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Classic galactosemia (CG) is a rare inherited metabolic disease caused by mutations in the GALT gene encoding the enzyme galactose-1 phosphate uridylyltransferase in galactose metabolism. The condition develops as a potentially fatal illness during the newborn period, but its acute clinical manifestations can be alleviated through a galactose restricted diet. Nonetheless, such dietary intervention is inadequate in preventing significant long-term consequences, including neurological impairments, growth restriction, cognitive delays, and, for most females, primary ovarian insufficiency. At present, no effective therapy exists to stop the progression of these complications, highlighting the urgent need for new treatment approaches to be developed. Supplements have been used in the treatment of other inborn errors of metabolism; however, they are not typically included in the clinical therapeutic regimen for CG. Recently, our research team has demonstrated that two generally recognized as safe supplements (purple weet potato color, PSPC and myo-inositol, MI) have been effective in partially restoring functions in the ovaries of our GalT-KO mouse model. However, the toxicological profile of both PSPC and MI has not been determined. In this study, we investigated the acute (30 days) and chronic (180 days) oral toxicities of PSPC and MI both in WT control and GalT-KO mice. Furthermore, our study aims to evaluate the effectiveness of oral feeding of PSPC and MI in correcting motor-related and behavioral phenotypes in GalT-KO mice. The long-term treatment of MI at a lower dose demonstrated promising improvements in motor deficit and anxiety driven hyperactivity in the mutant mice.

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BACKGROUND AND OBJECTIVE: Direct oral anticoagulants (DOACs) have been proven to be cost-effective for treating various conditions, including venous thromboembolism (VTE). Nevertheless, there are no studies assessing the cost-effectiveness of DOACs for VTE treatment in Saudi Arabia using real-world data. Hence, this study seeks to examine the costs and medical consequences of apixaban compared to rivaroxaban in treating VTE patients in Saudi Arabia. METHODS: A retrospective cohort study was carried out in three tertiary care hospitals spanning from January 2016 to December 2020. The measure of effectiveness is defined as the likelihood of preventing the composite of VTE recurrence (rVTE), major bleeding (MB), or clinically relevant non-major bleeding (CRNMB) within 90 days of the indexed VTE event, and rehospitalization due to rVTE, MB, or CRNMB. The effectiveness was determined by calculating 1 minus the probability of experiencing the composite outcome. The incremental cost-effectiveness ratio (ICER) was computed from the perspective of the Saudi National Health System, therefore only direct costs were considered. The 95% confidence interval surrounding mean costs and effectiveness rates was calculated using the bootstrapping method. Sensitivity analyses were also carried out. RESULTS: In the analysis, 367 patients were included, with 176 on apixaban and 191 on rivaroxaban. The average annual medication costs for apixaban and rivaroxaban were $547.05 and $577.77, respectively. The mean annual direct medical costs for apixaban and rivaroxaban were $6496.83 (95%CI 5748.86-7457.97) and $5528.58 (95%CI 4836.21-6024.52), respectively. Apixaban's and rivaroxaban's mean effectiveness rates were 0.91 (95%CI 0.87-0.96) and 0.77 (95%CI 0.71-0.83), respectively. This resulted in an ICER of $6916.07 for the prevention of an additional composite outcome when using apixaban instead of rivaroxaban. The use of apixaban for preventing composite outcomes has been found to be more effective but costlier in 94.81% of the bootstrap cost-effectiveness distributions compared to rivaroxaban. It was also found to be more effective and less costly in 5.19% of the bootstrap cost-effectiveness distributions. CONCLUSION: Apixaban demonstrated superiority over rivaroxaban in preventing composite outcomes, encompassing rVTE, MB, CRNMB, and rehospitalization. Nevertheless, this was correlated with increased direct medical expenses. These findings emphasize the necessity of a well-rounded approach when choosing anticoagulants, considering both clinical effectiveness and economic considerations. This study's results are impactful for improving patient care and resource allocation, underscoring the pivotal role of cost-effectiveness in healthcare decision-making.

