically using NVivo 10.

Results: The analysis revealed multi-level challenges. At the micro-level, Family Physicians faced dual role pressures as "state agents" and "public agents", leading to reduced discretionary power and a tendency for prosocial deviant behavior; their understanding of policies and effectiveness of communication with the public directly impacted policy implementation outcomes. At the meso-level, resource scarcity created supply-demand contradictions, triggering adaptive policy implementation, where Family Physicians innovatively met service needs under constraints and participated in community collaborative governance. At the macro-level, policy ambiguity was prominent, essential medicine supply chains faced difficulties, and training and career development pathways in general practice remained underdeveloped.

Conclusion: This study provides a deep understanding of the service supply challenges faced by Family Physicians during public health emergencies, offering a scientific basis for optimizing service supply strategies, and this theoretical framework can be extended to the analysis of other street-level bureaucrats.

Purpose: To investigate the interaction between metabolic and behavioral factors in non-proliferative diabetic retinopathy (NPDR) among elderly patients with type 2 diabetes mellitus (T2DM).

Patients and methods: A cross-sectional study was conducted from October 2023 to May 2024 using cluster random sampling to recruit elderly patients with T2DM from two tertiary hospitals in Nantong. A self-designed questionnaire was utilized to collect lifestyle and behavioral data. Non-mydriatic fundus photography was used for DR screening, and biochemical indicators were extracted from electronic medical records. Descriptive statistics were applied to analyze demographic characteristics, while univariate and multivariable logistic regression analyses were performed to identify factors influencing NPDR. Interaction models evaluated multiplicative and additive effects between metabolic indicators (low-density lipoprotein cholesterol [LDL-C], urine albumin-to-creatinine ratio [UACR]) and weekly fish consumption frequency on NPDR. Receiver operating characteristic (ROC) curves assessed the diagnostic value of elevated UACR, low fish consumption, and their interaction for NPDR.

Results: Among 978 eligible elderly patients with T2DM, 794 were included, with 306 (38.5%) diagnosed with DR, including 246 (31.0%) with NPDR. Multivariable logistic regression identified diabetes duration, LDL-C, UACR, and weekly fish consumption as independent risk factors for NPDR. Interaction analysis demonstrated significant positive multiplicative (OR=8.89, 95% CI=2.87-9.52, P<0.001) and additive interactions (RERI=2.77, API=0.31, SI=1.54) were observed between low fish consumption (<2 times/week) and severe UACR (>33.9 mg/mmol). No interactions were found with moderate UACR (3.4-33.9 mg/mmol) or elevated LDL-C (>1.8 mmol/L). ROC analysis demonstrated AUC values of 0.840, 0.816, and 0.893 for severe UACR, low fish consumption, and their combined effect, respectively, indicating enhanced diagnostic utility for NPDR.

Conclusion: The synergistic interaction between severe UACR and infrequent fish consumption significantly elevates NPDR risk in elderly patients with T2DM, highlighting its potential as a predictive marker for early intervention.

Background: Nurses are pivotal to healthcare delivery, particularly in critical care settings where their performance directly affects patient outcomes. While job satisfaction and work engagement are established predictors of job performance, their interactive effects remain underexplored in low-resource and high-stress contexts such as Jordan.

Aim: This study examined the moderating role of work engagement in the relationship between job satisfaction and job performance among critical care nurses in Jordan.

Methods: A descriptive cross-sectional design was employed with a convenience sample of 143 registered nurses from four public hospitals in Jordan. Data were collected using validated instruments: Demographic and Professional Characteristics Sheet, The Job Satisfaction Survey (JSS), the Utrecht Work Engagement Scale (UWES-9), and the Six-Dimension Scale of Nursing Performance (SDSNP). Descriptive statistics, Pearson's correlation, independent t-tests, and moderation analysis were conducted using SPSS v26.

Results: Participants reported moderate levels of job satisfaction (M = 2.90/4), work engagement (M = 3.58/6), and job performance in terms of both frequency (M = 3.31/4) and quality (M = 3.11/4). Job satisfaction positively correlated with work engagement (r = 0.28, p < 0.001) and job performance quality (r = 0.21, p < 0.05), but not frequency. Work engagement significantly moderated the relationship between job satisfaction and job performance frequency (β = 0.25, p = 0.027), but not quality.

Conclusion: Work engagement enhances the positive impact of job satisfaction on performance frequency, emphasizing its critical role in sustaining nurse productivity. Targeted strategies to improve both job satisfaction and engagement may enhance performance outcomes and healthcare quality in high-acuity environments.

