Selection of Medical Teachers: An Initiative for Ensuring a Fair and Transparent Selection Process.

BACKGROUND: The first step towards creating a sound educational environment and healthcare in a medical institute is employing medical teachers who maintain ethical behavior in their professional practice. A method where bias and subjectivity can be minimized is by making the recruitment process objective. MATERIAL AND METHODS: The recruitment started as an offline process and was soon converted into an online form incorporating parameters for scoring. A total of 1,151 medical teachers had submitted their applications for posts in various departments, and 778 candidates were shortlisted and called for an interview. After the interview process, a unique symposium on the selection of medical teachers was organized. The feedback was incorporated into the online application that was released for the subsequent phases of recruitment. RESULTS: The response rate of the study was 96.55%. Analysis of the feedback by the applicants showed that 47.59% of the applicants were of the opinion that the prevailing selection process in the country needs a change; 84.14% felt that the inclusion of objective criteria would make the selection process more transparent; and 91.03% were happy with the stratification of marks; 82.75% of the applicants and experts felt that knowledge of statistics for quality research and publications in indexed and institutional journals may be considered for the selection process; and 52.41% thought that all authors of an article should be given equal weightage. Adopting a fairly new concept of workplace-based assessment (WPBA) in India was acceptable to 83.45%. CONCLUSIONS: Parameter-based, objective selection reduces bias, and merit alone is recognized.

'People that suffer or have been through it know the answers': stakeholders' perspectives on improving healthcare systems for end-of-life care in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive and disabling lung condition with a high mortality. Our research has shown that health care for end-of-life COPD is poorly integrated. The aim of this study was to involve people with end-of-life COPD, their support people and health professionals in the design of healthcare services to help improve the delivery of care for advanced COPD, including informing system-level quality improvement. DESIGN: We conducted a focus group study involving stakeholders of healthcare services: people with end-of life COPD, support people, bereaved support people, and community- and hospital-based health care professionals. METHODS: We conducted qualitative analysis using deductive structural coding, and then inductive descriptive and pattern coding. Analyses were triangulated by investigators. The research positioned people with end-of-life COPD, their support people and health professionals as experts in healthcare services. Critical theory and Actor-Network theory informed the analysis. RESULTS: Seven focus groups involving 74 participants reported their experiences of end-of-life care for COPD. Five themes related to healthcare systems responses to improving care quality were identified: governance, system integration, resource design and development, standardisation of processes, and communication. CONCLUSION: Stakeholders provided multiple healthcare system-level responses to end-of-life care in COPD that could inform healthcare service design and clinical quality improvement.

A New Global Air Quality Health Index Based on the WHO Air Quality Guideline Values With Application in Cape Town.

Objectives: This study developed an Air Quality Health Index (AQHI) based on global scientific evidence and applied it to data from Cape Town, South Africa. Methods: Effect estimates from two global systematic reviews and meta-analyses were used to derive the excess risk (ER) for PM2.5, PM10, NO2, SO2 and O3. Single pollutant AQHIs were developed and scaled using the ERs at the WHO 2021 long-term Air Quality Guideline (AQG) values to define the upper level of the "low risk" range. An overall daily AQHI was defined as weighted average of the single AQHIs. Results: Between 2006 and 2015, 87% of the days posed "moderate to high risk" to Cape Town's population, mainly due to PM10 and NO2 levels. The seasonal pattern of air quality shows "high risk" occurring mostly during the colder months of July-September. Conclusion: The AQHI, with its reference to the WHO 2021 long-term AQG provides a global application and can assist countries in communicating risks in relation to their daily air quality.

Social Determinants of Health: An Overview for the Primary Care Provider.

Social determinants of health (SDoH) are reflected in how people live (access to health care, economic stability, built environment, food security, climate), learn (the educational environment), work (occupational environment), and play/socialize (social context and digital domain). All of these day-to-day conditions play a vital role in a patient's overall health, and a primary care provider should be prepared to understand their role to screen, assess, and address SDoH in clinical practice.

Developing Standard Treatment Workflows-way to universal healthcare in India.

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

Navigating language discordance in public health care in rural South Africa: a qualitative descriptive study of occupational therapists' perspectives.