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Police officers are vulnerable to psychological distress and trauma since they are constantly exposed to significant physical and mental violence. Poor mental health can lead to increased healthcare costs for individuals, organizations, and nations and negatively impacts public safety. Mental health interventions tailored to the nature of police work are needed; however, a research gap exists regarding understanding the mental health of police officers. This study aimed to explore the barriers, facilitators, and needs for mental health promotion among police officers. This study adopted a qualitative approach in South Korea. Twelve police officers working in a metropolitan city were recruited using purposive sampling methods. One-on-one interviews were conducted with open-ended questions regarding barriers, facilitators, and needs for improving mental health. Content analysis was used to derive relevant themes. The participants included 3 women and 9 men, with an average age of 37.8 years and working experience of 12.6 years. Three themes and 9 subcategories emerged. The theme related to barriers was "difficulty accessing resources"; the theme related to facilitators was "supportive environment for mental health prevention and management"; and the theme related to needs was "education and policies to promote mental health." Considering the occupational and organizational characteristics of the police profession, individual and organizational interventions and policies are needed to adequately manage the mental health of police officers.

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BACKGROUND: It is unclear whether an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better. METHODS: Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups. RESULTS: Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14-day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, -8.2% [95% CI, -13.8 to -2.7]), whereas there was no significant difference in in-hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, -3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group. CONCLUSIONS: This nationwide inpatient database study showed no significant difference in in-hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP.

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BACKGROUND: The impact of sex-related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear. METHODS AND RESULTS: This is a secondary analysis of patients with stable coronary artery disease who underwent both coronary computed tomography angiography  and fractional flow reserve derived from computed tomography as part of the FORECAST (Fractional Flow Reserve Derived From Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain) trial, investigating (1) the relationship between coronary stenosis severity on coronary computed tomography angiography and fractional flow reserve derived from computed tomography FFRCT by sex and (2) the association with revascularization, resource usage, and adverse clinical events. A total of 212 patients (64 female participants [32.1%]) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant coronary artery disease (38.2% of women versus 51.3% of men; P=0.073), but female participants had significantly less coronary flow impairment, according to the presence of at least 1 fractional flow reserve derived from computed tomography≤0.8 (47.0% versus 71.5%; P=0.008). Female subjects underwent fewer revascularization procedures (23.5% versus 42.3%; P=0.014), less coronary artery bypass graft surgery (2.9% versus 13.1%; P=0.025) and were less likely to be on statin treatment (72.0% versus 84.7%; P=0.022) by 9-month follow-up. This resulted in lower overall health care costs for female participants compared with male counterparts (median total cost, £1276 versus £2051; P=0.014). In multivariable Cox analysis the presence of significant coronary artery disease (hazard ratio [HR], 2.91; 95% CI, 1.30-6.51) and having a positive fractional flow reserve derived from computed tomography (HR, 4.11; 95% CI, 1.15-14.69) were independent predictors of major adverse cardiovascular events at 9 months, whereas sex was not statistically significant (p=0.13). CONCLUSIONS: There are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs, and adverse events.

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BACKGROUND: Assessing pain in neonates is crucial for their management but is inherently subjective. This study investigated the effects of visual attention, gaze patterns, and empathic responses of neonatal healthcare professionals on their assessments of neonatal pain. METHODS: Conducted at the Department of Neonatology, University Medical Center Hamburg-Eppendorf, we employed eye-tracking to monitor staff's responses to videos depicting neonates experiencing non-noxious thermal, brief noxious, and prolonged noxious stimuli. Videos were presented in two formats: full body view, providing contextual information, and face-only view, lacking contextual details. Pain assessments were measured using a Faces Pain Rating Scale (FPRS), exploring the impacts of contextual cues, professional experience, and job roles. RESULTS: The study found brief and prolonged noxious stimuli eliciting significantly higher FPRS scores compared to non-painful stimuli, with the full body view resulting in higher pain ratings than the face-only view. The mouth region attracted focused attention. Nurses generally reported higher pain scores and exhibited larger pupil diameters compared to physicians, suggesting a stronger empathic response. CONCLUSION: This research highlights the essential role of visual cues and empathic responses in neonatal pain assessment, demonstrating how professional roles and stimulus presentation format impact evaluations, and underlining the need for standardised protocols to improve neonatal pain management accuracy. SIGNIFICANCE: The study emphasises the importance of visual cues and empathy in neonatal pain assessment, highlighting the roles of healthcare professionals and stimulus presentation formats. It addresses challenges in understanding neonatal pain, advocating for standardised protocols. Using eye-tracking technology, the research explores how professionals' visual attention and empathy affect pain evaluations, suggesting more objective assessment methods.

