A study of prehospital EMS response time and influencing factors in the main urban area of Chongqing, China.

Shortening the prehospital emergency medical service (EMS) response time is crucial for saving lives and lowering mortality and disability rates in patients with sudden illnesses. Descriptive analyses of prehospital EMS response time and each component were conducted separately using ambulance trip data from the 120 Dispatch Command Centre in the main urban area of Chongqing in 2021, and then, logistic regression analyses were used to explore the influencing factors. The median prehospital EMS response time in the main urban area of Chongqing was 14.52 min and the mean was 16.14 min. A 44.89% of prehospital EMS response time exceeded 15 min. Response time was more likely to surpass this threshold during peak hours and in high population density areas. Conversely, lower probabilities exceeding 15 min were observed during the night shift, summer, and autumn seasons, and areas with a high density of emergency station. 33.28% of preparation time was >3 min, with the night shift and high population density areas more likely to be >3 min, while for the summer and autumn seasons, high Gross National Product (GDP) per capita areas had a lower likelihood of having preparation time >3 min. 45.52% of travel time was >11 min, with peak hours, summer and autumn, and high GDP per capita areas more likely to have had a travel time >11 min, while night shift and high emergency station density areas had a lower likelihood of travel time >11 min. The primary factors influencing prehospital EMS response time were shifts, traffic scenarios, seasons, GDP per capita, emergency station density, and population density. Relevant departments can devise effective interventions to reduce response time through resource allocation and department coordination, staff training and work arrangement optimisation, as well as public participation and education, thereby enhancing the efficiency of prehospital emergency medical services.

Factors influencing civil servants' willingness to implement cardiopulmonary resuscitation in Chongqing, China: Based on the theory of planned behavior.

Background: Timely bystander cardiopulmonary resuscitation is the key to improving the survival rate of out-of-hospital cardiac arrest. Civil servants are potential bystander CPR providers. This study aimed to explore civil servants' willingness to implement CPR in Chongqing, identify the influencing factors and mechanisms affecting civil servants' willingness to perform CPR, and then seek countermeasures to improve civil servants' willingness to implement CPR. Methods: We introduced the theory of perceived risk into the theory of planned behavior, developed a 7-point Likert scale based on the extended theory of planned behavior, and conducted a questionnaire survey on civil servants in Chongqing, China. Descriptive statistical analysis and one-way ANOVA were employed to explore respondents' willingness and differences. Structural equation modeling was used to analyze the relationship between attitude, subjective norm, perceived behavioral control and perceived risk and respondents' willingness to implement CPR. Results: A total of 1235 valid questionnaires were included for analysis. 50.1 % of respondents were willing to implement CPR. Male, over 40 years old, living with the elderly, having previous experience performing CPR on another person, and having higher CPR knowledge scores were associated with a more positive willingness to perform CPR. Attitude, subjective norm and perceived behavioral control had significant positive effects on willingness, and the standardized regression coefficients were 0.164, 0.326 and 0.313, respectively. The perceived risk has a significant negative effect on willingness, and the standardized regression coefficient was -0.109. The four latent variables accounted for 44.2 % of the variance in the willingness of civil servants to implement CPR. Conclusions: The willingness of civil servants in Chongqing to implement CPR needs to be improved, and the countermeasures to enhance the subjective norm and perceived behavioral control of civil servants should be emphasized, such as developing a social support network for rescuing conduct, establishing regular training mechanisms and improving the practical applicability and popularization of the Chinese-style "Good Samaritan Law" etc., to improve the willingness of civil servants in Chongqing to implement CPR.

Association between ambient temperatures and injuries: a time series analysis using emergency ambulance dispatches in Chongqing, China.

