Contaminação pelo Covid-19 em profissionais de hospital de referência no Pará / Contamination by Covid-19 in professionals of a reference hospital in Para's state / Contaminación por Covid-19 en profesionales de un hospital de referencia del estado de Pará

A pandemia do novo coronavírus colocou em alerta os sistemas de saúde, estabelecendo sentimentos de instabilidade e de medo. O trabalho é e importante pilar para o traçado de políticas públicas. Objetivo: analisar a contaminação pelo COVID-19 em profissionais de hospital de referência no Pará. Metodologia: Trata-se de estudo retrospectivo, quantitativo, observacional, com aplicação de série temporal no período de março de 2020 a março de 2022. Foram incluídos todos os servidores atuantes durante a pandemia, que apresentaram atestados médicos com diagnóstico de COVID, e/ou testagem positiva, ou atestados por suspeita de contaminação. O perfil de servidores foi analisado, explorando as variáveis sexo, idade, convivência ou não com parceiros, grau de escolaridade, cargo e setor; juntamente com a incidência de casos confirmados e incidência total (suspeitos e confirmados). Resultados: O total de afastamentos do trabalho devido ao diagnóstico de COVID-19 foi de 1.420 casos, mais 839 casos suspeitos; sendo que 173 trabalhadores apresentaram reincidência. A incidência foi maior nos meses de maio de 2020, março de 2021 e janeiro de 2022. Houve predominância do sexo feminino e da categoria de enfermagem. Setores administrativos e financeiros apresentaram maior porcentagem de contaminados durante a pandemia (73,40%), proporcionalmente ao quantitativo de servidores atuantes na lotação. Entretanto, foram servidores da assistência direta ao paciente que apresentaram maior porcentagem de reinfecção. Conclusão: Foi possível visualizar três ondas na distribuição temporal dos casos de COVID-19, com destaque para elevação nos primeiros meses de 2022. O declínio no diagnóstico de casos novos no hospital estudado após dois anos de pandemia pode representar esforços individuais e coletivos em resistir às dificuldades da conjuntura. É importante observar o comportamento da pandemia em distintas regiões do Brasil para atualização de estratégias de enfrentamento como um todo.

The new coronavirus pandemic has put health systems on alert, establishing feelings of instability and fear. Working is an important pillar for the design of public policies. Objective: to analyze the contamination by COVID-19 in professionals of a reference hospital in Para's State. Methodology: This is a retrospective, quantitative, observational study, with the application of a time series from March 2020 to March 2022. All civil servants working during the pandemic, who presented medical certificates with a diagnosis of COVID, and/or or positive test, or attestations for suspected contamination. The servants' profile was analyzed, exploring the variables sex, age, living or not with partners, education level, position and sector; along with the incidence of confirmed cases and total incidence (suspected and confirmed). Results: The total number of absences from work due to the diagnosis of COVID-19 was 1,420 cases, plus 839 suspected cases; 173 workers presented recurrence. The incidence was higher in the months of May 2020, March 2021 and January 2022. There was a predominance of females and the nursing category. Administrative and financial sectors had a higher percentage of people infected during the pandemic (73.40%), proportionally to the number of servers working in the capacity. However, it was direct patient care workers who had the highest percentage of reinfection. Conclusion: It was possible to visualize three waves in the temporal distribution of COVID-19 cases, with emphasis on an increase in the first months of 2022. The decline in the diagnosis of new cases in the hospital studied after two years of the pandemic may represent individual and collective efforts to resist to the difficulties of the situation. It is important to observe the behavior of the pandemic in different regions of Brazil to update coping strategies in a general scenery.