BACKGROUND: Language discordance occurs in healthcare when staff and service users do not share proficiency in the same language. It is a global phenomenon impacting on the quality of health services, as person-centred practice requires communication to establish partnerships and rapport. In a country as linguistically diverse as South Africa, effective ways to navigate language discordance in health care are urgently required, yet there is limited research. This study aimed to describe how occupational therapists navigated language discordance when working in the public health sector in KwaZulu-Natal. METHODS: A qualitative descriptive design involved using purposive sampling to recruit occupational therapists as participants (n = 8) for 15 semi-structured interviews. Thematic analysis was used to analyse the data, which included reflective journal entries from all participants. RESULTS: The four emergent themes were: (1) concurrent use of strategies, (2) I'm doing as much I can, what more can I do? (3) Language definitely impacts that therapy process and lastly, (4) systemic oppression perpetuating language discordance. CONCLUSION: Language discordance is a complex context-specific phenomenon, therefore insight into concurrent use of strategies is important to practitioners to enable them to navigate language discordance and ensure provision of quality services. These insights are significant for healthcare professionals and resource allocators as they shed light on the shortcomings of advocating for a single strategy such as providing trained interpreters. Successful navigation is characterised by determination, being kind to oneself, willingness to learn and use of pragmatic and flexible approaches. To prepare to navigate language discordance in a low-resource context, education should extend in time and scope, to include multiple strategies, culture and relevant languages.

Evaluation of the health risk using multi-pollutant air quality health index: case study in Tianjin, China.

Introduction: Air pollution imposes a significant burden on public health. Compared with the popular air quality index (AQI), the air quality health index (AQHI) provides a more comprehensive approach to measuring mixtures of air pollutants and is suitable for overall assessments of the short-term health effects of such mixtures. Methods: We established an AQHI and cumulative risk index (CRI)-AQHI for Tianjin using single-and multi-pollutant models, respectively, as well as environmental, meteorological, and daily mortality data of residents in Tianjin between 2018 and 2020. Results and discussion: Compared with the AQI, the AQHI and CRI-AQHI established herein correlated more closely with the exposure-response relationships of the total mortality effects on residents. For each increase in the interquartile range of the AQHI, CRI-AQHI and AQI, the total daily mortality rates increased by 2.06, 1.69 and 0.62%, respectively. The AQHI and CRI-AQHI predicted daily mortality rate of residents more effectively than the AQI, and the correlations of AQHI and CRI-AQHI with health were similar. Our AQHI of Tianjin was used to establish specific (S)-AQHIs for different disease groups. The results showed that all measured air pollutants had the greatest impact on the health of persons with chronic respiratory diseases, followed by lung cancer, and cardiovascular and cerebrovascular diseases. The AQHI of Tianjin established in this study was accurate and dependable for assessing short-term health risks of air pollution in Tianjin, and the established S-AQHI can be used to separately assess health risks among different disease groups.

Missed nursing care in emergency departments: A scoping review.

BACKGROUND: Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts. AIM: The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs. METHOD: A scoping review following the framework suggested by Arksey and O'Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation. RESULTS: In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe. CONCLUSION: The findings from this scoping review indicate that patients' fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.

Air quality health index (AQHI) based on multiple air pollutants and mortality risks in Taiwan: Construction and validation.

The currently used air quality index (AQI) is not able to capture the additive effects of air pollution on health risks and reflect non-threshold concentration-response relationships, which has been criticized. We proposed the air quality health index (AQHI) based on daily air pollution-mortality associations, and compared its validity in predicting daily mortality and morbidity risks with the existing AQI. We examined the excess risk (ER) of daily elderly (≥65-year-old) mortality associated with 6 air pollutants (PM2.5, PM10, SO2, CO, NO2, and O3) in 72 townships across Taiwan from 2006 to 2014 by performing a time-series analysis using a Poisson regression model. Random effect meta-analysis was used to pool the township-specified ER for each air pollutant in the overall and seasonal scenarios. The integrated ERs for mortality were calculated and used to construct the AQHI. The association of the AQHI with daily mortality and morbidity were compared by calculating the percentage change per interquartile range (IQR) increase in the indices. The magnitude of the ER on the concentration-response curve was used to evaluate the performance of the AQHI and AQI, regarding specific health outcomes. Sensitivity analysis was conducted using coefficients from the single- and two-pollutant models. The coefficients of PM2.5, NO2, SO2, and O3 associated with mortality were included to form the overall and season-specific AQHI. An IQR increase in the overall AQHI at lag 0 was associated with 1.90%, 2.96%, and 2.68% increases in mortality, asthma, and respiratory outpatient visits, respectively. The AQHI had higher ERs for mortality and morbidity on the validity examinations than the current AQI. The AQHI, which captures the combined effects of air pollution, can serve as a health risk communication tool to the public.

Disease specific air quality health index (AQHI) for spatiotemporal health risk assessment of multi-air pollutants.

