温州市小学生新型冠状病毒肺炎疫情期间用眼卫生现况

目的了解新型冠状病毒肺炎(以下简称"新冠肺炎")疫情期间温州市小学生居家上网课及用眼卫生相关情况,为开展用眼健康教育及制定近视预防策略提供依据。方法于2020年3月6—9日,方便抽取温州市6所小学一至六年级学生共1 127名,采用自编调查表通过在线方式调查疫情期间上课和用眼卫生相关情况。结果温州市小学生疫情期间的上课方式主要为网络上课(936名,83.1%),学习的主要工具是计算机(391名,34.7%)和手机(344名,30.5%),平均每天的上课总时间、完成作业和课外阅读的时间中位数为3.00,2.00,1.00 h;除学习之外,每天使用手机或平板电脑、计算机、电视时间中位数分别为1.00,0.50,1.00 h。受疫情限制,学生每天锻炼时间中位数为0.81 h,其中户外活动为0.00 h;每天睡眠时间为9.00 h。疫情期间学生报告眼部不适的有553人次(49.1%),其中最多见为眼睛干涩(379人次,47.4%)。多因素Logistic回归分析发现,阅读距离>30 cm、每天锻炼时间>0.5 h和户外活动时间>0.5 h与发生眼部不适症状负性相关;完成作业时间...     

Strategic purchasing and health systems resilience: Lessons from COVID-19 in selected European countries

Strategic purchasing is a popular and frequently proposed policy for improving the efficiency and adaptiveness of health systems. The COVID-19 pandemic shocked health systems, creating a test of the adaptability and resiliency of their key features. This research study explores (i) what role purchasing systems and agents played in the COVID-19 pandemic, (ii) if it was strategic, and (iii) how it has contributed to a resilient health system. We conducted a qualitative, comparative study of six countries in the European Union—focusing on three as in-depth case studies—to understand how and when strategic purchasers responded to seven clearly defined health system “shocks” that they all experienced during the pandemic. We found that every case country relied on the federal government to fund and respond to the pandemic. Purchasers often had very limited, and if any then only passive, roles.     

天津市基层医疗卫生机构疫情防控风险评估与控制研究

目的 建立天津市基层医疗卫生机构疫情防控风险评估体系,并进行风险评估,为实现疫情精准防控提供参考依据。方法 基于医疗失效模式与效应分析法对天津市11个区的基层医疗卫生机构进行调查,建立评估体系,对疫情防控风险进行定量风险评估,查找需要重点干预控制的风险点,制定精准控制措施,并对控制效果进行评价。如此循环进行,持续改进。结果天津市基层医疗卫生机构疫情防控风险体系包括院感管理规范、人员防护及培训、预检分诊管理、隔离技术规范4个部分。第一轮督导共查找风险点23个,确定其中需采取重点干预控制措施的风险点4个。改进结束后,再次进行风险评估,重点干预的4个风险点控制后的RPN值均<125,改进效果良好。结论 基于医疗失效模式与效应分析（HFMEA）建立基层医疗卫生机构疫情防控风险评估体系并定期进行风险评估,可及时发现基层医疗卫生机构疫情防控风险隐患,实现基层医疗卫生机构的疫情精准防控与及时阻断,防患于未然。     

Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire

Journal of Public Health - To validate a questionnaire to assess stress and burnout in healthcare workers during COVID-19 pandemic. In this study, content validity, Cronbach’s alpha, and...     

Declining influenza vaccination rates in an underserved pediatric primary care center during the COVID-19 pandemic

BackgroundInfluenza vaccination rates are decreasing in the United States. Disinformation surrounding COVID-related public health protections and SARS-CoV-2 vaccine roll-out may have unintended consequences impacting pediatric influenza vaccination. We assessed influenza vaccination rates before and during the COVID-19 pandemic in one pediatric primary care center, serving a minoritized population.MethodsA cross-sectional study assessed influenza vaccination rates for children aged 6 months to 12 years over the following influenza seasons (September-May): 1) 2018–19 and 2019–20 (pre-pandemic), and 2) 2020–21 and 2021–22 (intra-pandemic). Demographics and responses to social risk questionnaires were extracted from electronic health records. Total tetanus vaccinations across influenza seasons served as approximations of general vaccination rates. Generalized linear regression models with robust standard errors evaluated differences in demographics, social risks, and influenza vaccination rates by season. Multivariable logistic regression with robust standard errors evaluated associations between influenza season, demographics, social risks, and influenza vaccination.ResultsMost patients were young (mean age ～ 6 years), non-Hispanic Black (～80%), and publicly insured (～90%). Forty-two percent of patients eligible to receive the influenza vaccine who were seen in 2019–20 influenza season received the influenza vaccine, compared to 30% in 2021–22. Influenza and tetanus vaccination rates decreased during the COVID-19 pandemic (p < 0.01). The 2020–21 and 2021–22 influenza seasons, older age, Black race, and self-pay were associated with decreased influenza vaccine administration (p < 0.05).ConclusionsInfluenza vaccination rates within one pediatric primary care center decreased during the COVID-19 pandemic and have not rebounded, particularly for older children, those identifying as Black, and those without insurance.     