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BACKGROUND AND AIM: Artificial intelligence (AI)-powered chatbots, such as Chat Generative Pretrained Transformer (ChatGPT), have shown promising results in healthcare settings. These tools can help patients obtain real-time responses to queries, ensuring immediate access to relevant information. The study aimed to explore the potential use of ChatGPT-generated medical Arabic responses for patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: An English patient questionnaire on MASLD was translated to Arabic. The Arabic questions were then entered into ChatGPT 3.5 on November 12, 2023. The responses were evaluated for accuracy, completeness, and comprehensibility by 10 Saudi MASLD experts who were native Arabic speakers. Likert scales were used to evaluate: 1) Accuracy, 2) Completeness, and 3) Comprehensibility. The questions were grouped into 3 domains: (1) Specialist referral, (2) Lifestyle, and (3) Physical activity. RESULTS: Accuracy mean score was 4.9 ± 0.94 on a 6-point Likert scale corresponding to "Nearly all correct." Kendall's coefficient of concordance (KCC) ranged from 0.025 to 0.649, with a mean of 0.28, indicating moderate agreement between all 10 experts. Mean completeness score was 2.4 ± 0.53 on a 3-point Likert scale corresponding to "Comprehensive" (KCC: 0.03-0.553; mean: 0.22). Comprehensibility mean score was 2.74 ± 0.52 on a 3-point Likert scale, which indicates the responses were "Easy to understand" (KCC: 0.00-0.447; mean: 0.25). CONCLUSION: MASLD experts found that ChatGPT responses were accurate, complete, and comprehensible. The results support the increasing trend of leveraging the power of AI chatbots to revolutionize the dissemination of information for patients with MASLD. However, many AI-powered chatbots require further enhancement of scientific content to avoid the risks of circulating medical misinformation.

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In addition to having cultural importance, village chicken production remains an important source of cash income for most rural households in Burkina Faso. However, strict biosecurity and good management of chicken flocks are required to reduce the risk of exposure of communities to chicken waste at household level. We characterized village production systems in rural Burkina Faso in relation to importance to food security, biosecurity, husbandry and chicken health management. We surveyed 483 chicken-producing households and carried out 20 focus group discussions separately with men and women chicken producers in Boussouma commune, a typical rural setting. Crop farming was reported as the main income-generating activity carried out by chicken producers (79.5%). Seveny six per cent of households sold chicken to local markets. Chicken production and sales were aligned to social/cultural events (religious festivals, weddings, etc…) and school-fee payment period. While men spent more revenues from chicken production on agriculture and household equipment's, women spent more on food, education and medical expenses. The chicken management system is mainly extensive scavenging, with most farmers (81.4%) keeping 5 to 50 birds with little or no supplementary feeding and rudimentary housing. Most producers indicated that Newcastle disease was the main cause of chicken mortality. While men consider high disease burden, lack of finance, and poor chicken housing as the major constraints, women prioritized the lack of adequate chicken housing, lack of feeds and limited access to veterinary services. With locally adapted interventions that build one a One Health approach, village chicken keeping has the potential to secure and greatly improve smallholder livelihoods and household food security, while preserving public health in Burkina Faso.