La nueva pandemia de coronavirus ha puesto en alerta a los sistemas de salud, estableciendo sentimientos de inestabilidad y miedo. El trabajo es un pilar importante para el diseño de políticas públicas. Objetivo: analizar la contaminación por COVID-19 en profesionales de un hospital de referencia en el Estado de Pará. Metodología: Se trata de un estudio retrospectivo, cuantitativo, observacional, con la aplicación de una serie de tiempo de marzo de 2020 a marzo de 2022. Todos los funcionarios que trabajaron durante la pandemia, que presentaron certificados médicos con diagnóstico de COVID, y/o o test positivo, o atestados por sospecha de contaminación. Se analizó el perfil de los funcionarios, explorando las variables sexo, edad, convivencia o no con la pareja, nivel de escolaridad, cargo y sector; junto con la incidencia de casos confirmados y la incidencia total (sospechosos y confirmados). Resultados: El número total de bajas laborales por diagnóstico de COVID-19 fue de 1.420 casos, más 839 casos sospechosos; 173 trabajadores presentaron recurrencia. La incidencia fue mayor en los meses de mayo de 2020, marzo de 2021 y enero de 2022. Hubo predominio del sexo femenino y de la categoría de enfermería. Los sectores administrativo y financiero presentaron mayor porcentaje de infectados durante la pandemia (73,40%), proporcionalmente al número de servidores que trabajaban en esa función. Sin embargo, fueron los trabajadores de atención directa al paciente los que presentaron el mayor porcentaje de reinfección. Conclusiones: Fue posible visualizar tres olas en la distribución temporal de los casos de COVID-19, destacándose un aumento en los primeros meses de 2022. La disminución en el diagnóstico de nuevos casos en el hospital estudiado después de dos años de pandemia puede representar esfuerzos individuales y colectivos para resistir a las dificultades de la situación. Es importante observar el comportamiento de la pandemia en diferentes regiones de Brasil para actualizar las estrategias de afrontamiento en un escenario general.

Factores asociados a la infección por SARS-CoV-2 en profesionales de la salud de hospitales universitarios / Factors associated with the SARS-CoV-2 infection among health professionals from university hospitals / Fatores associados à infecção por SARS-CoV-2 entre profissionais da saúde de hospitais universitários

Objetivo: investigar los factores asociados a la infección por SARSCoV-2 en los profesionales de la salud de hospitales universitarios. Método: estudio multicéntrico, con abordaje mixto con estrategia incorporada concomitante, realizado con 559 profesionales en la etapa cuantitativa, y 599 en la etapa cualitativa. Fueron utilizados cuatro instrumentos de recolección de datos, aplicados a través un formulario electrónico. El análisis cuantitativo se realizó mediante estadística descriptiva e inferencial y los datos cualitativos mediante análisis de contenido Resultados: los factores asociados a la infección fueron: realización de la prueba "RT-PCR" (p<0,001) y unidades que atienden a pacientes con COVID-19 (p=0,028). Tener síntomas aumentó la prevalencia de infección 5,63 veces y cumplir la mayor parte del tiempo con el distanciamiento social en la vida privada la redujo un 53,9%. Los datos cualitativos mostraron las dificultades que enfrentaron los profesionales: escasez y baja calidad de equipos de protección personal, sobrecarga de trabajo, distanciamiento físico en el trabajo, procesos y rutinas inadecuados y la ausencia de una política de triage y testeo masivos. Conclusión: los factores asociados a la infección por SARS-CoV-2 en los profesionales de la salud se relacionaron mayormente con cuestiones laborales.

Objective: to investigate factors associated with the SARS-CoV-2 infection among health professionals from university hospitals. Method: a multicenter, mixed approach study with concomitant incorporated strategy, carried out with 559 professionals in the quantitative stage, and 599 in the qualitative stage. Four data collection instruments were used, applied by means of an electronic form. The quantitative analysis was performed with descriptive and inferential statistics and the qualitative data were processed by means of content analysis. Results: the factors associated with the infection were as follows: performance of the RT-PCR test (p<0.001) and units offering care to COVID-19 patients (p=0.028). Having symptoms increased 5.63 times the prevalence of infection and adhering to social distancing most of the time in private life reduced it by 53.9%. The qualitative data evidenced difficulties faced by the professionals: scarcity and low quality of Personal Protective Equipment, work overload, physical distancing at work, inadequate processes and routines and lack of a mass screening and testing policy. Conclusion: the factors associated with the SARS-CoV-2 infection among health professionals were mostly related to occupational issues.

Objetivo: investigar fatores associados à infecção por SARS-CoV-2 entre profissionais da saúde de hospitais universitários. Método: estudo multicêntrico, de abordagem mista com estratégia incorporada concomitante, realizado com 559 profissionais na etapa quantitativa, e 599 na etapa qualitativa. Foram utilizados quatro instrumentos de coleta de dados, aplicados via formulário eletrônico. A análise quantitativa foi realizada com estatística descritiva e inferencial e os dados qualitativos por meio de análise de conteúdo. Resultados: os fatores associados à infeção foram: realização de teste "RT-PCR" (p<0,001) e unidades com atendimento a pacientes com COVID-19 (p=0,028). Ter sintomas aumentou em 5,63 vezes a prevalência de infeção e aderir ao distanciamento social na maior parte do tempo na vida particular reduziu em 53,9%. Dados qualitativos evidenciaram dificuldades enfrentadas pelos profissionais: escassez e baixa qualidade de equipamentos de proteção individual, sobrecarga de trabalho, distanciamento físico no trabalho, processos e rotinas inadequadas e ausência de uma política de triagem e testagem em massa. Conclusão: os fatores associados à infecção por SARS-CoV-2 entre profissionais da saúde foram em sua maioria relacionados a questões ocupacionais.

