Caregiver coping mediates the relationship between caregivers' understanding of dementia as terminal and their distress.

We assessed which coping strategies (problem-focused, emotion-focused, dysfunctional) mediate the association between caregivers' understanding of dementia as terminal and their distress. A total of 215 caregivers of community-dwelling persons with severe dementia were surveyed every 4 months over 3 years. A generalized structural equation model was used to test mediation. Caregivers who correctly understood dementia as terminal and those unsure (vs incorrect), experienced more distress (correct: ß [95% confidence interval (CI)]: 0.80 [0.00 to 1.60]; unsure: 0.95 [0.04 to 1.87]). Caregivers with correct understanding of dementia as terminal (vs incorrect) employed more dysfunctional (2.01 [0.60 to 3.42]) and problem-focused coping strategies (2.56 [0.08 to 5.05]). Although dysfunctional and problem-focused coping (associated with higher distress) mediated the positive association between caregivers' understanding that dementia is terminal and their distress, emotion-focused coping (associated with lower distress) did not offset this relationship. Results suggest that terminal illness disclosure to caregivers should be accompanied by interventions to promote emotion-focused coping strategies. Highlights Caregivers who understood dementia as terminal experienced more distress. Dysfunctional and problem-focused coping mediated the positive relationship between terminal illness understanding and caregiver distress. Emotion-focused coping did not offset this relationship.

Comprehensive sexuality education in Hong Kong: study protocol for process and outcome evaluation.

BACKGROUND: Hong Kong lacks comprehensive school-based sexuality education. Recent public health concerns have brought the inadequacies of sex education in Hong Kong to the forefront. The aim of the proposed study is to develop and evaluate the effectiveness of a comprehensive school-based sexuality education program in Hong Kong. METHODS: The proposed study is a prospective longitudinal study implemented in six secondary schools in Hong Kong over two academic years. The study adopts an ecological approach providing informational workshops for students, teachers and school management, social workers and guidance counsellors and parents. Study outcomes will be evaluated through pre- and post-tests. RESULTS: Key outcomes of interest among students include sexual health knowledge, awareness of values motivating healthy sexual decisions, understanding and efficacy of sexual communication and intention to use contraception. Among school employees and parents key outcomes include self-efficacy to engage in sexual health discussions with students/children, sexual health knowledge and awareness of Hong Kong community sexual health resources. CONCLUSIONS: The proposed study will result in the development of a tested school-based culturally relevant comprehensive sexual health education program. Ultimately, this program aims to not only empower adolescents and their trusted adults in building a supportive environment for sexual health promotion but also construct a learning network to generate longitudinal evidence for the effectiveness of comprehensive sexuality education in improving sexual health outcomes. The program has the potential for expansion through widespread adoption in Hong Kong schools to benefit more adolescents and reduce the medical and societal burdens related to crisis pregnancy, sexually transmitted infections and sexual abuse.

Can hospital accreditation enhance patient experience? Longitudinal evidence from a Hong Kong hospital patient experience survey.

BACKGROUND: Hospital accreditation is expected to improve health care quality and patient satisfaction. However, little and conflicting evidence is currently available to support its effect on patient outcomes, particularly patient experience. Hong Kong recently launched a pilot programme to test an infrastructure for accreditation of both private and public hospitals with the Australian Council on Healthcare Standards. This study aims to evaluate the longitudinal impact of hospital accreditation on patient experience in a publicly-funded university teaching hospital in Hong Kong. METHODS: Three cross-sectional surveys were conducted at three time points: 9 months pre- accreditation as baseline (T1), three (T2) and fifteen months (T3) post-accreditation. Acute care inpatients aged 18 to 80 were recruited on the second day of hospital admission to complete the Picker Patient Experience Questionnaire-15 (PPE-15). Baseline data was first compared to the 2005 Hong Kong average for public hospitals using t-tests. Data was then analyzed using ANOVA and multiple linear regression to evaluate differences across the three cross-sections and examine the effect of accreditation over time while controlling for covariates. RESULTS: 3083 patients (T1 = 896, T2 = 1093, T3 = 1094) completed the survey for a response rate of 83.5, 86.1, and 83.8%, respectively. The hospital baseline domain and summary patient experience scores differed from the Hong Kong public hospital average obtained from the 2005 Thematic Household Survey. All domain and summary patient experience scores declined (improved) over the study period (T1 to T3). The multiple regression results confirmed the time point score comparisons with declining (improving) parameter estimates for T2 and T3 for all domain and summary scores except the 'continuity and transition' domain, for which the declining coefficient was only significant at T3. CONCLUSIONS: While hospital accreditation has not been shown to improve patient outcomes, this study suggests the accreditation exercise may enhance patient experience. Moreover, it suggests the quality improvement initiatives associated with accreditation may address areas of concern emphasized by Hong Kong patients, such as involvement in care and emotional support from providers.