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Depression commonly accompanies acute coronary syndrome (ACS), impacting up to 30% of patients and correlating with adverse outcomes. Our study aimed to assess the accuracy of clinical impression compared to the PHQ9 questionnaire for evaluating depression in ACS patients admitted to the cardiac intensive care unit. Screening for depression was conducted at least 48 hours from hospital admission and 24 hours following coronary angiography and PCI. The assessment was performed separately and in a blinded manner by the clinical assessment of the attending medical team and by the PHQ9 questionnaire. The study comprised 150 ACS patients with a mean age of 62 ± 13 years. Baseline clinical and demographic characteristics were typical for ACS patients. Based on the PHQ9 questionnaire, depressive symptoms were above the cutoff for clinical depression in 31 (20.7%) patients, with 10 (32.3%) of them experiencing moderate or severe depression (PHQ9 score >15). There were no significant differences in clinical baseline characteristics between the groups with and without clinical depression. Compared to the PHQ9 questionnaire, the medical team's assessment of depression demonstrated a reasonable specificity of 84% and low sensitivity of 32%. Negative and positive predictive values were 82.6% and 35.8%, respectively. Similar findings were observed in subgroup analyses according to gender, age, type of ACS, and history of cardiovascular disease. Depression is prevalent among ACS patients, highlighting the importance of an increased awareness of this condition. Our findings suggest that detecting clinically significant severity of depressive symptoms by the attending medical team alone may not suffice for depression assessment. Incorporating validated screening tools such as the PHQ9 questionnaire or involving psychological evaluations can enhance the accuracy of depression diagnosis in ACS patients. This multifaceted approach is crucial for ensuring comprehensive care and improving patient outcomes.

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The study examined a gender-based investigation of employment, workforce productivity and economic growth in West African countries. The empirical analysis is centred on panel consisting of 16 West African countries over the period 2007-2019 using Esteve-Volarts model. The method of estimation employed are panel system generalised method of moments. The major findings suggest that there exists a positive and major relationship between male and female wage and salaried workers to economic growth although male wage contribution to growth supersedes female contribution. Also, male and female labour force participation rate are directly linked to economic growth. Likewise, female workforce productivity contributed significantly to economic growth of the selected countries. This study recommends that programmes should be put in place to facilitate more female participation in well paid jobs which will help enhance productivity as well as increase the growth in the countries. These recommendations will help to narrow the inequality of gender inequality in employment and productivity of workforce amongst West African countries.

L'étude a examiné une enquête basée sur le genre sur l'emploi, la productivité de la main-d'œuvre et la croissance économique dans les pays d'Afrique de l'Ouest. L'analyse empirique est centrée sur un panel composé de 16 pays d'Afrique de l'Ouest sur la période 2007-2019 en utilisant le modèle Estève-Volarts. La méthode d'estimation utilisée est la méthode des moments généralisée par système de panel. Les principales conclusions suggèrent qu'il existe une relation positive et majeure entre les salaires et les travailleurs salariés des hommes et des femmes et la croissance économique, bien que la contribution salariale des hommes à la croissance supplante celle des femmes. En outre, le taux d'activité des hommes et des femmes est directement lié à la croissance économique. De même, la productivité de la main-d'œuvre féminine a contribué de manière significative à la croissance économique des pays sélectionnés. Cette étude recommande que des programmes soient mis en place pour faciliter une plus grande participation des femmes à des emplois bien rémunérés, ce qui contribuera à améliorer la productivité ainsi qu'à accroître la croissance dans les pays. Ces recommandations contribueront à réduire l'inégalité entre les sexes en matière d'emploi et de productivité de la main-d'œuvre dans les pays d'Afrique de l'Ouest.

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The prognostic value of metabolic tumor burden parameters obtained from 18F-FDG PET/CT imaging was evaluated in this retrospective national multicenter study of patients with metastatic posterior uveal melanoma (PUM) and compared to the largest diameter of the largest metastatic lesion (LDLM) and the American Joint Committee on Cancer (AJCC) staging system. The Maximal Standard Uptake Value (SUVmax), Metabolic Tumor Volume (MTV), and Total Lesion Glycolysis (TLG) were obtained in 106 patients. Higher values of SUVmax (p = 0.007, log-rank), MTV (p < 0.001, log-rank), and TLG (p < 0.001, long-rank) were associated with shorter survival. The three parameters were also independent predictors in the multivariate Cox model, while the AJCC staging turned insignificant. Time-dependent positive predictive value (PPV) analysis and Receiver Operating Characteristics (ROC) curves showed that MTV (Area Under the Curve (AUC) = 0.78), TLG (AUC = 0.78), and LDLM (AUC = 0.76) were good predictors of 1-year survival. For the subset of 97 patients with liver metastases, the corresponding regional measurements in the liver tended to be even better predictors. In conclusion, MTV and TLG were found to be better predictors of survival in metastatic PUM than the AJCC staging system, but when LDLM was used as a continuous variable it showed an equally good prediction of 1-year survival.