BACKGROUND: Global warming and increasing extreme weather have become a severe problem in recent years, posing a significant threat to human health worldwide. Research exploring the link between injury as one of the leading causes of death globally and ambient temperature was lacking. Based on the hourly injury emergency ambulance dispatch (IEAD) records from 2019-2021 in the main urban area of Chongqing, this study explored the role of temperature extremes on the pathogenesis of injury by different mechanisms and identified sensitive populations for different mechanisms of injury. METHODS: In this study, we collected hourly injury emergency ambulance dispatch (IEAD) records from Chongqing Emergency Dispatch Center in the main urban area of Chongqing from 2019 to 2021, and used a distributed lagged nonlinear model (DLNM) with quasi-Poisson distribution to evaluate the association between ambient temperature and IEADs. And the stratified analysis was performed by gender, age and different injury mechanisms to identify susceptible groups. Finally, the attributable burden of ambient extreme temperatures was also investigated. RESULTS: The risk for total IEADs increased significantly at high temperature (32 °C) compared with optimal temperature (9 °C) (CRR: 1.210; 95%CI[1.127,1.300]). The risks of traffic accident injury (CRR: 1.346; 95%CI[1.167,1.552]), beating injury (CRR: 1.508; 95%CI[1.165,1.952]), fall-height injury (CRR: 1.871; 95%CI[1.196-2.926]) and injury of sharp penetration (CRR: 2.112; 95%CI[1.388-3.213]) were significantly increased. At low temperature (7 °C), the risk of fall injury (CRR: 1.220; 95% CI [1.063,1.400]) increased significantly. Lag for 24 hours at extreme low temperature (5 °C), the risk of 18-45 years (RR: 1.016; 95%CI[1.009,1.024]) and over 60 years of age (RR: 1.019; 95%CI[1.011,1.025]) increased significantly. The effect of 0 h delay in extreme high temperature (36 °C) on males aged 18-45 years (RR: 1.115; 95%CI[1.071,1.162]) and 46-59 years (RR: 1.069; 95%CI[1.023,1.115]) had significant impact on injury risk. CONCLUSIONS: This study showed that ambient temperature was significantly related to the risk of injury, and different mechanisms of injury were affected differently by extreme temperature. The increasing risk of traffic accident injury, beating injury, fall-height injury and sharp penetrating injury was associated with extreme heat, while fall injury was associated with extreme cold. The risk of injury in high temperature environment was mainly concentrated in males and young adults. The results of this study can help to identify the sensitive population with different injury mechanisms in extreme temperature environment, and provide reference for public health emergency departments to respond to relevant strategies in extreme temperature environment to minimize the potential risk to the public.

A Spatio-temporal Bayesian model to estimate risk and influencing factors related to tuberculosis in Chongqing, China, 2014-2020.

BACKGROUND: Tuberculosis (TB) is a serious infectious disease that is one of the leading causes of death worldwide. This study aimed to investigate the spatial and temporal distribution patterns and potential influencing factors of TB incidence risk, and to provide a scientific basis for the prevention and control of TB. METHODS: We collected reported cases of TB in 38 districts and counties in Chongqing from 2014 to 2020 and data on environment, population characteristics and economic factors during the same period. By constructing a Bayesian spatio-temporal model, we explored the spatio-temporal distribution pattern of TB incidence risk and potential influencing factors, identified key areas and key populations affected by TB, compared the spatio-temporal distribution characteristics of TB in populations with different characteristics, and explored the differences in the influence of various social and environmental factors. RESULTS: The high-risk areas for TB incidence in Chongqing from 2014 to 2020 were mainly concentrated in southeastern and northeastern regions of Chongqing, and the overall relative risk (RR) of TB showed a decreasing trend during the study period, while RR of TB in main urban area and southeast of Chongqing showed an increasing trend. The RR of TB was relatively high in the main urban area for the female population and the population aged 0-29 years, and the RR of TB for the population aged 30-44 years in the main urban area and the population aged 60 years or older in southeast of Chongqing had an increasing trend, respectively. For each 1 µg/m3 increase in SO2 and 1% increase in the number of low-income per 1000 non-agricultural households (LINA per 1000 persons), the RR of TB increased by 0.35% (95% CI: 0.08-0.61%) and 0.07% (95% CI: 0.05-0.10%), respectively. And LINA per 1000 persons had the greatest impact on the female population and the over 60 years old age group. Although each 1% increase in urbanization rate (UR) was associated with 0.15% (95% CI: 0.11-0.17%) reduction in the RR of TB in the whole population, the RR increased by 0.18% (95% CI: 0.16-0.21%) in the female population and 0.37% (95% CI: 0.34-0.45%) in the 0-29 age group. CONCLUSION: This study showed that high-risk areas for TB were concentrated in the southeastern and northeastern regions of Chongqing, and that the elderly population was a key population for TB incidence. There were spatial and temporal differences in the incidence of TB in populations with different characteristics, and various socio-environmental factors had different effects on different populations. Local governments should focus on areas and populations at high risk of TB and develop targeted prevention interventions based on the characteristics of different populations.