Auriculoterapia para reducir el dolor crónico de la columna vertebral de los trabajadores de la salud: ensayo clínico / Auriculotherapy for reducing chronic spinal pain in health workers: a clinical trial / Auriculoterapia para redução da dor crônica na coluna vertebral em trabalhadores da saúde: ensaio clínico

Objetivo: evaluar la efectividad de la auriculoterapia para reducir el dolor musculoesquelético crónico de la columna vertebral de los trabajadores de la salud. Método: ensayo clínico aleatorizado, triple ciego, realizado con trabajadores de la salud diagnosticados con dolor crónico en la columna vertebral. Se aplicaron ocho sesiones de auriculoterapia con semillas, dos por semana. Los resultados fueron medidos con la Escala Numérica del Dolor, el Inventario Breve del Dolor, el Cuestionario de Discapacidad de Roland-Morris y los instrumentos SF-36, en la 1.ª, 4.ª, 8.ª sesión y follow-up a los 15 días. Análisis descriptivo e inferencial. Resultados: participaron 34 trabajadores del grupo intervención y 33 del grupo control, ambos mostraron una reducción en la intensidad del dolor (p>0,05). En el follow-up se registró una mayor reducción en el grupo intervención (3,32 ± 0,42) que en el grupo control (5,00 ± 0,43) (p=0,007). En cuanto a la calidad de vida, mejoró la vitalidad (p=0,012) y la limitación por aspectos emocionales (p=0,025). La relación entre auriculoterapia, discapacidad física e interferencia del dolor no difirió entre los grupos (p>0,05). El uso de medicamentos en el follow-up se mantuvo en el grupo control (77,8%) con respecto al grupo intervención (22,2%) (p=0,013). Conclusión: la auriculoterapia tuvo el mismo efecto en ambos grupos sobre la intensidad del dolor y duró más en el follow-up. Hubo una mejora en la calidad de vida y una reducción en el consumo de medicamentos. REBEC: RBR-3jvmdn.

Objective: to evaluate the effectiveness of auriculotherapy in reducing chronic musculoskeletal pain in the spine of health workers. Method: a randomized, triple-blind clinical trial conducted with health workers diagnosed with chronic spinal pain. Eight sessions of auriculotherapy with seeds were applied, two per week. The outcomes were measured with the Numerical Pain Scale, Brief Pain Inventory, Rolland-Morris Disability Questionnaire and SF-36 instruments, in the 1st, 4th and 8th session, and in the 15-day follow-up period. Descriptive and inferential analyses were performed. Results: 34 workers took part in the Intervention Group and 33 in the Control Group, and both presented reduced pain intensity (p>0.05). In the follow-up period, there was a greater reduction in the Intervention Group (3.32 ± 0.42), when compared to the Control Group (5.00 ± 0.43) (p=0.007). In quality of life, there was improved vitality (p=0.012) and limitation due to emotional aspects (p=0.025). The relationship between auriculotherapy, physical disability and pain interference did not differ between the groups (p>0.05). Medication use in the follow-up period remained unchanged in the Control Group (77.8%) when compared to the Intervention Group (22.2%) (p=0.013). Conclusion: auriculotherapy exerted the same effect between the groups on pain intensity, lasting longer in the follow-up period. There was an improvement in quality of life and a reduction in medication use. REBEC: RBR-3jvmdn.