Virtual primary care in high-income countries during the COVID-19 pandemic: Policy responses and lessons for the future

BackgroundTelemedicine, once defined merely as the treatment of certain conditions remotely, has now often been supplanted in use by broader terms such as ‘virtual care’, in recognition of its increasing capability to deliver a diverse range of healthcare services from afar. With the unexpected onset of COVID-19, virtual care (e.g. telephone, video, online) has become essential to facilitating the continuation of primary care globally. Over several short weeks, existing healthcare policies have adapted quickly and empowered clinicians to use digital means to fulfil a wide range of clinical responsibilities, which until then have required face-to-face consultations.ObjectivesThis paper aims to explore the virtual care policies and guidance material published during the initial months of the pandemic and examine their potential limitations and impact on transforming the delivery of primary care in high-income countries.MethodsA rapid review of publicly available national policies guiding the use of virtual care in General Practice was conducted. Documents were included if issued in the first six months of the pandemic (March to August of 2020) and focussed primarily on high-income countries. Documents must have been issued by a national health authority, accreditation body, or professional organisation, and directly refer to the delivery of primary care.ResultsWe extracted six areas of relevance: primary care transformation during COVID-19, the continued delivery of preventative care, the delivery of acute care, remote triaging, funding & reimbursement, and security standards.ConclusionVirtual care use in primary care saw a transformative change during the pandemic. However, despite the advances in the various governmental guidance offered, much work remains in addressing the shortcomings exposed during COVID-19 and strengthening viable policies to better incorporate novel technologies into the modern primary care clinical environment.     

Sources of information in times of health crisis: evidence from Turkey during COVID-19

Journal of Public Health - Media as a source of information can shape public opinion regarding the COVID-19 response. Identifying how and where people seek information during the COVID-19 outbreak...     

Implementation of lean Six-Sigma project in enhancing health care service quality during COVID-19 pandemic

The recent outbreak of coronavirus (COVID-19) pandemic has exposed the weakness of the existing healthcare facilities in developing countries, and Pakistan has no exception. The increasing amount of patients has made this condition more vulnerable to failure. It became difficult for health care management to handle the surge of patients. This case study is based on the XYZ hospital system of Pakistan. The hospital initiates passive immunization as a savior in the absence of a vaccine. The process initiates numerous challenges as the same facility was using for passive immunization and routine operations of the hospital. DMAIC lean sig-sigma problem-solving methodology has been adopted to Define, Measure, Analyze, Implement and Control the improvement process for smooth special and routine activities. The staff and patients were interviewed, their issues were listed, and a comprehensive solution was suggested to deal with operational uncertainties. The results identified various factors through VOC and SIPOC processes, prioritized using fishbone diagram, analyzed through Kano model, and finally proposed process improvement by incorporating Kaizen process improvement methodology. Other industries could use this set of tools to evaluate and optimize routine problems, which ultimately enhances the quality and reduces cost.     

Proceedings from an International Virtual Townhall: Reflecting on the COVID-19 Pandemic: Themes from Long-Term Care

Residents of long-term care (LTC) homes have suffered disproportionately during the COVID-19 pandemic, from the virus itself and often from the imposition of lockdown measures. Provincial Geriatrics Leadership Ontario, in collaboration with interRAI and the International Federation on Aging, hosted a virtual Town Hall on September 25, 2020. The purpose of this event was to bring together international perspectives from researchers, clinicians, and policy experts to address important themes potentially amenable to timely policy interventions. This article summarizes these themes and the ensuing discussions among 130 attendees from 5 continents. The disproportionate impact of the COVID-19 pandemic on frail residents of LTC homes reflects a systematic lack of equitable prioritization by health system decision makers around the world. The primary risk factors for an outbreak in an LTC home were outbreaks in the surrounding community, high staff and visitor traffic in large facilities, and crowding of residents in ageing buildings. Infection control measures must be prioritized in LTC homes, though care must be taken to protect frail and vulnerable residents from their overly blunt application that deprives residents from appropriate physical and psychosocial support. Staffing, in terms of overall numbers, training, and leadership skills, was inadequate. The built environment of LTC homes can be configured for both optimal resident well-being and infection control. Infection control and resident wellness need not be mutually exclusive. Improving outcomes for LTC residents requires more staffing with proper training and interprofessional leadership. All these initiatives must be underpinned by an effective quality assurance system based on standardized, comprehensive, accessible, and clinically relevant data, and which can support broad communities of practice capable of effecting real and meaningful change for frail older persons, wherever they chose to reside.     