The influence of hospital accreditation: a longitudinal assessment of organisational culture.

BACKGROUND: A growing body of evidence supports the link between hospital organisational culture and health outcomes. Organisational culture is thus an essential consideration for hospital accreditation, a practice of systematically assessing the quality of hospital care against accepted standards. This study assesses the interplay between accreditation and hospital professional staff perception of organisational culture. METHODS: A prospective cohort study design was used to explore the influence of accreditation on organisational culture within a large, publicly-funded, university teaching hospital in Hong Kong. All full-time hospital and academic physicians, nurses and allied health professionals were invited to participate. Organisational culture was evaluated using the Competing Values Framework through the Quality Improvement Implementation Survey. Organisational culture was assessed longitudinally at 9 months prior to accreditation, 3 months following and 15 months after accreditation. To capture potential shifts in staff perception of organisational culture through the accreditation process, we conducted a between time-point comparison using a linear trend model. RESULTS: 545 clinical staff completed the organisational culture survey pre-accreditation, 378 three- months post-accreditation and 141 15-months post-accreditation. Hierarchical culture was the dominant organisational culture domain pre-accreditation, followed by rational, developmental and group culture, respectively. Following accreditation, hierarchical culture declined but remained dominant, while group and developmental culture increased. However, the decline in hierarchical culture was U-shaped with scores increasing at 15-months post-accreditation, though not to pre-accreditation levels. When stratified by professional group, hierarchical culture declined following accreditation with corresponding increases in group culture and developmental culture among physicians and nurses, respectively. While allied health professionals did not perceive any significant cultural differences directly following accreditation, a significant increase in hierarchical culture and corresponding decrease in group culture was found 15-months post-accreditation. CONCLUSIONS: This study suggests the hospital accreditation process may contribute to shifts in staff perception of organisational culture. Our findings also indicate differential views of organisational culture across professional groups. Finally, we note the striking dominance of hierarchical culture in this Hong Kong hospital across all time points, far surpassing other studies, even those in which hierarchical culture prevailed.

Presenteeism exposures and outcomes amongst hospital doctors and nurses: a systematic review.

BACKGROUND: Presenteeism is a behavior in which an employee is physically present at work with reduced performance due to illness or other reasons. Hospital doctors and nurses are more inclined to exhibit presenteeism than other professional groups, resulting in diminished staff health, reduced team productivity and potentially higher indirect presenteeism-related medical costs than absenteeism. Robust presenteeism intervention programs and productivity costing studies are available in the manufacturing and business sectors but not the healthcare sector. This systematic review aims to 1) identify instruments measuring presenteeism and its exposures and outcomes; 2) appraise the related workplace theoretical frameworks; and 3) evaluate the association between presenteeism, its exposures and outcomes, and the financial costs of presenteeism as well as interventions designed to alleviate presenteeism amongst hospital doctors and nurses. METHODS: A systematic search was carried out in ten electronic databases from 1998 to 2017 and screened by two reviewers. Quality assessment was carried out using the Critical Appraisal Skills Program (CASP) tool. Publications meeting predefined assessment criteria were selected for data extraction. RESULTS: A total of 275 unique English publications were identified, 38 were selected for quality assessment, and 24 were retained for data extraction. Seventeen publications reported on presenteeism exposures and outcomes, four on financial costing, one on intervention program and two on economic evaluations. Eight (39%) utilized a theoretical framework, where the Job-Demands Resources (JD-R) framework was the most commonly used model. Most assessed work stressors and resources were positively and negatively associated with presenteeism respectively. Contradictory and limited comparability on findings across studies may be attributed to variability of selected scales for measuring both presenteeism and its exposures/outcomes constructs. CONCLUSION: The heterogeneity of published research and limited quality of measurement tools yielded no conclusive evidence on the association of presenteeism with hypothesized exposures, economic costs, or interventions amongst hospital healthcare workers. This review will aid researchers in developing a standardized multi-dimensional presenteeism exposures and productivity instrument to facilitate future cohort studies in search of potential cost-effective work-place intervention targets to reduce healthcare worker presenteeism and maintain a sustainable workforce.