Objetivo: avaliar a eficácia da auriculoterapia na redução da dor musculoesquelética crônica na coluna vertebral de trabalhadores da área da saúde. Método: ensaio clínico randomizado, triplo cego, realizado com trabalhadores da saúde com diagnóstico de dor crônica na coluna vertebral. Aplicaram-se oito sessões de auriculoterapia com sementes, duas por semana. Desfechos mensurados com os instrumentos Escala Numérica da Dor, Inventário Breve de Dor, Questionário de Incapacidade de Rolland-Morris e SF-36, na 1ª, 4ª, 8ª sessão, e follow-up de 15 dias. Análise descritiva e inferencial. Resultados: participaram 34 trabalhadores no grupo intervenção e 33 no controle, ambos apresentaram redução da intensidade da dor (p>0,05). No follow-up, maior redução no grupo intervenção (3,32 ± 0,42), comparado ao controle (5,00 ± 0,43) (p=0,007). Na qualidade de vida, melhorou a vitalidade (p=0,012) e limitação por aspectos emocionais (p=0,025). Relação entre auriculoterapia, incapacidade física e interferência da dor não diferiu entre os grupos (p>0,05). O uso de medicamentos, no follow-up, manteve-se no grupo controle (77,8%) se comparado à intervenção (22,2%) (p=0,013). Conclusão: a auriculoterapia apresentou igual efeito entre os grupos na intensidade da dor, com maior durabilidade deste no follow-up. Houve melhora da qualidade de vida e redução do consumo de medicamentos. REBEC: RBR-3jvmdn.

Impacto de la pandemia de COVID-19 en los profesionales de Atención Primaria y propuestas de mejora / Impact of the COVID-19 pandemic on Primary Care professionals and proposals for betterment

La pandemia de la COVID-19 ha supuesto un cambio brusco en el abordaje habitual de la promoción de la salud, la prevención, el tratamiento y la rehabilitación de las enfermedades. La Atención Primaria (AP) ha sufrido un importante impacto debido a la situación de pandemia y sus profesionales han tenido un papel fundamental, al mismo tiempo que tanto su vida profesional como personal han sufrido grandes alteraciones.El objetivo del estudio fue conocer y comprender el impacto de la pandemia en las esferas personales y profesionales de quienes trabajan en AP, así como también analizar y exponer propuestas a nivel organizativo y de atención.Se hizo un estudio cualitativo mediante cuatro grupos focales interdisciplinares en el que participaron 26 profesionales de AP (auxiliares administrativos, técnicos de cuidados auxiliares de enfermería [TCAE], enfermeras y médicas). Para hacer el análisis, se utilizó la metodología de análisis inductivo del contenido a través del método de comparaciones constantes de Glaser y Strauss y el programa informático Atlas Ti.Los cuatro grupos focales se transcribieron, y las citas analizadas se agruparon en trece categorías que se englobaron en cinco metacategorías: impacto de la pandemia en los profesionales, cambios en la atención familiar y comunitaria, repercusión de la pandemia en la población, trabajo en equipo y propuestas de mejora.Como conclusiones se obtuvieron: el miedo de los profesionales en la etapa inicial de la pandemia que se transformó en frustración, cansancio y tristeza en fases posteriores, la ruptura con la AP tradicional, así como diversas propuestas de mejora (empoderamiento del paciente, potenciación de los equipos multidisciplinares…). (AU)

The COVID-19 pandemic has entailed a sudden change in the usual approach to health promotion, prevention, treatment and rehabilitation of diseases. Primary care has undergone a significant impact due to the pandemic situation and its professionals have played an essential role. At the same time both their professional and personal lives have undergone major changes.The aim of the study was to know and understand the impact of the pandemic on the personal and professional spheres of primary care, as well as analyze and present proposals at the organizational and attention level.A qualitative study was performed by means of four interdisciplinary focus groups in which 26 primary care professionals took part (administrative assistants, nursing assistants, nurses and doctors).To perform the analysis, inductive content analysis methodology was used by means of the method of constant comparisons of Glaser and Strauss and Atlas TI computer software.The four focus groups were transcribed, and the citations analyzed were grouped into thirteen categories. They were included in five meta-categories: impact of the pandemic on professionals, changes in family and community care, impact of the pandemic on the population, teamwork and proposals for betterment.Conclusions drawn were the fear felt by professionals at the initial stage of the pandemic, which turned into frustration, tiredness and sadness in later phases, the break with traditional primary care, as well as various proposals for improvement (patient empowerment, enhancement of multi-disciplinary teams, etc.) (AU)

Awareness of healthcare providers on environment-friendly practices in operating rooms in selected hospitals in Riyadh, Saudi Arabia.