Disparities in COVID-19 vaccine uptake among health care workers

BackgroundCOVID-19 vaccine uptake by healthcare workers (HCWs) is critical to protect HCWs, the patients they care for, and the healthcare infrastructure. Our study aims to examine the actual COVID-19 vaccination rate among HCWs and identify risk factors associated with vaccine nonacceptance.Study Design and MethodsA retrospective analysis of COVID-19 vaccinations for HCWs at a large multi-site US academic medical center from 12/18/2020 through 05/04/2021. Comparisons between groups were performed using unpaired student t-test for continuous variables and the chi-square test for categorical variables. A logistic regression analysis was used to assess the associations between vaccine uptake and risk factor(s).ResultsOf the 65,270 HCWs included in our analysis, the overall vaccination rate was 78.6%. Male gender, older age, White and Asian race, and direct patient care were associated with higher vaccination rates (P <.0001). Significant differences were observed between different job categories. Physicians and advanced practice staff, and healthcare professionals were more likely to be vaccinated than nurses and support staff.ConclusionsOur data demonstrated higher initial vaccination rates among HCWs than the general population national average during the study period. We observed significant disparities among different high-risk HCWs groups, especially among different job categories, black HCWs and younger HCWs despite their high risk of contracting the infection. Interventions to address lower vaccination rate and vaccine hesitancy should be built with these disparities and differences in mind to create more targeted interventions.     

Cardiovascular health care and health literacy among immigrants in Europe: a review of challenges and opportunities during the COVID-19 pandemic

Journal of Public Health - Europe is a destination for many migrants, a group whose proportion of the overall population will increase over the next decades. The cardiovascular (CV) risk...     

Characteristics of patients with panic disorder attended in primary care during the COVID-19 pandemic: A cross-sectional multicenter study

ObjectiveTo assess the prevalence of panic disorder during the second and third waves of the COVID-19 pandemic.DesignCross-sectional multicenter study.SettingPrimary care.ParticipantsParticipating primary care physicians selected patients visiting their primary care centers for any reason over a 16-month period.Main outcome measureDiagnosis of panic disorder was established using The Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument.ResultsOf a total of 678 patients who met the inclusion criteria, 36 presented with panic disorder, with a prevalence of 5.3% (95% confidence interval 3.6–7.0). A total of 63.9% of cases occurred in women. The mean age was 46.7 ± 17.1 years. Socioeconomic difficulties, such as very low monthly income rate, unemployment, and financial constraints to make housing payments and to make ends meet were more frequent in patients with panic disorders as compared to patients without panic disorder. A high level of stress (Holmes–Rahe scale > 300), concomitant chronic fatigue syndrome and irritable bowel disease, and having financial difficulties in the past 6 months were associated with factors of panic disorder.DiscussionThis study characterizes patients with panic disorder diagnosed with a validated instrument during the COVID-19 pandemic and identified risk factors for this disease.ConclusionsIn non-selected consecutive primary care attendees in real-world conditions during the COVID-19 pandemic, the prevalence of panic disorder was 5.3%, being more frequent in women. There is a need to enhance primary care resources for mental health care during the duration of the pandemic and beyond.     

Values in European health care markets: Values in European health care markets

The discipline of public health has played an important rolein showing that the health of populations depends on more thanthe amount and quality of the health services available. Therelationship between health services and health status has beena traditional theme within the discipline. This paper proposesthat public health has a part to play in current health reformdebates and research, which have been dominated by attentionto economic incentives and the technical operation of the systems.The focus has been on the inputs to and processes within healthsystems, with relatively little attention to the likely impactof these changes on outcomes and population health. The paperconsiders one aspect of health reforms which affects populationhealth status: the part played by the social values of choiceand equity. It gives an analysis of these concepts to help evaluatereforms, and as a basis for empirical research into the impactof reforms. It considers how the NHS reforms have affected choiceand equity and how to increase patient choice and uphold certaintypes of equity which many health service staff and the publicbelieve to be important. It shows how some types of choice conflictwith some types of equity and that different groups in societybenefit according to whether choice or equity is more prominentin health reform. The purpose of this paper is to help researchers,public health practitioners and policy makers consider, fora particular health reform, the following questions: i) willreforms increase the choices which are important to most people?,ii) what will the effect be on different types of equity?, iii)how will the changes affect population health?, iv) how shouldpublic health aims be pursued in systems with market competition?     

新冠肺炎疫情背景下公共卫生安全问题反思

新冠肺炎疫情的暴发与蔓延,给公共卫生安全体系带来巨大挑战。文章以新冠肺炎疫情为例,剖析疫情暴发与应对过程中所暴露的公共卫生安全问题及其链锁机制,从多层面、多主体探析公共卫生安全危机产生的深层次原因。目前,亟待提高全社会安全意识、完善公共卫生法律体系、整合社会资源,引导社会合作与社会参与共同建立常态化应急准备机制,同时建立卫生问题国内多部门协同治理的联防联控机制以及国际合作机制协同,强化事后反思与容错机制,以期铸就公共卫生安全的严密防线。