Maternity Leave Access and Health: A Systematic Narrative Review and Conceptual Framework Development.

Background Maternity leave is integral to postpartum maternal and child health, providing necessary time to heal and bond following birth. However, the relationship between maternity leave and health outcomes has not been formally and comprehensively assessed to guide public health research and policy in this area. This review aims to address this gap by investigating both the correlates of maternity leave utilization in the US and the related health benefits for mother and child. Methods We searched the peer-reviewed scholarly literature using six databases for the years 1990 to early 2015 and identified 37 studies to be included in the review. We extracted key data for each of the included studies and assessed study quality using the "Weight of the Evidence" approach. Results The literature generally confirms a positive, though limited correlation between maternity leave coverage and utilization. Likewise, longer maternity leaves are associated with improved breastfeeding intentions and rates of initiation, duration and predominance as well as improved maternal mental health and early childhood outcomes. However, the literature points to important disparities in access to maternity leave that carry over into health outcomes, such as breastfeeding. Synthesis We present a conceptual framework synthesizing what is known to date related to maternity leave access and health outcomes.

Understanding Patient, Provider, and System Factors Related to Medicaid Readmissions.

BACKGROUND: Efforts on reducing hospital readmissions, which are intended to improve quality and reduce costs, tend to focus on elderly Medicare beneficiaries without recognition of another high-risk population--adult nonmaternal Medicaid patients. This study was undertaken to understand the complexity of Medicaid readmission issues at the patient, provider, and system levels. METHODS: Multiple qualitative methods, including site visits to nine safety-net hospitals, patient/family/caregiver inter views, and semistructured interviews with health plans and state Medicaid agencies, were used in 2012 and 2013 to obtain information on patient, provider, and system issues related to Medicaid readmissions; strategies considered or currently used to address those issues; and any perceived financial, regulatory or, other policy factors inhibiting or facilitating readmission reduction efforts. RESULTS: Significant risk factors for Medicaid readmissions included financial stress, high prevalence of mental health and substance abuse disorders, medication nonadherence, and housing instability. Lacking awareness on Medicaid patients' high risk, a sufficient business case, and proven strategies for reducing readmissions were primary barriers for providers. Major hurdles at the system level included shortage of primary care and mental health providers, lack of coordination among providers, lack of partnerships between health plans and providers, and limited data capacity for realtime monitoring of readmissions. CONCLUSIONS: The intertwining of behavioral, socioeconomic, and health factors; the difficulty of accessing appropriate care in the outpatient setting; the lack of clear financial incentives for health care providers to reduce readmissions; and the fragmentation of the current health care system warrant greater attention and more concerted efforts from all stakeholders to reduce Medicaid readmissions.

Prognostic understanding among advanced heart failure patients and their caregivers: A longitudinal dyadic study.

OBJECTIVES: To examine heart failure patients' and caregivers' prognostic understanding (PU) over time, and patient and caregiver factors associated with their own and each other's PU. METHODS: We used longitudinal dyadic data from Singapore, involving surveys with 95 heart failure patient-caregiver dyads every 4 months for up to 4 years. We assessed the association of PU with patient health status, caregiver psychological distress and caregiving hours using random effects multinomial logistic models, controlling for patient and caregiver characteristics. RESULTS: At baseline, half of patients and caregivers reported correct PU. Patient and caregiver variables were associated with their own and each other's PU. Patients with poorer functional well-being were less likely to report correct PU [Average Marginal Effects (95 % CI) 0.008 (0.002, 0.015)] versus incorrect PU. Greater caregiver psychological distress was associated with a lower likelihood of caregivers reporting a correct PU [- 0.008 (-0.014, -0.002)]. Higher caregiving hours reduced the likelihood of patients reporting correct [- 0.002 (-0.003, -0.001)] and increased the likelihood of patients reporting uncertain [0.001 (0, 0.002)] PU. CONCLUSIONS: We found PU among patients and caregivers was influenced by their own and each other's experience. Our findings highlight the importance of ongoing communication to enhance PU of patients and caregivers.