Climate change will have a great impact on humanity in upcoming years and will affect the health of all living creatures. Hospitals play a significant role in climate change due to their substantial waste production and they are considered a profound pollution source, with the Operating Theater as a main contributor. This study was aimed to examine the level of knowledge among healthcare professionals in Saudi Arabia concerning the proper implementation of operating room (OR) environmental procedures and efficient management of hospital waste. This is a cross sectional study performed across 3 hospitals in Riyadh, Saudi Arabia. The hospitals included are Prince Sultan military hospital, National guard hospital and King Salman hospital. The study included all the staff and health workers in OR (operating room), excluding all staff and health workers not in OR. The study took place between September 1 and November 1, 2022. None of the study participants mentioned that their institute or hospital fully engaged in Greenhealth Greening the OR initiative. Almost 1 to 3rd of the study participants (38.1%) mentioned that endorsement and participation in the practice of Greenhealth Greening the OR initiative was not implemented at all, and 45% of the participants were completely unaware of such an initiative. The study's findings suggest that healthcare providers in Saudi Arabia are not fully aware of environmentally friendly practices. Further, the current initiatives undertaken by the hospital administration fall short in attaining environmentally sustainable benchmarks.

Community Awareness and Education: In the West and Southeast Asia.

Although cholangiocarcinoma (CCA) or bile duct cancer is considered rare, worldwide it is the second most common primary liver cancer. The incidence is increasing globally, and mortality is high owing to its aggressiveness, late diagnosis, and refractory nature. In this chapter, the awareness of cholangiocarcinoma in the West and in Southeast Asia, particularly Thailand, is explored. The background to this cancer in each region is described, and the challenges faced by both by healthcare professionals and patients are uncovered. Although there is a growing number of organisations working at every level in each region to improve the situation for those with cholangiocarcinoma, there remains little awareness of the public health importance of this cancer. However, it is with health agencies and those at government level that hopes for an improved future for all those with cholangiocarcinoma must lie.

Feasibility of a Stop Smoking Program for Healthcare Workers in an Italian Hospital: Econometric Analysis in a Total Worker Health® Approach.

Background: Over 20% of healthcare workers (HCWs) are active smokers. Smoking is a targeted issue for workplace health promotion (WHP) programs. Objective: Our study aims to evaluate the effectiveness of the Stop Smoking Promotion (SSP) intervention, a 6-hour training course for HCWs, which took place from May 2018 to July 2019. Methods: We compared HCWs who successfully quit smoking (n = 15) to those who did not (n = 25) in terms of Sickness Absence Days (SADs). Moreover, we conducted an econometric analysis by calculating the return on investment and implementing a break-even analysis. Findings: Among the 40 enrolled workers, a success rate of 37.5% was observed after a span of over two years from the SSP intervention (with nurses and physicians showed the best success rate). Overall, participants showed a noticeable absenteeism reduction after the SSP intervention, with a reduction rate of 85.0% in a one-year period. The estimated ROI for the hospital was 1.90, and the break-even point was 7.85. In other words, the organization nearly doubled its profit from the investment, and the success of at least eight participants balanced costs and profits. Conclusion: Our pilot study confirms that WHP programs are simple and cost-saving tools which may help improve control over the smoking pandemic in healthcare settings.

Sense of Coherence (SOC) of Italian healthcare workers during the COVID-19 pandemic: analysis of associated factors.

Introduction: The COVID-19 pandemic has posed significant challenges for healthcare workers worldwide, potentially affecting their sense of coherence (SOC) and overall well-being. This study aimed to identify factors associated with different levels of SOC among healthcare workers, exploring demographic characteristics, work-related factors, changes in relationships and social habits, and the overall well-being. Methods: A cross-sectional study was conducted among 628 healthcare workers. SOC scores were assessed using a standardized questionnaire. Statistical analyses were performed to identify associations between these factors and SOC. Results: Healthcare workers had a lower average SOC score (mean: 57.1) compared to the national average in Italy (mean: 60.3). Younger age and shorter length of service were associated with a higher risk of low SOC (p < 0.0001). Healthcare workers in the northwestern regions of Italy had an increased risk of low SOC compared to their counterparts in the northeastern regions (p = 0.0336). Adverse pandemic-related experiences and worsening social relationships were also associated with a higher risk of low SOC (p < 0.0001). Conclusions: This study highlights the unique challenges and stressors faced by healthcare workers during the COVID-19 pandemic and their impact on SOC. Age, length of service, geographic location, and social status were significant factors influencing SOC levels. Targeted interventions are needed to enhance SOC and well-being, particularly for younger and newly employed healthcare workers. Strategies promoting social connections, work-life balance, and psychological support services are crucial to support healthcare workers' resilience and coping abilities.