Purpose: Chemotherapy remains the primary treatment for haematological malignancies (HMs). While recent therapeutic advances have improved patient survival, treatment-induced immunosuppression and prolonged neutropenia significantly elevate the risks of bloodstream infection (BSI), contributing to higher mortality. This study identifies risk factors for BSI in pediatric HM patients, aiming to establish evidence-based protocols for infection prevention and risk stratification, thereby informing targeted healthcare policies to reduce complications and improve treatment outcomes.

Patients and methods: We retrospectively analyzed 682 pediatric HM patients presenting with fever at our institution, including 98 BSI-confirmed cases.Results were statistically compared across multiple aspects.

Results: Pediatric HM patients with bloodstream infection showed significantly higher AML prevalence (47.96% vs 33.22%, P = 0.005) and Gram-negative bacteria predominance (66.33%), notably Escherichia coli (E. coli) (27.55%). Stenotrophomonas maltophilia infection rates were significantly higher in lymphoma patients than in other hematological malignancies (P < 0.05). Multivariable analysis identified four modifiable risk factors: peak body temperature (OR = 5.468, 95% CI 3.407-8.775, P < 0.001), duration of neutropenia (OR = 1.181, 95% CI 1.120-1.245, P < 0.001), febrile neutropenia (OR = 8.193, 95% CI 3.574-18.780, P < 0.001), and invasive procedures (OR = 4.265, 95% CI 1.920-9.474, P < 0.001).

Conclusion: To reduce BSI complications in pediatric HM patients, we recommend implementing risk-stratified temperature protocols and strict neutropenia control (≤7 days), emphasizing rigorous clinical criteria for invasive procedures (PICC). These findings provide an evidence base for healthcare policies aimed at reducing infection-related mortality through optimized treatment protocols and enhanced clinical care standards.

Purpose: To explore strategies for optimizing Automated External Defibrillator (AED) configuration in urban areas of China and improving the treatment conditions for out-of-hospital cardiac arrest (OHCA) patients.

Material and methods: Taking Dongcheng District, Beijing as the research object, spatial data such as administrative divisions, transportation road networks, AED configuration points, and points of interest in key public places, as well as non-spatial data such as population statistics, were collected. Service area analysis and location-allocation models were used to analyze the current status of AED configuration and explore optimization strategies for AED deployment.

Results: As of September 2024, a total of 86 AEDs had been configured in Dongcheng District, and their service area covered 13.74% of the district. The combined service area of AEDs and hospitals covered 82.62% of the district. After achieving the goal of full AED coverage in key public places in the future, AED service area will cover 34.80% of the district, and the combined service area of AEDs and hospitals will cover 85.92% of the district. According to the optimization plan proposed in this study, an additional 218 AEDs are needed in Dongcheng District, bringing the total number of AEDs to 519. At this point, AED service area will cover 50.62% of the district, and the combined service area of AEDs and hospitals will cover 97.28%.

Conclusion: The AED configuration optimization strategy proposed in this study is highly reasonable, and relevant government agencies can refer to this framework to optimize the AED deployment in urban areas. Additionally, technologies such as the Internet of Things and drones can be leveraged to establish urban AED search and delivery platforms, further enhancing the accessibility and utilization rate of AED to achieve optimal treatment outcomes for OHCA patients and save more lives.

Context: Medical errors are the third leading cause of death after heart disease and cancer, but in contrast to these conditions, progress in reducing mistakes has been minimal.

Personal experience and learning: I learned firsthand about barriers to improvement during events surrounding the death of my grandson, who had a complex heart defect missed on a pregnancy ultrasound. Following his tragedy, universal pulse oximetry screening was implemented at a national level, probably saving dozens of children from a similar fate every year in our country.

Barriers to improvement: On the other hand, I also found a refusal to link failure with correction. Lawyers working for the HMO where ultrasound had missed the heart defect claimed that the practice was reasonable, rejecting responsibility for the failure and quest for improvement, such as considering adoption of AI for enhanced diagnostic accuracy. Pulse oximetry universal screening could have been implemented a decade ago (thereby preventing our tragedy). Still, the people in charge at a National Council then did not listen to the committee of experts they had appointed and who recommended the screening.

Insights: Linking errors with improvement brings meaning to suffering: the tragedy would not have been in vain if it had motivated corrective actions. Communication failure is responsible for most errors, and a significant barrier is the fear of speaking up. The lesson was tragically learned at NASA and other organizations, emphasizing the importance of listening to everyone to prevent disasters. Respectful listening is an essential key to cooperation and success.

Conclusion: Healthcare needs a paradigm shift to a culture of transparency, responsibility and collaboration, building growth from past failures, learning from mistakes to improve patient safety.