Caregiver-reported use of physical restraints among community-dwelling older adults with severe dementia in Singapore.

BACKGROUND: Older adults with severe dementia are at increased risk of being physically restrained in nursing homes and acute care settings, but little is known about restraint use among those cared for at home. This study explores caregiver-reported use of restraints among community-dwelling older adults with severe dementia. METHODS: Using cross-sectional data from 215 family caregivers, we describe restraint use among older adults with severe dementia living at home. We then use multivariable logistic regression to identify factors associated with restraint use. RESULTS: Nearly half (47%) of caregivers reported on older adults who had been subject to restraints. Most caregivers reporting restraint use suggested safety reasons, such as prevention of falls (68%), wandering (30%), and removal of catheters or feeding tubes (29%); and 44% indicated doctors or other health care providers were involved in the decision to restrain. Feeding tubes (OR = 4.16, 95% CI: 1.27-13.59) and physically aggressive agitation behaviors (OR = 1.93, 95% CI: 1.09-3.40) were associated with higher odds of restraint use among older adults with severe dementia. Caregivers who received strong emotional support from friends (OR = 0.45, 95% CI: 0.21-0.95) were less likely to report restraint use while serving as a caregiver to others (OR = 2.77, 95% CI: 1.36-5.63) increased the odds of restraint use. CONCLUSIONS: The pervasiveness of restraint use is concerning and suggests a lack of evidence-based guidance and support for both caregivers and healthcare providers to prevent restraint use among older adults with severe dementia cared for at home.

How do organizational culture and leadership style affect nurse presenteeism and productivity?: A cross sectional study of Hong Kong acute public hospitals.

BACKGROUND: Presenteeism is defined as a type of work behavior in which employees are physically present at work when ill, often with reduced performance. While organizational culture and leadership style are known to impact the organizational behavior of hospital staff, as indicated by increased burnout and decreased work engagement, their impact on nurse presenteeism and productivity has not been explored. Moreover, nursing studies often neglect the importance of using multi-level analysis, adopting aggregated unit-level scores to account for collective perceptions to evaluate culture and leadership. OBJECTIVE: This study aims to evaluate the impact of unit-level organizational culture and leadership style on individual-level nurse presenteeism and productivity in acute care hospitals using multilevel analysis. DESIGN: Cross-sectional study. SETTING(S): Three major acute care public hospitals in Hong Kong, where public hospitals provide over 90 % of inpatient services. PARTICIPANTS: All full-time nurses (N = 4657) in the three study hospitals were invited to participate in this study. A total of 2339 nurses responded to the survey for a 65 % response rate. METHODS: Organizational culture and leadership style are characterized using the competing values framework and a two-factor leadership style typology, respectively. Multilevel hierarchical linear modeling was applied with unit-level clustering in each hospital. RESULTS: Hierarchical culture was the dominant culture (M = 3.64, SD = 0.74) in our nurse sample. None of the unit-level organizational culture and leadership styles were associated with nurse presenteeism, however, rational organizational culture at the unit-level was significantly associated with increased productivity (regression coefficient: 0.17, 95 % CI: 0.04-0.31). CONCLUSIONS: This study provides hospital managers with improved understanding of the differential impact of unit-level organizational culture and leadership style on nurse presenteeism and productivity. Unit-level leadership style did not have a direct impact on nurse presenteeism and productivity in this study, while the externally focused rational organizational culture increased nurse productivity. Further research is needed to understand the impacts of modifiable work factors and nurse psychosocial emotions on presenteeism and productivity.

Opioid Access among Advanced Cancer Patients in Low- and Middle-Income Countries in Asia.