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BACKGROUND: The incidence and mortality rates of pancreatic cancer are rising globally. This study examines global and regional trends in pancreatic cancer incidence, Disability Adjusted Life Years (DALYs), and mortality from 1990 to 2021, utilizing data from the most recent Global Burden of Disease (GBD) 2021 database. METHODS: Data were sourced from the GBD database over the period from 1990 to 2021. Age-standardized rates for incidence, DALYs, and mortality were calculated per 100,000 population. We also calculated the proportion of DALYs and mortality attributable to risk factors. The Bayesian age-period-cohort model was applied to project future trends until 2050. RESULTS: Between 1990 and 2021, the global incidence of pancreatic cancer increased significantly, with the number of cases rising from approximately 207,905 to 508,533 and the age-standardized incidence rate (ASIR) increasing from 5.47 to 5.96 per 100,000 population. The global burden of pancreatic cancer, measured in DALYs, rose from 5.21 million to 11.32 million. Mortality rates showed a similar upward trend, with the number of deaths increasing from around 211,613 to 505,752, and the age-standardized mortality rate (ASMR) rising from 5.655 to 5.948 per 100,000 population. Notable increases in ASIR and ASMR were observed in low-middle and low sociodemographic index regions with males experienced higher rates compared to females. Age-standardized DALYs rate (ASDR) and ASMR worldwide were attributable to tobacco smoking, high BMI, and high fasting plasma glucose. Furthermore, our projection model estimates that the ASIR and ASMR of pancreatic cancer will significantly decline, while the ASDR is anticipated to maintain a steady downward trend by 2050. CONCLUSION: This study offers a comprehensive analysis of pancreatic cancer trends, providing crucial insights for public health planning and policy-making. Addressing identified risk factors and targeting high-risk populations are essential for effective strategies to reduce the global burden of pancreatic cancer.

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BACKGROUND: Leprosy reactions (LR) are immune-mediated complications of leprosy that may be associated with severe and irreversible nerve damage. Non-medical aspects, such as financing, service provision, and healthcare resources in the management of LR are generally overlooked as studies tend to concentrate on clinical features and treatment. Barriers to accessing care and services are a major cause of suboptimal care for people with leprosy. This study aims to explore the barriers to and facilitators of high-quality care and management of LR in two leprosy-endemic countries with different health care models - Indonesia and India - and identify areas for improvement. METHODS: A socio-ecological model was adopted. Data were obtained from 66 interviews with individuals who experienced LR and were seeking care at the two study sites. In addition, immediate family members of individuals with LR and healthcare workers attending to people with leprosy participated in seven focus group discussions (FGDs). RESULTS: This study highlights the significant impact of public health insurance regulations and uptake at the macrosystem level on the provision of healthcare services, clinical decision-making, care expenditure, and the psychological well-being of individuals with LR in Indonesia and India. Lack of specialized health professionals and communication challenges were identified in both study populations. Indonesian participants encounter additional challenges due to a fragmented information system and drug shortages. This study identifies key facilitators in providing high-quality care for LR-affected individuals, including financial assistance, availability of corticosteroid alternatives, timely provision of care, and counselling. It found that the high coverage of public health insurance cards in the Indonesian model has increased access to care among individuals affected by LR, despite the challenges. Conversely, the Indian model of care offers treatment subsidies. The advantage of the Indonesian model is its ability to provide wider access to high-quality care, whereas the Indian model focuses on those in most need. This study emphasizes the importance of addressing these challenges through improved communication strategies, education aimed at the affected individuals, and accessible medical care. Furthermore, variations in care-seeking behaviour and self-care practices were observed in both sites, underscoring the need for culturally sensitive and comprehensive approaches to the management of LR. CONCLUSION: The study findings demonstrate that the factors identified at the four systemic levels are interrelated and have an impact on the access, acceptability, and management of LR services. Despite its accessibility and wider coverage of public health insurance, the integrated service model in Indonesia faces challenges associated with complex regulations and the availability of medication. India's care model offers intensive, specialised care but has difficulties in ensuring sufficient health personnel, resources, and public health insurance coverage. These findings highlight the need to address these challenges to ensure timely, effective, and comprehensive care for individuals with LR.

