Inequities in access to VA’S aid and attendance enhanced pension benefit to help Veterans pay for long‐term care

ObjectiveTo examine characteristics that are associated with receipt of Aid and Attendance (A&A), an enhanced pension benefit for Veterans who qualify on the basis of needing daily assistance, among Veterans who receive pensions.Data sourcesSecondary data analysis of 2016‐2017 national VA administrative data linked with Medicare claims.Study designObservational study examining sociodemographic, medical, and healthcare utilization characteristics associated with receipt of A&A among Veterans receiving pension.Principal findingsIn 2017, 9.7% of Veterans with pension newly received the A&A benefit. The probability of receiving A&A among black and Hispanic pensioners was 4.6 percentage points lower than for white pensioners (95%CI = −0.051, −0.042). Married Veterans receiving pension had a 4.4‐percentage point higher probability of receiving A&A (95%CI = 0.039, 0.048). Most indicators of need for assistance (eg, home health utilization, dementia, stroke) were associated with significantly higher probabilities of receiving A&A, with notable exceptions: pensioners with a diagnosis of Post‐Traumatic Stress Disorder (marginal effect = −0.029 95%CI = −0.037, −0.021) or enrolled in Medicaid (marginal effect = −0.053, 95%CI = −0.057, −0.050) had lower probabilities of receiving A&A. Unadjusted and adjusted rates of receiving A&A among Veterans receiving pension varied by VA medical center.ConclusionsThis study identified potential inequities in receipt of the A&A enhanced pension among a sample of Veterans receiving pension. Increased Veteran outreach, provider education, and VA office coordination can potentially reduce inequities in access to this benefit.     

Effects of participatory workplace improvement program on stress-related biomarkers and self-reported stress among university hospital nurses: a preliminary study

Although participatory workplace improvement programs are known to provide favorable effects on high stress occupations like nursing, no studies have confirmed its effect using biomarkers. The aim of this study was to determine whether a participatory workplace improvement program would decrease stress-related symptoms as evaluated by biomarkers and self-reported stress among hospital nurses. Three actions to alleviate job stress, which were determined through focus group interviews and voting, were undertaken for two months. A total of 31 female Japanese nurses underwent measurement of inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) at three-time points; before the program (T1), within a week after the completion of the program (T2), and three months after the program (T3). A series of inflammatory markers (Interferon-γ, Interleukin (IL)-6, and IL-12/23p40) decreased significantly at T2, and IL-12/23p40 and IL-15 significantly decreased at T3 compared to T1, while ANA and PJS remained unchanged. Our participatory program exerted beneficial effects in reducing inflammatory responses, but not for ANA and PJS. Further investigations with a better study design, i.e., a randomized controlled trial, and a larger sample size are warranted to determine what exerted beneficial effects on inflammatory markers and why other outcomes remained unchanged.     

2012—2020年济南市非免疫规划疫苗使用情况分析

目的 分析2012—2020年济南市非免疫规划疫苗（Non-National Immunization Program Vaccine,nNIP）的使用情况,为提高和加强nNIP疫苗的接种服务与管理提供参考。方法 对2012—2020年济南市nNIP疫苗使用数据进行描述分析。结果 2012—2020年,济南市使用的nNIP疫苗总量在553720~1407987剂次之间,nNIP疫苗占疫苗总使用量的比例在28%~30%之间。nNIP疫苗使用种类在15~25种之间,呈逐年增加趋势。城区人均nNIP疫苗使用量高于农村地区,城乡人均接种剂次比为2.05[DK]∶1。使用量较多的nNIP疫苗主要有水痘、EV71、狂犬、A群C群流脑结合、ACYW135 群流脑多糖、流感、乙肝和甲肝疫苗,近年五联、四联、PCV13和HPV疫苗使用量也进入前10位。可替代免疫规划疫苗的几种主要nNIP疫苗使用总量由17.71万剂增至34.03万剂,总平均替代率为23.44%（16.58%~30.59%之间）,其中以A群C群流脑结合替代A群流脑多糖疫苗比例最高。结论 2012—2020 年济南市nNIP疫苗使用量基本呈上升趋势,nNIP疫苗使用种类和人均使用剂次城市地区多于农村地区。应通过健康宣教、增加政府投入和创新激励机制等措施提高nNIP疫苗利用率。     

Examining community pharmacists’ intention to provide pharmacist-driven vaccination services: A structural equation modelling