CONTEXT: Most cancer-associated pain is experienced in low- and middle-income countries (LMICs) due to inequitable access to opioids. OBJECTIVE: To determine opioid access as estimated by both patients and providers and to understand patient and facility-level factors influencing access among patients with advanced cancer in LMICs in Asia using the Behavioral Model of Health Services Use. METHODS: The APPROACH cross-sectional study was conducted in seven LMICs in Asia, involving in-depth surveys with providers and advanced cancer patients. A hierarchical logistic regression model was used to assess predisposing (i.e. individual factors), enabling (i.e. health care system and facility-level resources) and need (i.e. pain severity) factors predicting opioid access. RESULTS: Among patient participants (n=1,933), approximately 40% reported opioid use. Meanwhile 80% of facilities, as reported by providers, indicated at least half of their advanced cancer patients receive oral morphine prescriptions. Predisposing characteristics factored in the least in the model, with patient education positively associated with access (Odds ratio (OR): 1.01; 95% CI=1.00, 1.03). Facility-level enabling resources, factoring the most, included oral morphine prescription duration >14 days (OR: 1.27; 95% CI=1.05, 1.53) and the extent of physician palliative care training (extensive (>160 hours) OR: 3.95; CI=3.19, 4.88; basic (up to 40 hours) OR: 1.03; CI=1.03, 1.04). Patient need as indicated by greater pain severity predicted access (OR: 1.55; CI=1.47, 1.64). CONCLUSION: Study findings emphasize the importance of palliative care training-even a minimal amount-in supporting access to opioids for advanced cancer patients. This study also highlights pragmatic site-level policies, such as extended morphine prescription durations, enabling access.

Extended Paid Maternity Leave Associated With Improved Maternal Mental Health In Hong Kong.

In July 2020, Hong Kong extended statutory paid maternity leave from ten weeks to fourteen weeks to align with International Labour Organization standards. We used the policy enactment as an observational natural experiment to assess the mental health implications of this policy change on probable postnatal depression (Edinburgh Postnatal Depression Scores of 10 or higher) and postpartum emotional well-being. Using an opportunistic observational study design, we recruited 1,414 survey respondents with births before (August 1-December 10, 2020) and after (December 11, 2020-July 18, 2022) policy implementation. Participants had a mean age of thirty-two, were majority primiparous, and were mostly working in skilled occupations. Our results show that the policy was associated with a 22 percent decrease in mothers experiencing postnatal depressive symptoms and a 33 percent decrease in postpartum emotional well-being interference. Even this modest change in policy, an additional four weeks of paid leave, was associated with significant mental health benefits. Policy makers should consider extending paid maternity leave to international norms to improve mental health among working mothers and to support workforce retention.

Using a risk assessment approach to determine which factors influence whether partially bilingual physicians rely on their non-English language skills or call an interpreter.

BACKGROUND: Partially bilingual physicians may weigh a number of factors in deciding whether to use their own limited non-English language skills or call an interpreter when caring for patients with limited English proficiency. Yet little is known about this decision process or how it might fail. In a patient safety approach to exploration of this complex, potentially high-stakes decision, key risk factors that may contribute to miscommunication during health care encounters in non-English languages were identified. METHODS: The Healthcare Failure Mode and Effects Analysis (HFMEA) method was adapted to examine the decision process. An initial set of possible decision factors was presented to a national expert panel of eight physicians, who modified and expanded the list of factors and then rated each according to four scales: Frequency, Importance, Amenability to Intervention, and Detectability. A "5 Whys" approach was used to examine underlying causes of these failure modes and generate potential interventions. FINDINGS: Nine factors were described that could lead physicians to use their own skills rather than an interpreter when that decision might pose unacceptable risk. The highest-priority factor was lack of knowledge regarding the value of using a trained interpreter and how to work with a trained interpreter effectively. For the top failure mode, a sample hypothetical 5 Whys exercise shows how to examine potential underlying causes and produce recommendations. CONCLUSIONS: A variety of discrete factors can have important effects on physicians' decisions to use their own non-English language skills or an interpreter. Because this decision can affect patient safety, organizations and policy makers should use these factors to guide local efforts to examine these issues and develop quality improvement and safety activities.

Does Seasonal Influenza Related Hospital Occupancy Surge Impact Hospital Staff Sickness Presenteeism and Productivity Costs?

