Understanding Healthcare Providers' Care for Patients with Medications Treating Opioid Use Disorder in the Emergency Department: A Scoping Review.

BACKGROUND: There is limited research exploring the changing clinical practices among healthcare providers (HPs) care for patients with Emergency Department (ED)-initiated Medication for Opioid Use Disorder (MOUD). METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus for related studies from inception through October 12, 2022. Following the application of inclusion and exclusion criteria, 16 studies were included. Subsequently, they were charted and analyzed thematically based on ecological systems theory. RESULTS: The main determinants in the four ecological systems were generated as follows: (1) microsystem: willingness and attitude, professional competence, readiness, and preference; (2) mesosystem: ED clinical practices, departmental factors; (3) exosystem: multidisciplinary approaches, discharge planning, and (4) macrosystem: stigma, health insurance, policy. The findings have implications for HPs and researchers, as insufficient adoption, implementation, and retention of MOUD in the ED affect clinical practices. CONCLUSIONS: Across the four ecological systems, ED-initiated MOUD is shaped by multifaceted determinants. The microsystem underscores pivotal patient-HP trust dynamics, while the mesosystem emphasizes interdepartmental synergies. Exosystemically, resource allocation and standardized training remain paramount. The macrosystem reveals profound effects of stigma, insurance disparities, and evolving policies on treatment access and efficacy. Addressing these interconnected barriers is crucial for optimizing patient outcomes in the context of MOUD.

Examining the Association between Medical Marijuana Legalization and Criminal Behaviors: Evidence from a U.S. Representative Sample.

Background: Medical marijuana legalization (MML) has been widely implemented in the past decade. However, the debates regarding the consequences of MML persist, especially criminal behaviors. Objectives: We examined the association between MML and criminal behaviors among adults in the United States. The criminal behaviors measured three past-year offenses: whether the adult (1) have sold illegal drugs, (2) have stolen anything worth > $50 USD, or (3) have attacked someone. Methods: Using the 2015-2020 National Survey of Drug Use and Health, we included 214,505 adults in our primary analysis for 2015-2019 and 27,170 adults in 2020 for supplemental analysis (age > = 18). Weighted multivariable logistic regression models were used to examine the association between MML and three criminal behaviors. Results: In our primary analysis, we observed no statistically significant association between MML and the three outcomes of criminal behavior. Nevertheless, our supplemental analysis of the 2020 data showed MML was associated with increasing odds of the three criminal behaviors (have sold illegal drugs: AOR [adjusted odds ratio] = 1.7; have stolen anything worth > $50 USD: AOR = 1.9; have attacked someone: AOR = 1.8; all p < 0.05). Conclusion: Surveys from 2015 to 2019 did not suggest MML as a risk factor for higher incidence of criminal behaviors. However, 2020 data showed statistically significant association between MML and selected criminal behaviors. Issues related to the COVID-19 pandemic, such as the U.S. economic downturn, could potentially explain this discrepancy. Further research efforts may be warranted.

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review.

OBJECTIVE: Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS: Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION: The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE: EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Taiwan's National Health Insurance at the Emergency Department following the COVID-19 outbreak.

Taiwan's National Health Insurance (NHI) is a widely acclaimed universal healthcare system. In the past few years, particularly following the COVID-19 outbreak, challenges related to maintaining the NHI system have surfaced. Since 2020, NHI has faced a series of challenges, including excessive patient visits to the hospital emergency department, a lack of an effective primary care and referral system, and a high turnover rate of healthcare workers. We review major problems related to Taiwan's NHI, emphasizing input from frontline healthcare workers. We provide recommendations for potential policies addressing the concerns around NHI, for example, strengthening the role of primary care services under the NHI administration, reducing the high turnover rate of healthcare workers, and increase the premium and copayments. We hope that this policy analysis may allow policymakers and scholars to understand both the merits and critical problems related to NHI from the clinical perspective.

Participation in mahjong and the associated smoking and alcohol consumption behaviors among Chinese older adults.

This study examined the relationship of playing mahjong with smoking and alcohol consumption behaviors among Chinese older adults. We used a large and nationally representative dataset, the 8th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Older adults who were 65 years old or above were included in the final analysis sample (n = 10,954). Multivariable logistic regressions were used to examine the associations of playing mahjong with current and former smoking/alcohol consumption status. Additionally, we used negative binomial and multiple linear regressions to investigate the number of cigarettes smoked per day and the amount of alcohol consumed per day. Compared with older adults who did not play mahjong, those who played mahjong at least once per month were more likely to report both current and prior smoking/alcohol consumption habits (all p < 0.05). The sub-analysis revealed that older adults who played mahjong at least once per week tended to smoke more cigarettes per day (all p < 0.05) than those who did not play mahjong at all. When public health practitioners advocate for the health benefits of playing mahjong, they should also consider its associations with smoking/alcohol consumption behaviors among Chinese older adults.