The short-term effect of air pollution on the incidence of pulmonary tuberculosis in Chongqing, China, 2014-2020.

INTRODUCTION: Tuberculosis (TB) is one of the top ten causes of death in the world. The purpose of this study was to explore the relationship between the short-term exposure to air pollutants and the risk of pulmonary TB in Chongqing. METHODOLOGY: A distributed lag nonlinear model was used to explore the effect of short-term exposure to air pollutants on the risk of pulmonary TB. Stratified analysis was used to explore the impact of gender and age on the risk of pulmonary TB. RESULTS: There were 170,934 confirmed cases of pulmonary TB in Chongqing from January 1st, 2014 to December 30th, 2020. There was a positive correlation between the exposure to particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5), particulate matter with aerodynamic diameter less than 10 µm (PM10) ozone (O3) and the incidence risk of TB. The maximum lag-specific relative risk (RR) of pulmonary TB was 1.012 (95% CI: 1.001-1.023, 14 days delay) for each 10 µg/m3 increase in PM2.5; 1.010 (95% CI: 1.003-1.017, 14 days delay) for each 10µg/m3 increase in PM10; and 1.002 (95% CI:1.000-1.004, 2 days delay) for each 10 mg/m3 increase in O3. Stratified analysis showed that the exposure effects of PM2.5, PM10 and O3 were different between different genders and age. CONCLUSIONS: This study suggested that exposure to PM2.5, PM10, and O3 was associated with the risk of pulmonary TB, and the risk was higher for males than females, while the exposure to PM2.5 and PM10 was riskier for people aged 15-60 years.

The effect of daily mean temperature on hand, foot and mouth disease and the source of regional heterogeneity in Chongqing, China, 2010-2019.

BACKGROUND: Hand, foot and mouth disease (HFMD) is a serious infectious disease which has become a public health problem. A multi-regional study was conducted in this study to explore the relationship between temperature and HFMD in different regions and the source of heterogeneity, and further detect the effect modifiers such as socio-economic factors, medical and health factors and meteorological factors. METHODS: The data on daily reported HFMD cases and meteorological data from 2010 to 2019 in Chongqing were collected. Thirty-eight districts and counties of Chongqing were divided into 6 regions. The distributed lag nonlinear model (DLNM) was applied to assess the effect of daily mean temperature on HFMD at region level with the pooled effect estimates from multivariate meta-regression model analysis. Stratified analyses by gender, age and children's type were also conducted. Potential modifiers were considered in meta regression to explore the source of heterogeneity. RESULTS: There were nonlinear relationships with an inverted V-shape between temperature and HFMD. A maximum cumulative relative risk (CRR) of 1.22 (95% confidence interval (CI): 1.12-1.34) peaked at 23.8 °C, and the risk appeared immediately and lasted for the whole 14 days. Compared with other groups, warm temperature had a stronger effect on children aged 0-1 and scattered children, while cold temperature had a stronger effect on female, children aged 3-6 and childcare children with an M-shape. We found that socio-economic factors, medical health factors and meteorological factors were significantly associated with heterogeneity. Density of medical technical personnel, urbanization rate and density of health care institutions were the main modifiers for explaining heterogeneity of 26.10%, 24.90% and 24.86% respectively which were revealed by meta-analysis. CONCLUSIONS: There was a significant nonlinear correlation between temperature and HFMD. Compared with other groups, children aged 0-1 and scattered children were more susceptible to warm temperature, while female, children aged 3-6 and childcare children were more susceptible to cold temperature. Socio-economic factors, medical health factors and meteorological factors may be the source of the heterogeneity. Therefore, local governments should consider different temperature-HFMD relationships between different regions and populations when formulating appropriate preventive measures.

Study on the associated factors of turnover intention among emergency nurses in China and the relationship between major factors.