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Amid a global shift towards eco-friendly practices, this study investigates the impact of green human resource management (GHRM) practices on green innovative work behavior (GIWB) in the hospitality sector, focusing on emerging and developing countries, specifically China and Pakistan. The research also explores the mediating roles of green perceived organizational support (GPOS) and organizational citizenship behavior towards the environment (OCBE), as well as the moderating role of green transformational leadership (GTL). This study is grounded in the AMO (ability, motivation, and opportunity) theory and organizational support theory. Data were collected through a questionnaire, yielding 503 valid responses from hotel employees in Beijing, China, and 498 valid responses from Islamabad, Pakistan. Structural Equation Modeling (SEM) was employed to examine and compare the results across both samples. The findings reveal positive and significant relationships between GHRM and GIWB, as well as notable mediation and moderation effects among the specified variables. Interestingly, GTL did not significantly moderate the relationship between GHRM and GIWB in Pakistan's sample, highlighting a regional contrast. This study contributes to advancing the implementation of GHRM practices to enhance GIWB in the hospitality sector, with insights into the role of GTL across different cultural contexts.

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BACKGROUND: Clostridioides difficile infection (CDI) is one of the most common hospital-acquired infections, with its incidence and disease burden increasing markedly worldwide over the past decade. METHODS: To assess the attributable costs of CDI in Korea, the expenses related to hospital management of CDI cases were computed. This analysis used data from the National Health Insurance Service-National Sample Cohort spanning a decade (2010-2019). The annual national burden of CDI was determined by combining the attributable cost per CDI case with the number of patients with CDI obtained from the Health Insurance Review and Assessment Service data. RESULTS: The attributable costs of CDI were determined based on variations in the length of hospital stay and medical costs between patients with CDI and control patients. The mean length of hospital stay was significantly longer for patients with CDI than that for control patients: 43.06 vs. 14.76 days (a difference of 28.30 days, P < 0.001). The adjusted medical costs (2019 = 100) for cases of CDI and controls were 11,162 USD and 3,318 USD, respectively, with a significant difference of 7,843 USD (P < 0.001). The cost of CDI per case exhibited a noticeable annual increase from 2010 to 2019, despite an annual decreasing trend in length of hospital stay. The estimated national cost attributed to CDI was $28.9 million in 2010; however, it increased gradually each year, reaching $205.6 million in 2019 (a 600% increase over 10 years). CONCLUSION: CDI is associated with substantial healthcare costs in Korea. The economic burden of CDI has gradually increased in South Korea.

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OBJECTIVE: To determine factors leading to interhospital care fragmentation (ICF); evaluate how ICF affects rehospitalization costs, length of stays (LOS), and delayed discharge; and analyze ICF disparity among equity-seeking groups. MATERIALS AND METHODS: We used a 13-year retrospective cohort of older adults (65+) in Ontario, Canada. Utilizing multivariable logistic regression, we identified characteristics associated with ICF and determined its association with outcomes. RESULTS: Discharge to facilities except home and homecare and travel distance were the strongest risk factors for ICF. Patients were less likely to experience ICF if they were older, frail, or had multiple comorbidities. ICF was strongly associated with an increase in the daily costs of readmission. Moreover, the risks of a prolonged LOS after ICF and delayed discharge were higher among returning surgical patients. The rural residency was a source of health inequality. CONCLUSIONS: ICF exacerbates health disparities and worsens patient outcomes. Our study identified several risk factors associated with ICF, some of which are controllable, paving the way for interventions to mitigate this issue. To promote health equity and reduce adverse outcomes, policymakers should focus on policies for reducing care discontinuity, particularly addressing the controllable risk factors.