BackgroundThe evidence of pharmacists' current involvement in vaccination services in low- and middle-income countries (LMICs) is uncertain. This study would be a first step to develop vaccination services by investigating community pharmacists’ intention to be involved in PDV services not just during COVID-19 pandemic but also during standard service provision in Turkey which can be taken as an example across LMICs.ObjectiveConsidering the efforts to empower community pharmacists in service provision, the goal of the present study was to develop a structural equation model to explain the “Pharmacist-Driven Vaccination Service Intention Model (PDV-SIM)” by using the theory of planned behavior (TPB).MethodsBased on the constructs of TPB, a measurement tool was developed. Sub-factors of PDV service intention was determined by conducting exploratory factor analysis (EFA). In the second step, confirmatory factor analysis (CFA) was conducted to prove the theoretical structure of the tool. Finally, a model explaining the relationship between observed variables, latent constructs from TPB was developed by SEM analysis.ResultsIn the proposed PDV-SIM, patient related attitude toward PDV services, attitude toward negative consequences of PDV services, and subjective norm about PDV services had an impact on the behavioral intention of community pharmacists. Nevertheless, professional development attitude toward PDV services and perceived behavioral control were not evaluated as determinants of the behavioral intention.ConclusionResults of this study revealed that TPB is appropriate for modelling PDV service intention of community pharmacists. This model can be utilized as a guide to potential pharmacy regulatory bodies and policy makers in their efforts to enable community pharmacists as vaccinators across LMICs.     

Predictive equation for acquisition of hepatitis B in hospital workers in a general hospital

A cross-sectional study was performed to obtain risk factors for hepatitis B disease, HBsAg carriers and immunised personnel, among 2470 workers in a general hospital in Madrid, Spain. The data obtained were analyzed with multiple logistic regression to obtain coefficients for variables. The results of the analysis show that being a nurse or being regularly exposed to blood are the most important risk factors for hepatitis B acquisition. The length of time working at the same job activity was also a risk factor. The resulting coefficients allow the construction of a predictive equation for non-immunised, HBsAg carrier and immunised HBV status, which can select subjects for a hepatitis B vaccination program.     

基层医院如何开展临床药学工作

临床药学是现代药学的重要组成部分,临床药学工作在各级医院开展极不平衡,特别是基层医院开展较差。本文论述了在基层医院应从人才的选择入手开展临床药学工作。     

Delivering a psychosocial program for older people living in retirement homes during the Covid-19 pandemic: A process evaluation and recommendations for community interventions

The Covid-19 pandemic lockdown regulations caused retirement homes to temporarily ban in-person visitation potentially increasing the mental health risks of older people. An opportunity arose for a multistakeholder community collaboration to design a mental health program for older people. To evaluate the process of delivering a 12-week psychosocial program aimed at preventing loneliness, countering boredom, and providing older people in restricted settings with education about Covid-19 during the lockdown, in Durban, South Africa. A qualitative retrospective design was used. Data from two focus groups and six semistructured individual interviews conducted with stakeholders (volunteers, social workers, and residents) postproject were analyzed using reflexive thematic analysis. Stakeholders had varied experiences of the project, in terms of content, processes of engagement, and implementation, resulting in five themes. The study concluded with recommendations. A strong need exists for multistakeholder community collaborations when implementing a program where the context restricts physical access.     

电教多媒体数据库管理系统的设计

目的：设计研制一个面向院校电教中心的多媒体数据库管理系统,以便用现代信息技术管理电教中心众多的信息资料。方法：在国产MIS开发平台Multibase2．0上,用原型法进行无编程设计开发。结果：制作的数据库管理系统运行稳定,操作方便,维护简单,查询功能新颖而强大,基本功能设计具有较强的针对性,能够满足电教中心日常工作的需要。结论：采用国产无编程MIS开发平台Multibase完全可以开发出实用的多媒体数据库管理系统,本数据库管理系统可向军内外院校推广使用。     

Human immunodeficiency virus/acquired immunodeficiency syndrome training from a union perspective.

The authors developed a union sponsored 2-day human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) "train the trainer" program for healthcare workers in the San Francisco Bay Area. The program incorporated the "education for action" approach in an effort to respond to the inadequacies in many traditional, institutional trainings. Service Employees International Union (SEIU) and Labor Occupational Health Program (LOHP) conducted the HIV/AIDS "train the trainer" program for approximately 100 healthcare workers in county public hospitals and community health clinics. After completing the program, these workers went back to their healthcare facilities, or community organizations, and led additional classes on HIV/AIDS transmission and prevention for approximately 600 more people. The goal of the program was to empower healthcare workers to: 1) identify the occupational risks associated with exposure to blood and potentially infectious body fluids at the workplace; 2) develop strategies to reduce those risks; 3) discuss their feelings about caring for an HIV/AIDS patient; and, 4) conduct HIV/AIDS workshops at the workplace.