Background-The workload of public hospital staff is heightened during seasonal influenza surges in hospitals serving densely populated cities. Such work environments may subject staff to increased risk of sickness presenteeism. Presenteeism is detrimental to nurses' health and may lead to downstream productivity loss, resulting in financial costs for hospital organizations. Aims-This study aims to quantify how seasonal influenza hospital occupancy surge impacts nurses' sickness presenteeism and related productivity costs in high-intensity inpatient metropolitan hospitals. Methods-Full-time nurses in three Hong Kong acute-care hospitals were surveyed. Generalized estimating equations (GEE) was applied to account for clustering in small number of hospitals. Results-A total of 71.3% of nurses reported two or more presenteeism events last year. A 6.8% increase in hospital inpatient occupancy rate was associated with an increase of 19% (1.19, 95% CI: 1.06-1.34) in nurse presenteeism. Presenteeism productivity loss costs between nurses working healthy (USD1983) and worked sick (USD 2008) were not significantly different, while sick leave costs were highest (USD 2703). Conclusion-Presenteeism prevalence is high amongst acute-care hospital nurses and workload increase during influenza flu surge significantly heightened nurse sickness presenteeism. Annual presenteeism productivity loss costs in this study of USD 24,096 were one of the highest reported worldwide. Productivity loss was also considerably high regardless of nurses' health states, pointing towards other potential risk factors at play. When scheduling nurses to tackle flu surge, managers may want to consider impaired productivity due to staff presenteeism. Further longitudinal research is essential in identifying management modifiable risk factors that impact nurse presenteeism and impairing downstream productivity loss.

Estimating length of stay and inpatient charges attributable to hospital-acquired bloodstream infections.

BACKGROUND: Hospital-acquired bloodstream infection (BSI) is associated with high morbidity and mortality and increases patients' length of stay (LOS) and hospital charges. Our goals were to calculate LOS and charges attributable to BSI and compare results among different models. METHODS: A retrospective observational cohort study was conducted in 2017 in a large general hospital, in Beijing. Using patient-level data, we compared the attributable LOS and charges of BSI with three models: 1) conventional non-matching, 2) propensity score matching controlling for the impact of potential confounding variables, and 3) risk set matching controlling for time-varying covariates and matching based on propensity score and infection time. RESULTS: The study included 118,600 patient admissions, 557 (0.47%) with BSI. Six hundred fourteen microorganisms were cultured from patients with BSI. Escherichia coli was the most common bacteria (106, 17.26%). Among multi-drug resistant bacteria, carbapenem-resistant Acinetobacter baumannii (CRAB) was the most common (42, 38.53%). In the conventional non-matching model, the excess LOS and charges associated with BSI were 25.06 days (P < 0.05) and US$22041.73 (P < 0.05), respectively. After matching, the mean LOS and charges attributable to BSI both decreased. When infection time was incorporated into the risk set matching model, the excess LOS and charges were 16.86 days (P < 0.05) and US$15909.21 (P < 0.05), respectively. CONCLUSION: This is the first study to consider time-dependent bias in estimating excess LOS and charges attributable to BSI in a Chinese hospital setting. We found matching on infection time can reduce bias.

Measuring equity: an index of health care disparities.

OBJECTIVE: To create an index that would serve as a simple tool to measure the quality of hospital care by race and ethnicity. STUDY DESIGN: Following extensive review of existing disparities indices, we created a disparities quality index (DQI) designed to easily measure differences in the quality of care hospitals deliver to different populations. The DQI uses performance data already collected by virtually all hospitals. It highlights areas where there are large numbers of patients in a specific population receiving potentially lower-quality care. SETTING: Data were collected from 2 acute care hospitals that participated in a multihospital collaborative. DATA COLLECTION/EXTRACTION METHODS: We applied the DQI to 2 hospitals' quality data, specifically to their performance on the Hospital Quality Alliance measure for patients with heart failure who were receiving angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. RESULTS: The DQI was simple to apply and was able to measure differences in the care of different ethnic groups. It also detected changes in disparities over time. CONCLUSIONS: The DQI can help hospitals and other providers focus on the domain of equity in their quality-improvement efforts. Further testing is required to determine its applicability for community-wide equity projects.

Incidence of healthcare-associated infections in a tertiary hospital in Beijing, China: results from a real-time surveillance system.