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BACKGROUND: Every healthcare clinical event aims to create value at a certain cost. This value has been defined as the outcome achieved (the degree to which a care event achieved a clinical goal) divided by the cost incurred (determined by the combined price charged by the care provides) to generate the outcome. Subsequently, patient experience has been included as a third factor contributing to value of care, but its value and relationship relative to clinical outcome and event cost is not well understood. This cross-sectional comparative study explored the relative importance of 1) clinical outcome, 2) event cost, and 3) patient experience as they relate to the value of care in the South African private healthcare context. MATERIALS AND METHODS: Using a value perspectives survey, healthcare consumers (n = 662) and healthcare providers (n = 318) distributed 100 points between the three factors according to how they perceived their value. They were then asked to assess the value of the three factors across six clinical scenarios progressing in clinical severity. RESULTS: For all scenarios, all participants valued patient experience above event cost, but lower than clinical outcome. However, there were significant differences between consumers and providers in the relative value assigned to each of the three factors. These values changed as the severity of the surgical and medical scenarios changed. Patient experience was consistently assigned a higher value than event cost, thereby making a strong argument for its inclusion into the healthcare value equation. CONCLUSION: Both South African healthcare consumers and providers assigned significant value to patient experience across a range of clinical scenarios. These findings suggest that patient experience should be included as a factor in the Value Care Index (VCI) where VCI = (Outcome ÷ Cost) x Patient Experience.

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The demand for big data talent is rapidly increasing with the growth of the big data industry. However, there has been limited research on what employers seek in recruiting big data talent. This paper aims to apply labor market segmentation theories to the big data labor market and develop a theoretical framework to analyze the distribution of big data talent in different labor market segments. Furthermore, we develop a salary determination model to explain wage differentials. An empirical analysis is conducted using online job advertisements from a Chinese recruitment website to investigate the labor market for big data talent in China. Our findings show that there are significant differences in the demand for big data talent across different types of cities and industries. Different types of enterprises have different requirements for individual characteristics and offer various levels of big data job positions. Furthermore, our results reveal that individual, job-related and organizational characteristics are all significant predictors of salaries. These findings can provide particularly useful insights for organizations and managers in the big data industry.

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Burnout among critical care physicians is an important issue that affects patient care and staff well-being. This study, conducted by the Korean Society of Critical Care Medicine, aimed to investigate the prevalence and associated factors of burnout among intensivists and critical care fellows in South Korea. From May to July 2019, a cross-sectional survey was conducted in 51 hospitals and 79 intensive care units offering subspecialty training in critical care medicine. Invitations were sent by email and text, and responses were collected using NownSurvey and Google Forms. Of the 502 invited participants, 253 responded (response rate: 50.4%). Significant contributing factors of burnout included being in an intensivist position (assistant professor/fellow) (odds ratio [OR], 3.916; 95% confidence interval [CI], 1.485-10.327; p = 0.006), working in a medical ICU (OR, 4.557; 95% CI, 1.745-11.900; p = 0.002), the number of stay-home night calls per month (OR, 1.070; 95% CI, 1.005-1.139; p = 0.034), and recent conflicts with colleagues (OR, 5.344; 95% CI, 1.140-25.051; p = 0.033). Similar factors were found to influence severe levels of burnout. This nationwide study indicates that a significant proportion of critical care physicians in South Korea experience burnout. Strategies to reduce overtime and workplace conflict are imperative to reduce burnout among these physicians and protect their mental health. Future research should explore targeted interventions for these specific factors.

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Identifying socioeconomic disparities within a local area is critical for tailoring policy solutions to older adult populations. However, a comprehensive index for characterizing socioeconomic disadvantage for older adult households in the U.S. is yet to be developed. This study is the first of its kind and used secondary data from the U.S. Census to develop a new socioeconomic disadvantage index for adults older than 60 years, with a focus on food insecurity, for a large region in Central Texas. The Older Adult Socioeconomic Disadvantage Index (OASDI) includes 12 variables related to unmet needs for food, housing, healthcare access, and transportation, and others at the census tract level. For each variable, the values were ranked based on quintiles using ArcGIS Pro 3.2. An unweighted sum was used to create the OASDI, where a higher score indicated greater socioeconomic disadvantage. Choropleth maps were used to visualize the OASDI and persistent poverty for all census tracts within the study area. The OASDI was used to statistically compare two local policy regions for senior nutrition programs in the Austin and San Antonio, Texas metro areas. Results showed a greater socioeconomic disadvantage in the San Antonio region compared to the Austin region (Mann-Whitney-U = 198,303; p < 0.0001). The statistical analysis identified an area with extreme disadvantage relative to the local policy region and confirmed with member checking. Findings provided insights into local socioeconomic disparities at different levels and can be applied to advocate for policies, systems, and environmental changes for senior nutrition.