Underdiagnosis of iron deficiency anemia among patients with colorectal cancer: an examination of electronic medical records.

BACKGROUND: Timely diagnosis and management of iron deficiency anemia (IDA) in colorectal cancer (CRC) patients improves overall quality of life and survival. This study assessed the proportion of CRC patients who were formally diagnosed with IDA and factors that predict a formal diagnosis of IDA and receiving iron therapy. METHODS: We retrieved electronic medical records (EMRs) of CRC patients from a large comprehensive cancer center in the Northeastern part of the United States (n = 499). We abstracted sociodemographic characteristics, relevant laboratory results, IDA diagnosis, and iron supplementation from the EMRs. We assessed relationships between participant characteristics, a diagnosis of IDA and receiving iron therapy through adjusted logistic regressions. RESULTS: IDA was formally diagnosed in 26 (5.2%) individuals judged by EMR documentation. Only 153 (30.7%) participants had iron laboratory results available. Among the 153 patients with iron panel data available, 113 (73.9%) had iron deficiency. Seventy-six had absolute iron deficiency as shown by ferritin levels below 100 ng/mL and iron saturation less than 20% and 37 had functional iron deficiency as shown by ferritin levels between 100 and 500 ng/mL and iron saturation less than 20%. 12% of all patients had documentation of iron therapy receipt. A formal diagnosis of IDA was not associated with any of the covariates. CONCLUSIONS: Iron deficiency anemia is under-diagnosed among CRC patients and most likely under-documented in clinical notes. Rates of iron repletion are low, suggesting that many patients with IDA are untreated. Future research should explore provider-level and other strategies for improving assessment and diagnosis of IDA among CRC patients.

Transition of Living Arrangement and Cognitive Impairment Status among Chinese Older Adults: Are They Associated?

Background and Objectives: Living arrangement is a crucial factor for older adults' health. It is even more critical for Chinese older adults due to the tradition of filial piety. With the aging of China's population, the prevalence of cognitive impairment among older adults has increased. This study examines the association between living arrangement transition and cognitive function among Chinese older adults. Materials and Methods: Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2008-2009, 2011-2012, and 2014), we analyzed data for older adults (age ≥ 65) who lived with other household members and reported good cognitive function or mild cognitive impairment when they participated in the survey. Multistate Cox regression was employed to study changes in cognitive function. Results: Older adults who transitioned to living alone had lower risk of cognitive impairment (hazard ratio (HR) = 0.66, 95% CI: 0.52, 0.83; p < 0.01), compared with those who continued to live with other household members. Moving into an institution was also not associated with cognitive impairment. Conclusions: With older adults' transition to living alone, public health practitioners or social workers might educate them on the benefits of such a living arrangement for cognitive function.

Rural-urban disparities in smoking patterns among Chinese adults: a social-ecological approach.

China has a long history of smoking behavior. Currently, nearly 26% of Chinese citizens smoke daily. This research used a nationally representative database to study the urban and rural disparities on smoking patterns applying the social-ecological model. Using the 2011 China Health and Nutrition Survey, the study sample included adult participants who were at least 18 years of age (n = 12,688). A subanalysis was carried out to investigate smoking cessation duration among smoking quitters (n = 519). Multinomial logistic regression was used to examine participants' smoking status. Zero-inflated negative binomial regression was applied to investigate participants' number of cigarettes smoked per day, and multivariable logistic regression was used to examine nondaily smoking behavior. Negative binomial regression was carried out to assess the duration of smoking cessation for individuals who quit smoking. Urban residents had lower odds of reporting current smoking status (AOR [adjusted odds ratio] = 0.83, 95% CI [0.74, 0.95]) as compared to rural residents. Urban residents also had higher odds of reporting nondaily smoking status (AOR = 1.17, 95% CI [1.04, 1.32]) and smoked fewer cigarettes per day (IRR [incidence rate ratio] = 0.93, 95% CI [0.89, 0.98]) as compared to rural participants. The disparity between urban and rural areas was not observed for smoking cessation duration. Further efforts should target the disparity between urban and rural regions regarding smoking prevention.

