Public Transport Strikes and Their Relationships With Air Pollution, Mortality, and Hospital Admissions.

There is limited suggestive evidence of relationships between public transport strikes and either increased air pollution or worse population health. In this study we aimed to assess whether public transport strikes were associated with increases in health events (overall, cardiovascular and respiratory mortality, and cardiovascular and respiratory hospitalizations). We also explored whether air pollution mediated those associations. We used data from the city of Barcelona (Spain) for the period 2005-2016 on strikes, health events, and ambient air pollution (nitrogen dioxide, nitrogen monoxide, particulate matter (PM) with an aerodynamic diameter ≤10 µm, PM with an aerodynamic diameter ≤2.5µm, PM with an aerodynamic diameter ≤1µm, number of particles with a diameter greater than 5 nm per cm3 (particle number concentration), and black carbon). We used linear and quasi-Poisson regression models to explore the associations between air pollution and public transport strikes and between public transport strikes and health outcomes. We also investigated potential causal mediation by air pollution. Overall, this study suggested that public transport strikes are associated with increased overall mortality, respiratory mortality, and respiratory hospitalizations. However, our findings suggest that such increases are not mediated by the increase in air pollution. Our results indicate the need to further investigate these relationships and potential mechanisms.

The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya.

BACKGROUND: Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya's health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses' strike and 20 day clinical officer strike in Kenya. METHODS: Monthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department. RESULTS: There was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient - 649 (95% CI -950, - 347) p < 0.0001. The physicians' strike saw a significant decline in mortality (ß) coefficient - 19.0 (95%CI -29.2, - 8.87) p < 0.0001. Nurses and Clinical Officer strikes' did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12. CONCLUSION: Declines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.

The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics.

OBJECTIVE: This article looks at lessons learned from the 1995 Kikwit Ebola outbreak and suggests how modern hospitals should apply these lessons to the next lethal viral epidemic that occurs. METHOD: The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo (formally Zaire) is one of the most well studied epidemics to have occurred to date. Many of the lessons learned from identifying, containing and treating that epidemic are applicable to future viral outbreaks, natural disasters and bioterrorist attacks. This is due to Ebola's highly contagious nature and high mortality rate. RESULTS: When an outbreak occurs, it often produces fear in the community and causes the basic practice of medicine to be altered. Changes seen at Kikwit included limited physical examinations, hesitance to give intravenous medications and closure of supporting hospital facilities. The Kikwit Ebola outbreak also provided beneficial psychological insight into how patients, staff and the general community respond to a biological crisis and how this will affect physicians working in an epidemic. CONCLUSIONS: General lessons from the outbreak include the importance of having simple, well-defined triage procedures; staff who are flexible and able to adapt to situations with unknowns; and the need to protect staff physically and emotionally to ensure a sustained effort to provide care.

Impact of Nurses' Strike in Kenya on Number of Fully Immunized Infants in 18 County Referral Hospitals.

INTRODUCTION: Nurses in Kenya provide significant health care including immunization in government-run health facilities. Nurses' went on strike for 150 days in 2017. This study sought to determine the strike's effect on immunization services. METHODS: Data on number of fully immunized infants reported in 18 county referral hospitals was extracted from the Kenya Health Information System and analyzed for strike and similar non-strike months. A similar analysis was conducted for 14 faith-based health facilities that were not affected by the strike. RESULTS: A Mann-Whitney U Test revealed significant difference in the mean number of fully immunized infants during the strike period (Md= 111, n=18) and non-strike period (Md=289, n=18), U=37, z= -4.0, p= .000, r=.6. A decline of 56.9% was reported during the strike. Faith-based health facilities reported an increase of 251.6% during the strike periodConclusion. This nurses' strike may have adversely affected immunization services.

[Public service strike. Effects on operating room management and training at a surgical university clinic]. / Streik im öffentlichen Dienst. Folgen für OP-Management und fachärztliche Weiterbildung an einer chirurgischen Universitätsklinik.