Knowledge, Attitude and Practice Among Palestinian Healthcare Workers in the Gaza Strip Towards Hepatitis B: Cross-sectional survey.

Objectives: Healthcare workers are at high risk of contracting hepatitis B virus (HBV). This survey aimed to identify the gaps and strengths in the knowledge, attitudes and practices of healthcare workers towards HBV to drive appropriate health interventions. Methods: This cross-sectional study was conducted between March and April 2022. A convenience sample of three at-risk healthcare professions from the major health facilities in Gaza was surveyed. A 40-item self-administered questionnaire was used. Statistical data analysis was conducted using Statistical Package for Social Sciences version 25 to obtain descriptive and inferential statistics via various nonparametric, correlation and regression tests (with P <0.05). Results: A total of 447 healthcare workers participated in the study. Overall, 105 of the participants (23.5%) demonstrated poor knowledge (below 14/20 points) of HBV, 284 (63.5%) had moderate knowledge (14-17 points) and 58 (13%) showed good knowledge. The majority (n = 367, 82.1%) expressed an excellent attitude. Finally, 287 (64.2%) demonstrated a good level of practice regarding HBV infection. A history of needlestick injury was reported by 233 (52.1%) participants, 170 (73.3%) of whom reported taking appropriate preventive actions after exposure. Conclusion: The majority of the participants demonstrated overall good knowledge regarding HBV infection. Nonetheless, significant gaps remain in the different aspects of the knowledge, attitude and practice construct that require appropriate awareness campaigns to further limit the spread of this preventable viral infection.

Identification of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections Among Healthcare Workers at Sultan Qaboos University Hospital, Oman.

Objectives: This study aimed to describe the incidence and features of asymptomatic COVID-19 infections among healthcare workers (HCWs) at a tertiary hospital in Oman. Methods: This cross-sectional study was conducted between August 2020 and February 2021 among HCWs with no history of COVID-19 infection. An online questionnaire collected sociodemographic and clinical data. COVID-19 infection was diagnosed using nasopharyngeal/throat swabs, which were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Analyses were performed using the Chi-squared test, Fisher's exact test or univariate ordinary least squares regression, as appropriate. Results: A total of 583 HCWs participated in the study, most of whom were female (56.6%), and the mean age was 35 ± 8 years. Only 9.6% (95% confidence interval [CI]: 7.3-12.3%) of the HCWs were at high exposure risk as they were directly involved in the care of COVID-19-infected patients. Overall, 4.1% (95% CI: 2.7-6.1%) of the HCWs screened positive for SARS-CoV-2, of which 20.8% developed symptoms within two weeks. The frequency of SARS-CoV-2 positivity among HCWs working in high-, intermediate-, low- and miscellaneous-risk areas was 1.8% (95% CI: <0.1-9.6%), 2.6% (95% CI: <0.1-6.5%), 5.3% (95% CI: 0.3-9.3%) and 4.8% (95% CI: <0.1-69.3%), respectively. Working in high-risk areas was associated with increased compliance with various infection control strategies (P <0.001). Conclusion: There was a greater frequency of SARS-CoV-2 positivity among HCWs working in low-risk areas, whereas HCWs who worked in high-risk areas were significantly more likely to report increased compliance with infection control strategies.

Utilization, Steering, and Spending in Vertical Relationships Between Physicians and Health Systems.

