Rapid behavioral assessment of barriers and opportunities to improve vaccination coverage among displaced Rohingyas in Bangladesh,January 2018

Background

In November 2017, the World Health Organization received initial reports of suspected diphtheria cases in camps established for displaced Rohingyas in Cox’s Bazar district, Bangladesh. By January 11, 2018, over 4,000 suspected cases of diphtheria and 30 deaths were reported. The Bangladesh government and partners implemented a diphtheria vaccination campaign in December 2017. Outbreak response staff reported anecdotal evidence of vaccine hesitancy. Our assessment aimed to understand vaccination barriers and opportunities to enhance vaccine demand among displaced Rohingyas in Bangladesh.

Automatic laboratory interventions to unmask and treat hypomagnesemia in the Emergency Department

IntroductionThe significance of hypomagnesemia and the need for treatment are under-recognized in clinical practice. Our objective was to design, establish, and test two interventions to screen for patients with hypomagnesemia and increase the rate of treatment of hypomagnesemia in the Emergency Department (ED).Material and MethodsA prospective two-year study was conducted. The Laboratory Information System was set to automatically order plasma magnesium in ED patients with plasma calcium < 7.5 mg/dL (1.9 mmol/L) and/or plasma potassium < 2.5 mEq/L (2.5 mmol/L). We counted the number of identified cases of hypomagnesemia, and calculated the total economic cost per identified patient. The study had three periods “Central lab” “Stat lab” and “Stat lab with comment” according to the availability to measure plasma magnesium levels in the stat laboratory and the inclusion of an automatic comment in the laboratory report in cases of hypomagnesemia. We retrospectively reviewed the medical records of patients with magnesium < 1.5 mg/dL (0.6 mmol/L), to investigate whether they have been appropriately treated.ResultsA total of 410 plasma magnesium were measured due to our intervention; 179 due to hypokalemia and 231 due to hypocalcemia. Two hundred thirty (56.1%) of 410 showed hypomagnesemia. Each detected case resulted in reagent cost of 0.7$, when prompted by hypocalcemia, and 0.6$ when prompted by hypokalemia. The rate of patients with hypomagnesemia that were appropriately treated increased from 15% to 75% along the study period.ConclusionsOur strategies successfully identified patients with hypomagnesemia in the ED at a very affordable cost, and increased the percentage of patients with hypomagnesemia that received treatment.     

Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals

IntroductionToo frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI).MethodsThe amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken.ResultsBefore RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively.ConclusionBoth the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER.     

Commentary: PDA – public display of affection or pathological demand avoidance? – reflections on O'Nions et al. (2014)

A group of children presents with a rather peculiar type of oppositional behaviours, sometimes now subsumed under the label of ‘pathological demand avoidance’ syndrome, also increasingly referred to as PDA. Boys and girls with ‘this kind of PDA’ will do anything to avoid meeting demands of adults and children alike. The behaviours ‘used’ in maintaining avoidance range from openly oppositional or manipulative to ‘extreme shyness’, passivity and muteness. These behaviours in terms of expression of affection are rather the opposite of those associated with the commonly used meaning of PDA. However, the avoidant behaviour is quite often ‘publicly displayed’ and with no feeling for the inappropriateness of the, sometimes even, exhibitionist style of extreme demand avoidance (EDA). The ‘disorder’ was first heard of in 1980, when Elisabeth Newson presented the first 12 cases of what she believed to be a ‘new’ and separate syndrome and that she referred to as PDA. Even though PDA has attracted quite a bit of clinical attention in the United Kingdom and other parts of Europe (including Scandinavia), virtually no research has been published in the field so far (Newson, Le Maréchal, & David, 2003 ). Experienced clinicians throughout child psychiatry, child neurology and paediatrics testify to its existence and the very major problems encountered when it comes to intervention and treatment. It is therefore a major step forward that O′Nions and co‐workers (this issue) have developed a new ‘trait measure’ for PDA (‘the EDA‐Q’), a measure that appears to hold considerable promise for research, and eventually for clinical practice.     

广州市某区居民对社区卫生服务的需求利用和满意度分析

目的　了解广州市居民对社区卫生服务机构的利用情况、公共卫生基本项目的知晓情况和满意度情况,为改善广州市社区卫生服务质量提供方向和参考依据。方法　2020年12月,采取多阶段随机抽样的方法在广州市某区抽取1 050名居民进行问卷调查。单因素分析采用Pearson卡方检验,多因素分析采用二元logistic回归。结果　共发放问卷1 092份,收到有效问卷1 050份,有效率96.2%。受访居民过去一年在社区卫生服务中心看病或接受其他卫生服务的次数为（4.60±4.10）次;对公共卫生基本服务项目总知晓率为91.6%（962/1 050）,总知晓免费率为89.5%（940/1 050）;居民的社区卫生服务机构总体满意度得分为（4.61±0.75）分,其中得分最高为基本医疗服务情况,最低为机构设施、制度及基本情况。单因素分析发现,医保类型、就诊首选的医疗机构、步行到社区中心的时间和就诊服务时间等10个因素是居民总体满意度的影响因素;多因素分析发现机构设施、制度及基本情况,基本医疗服务情况,医疗费用情况,首诊医院4个因素为居民总体满意度的影响因素（OR值分别为21.294、109.013、18.203和20.989）。结论　广州市某区居民对社区卫生服务的利用情况较好,公共卫生服务项目的知晓率较高,但居民的社区卫生服务满意度仍有待提高,尤其是设施设备和医护人员服务效率等方面。     

医生对医疗责任保险的认知和需求调查——以广州某三甲综合医院为例

目的:调查医生对医责险的认知与需求,为医责险在我国的进一步发展提供政策建议。方法:对广州某三甲综合医院医生进行分层随机抽样调查,同时对相关部门负责人及个别医生进行访谈。结果:风险越高的科室,对医责险的认知越高,工龄越长的医生,对医责险越了解;医责险受到医生的普遍支持,需求意愿强烈,但对保费承担主体及分担意见差异较大。讨论:医生对医责险仍缺乏足够的认知,有效宣传较缺乏;医责险的构建模式仍比较模糊,政府主导能力及市场运作能力严重不足。建议:加大宣传力度并优化流程,提高医责险的认知度和参与度,完善医责险具体内容,加强监管,探索建立适合我国国情的医责险发展模式。     

城乡老年人长期照护需求溢出:理论分析与实证检验

首先分析了老年人长期照护需求溢出的内在逻辑,构建了影响长期照护需求溢出内在逻辑的分析框架;然后依据中国综合社会调查(CGSS)2015年数据,运用多项有序Logit回归对老年人长期照护需求溢出的影响因素进行分析,得出以下结论:从全体居民来看,年龄、受教育程度、是否参加基本养老保险和政府在老年人生活帮助中的责任与长期照护外溢成正相关,身体健康状况、子女数、个人地位和家庭经济状况与长期照护需求外溢程度呈负相关。然而,城乡居民的照护需求外溢存在显著差异,城市居民长期照护需求外溢的程度要比农村居民高,影响农村居民照护需求外溢的主要是家庭经济状况,影响城市居民照护需求外溢的主要是养老保险和政府在老年人生活帮助中的责任。因此,要弘扬传统的孝文化,重视家庭的作用;理性定位政府责任边界,优先建立补缺型的照护津贴制度;统筹城乡照护服务发展,补齐农村照护短板。