Associations of alcohol consumption status with activities of daily living among older adults in China.

BACKGROUND: With the rapid growth of the elderly population and public health challenges in China, concerns arise related to disability associated with activities of daily living (ADLs) and alcohol consumption status. This study assesses the relationships of alcohol consumption status with basic daily activities among Chinese older adults. METHODS: A total of 5,133 participants aged 60 years or above from three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014) were analyzed. Independent ADL items included bathing, dressing, toileting, indoor moving, continence, and feeding (without others' assistance). Multilevel ordered logistic regression model estimation was used to examine the results of total scores based on the Katz index. Multilevel logistic regression models also were estimated to study each index item separately to examine differences across each of the six ADLs. Additional confirmatory factor analysis (CFA) was performed to examine the validity of the index. RESULTS: Preliminary CFA showed that most items had good factor loadings (>0.700), except for continence (0.256) and feeding (0.481). Based on the ordered regression model, former (AOR = 0.412, 95% CI: 0.294, 0.579, p < 0.001) and non-alcohol consumption (AOR = 0.598, 95% CI: 0.447, 0.800, p < 0.001) were negatively associated with the total score. Non-alcohol consumption status was negatively associated with ADL items separately (all ps < 0.05), with the exceptions of continence and feeding. CONCLUSION: Alcohol consumption may be associated with Chinese older adults' better ADLs. However, further clinical or experimental trials are needed to examine the impact of alcohol consumption on older adults' ADLs.

Trends and sociodemographic factors of e-cigarette use among adult daily smokers in South Korea.

OBJECTIVE: Previous studies have identified the sociodemographic factors associated with e-cigarette use among adolescents in South Korea. However, literature regarding e-cigarette use among adult smokers remains limited in South Korea. METHODS: Applying four waves (2013-2016) of The Korea National Health and Nutrition Examination Survey (n = 3227), sociodemographic factors were included in the multivariable logistic regression model to study their relationships with e-cigarette use among adult daily smokers. RESULTS: E-cigarette use increased from approximately 21.2% to 34.6% from 2013 to 2016, respectively. Females had lower odds of e-cigarette use (adjusted odds ratio [AOR] = 0.76; 95% CI, 0.58-0.99, P < .05) compared with males. Older age was negatively associated with e-cigarette use experience (all Ps < .01). Daily smokers with high school education or above all had higher odds of using e-cigarettes compared those with elementary school education (all Ps < .05). CONCLUSION: As this study examined the trends of e-cigarette use and factors associated with e-cigarette use among adult daily smokers in South Korea, further research is needed to investigate the long-term effect of e-cigarette use on smoking cessation in South Korea as well as other Asian countries.

Is preventive care utilization associated with lower outpatient and inpatient health-care expenses among Chinese older adults? A longitudinal analysis.

BACKGROUND: China has made major improvements to its health-care system since the early 21st century. However, the effectiveness of preventive care utilization on health-care costs remains limited. This study seeks to understand the effect of preventive care utilization on outpatient and inpatient health-care expenses. METHODS: With the use of the Chinese Longitudinal Healthy Longevity Survey with older adults who were 65 years old or above (n = 2828), Tobit regression models were estimated to examine the association of preventive care utilization and expenses with medical treatments. Preventive care utilization in the previous wave was used to predict health-care costs for treatments in the next wave. Propensity score matching was used to reduce potentially confounding factors. FINDINGS: Results indicated that preventive care utilization was positively associated with outpatient health care among Chinese older adults (ß = 231.8, standard error [SE] = 71.5, P < .01). The association between preventive care utilization and inpatient health-care expenses was not significant. CONCLUSIONS: Despite the results from previous studies suggesting that preventive care utilization can help reduce health-care expenses, this study does not support such a claim among Chinese older adults. The long-term association between preventive care utilization and health-care expenses for treatment should be studied further.

Living Arrangements and Sleep-Related Outcomes Among Older Adults in China : A Panel Analytic Approach.

It has been discussed previously that older adults' living arrangements are associated with mortality. This study investigated the relationships between older adults' living arrangements and sleep-related outcomes in China. The nationally representative sample included 4,731 participants who participated on two different occasions, with a total of 9,462 observations (2012 and 2014 waves). Panel logistic regression and panel ordinary least squares regression models were estimated with outcomes of sleep quality and average hours of sleep daily, respectively. Approximately 62% of individuals reported good quality of sleep. We observed that older adults who lived with family members had 17% greater odds of reporting good quality of sleep (adjusted odds ratio = 1.17, 95% confidence interval [1.03, 1.34], p < .05) and reported longer sleep duration daily (ß = .334, standard error = .069, p < .01), compared with those who lived alone. Social support is needed to strengthen the residential relationship, especially with family members.