Importance: Vertical relationships (eg, ownership or affiliations, including joint contracting) between physicians and health systems are increasing in the US. Objective: To analyze how vertical relationships between primary care physicians (PCPs) and large health systems are associated with changes in ambulatory and acute care utilization, referral patterns, readmissions, and total medical spending for commercially insured individuals. Design, Setting, and Participants: This case-control study with a repeated cross-section, stacked event design analyzed outcomes of patients whose attributed PCP entered a vertical relationship with a large health care system in 2015 or 2017 compared with patients whose attributed PCP was either never or always in a vertical relationship with a large health system from 2013 to 2017 in the state of Massachusetts. The sample consisted of commercially insured patients who met enrollment criteria and who were attributed to PCPs who were included in the Massachusetts Provider Database in 2013, 2015, and 2017 and for whom vertical relationships were measured. Enrollee and claims data were obtained from the 2013 to 2017 Massachusetts All-Payer Claims Database. Statistical analyses were conducted between January 5, 2021, and June 5, 2023. Exposure: Evaluation-and-management visit with attributed PCP in 2015 to 2017. Main Outcomes and Measures: Outcomes (which were measured per patient-year [ie, per patient per year from January to December] in this sample) were utilization (count of specialist physician visits, emergency department [ED] visits, and hospitalizations overall and within attributed PCP's health system), spending (total medical expenditures and use of high-price hospitals), and readmissions (readmission rate and use of hospitals with a low readmission rate). Results: The sample of 4 030 224 observations included 2 147 303 females (53.3%) and 1 881 921 males (46.7%) with a mean (SD) age of 35.07 (19.95) years. Vertical relationships between PCPs and large health systems were associated with an increase of 0.69 (95% CI, 0.34-1.04; P < .001) in specialist visits per patient-year, a 22.64% increase vs the comparison group mean of 3.06 visits, and a $356.67 (95% CI, $77.16-$636.18; P = .01) increase in total medical expenditures per patient-year, a 6.26% increase vs the comparison group mean of $5700.07. Within the health care system of the attributed PCPs, the number of specialist visits changed by 0.80 (95% CI, 0.56-1.05) per patient year (P < .001), a 29.38% increase vs the comparison group mean of 2.73 specialist visits per patient-year. The number of ED visits changed by 0.02 (95% CI, 0.01-0.03) per patient year (P = .001), a 14.19% increase over the comparison group mean of 0.15 ED visits per patient-year. The number of hospitalizations changed by 0.01 (95% CI, 0.00-0.01) per patient-year (P < .001), a 22.36% increase over the comparison group mean of 0.03 hospitalizations per patient-year. There were no differences in readmission outcomes. Conclusions: Results of this case-control study suggest that vertical relationships between PCPs and large health systems were associated with steering of patients into health systems and increased spending on patient care, but no difference in readmissions was found.

Strategies for Working With Parents With Vaccination Hesitancy.

The purpose of this article is to provide an overview of effective strategies for working with parents' vaccination hesitancy or refusal. An overview of historical and current trends in vaccination hesitancy and factors that contribute to and strategies for addressing vaccine hesitancy are discussed. This includes an emphasis on the critical role played by health care providers, as trusted advisors and a primary source of health care information, in encouraging vaccine acceptance. Legal and ethical implications are also considered. Vaccination hesitancy strategies are most effective if they are timely, multifaceted, and collaborative.

[Organ donation is not a gift]. / Le don d'organes n'est pas un don.

If the obligation to donate as defined by French law ("we are all donors") remains in the wake of sociologist Marcel Mauss's Essai sur le don (Essay on donation), there the similarity ends. How do you make a counter-donation to a deceased person? In the case of inter vivos organ donation, the act is more akin to mutualization than donation.

Predictors of persistent opioid use in non-cancer older adults: a retrospective cohort study.

BACKGROUND: Long-term opioid use and associated adverse outcomes have increased dramatically in recent years. Limited research is available on long-term opioid use in older adults. OBJECTIVE: We aimed to determine the incidence and predictors of long-term or persistent opioid use (POU) amongst opioid-naïve older adults without a cancer diagnosis. METHODS: This was a retrospective cohort study using five national administrative healthcare databases in New Zealand. We included all opioid-naïve older adults (≥65 years) who were initiated on opioid therapy between January 2013 and June 2018. The outcome of interest was POU, defined as having continuously filled ≥1 opioid prescription within 91-180 days after the index opioid prescription. Multivariable logistic regression was used to examine the predictors of POU. RESULTS: The final sample included 268,857 opioid-naïve older adults; of these, 5,849(2.2%) developed POU. Several predictors of POU were identified. The use of fentanyl (adjusted odds ratio (AOR) = 3.61; 95% confidence interval (CI) 2.63-4.95), slow-release opioids (AOR = 3.02; 95%CI 2.78-3.29), strong opioids (AOR = 2.03; 95%CI 1.55-2.65), Charlson Comorbidity Score ≥ 3 (AOR = 2.09; 95% CI 1.78-2.46), history of substance abuse (AOR = 1.52; 95%CI 1.35-1.72), living in most socioeconomically deprived areas (AOR = 1.40; 95%CI 1.27-1.54), and anti-epileptics (AOR = 2.07; 95%CI 1.89-2.26), non-opioid analgesics (AOR = 2.05; 95%CI 1.89-2.21), antipsychotics (AOR = 1.96; 95%CI 1.78-2.17) or antidepressants (AOR = 1.50; 95%CI 1.41-1.59) medication use were the strongest predictors of POU. CONCLUSION: A significant proportion of patients developed POU, and several factors were associated with POU. The findings will enable healthcare providers and policymakers to target early interventions to prevent POU and related adverse events.