BACKGROUND: In China, the demand for emergency medical services is increasing. However, there is a shortage of nurses and a high turnover rate. The study has three purposes: (1) to investigate the turnover intention of emergency nurses in China; (2) to analyze the associated factors of turnover intention; and (3) to clarify the relationship between work stress, job burnout, perceived organization support, job satisfaction and turnover intention. METHODS: A cross-sectional study was conducted to investigate 56 hospitals with independent emergency departments in Chongqing. A total of 522 emergency nurses were included. Descriptive statistics, One-way analysis of variance, Pearson correlated analysis and a mediation regression analysis were used to analyze the turnover intention, associated factors, and the relationship between the major study variables. RESULTS: The score of turnover intention was 2.38 ± 0.57, and the proportion of nurses with high turnover intention was 40.61%. Age, working years in emergency department (ED), marital status, employment forms, professional title, promotion opportunities, weekly working hours, monthly night shifts and exposure to workplace violence during the year influenced turnover intention of emergency nurses. Work stress and job burnout were positively correlated with turnover intention (r = 0.189, r = 0.391), while perceived organization support and job satisfaction were negatively correlated with turnover intention (r = - 0.349, r = - 0.485). perceived organization support plays a mediating role between work stress and job burnout, between work stress and job satisfaction, and between work stress and turnover intention. CONCLUSION: Work stress, job burnout, perceived organization support and job satisfaction are important associated factors of emergency nurses' turnover intention in China. It is suggested to take intervention measures to reduce work stress and job burnout and to improve perceived organization support and job satisfaction.

Spatial accessibility of emergency medical services in Chongqing, Southwest China.

Background: Timely access to emergency medical services (EMS) can significantly reduce mortality. In China, the evidence of the accessibility of complete EMS which considers two related trips and involves large rural areas is insufficient. This study aimed to explore the accessibility of ambulance services and complete EMS in Chongqing and its regional differences, and to provide a reference for improving spatial accessibility of EMS in Chongqing and optimizing allocation of EMS resources. Methods: The nearest neighbor method was used to measure spatial accessibility of ambulance services and complete EMS. Spatial aggregation patterns and influencing factors of spatial accessibility of complete EMS were analyzed using Moran's I index, Pearson correlation and multiple linear regression. Results: The medians of shortest travel time for ambulance, monitoring ambulance, primary EMS and advanced EMS in Chongqing were 7.0, 18.6, 36.2, and 47.8 min. The shortest travel time for complete EMS showed significant spatial aggregation characteristics. The Low-Low types that referred to cluster of short EMS travel time mainly distributed in city proper. The High-High types that referred to cluster of long EMS travel time mainly distributed in northeast and southeast of Chongqing. Urbanization rate was a negative influencing factor on shortest travel time for primary EMS, while average elevation and the number of settlements were positive influencing factors. GDP per capita and urbanization rate were negative influencing factors on shortest travel time for advanced EMS, while the number of settlements was a positive influencing factor. Conclusion: This study evaluated the accessibility of EMS which considers two related trips in Chongqing. Although the accessibility of ambulances in Chongqing was relatively high, the accessibility of monitoring ambulance was relatively low. Regional and urban-rural differences in the accessibility of complete EMS integrating two related trips were obvious. It was recommended to increase financial investment in economic backward areas, increase high-quality EMS resources, enhance EMS capacity of central township health centers, strengthen road construction in mountainous areas, and provide reasonable planning of rural settlements for improving the spatial accessibility of EMS, narrowing the urban-rural gap and improving equity in getting EMS for all the people.

Knowledge, training and willingness to perform bystander cardiopulmonary resuscitation among university students in Chongqing, China: a cross-sectional study.

OBJECTIVE: To evaluate knowledge of cardiopulmonary resuscitation (CPR) among Chinese college students and their attitude towards participating in CPR training and willingness to perform bystander CPR. DESIGN: A cross-sectional study. PARTICIPANTS: A total of 1128 college students were selected through a multistage stratified random sampling method from 12 universities in Chongqing, China. PRIMARY AND SECONDARY OUTCOMES: Primary outcomes included CPR knowledge and willingness to participate in training and perform bystander CPR; secondary outcomes included CPR training experience and obstacles to training and performing CPR. RESULTS: The average score on CPR knowledge was 2.078 (±1.342). Only 45.5% of the respondents were willing to participate in CPR training. Women, respondents who were postgraduate or above, with liberal arts as major and with high CPR knowledge level were more willing to participate in CPR training. A total of 47.2% of the respondents were willing to provide simple assistance, such as checking the consciousness and breathing of the patient and dialling 120 (medical emergency call). Only 34.1% indicated their willingness to perform bystander CPR on strangers. Perceived behavioural control, behavioural attitudes and subjective norms are positive predictors of willingness to provide bystander CPR. CONCLUSIONS: CPR knowledge and training rate were low among Chongqing college students. Willingness to participate in training and perform bystander CPR was also low. Improving legislation, strengthening training programmes, incorporating CPR training into the school curriculum and reshaping the social and public culture of offering timely help to those in need are recommended strategies to improve bystander CPR performance.