Correlates of alcohol consumption and alcohol dependence among older adults in contemporary China: Results from the Chinese Longitudinal Healthy Longevity Survey.

China has one of the world's largest populations using alcohol. With the trend of increasing alcohol consumption and the rapid growth of its aging population, China has faced imminent public health challenges in the past few decades. This research study aims to investigate determinants related to alcohol consumption behaviors or alcohol dependence among older adults (age ≥60) in China. Using the Chinese Longitudinal Healthy Longevity Survey from 2000 to 2014 waves (n = 35,377), we estimated multivariable logistic regression models to examine the factors associated with current alcohol consumption status, alcohol consumption experience, daily consumption, and alcohol dependence. Of all respondents between 2000 and 2014, 5.7% were current alcohol users, 20.3% reported alcohol use experience, 3.3% used alcohol daily, and approximately 1.1% reported alcohol dependence. Current smoking status, health status, and respondents' gender were associated with all alcohol-related behaviors (p < .05). In addition, older adults from newer waves had higher odds of becoming daily alcohol consumers and having alcohol dependence, compared with older adults in the 2000 wave. Older adults living in an institution had lower odds of becoming current alcohol users, compared with those living with household members. Older adults residing in eastern regions had higher odds of becoming current alcohol users, compared with northern residents. Rural residents had higher odds of reporting alcohol use patterns (p < .01), except alcohol use experience. Future public health interventions and promotional strategies should focus on regional and community disparities in China.

Are older adults' home exposures to secondhand smoking during earlier life stages associated with current health status and life satisfaction in China? A multilevel approach.

Secondhand smoking (SHS) has become a critical challenge in Chinese society, and progress on SHS prevention remains unknown. There is little knowledge targeting Chinese older adults generally to investigate the associations between SHS exposure experiences during earlier life stages and health-related measurements. Using cross-sectional data from a nationally representative data set, the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 4,414), multilevel logistic regression models with random effects for Chinese provinces were used for analyses. Two health-related measurements included self-reported health status and life satisfaction. All regression models included the same set of predictors and covariates with socioeconomic factors and basic biological information. Approximately 40% and 47% of older adults reported SHS exposure in childhood and in younger adulthood at home, respectively. Older adults with SHS exposure in childhood had lower odds of reporting better health status, compared with those who did not have such exposure (adjusted odds ratio [AOR] = 0.69, 95% CI [0.55, 0.86], p < .01). However, life satisfaction was not associated with any SHS exposure experiences. Policy makers and public health practitioners should continue to investigate the long-term effect of SHS exposure on human health, including older adults. Policy regarding SHS prevention should be enhanced.

Depictions of Tobacco and Alcohol Use in Contemporary Japanese Shonen Manga: A Content Analysis.

Japanese manga, which present dramatic and imaginative stories in comic book form, have a growing readership in Asia, Europe, and North America. We investigated depictions of tobacco and alcohol use in a sample of contemporary shonen manga, which have a primary readership of males ages 8-18, but also appeal to young females and adults. Large number of characters were shown smoking cigarettes and drinking alcohol, especially males, adults, and those categorized as "good" characters. Compared to the shonens' early chapters (initiated in 1990-2003, depending on the series), more recently published chapters (2011-2016) portrayed fewer characters overall using a tobacco product and fewer minors using an alcohol product. The later chapters also presented significantly fewer depictions of tobacco-related behavior, consumption of both beer and other/unknown alcoholic beverages, and alcohol-related paraphernalia. Antitobacco and antialcohol behaviors or dialogue were rare. These findings raise legitimate concerns about the influence of these depictions on young readers' beliefs, attitudes, and behavioral choices. Future research should explore whether those concerns are warranted, but in the interim, government agencies and watchdog groups in Japan should consider applying increased public pressure on manga artists and producers to curtail these depictions and to offer positive role models in their place.

Is Taiwan's National Health Insurance a perfect system? Problems related to health care utilization of the aboriginal population in rural townships.