BACKGROUND: In 2006 the longest strike so far in the German health service occurred. Contrary to most hospitals in public authorities, the medical doctors of the University Hospital of Homburg/Saar did not participate in the strike, leading to pronounced tensions between patients, strikers and medical staff. MATERIAL AND METHODS: The effect of the strike on operating room (OR) management, medical personnel resource planning, and surgical training were compared with the remaining period of the year 2006. RESULTS: Elective surgical procedures were accomplished significantly more frequently by more qualified surgeons, leading to shorter OR time; surgical training was performed significantly less. The rate of emergency operations and the care of tumor patients increased significantly during the strike. CONCLUSION: Surgical training was neglected during the strike. Transferring non-job-related tasks to medical doctors and expanding their working time allowed optimal utilization of the limited resources.

Improving work conditions through strike: Examination of nurses' attitudes through perceptions of two physician strikes in Israel.

BACKGROUND: Strikes are means to influence policies related to working conditions, yet raise ethical dilemmas for healthcare workers. Nurse strikes have become more prominent around the world. OBJECTIVE: To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike. METHODS: An anonymous survey was administered once in 2000 (N = 106) and again in 2011 (n = 175) following 110 days of a physician strike, to assess nurses' attitudes towards the strike and resulting ethical issues. RESULTS: A statistically significant change (p < 0.05) between administrations revealed that in 2011 more nurses identified striking as a legitimate mechanism, would strike under the same circumstances, and felt that collaboration with physicians persisted despite the strike. Additionally, an increasing number of nurses said that the suffering of patients due to the strike is somewhat or entirely justified, although they were faced with a difficult dilemma of loyalty to physician colleagues vs. PATIENTS: Nurses reported finding ways to mitigate the suffering of patients resulting from the strike. CONCLUSIONS: While patient-centered care remains nurses' first and foremost priority, findings indicate an increasing support of collective bargaining and strike to promote working conditions related to professional and public health agendas.

The Impact of General Strike on Government Healthcare Delivery in Kerala State in India.

General strike (also known as hartal) is used as a mode of protest by organizations and political parties in India. It is generally thought that hartals negatively impact the healthcare delivery in a society. We used the Right to Information Act to obtain data from government health centers in Kerala state in India for four hartal days (H-day) and two control days (A-day and B-day) for each H-day, from sixteen health centers including 6 Community Health Center (CHC), 6 Secondary Health Center (SHC), and 4 Tertiary Health Center (THC). Data on emergency room visits was available for six HCs. 15 HCs had a statistically significant decrease in the number of outpatient visits on H-day. There was no difference in the number of outpatient visits between the two control days (A and B) in 15 HCs, suggesting the lack of a posthartal surge in visits. Median decrease in outpatient visits in CHCs, SHCs, and THCs was 50.4%, 59.5%, and 47.4%, respectively. Hartal did not impact the number of emergency room visits in 6 out of 7 health centers assessed. Our study identified a significant harmful impact on government healthcare delivery due to hartals in Kerala. These findings have major public health implications.

Care around birth, infant and mother health and maternal health investments - Evidence from a nurse strike.

Care around birth may impact child and mother health and parental health investments. We exploit the 2008 national strike among Danish nurses to identify the effects of care around birth on infant and mother health (proxied by health care usage) and maternal investments in the health of their newborns. We use administrative data from the population register on 39,810 Danish births in the years 2007-2010 and complementary survey and municipal administrative data on 8288 births in the years 2007-2009 in a differences-in-differences framework. We show that the strike reduced the number of mothers' prenatal midwife consultations, their length of hospital stay at birth, and the number of home visits by trained nurses after hospital discharge. We find that this reduction in care around birth increased the number of child and mother general practitioner (GP) contacts in the first month. As we do not find strong effects of strike exposure on infant and mother GP contacts in the longer run, this result suggests that parents substitute one type of care for another. While we lack power to identify the effects of care around birth on hospital readmissions and diagnoses, our results for maternal health investments indicate that strike-exposed mothers-especially those who lacked postnatal early home visits-are less likely to exclusively breastfeed their child at four months. Thus reduced care around birth may have persistent effects on treated children through its impact on parental investments.

Impact of a resident strike on emergency department quality indicators at an urban teaching hospital.