Background: To quantify the five year incidence trend of all healthcare-associated infections (HAI) using a real-time HAI electronic surveillance system in a tertiary hospital in Beijing, China. Methods: The real-time surveillance system scans the hospital's electronic databases related to HAI (e.g. microbiological reports and antibiotics administration) to identify HAI cases. We conducted retrospective secondary analyses of the data exported from the surveillance system for inpatients with all types of HAIs from January 1st 2013 to December 31st 2017. Incidence of HAI is defined as the number of HAIs per 1000 patient-days. We modeled the incidence data using negative binomial regression. Results: In total, 23361 HAI cases were identified from 633990 patients, spanning 6242375 patient-days during the 5-year period. Overall, the adjusted five-year HAI incidence rate had a marginal reduction from 2013 (4.10 per 1000 patient days) to 2017 (3.62 per 1000 patient days). The incidence of respiratory tract infection decreased significantly. However, the incidence rate of bloodstream infections and surgical site infection increased significantly. Respiratory tract infection (43.80%) accounted for the most substantial proportion of HAIs, followed by bloodstream infections (15.74%), and urinary tract infection (12.69%). A summer peak in HAIs was detected among adult and elderly patients. Conclusions: This study shows how continuous electronic incidence surveillance based on existing hospital electronic databases can provide a practical means of measuring hospital-wide HAI incidence. The estimated incidence trends demonstrate the necessity for improved infection control measures related to bloodstream infections, ventilator-associated pneumonia, non-intensive care patients, and non-device-associated HAIs, especially during summer months.

User rating activity within KIWI: A technology for public health event monitoring and early warning signal detection.

OBJECTIVES: To review user signal rating activity within the Canadian Network for Public Health Intelligence's (CNPHI's) Knowledge Integration using Web-based Intelligence (KIWI) technology by answering the following questions: (1) who is rating, (2) how are users rating, and (3) how well are users rating? METHODS: KIWI rating data was extracted from the CNPHI platform. Zoonotic & Emerging program signals with first rating occurring between January 1, 2016 and December 31, 2017 were included. Krippendorff's alpha was used to estimate inter-rater reliability between users. A z-test was used to identify whether users tended to rate within 95% confidence interval (versus outside) the average community rating. RESULTS: The 37 users who rated signals represented 20 organizations. 27.0% (n = 10) of users rated ≥10% of all rated signals, and their inter-rater reliability estimate was 72.4% (95% CI: 66.5-77.9%). Five users tended to rate significantly outside of the average community rating. An average user rated 58.4% of the time within the signal's 95% CI. All users who significantly rated within the average community rating rated outside the 95% CI at least once. DISCUSSION: A diverse community of raters participated in rating the signals. Krippendorff's Alpha estimate revealed moderate reliability for users who rated ≥10% of signals. It was observed that inter-rater reliability increased for users with more experience rating signals. CONCLUSIONS: Diversity was observed between user ratings. It is hypothesized that rating diversity is influenced by differences in user expertise and experience, and that the number of times a user rates within and outside of a signal's 95% CI can be used as a proxy for user expertise. The introduction of a weighted rating algorithm within KIWI that takes this into consideration could be beneficial.

The economic benefits of fruit and vegetable consumption in Canada.

OBJECTIVES: The objectives of this study were to determine the proportion of the population that meets or exceeds Canada's Food Guide (CFG) recommendations regarding the number of daily servings of fruits and vegetables (F/V), to assess trends in this proportion between 2000 and 2013, to estimate the annual economic burden attributable to inadequate F/V consumption within the context of other important risk factors, and to estimate the short- and long-term costs that could be avoided if modest improvements were made to F/V consumption in Canada. METHODS: We used a previously developed methodology based on population-attributable fractions and a prevalence-based cost-of-illness approach to estimate the economic burden associated with low F/V consumption. RESULTS: Over three quarters of Canadians are not meeting CFG recommendations regarding the number of daily servings of F/V, leading to an annual economic burden of $4.39 billion. If a 1% relative increase in F/V consumption occurred annually between 2013 and 2036, the cumulative reduction in economic burden over the 23-year period would reach $8.4 billion. Consumption levels of F/V, and the resulting economic burden, varied by sex, age and province. CONCLUSION: A significant majority of Canadians are not consuming the recommended daily servings of F/V, with important consequences to their health and the Canadian economy. Programs and policies are required to encourage F/V consumption in Canada.