National Health Insurance (NHI) was implemented in Taiwan in 1995, and has significantly increased coverage to 99% of the population. The implementation of NHI has had large impacts on health disparities. Despite that, the NHI faces multiple challenges, including the condition of "coverage without access" among the Taiwanese aboriginal population, mostly residing in mountainous townships and experiencing lower socioeconomic status, decreased health outcomes, and limited access to adequate high-quality health care services. This paper summarizes the persistent health gap and the differences in health care utilization and health outcomes between the aboriginal population in rural townships and urban populations in Taiwan. Mountainous townships face challenges including lack of access to high-quality health care services and limited medical resources. Further policy recommendations and current progress are highlighted and discussed.

Preventative care utilization and associated health-related measurements among older adults following the 2009 health reform in China.

PURPOSE: It is unclear if older adults' preventive health care utilization is associated with better health in China, as the elderly population and prevalence of chronic disease have escalated. METHODS: Applying the Donabedian's model for evaluating quality of health care, we analyzed data from the 2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey with 5304 older adults 65 years old and above. The study used propensity score matching to decrease selection bias on preventive care utilization. Preventive care utilization was defined as the use of annual physical examination at least once a year among older adults. Three ordered logistic regression models were performed to evaluate preventive care utilization and three health-related measurements of current health status, overall health status improvement in the past 12 months, and life satisfaction, controlling for socioeconomic, demographic, and biological factors. RESULTS: Older adults who used preventive care reported better health status, overall health status improvement in the past 12 months, and life satisfaction (adjusted odds ratios [AORs] = 1.24, 1.20, 1.30, respectively; all Ps < 0.01), compared with participants who did not use preventive care. CONCLUSION: The research findings suggest that the Chinese central government should continue to enhance the role of preventive care services with further reforms in order to improve older adults' health and life conditions.

Growing concerns and controversies to Taiwan's National Health Insurance-what are the lessons from mainland China, South Korea and Singapore?

It has been over 20 years since Taiwan's implementation of its National Health Insurance (NHI) program. Under this program, the health insurance coverage rate has reached approximately 99% of the population. Despite guaranteeing the residents of Taiwan equal access regardless of socioeconomic status and background, critical problems and controversies persist, and they continue to challenge the NHI. We analyze the primary issues facing the NHI program with emphasis on financial and consumer behavioral aspects. Furthermore, we apply models from mainland China, South Korea and Singapore to discuss what Taiwan could learn from the systems employed by these countries to modify the NHI. Targeting the needs of the NHI, we have three policy recommendations: separating the NHI scheme into different target populations, strengthening the NHI referral system and regulating the access of overseas citizens to health services while in Taiwan. After two decades in existence, problems persist and there is a continuing need to improve Taiwan's NHI. Copyright © 2016 John Wiley & Sons, Ltd.

Chinese residents' educational disparity and social insurance coverage.

PURPOSE: The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China's social health insurance scheme following the reform. DESIGN/METHODOLOGY/APPROACH: Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design ( n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported. FINDINGS: The authors found that education is associated with all social health insurance schemes in China after the reform ( p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44-8.13) or university and above (OR: 9.86, 95% CI: 8.14-11.96), are associated with UEBMI, compared with lower-educated individuals. PRACTICAL IMPLICATIONS: The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China's universal health coverage and social disparity. ORIGINALITY/VALUE: This study is the first to investigate the association between residents' educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

Residents' educational attainment and preventive care utilization in China.

Purpose China launched a comprehensive health reform in 2009 to improve healthcare quality. Because preventive care utilization in China has not been frequently discussed, the purpose of this paper is to focus on the association between education level and preventive care before and after the initiation of the reform. Education has been referred to as the best health outcome indicator and China's educational reform has been progressive, such as the health reform. Design/methodology/approach The authors analyzed data from four China Health and Nutrition Surveys (CHNS): 2004 ( n=9,617); 2006 ( n=9,527); 2009 ( n=9,873); and 2011 ( n=9,430). Variables were selected based on Andersen's healthcare utilization model (predisposing, enabling and need factors). Multivariable logistic regression models, odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) were conducted and reported. Findings In the adjusted multivariable logistic regression models, the authors found that general education was associated ( p<0.05) with access to preventive care in 2004, 2009 and 2011, but not in 2006. Individuals with higher education had higher ORs for utilizing preventive care, compared with lower education (primary school education or none). Practical implications Policy implications include providing educational protocols regarding preventive care's significance to residents educated at lower level schools, especially younger individuals. Originality/value To the authors' knowledge, this is the first comparative assessment on education level and preventive care utilization before and after the implementation of the Chinese health reform.