OBJECTIVE: To evaluate the indicators of activity and quality within the emergency department (ED) during a resident physicians' strike. METHODS: This was an observational study comparing a strike period (SP) and a non-strike period (NSP) in the ED of a 1,000-bed tertiary care teaching hospital in Barcelona, Spain, with an annual census of 100,000 emergency visits. During a period of nine nonconsecutive days, the resident physicians were on strike. Emergency visits were handled by staff members. Data were compared between all patients treated in the ED during the SP and those treated during the NSP, matched by the weekday. The authors compared lengths of stay (LOSs), rates of use of laboratory tests and radiology procedures, numbers of patient walkouts, patient/physician ratios, emergency hospital admission rates, home discharge rates, unscheduled return rates, and mortality rates. RESULTS: The two groups (SP 2,610 patients and NSP 3,634 patients) were comparable in terms of average daily attendance rate (SP: 290 +/- 12 vs NSP: 302 +/- 21; p = 0.13), elective hospital admission rate, and severity of illness. Statistically significant differences were found in terms of mean total patients' LOS (SP: 206.75 +/- 12.27 vs NSP: 235.10 +/- 27.08 minutes; p < 0.001), number of laboratory tests per patient (SP: 0.30 +/- 0.05 vs NSP: 0.38 +/- 0.04; p < 0.001), and radiographs per patient (SP: 0.78 +/- 0.06 vs NSP: 0.88 +/- 0.09; p = 0.021). CONCLUSIONS: This study demonstrated that replacing residents with staff physicians resulted in fewer laboratory tests ordered, fewer radiographs ordered, and shorter lengths of stays in the ED.

Hunt's 'sincere' words only strike a false note.

The first strike by NHS staff over pay in more than 30 years - and the first by members of the Royal College of Midwives in its history - will hopefully force ministers to rethink their decision to freeze pay rates for 1.3 million health service staff. Those taking part in Monday's four-hour stoppage and this week's 'work-to-rule' deserve great credit for making a sacrifice so that everyone in the NHS may benefit.

Striking nurses and midwives stand united against Hunt's pay freeze.

Thousands of nurses and midwives in England and Northern Ireland went on strike in protest at the government's decision to deny 70 per cent of NHS nurses a 1 per cent cost of living pay rise.

Second pay strike set to be bigger as further action adds to pressure.

Thousands of nurses and midwives in England are preparing to strike for the second time in six weeks in protest at the government's refusal to give all NHS staff a 1 per cent cost of living pay rise.

A retrospective study of the impact of the doctors' strike in England on 21 June 2012.

OBJECTIVE: To examine the effect of the 24-h doctors' strike on 21 June 2012 on hospital activity in English NHS hospitals. DESIGN: Retrospective descriptive study of inpatient, outpatient and Accident and Emergency (A&E) activity in NHS hospitals over the strike period. SETTING: All English NHS hospitals. PARTICIPANTS: Patients admitted to hospital, patients with outpatient appointments and A&E attendances over a three-week period (from 11 to 29 June 2012), excluding weekends and spanning the strike day. MAIN OUTCOME MEASURES: Numbers and percentage change of inpatient admissions (elective and emergency), day surgery cases, outpatient appointments cancellations, A&E attendances and in-hospital deaths on the day of the strike compared with patient activity on the Thursday before and the Thursday after the strike week. RESULTS: There were a total of 795,267 admissions, 5,602,971 outpatient appointments, 356,645 outpatient cancellations (by NHS provider), 4,470,208 outpatients seen by medical staff, 986,322 A&E attendances and 13,857 in-hospital deaths over the three-week period. Compared with the non-strike period, on the day of the strike, emergency admissions fell by 2.4% while the elective admissions decreased by 12.8%. There was a 7.8% drop in the number of outpatients seen by medical staff on the day of the strike and a 45.5% increase in the number of cancelled appointments by NHS hospitals, while A&E attendances dropped by 4.7%. The impact of the strike across regional Health Authorities in England was varied. The North West Health Authority was affected the most while the least affected Health Authorities were the South West, East of England and South Central. CONCLUSIONS: The 24-h doctors' strike in England on 21 June 2012 significantly affected the provision of healthcare by NHS hospitals. We observed regional variations on NHS service levels on the day of the strike.