Age and professional experience as determinants of the utilization of psychoneuroimmunological research in clinical practice: An exploratory study.

The immune system is affected by psychosocial stimuli and plays a major role in the development of various diseases. Psychoneuroimmunology (PNI)-based interventions may positively influence the disease course; however, the impact of PNI research findings on clinical practice differs depending on the medical specialties involved. A comprehensive overview of the use of PNI research findings in clinical practice is currently lacking. This exploratory study aimed to provide insight into the dissemination of PNI research findings and their practical applications among clinical practitioners. Data was collected from 50 physicians using an ad hoc online questionnaire. We invited participants to take part in our online survey via an article in the DocCheck Newsletter, a German-language newsletter for physicians. Bivariate nonparametric correlation analysis (Spearman correlation) were used to explore the relationship between independent variables (age, sex, medical specialty, professional experience, and clinical environment) and dependent variables (six questionnaire items concerned with awareness, relevance, and utilization of PNI concepts). While 46% of respondents believed that PNI research findings were relevant to patient treatment, only 22% used PNI-based interventions as part of their therapeutic regimen. Furthermore, 90% of participants could not refer their patients to therapists offering PNI-based interventions. Moderately positive correlations were identified between the increasing age (rs = .48, P < .001) and increasing amount of professional experience (rs = .34, P = .02) of study participants and awareness of the theoretical foundations of PNI research. Although there is some awareness of PNI among medical practitioners, there appears to be a clear barrier inhibiting the implementation of research findings in current treatment practices. Therefore, it is necessary to examine the impact of increasing age and professional experience on the utilization of PNI-based interventions in patient care.

Workplace bullying and violence in health sector in Saudi Arabia.

Workplace bullying violence (BV), with psychological and physical impacts, is increasing globally. However, studies from Saudi Arabia investigating which specialties are most exposed, and linking them with other factors, such as sociodemographic conditions, are scarce. This study aimed to estimate the prevalence of workplace BV over a 12-month period and determine the circumstances related to the event, consequences for the attacker, and targeted personnel among all healthcare providers in the Kingdom of Saudi Arabia (KSA). This analytical cross-sectional study included all health providers registered with the Saudi Commission for Health Specialties who worked for more than 1 year in the healthcare sector (governmental or private) in the KSA until May 2019. In total, 7398 healthcare workers were electively enrolled in the study; 51.3% were men, and 48.7% were women, with a mean age of 40 ± 8.62 years. They were mostly (60%) non-Saudi. Overall, 26.6% encountered BV. Those who worked in the private sector, in shifts, especially evening shifts, were significantly more exposed. Furthermore, pharmacists had the highest prevalence of workplace violence. The prevalence of BV is moderately high; however, it is a serious issue faced by healthcare workers, especially those working night shifts. Pharmacists were more likely to experience bullying. This demonstrates that more support, specific strategies, and policies are required to reduce the occurrence of workplace BV, protect healthcare providers, and prevent attacks. Underreporting these situations may give an incorrect indication of the magnitude of the problem; thus, more education and further studies in the KSA are needed.

Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers.

BACKGROUND: Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome. PURPOSE: To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave. METHODS: This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits - one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned. RESULTS: Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed. CONCLUSIONS: Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.

Knowledge and experiences of families regarding amber necklaces.

BACKGROUND: Amber necklaces have been used frequently to reduce the complaints of babies during teething. In this study, the knowledge and experience of families regarding the use of amber necklaces investigated. METHODS: The structured questionnaire was applied face-to-face to parents with a 4-24 month old baby who applied to the paediatric outpatient clinic. RESULTS: One hundred one families participating in the study reported that they used the amber necklace most frequently for restlessness (n = 72, 71.3%). Eighty- three% of families reported that the amber necklace was beneficial. It determined that 2% of the babies had suffocation and 2% had problems dispersing the grains. CONCLUSION: Although the parents think that the use of amber necklaces is effective during the teething period, they are not aware of the risks. It is important for healthcare professionals to inform their families about teething and especially the risks of using amber necklaces.