Associations between floods and bacillary dysentery cases in main urban areas of Chongqing, China, 2005-2016: a retrospective study.

BACKGROUND: Understanding the association between floods and bacillary dysentery (BD) incidence is necessary for us to assess the health risk of extreme weather events. This study aims at exploring the association between floods and daily bacillary dysentery cases in main urban areas of Chongqing between 2005 and 2016 as well as evaluating the attributable risk from floods. METHODS: The association between floods and daily bacillary dysentery cases was evaluated by using distributed lag non-linear model, controlling for meteorological factors, long-term trend, seasonality, and day of week. The fraction and number of bacillary dysentery cases attributable to floods was calculated. Subgroup analyses were conducted to explore the association across age, gender, and occupation. RESULTS: After controlling the impact of temperature, precipitation, relative humidity, long-term trend, and seasonality, a significant lag effect of floods on bacillary dysentery cases was found at 0-day, 3-day, and 4-day lag, and the cumulative relative risk (CRR) over a 7-lag day period was 1.393 (95%CI 1.216-1.596). Male had higher risk than female. People under 5 years old and people aged 15-64 years old had significantly higher risk. Students, workers, and children had significantly higher risk. During the study period, based on 7-lag days, the attributable fraction of bacillary dysentery cases due to floods was 1.10% and the attributable number was 497 persons. CONCLUSIONS: This study confirms that floods can increase the risk of bacillary dysentery incidence in main urban areas of Chongqing within an accurate time scale, the risk of bacillary dysentery caused by floods is still serious. The key population includes male, people under 5 years old, students, workers, and children. Considering the lag effect of floods on bacillary dysentery, the government and public health emergency departments should advance to the emergency health response in order to minimize the potential risk of floods on public.

China Medical Team: Medical rescue for "4.25" Nepal earthquake.

In recent years, global natural disasters have been frequent and resulted in great casualties and property loss. Since Wenchuan earthquake, the disaster emergency rescue system of China has obtained considerable development in various aspects including team construction, task scheduling, personnel training, facilities and equipments, logistics, etc. On April 25, 2015, an earthquake that measured 8.1 on the Richter scale attacked Nepal. Chinese government firstly organized a medical team, named China Medical Team, and sent it to the attacked region in Nepal to implement medical rescue. The medical team completed the rescue mission successfully and creatively based on their experiences.

[Spatial data based study of distribution of hepatitis C in Chongqing].

OBJECTIVE: To understand the spatial distribution of hepatitis C in Chongqing and its influencing factors. METHODS: The surveillance data of hepatitis C in 38 counties in Chongqing from January 2010 to December 2014 were collected, and spatial autocorrelation analysis and spatial regression analysis were conducted respectively by using software GeoDa 1.6.7. RESULTS: The reported incidence of hepatitis C in Chongqing ranged from 7.3/100,000 to 13.6/100,000 during 2010-2014, with the annual reported incidence of 10.3/100,000. The global Moran's I values were 0.478, 0.503, 0.529, 0.438, 0.406 respectively (P<0.05). The local spatial autocorrelation analysis indicated there were 6, 4, 7, 5 and 6 areas with high incidences of hepatitis C in 2010, 2011, 2012, 2013 and 2014 respectively. Spatial regression analysis revealed that the reported incidence of hepatitis C in Chongqing was associated with the urbanization rate (Z=2.126, P=0.033). CONCLUSIONS: The spatial distribution of hepatitis C in Chongqing from 2010 to 2014 was highly clustered. The hot spot of hepatitis C were mainly in the core areas and extended areas with well-developed economy, however the cold spot were in southeastern ecological reserve area with less developed economy. Urbanization had a certain positive influence on the distribution of hepatitis C in Chongqing.