While significant reductions in certain air pollutant concentrations did not induce obvious mitigations of health risks, a shift from air quality management to health risk prevention and control might be necessary to protect public health. This study thus constructed an Air Quality Health Index (AQHI) for respiratory (Res-AQHI), cardiovascular (Car-AQHI), and allergic (Aller-AQHI) risk groups using mixed exposure under multi-air pollutants and portrayed their distribution and variation at multiple spatiotemporal scales using spatial analysis in GIS with the medical big data and air pollution remote sensing data by taking Hunan Province in China as a case. Results showed that the AQHIs constructed for specific health-risk groups could better express their risks than common AQHI and AQI. Moreover, based on the spatiotemporal association of health and environmental information, the allergic risk group in Hunan provided the highest health risk mainly affected by O3. The following cardiovascular and respiratory risk groups can be significantly attributed to NO2. Moreover, the spatiotemporal heterogeneity of AQHIs within regions was also evident. On the annual scale, the population in the air health risk hotspots for respiratory and cardiovascular risk decreased, while allergic risks increased. Meanwhile, on seasonal scale, the hotspots for respiratory and cardiovascular risks expanded significantly in winter while completely disappearing for allergic risk. These findings suggest that disease specific AQHIs effectively disclose the health effects of multi-air pollutants and their subsequently varied spatiotemporal distribution patterns.

Why Bhutan needs a policy push on person-centred care.

Delivering quality healthcare services to people has become a core issue for the Bhutanese healthcare system. There are considerable challenges for healthcare policymakers to recognise and implement an appropriate healthcare model to enhance quality healthcare services in the Bhutanese healthcare system. Actions to improve quality healthcare services in Bhutan requires careful analysis of the healthcare model in the context of the Bhutanese socio-political and healthcare environment. This article provides a brief concept analysis of person-centred care in the context of the Bhutanese socio-political and healthcare environment and describes why it is important to integrate person-centred care into the healthcare system. The article argues that person-centred care is important and relevant to the Bhutanese healthcare system to achieve quality healthcare services and Gross National Happiness.

Leverage of mHealth integration in Maternal and child health services and COVID-19 Pandemic.

The growing use of mobile phones has enabled potential mobile health users to respond to various healthcare crises, even during the COVID-19 pandemic. In low- and middle-income countries where people lack access to basic healthcare, various "mHealth" interventions have been proven effective. In addition, it would facilitate public health researchers in developing new ways to improve the sustainability of MNCH programmes during emergencies or public health alerts. This article aims to provide evidence of mHealth integration in Pakistan's MNCH programme and to look into unique techniques used during the COVID-19 pandemic. This article suggested four key innovative mHealth strategies, including improving communication, teleconsultation, and CHW accessibility via mobile phones, providing free medication supplies to ANC&PNC mothers during health emergencies; and advocating for women's access to abortion services when necessary to support safe abortion. This article observes that mHealth can help improve maternal health in Pakistan and other LMICs by increasing human resource management and training, quality service delivery, and teleconsultation. However, additional digital health solutions are needed to attain SGD 3.

The state of adolescent medicine as a specific field: an international exploratory survey.

OBJECTIVES: The emergence of adolescent medicine (AM) as a specific area of training and health care delivery is progressing at various pace around the world. The objective of this exploratory survey was to inquire about the existence of official bodies and institutions offering recognition of the discipline as a specific field and on the status of related training initiatives. METHODS: A questionnaire was spread among a convenience sample of 21 colleagues involved in adolescent health care around the world, and answers were collected and analysed manually. RESULTS: All 21 colleagues from the North and South American, African, Asian and European regions have responded. Only seven countries report the existence of adolescent inpatient wards in some hospitals, while 16 have specialized outpatient clinics; in only eight countries is formal mandatory training in AM required for paediatricians; in seven others, such a stay is available but optional. Six countries have implemented a systematic assessment tackling AM in the certification process of paediatricians and just four recognize AM as a sub-specialty. Only two countries mention compulsory training in AM for family doctors. Fourteen countries report on the existence of an AM association. CONCLUSIONS: Despite an encouraging number of initiatives testifying the growing place of AM in the practice of medicine, our data bring a worrisome portray of the status of AM in the involved countries and call for the development of appropriate health care and training centres.

Long-term variation and evaluation of air quality across Hong Kong.

Study of Air Quality Objectives (AQOs) and long-term changes of air pollution plays a decisive role in formulating and refining pollution control strategies. In this study, 10-year variations of six major air pollutants were analyzed at seven monitoring sites in Hong Kong. The continuous decrease of annual averaged concentrations of NO2, SO2, CO, PM2.5 and PM10 and numbers of days with severe pollution conditions validated the efficiency of the series of air pollution control schemes implemented by the Hong Kong government. However, there is still a big gap to meet the ultimate targets described by the World Health Organization. Besides, the concentration of O3 at roadside and urban stations increased by 135% ± 25% and 37% ± 18% from 2011 to 2020, respectively, meanwhile the highest 8 hr averaged O3 concentration was observed as 294 µg/m3 at background station in 2020, which pointed out the increasing ozone pollution in Hong Kong. There was a great decrease in the annual times of air quality health index (AQHI) laying in "high", "very high" and "serious" categories from 2011 to 2020 with the decrease rate of 89.70%, 91.30% and 89.74% at roadside stations, and 79.03%, 95.98% and 72.73% at urban stations, respectively. Nevertheless, the number of days categorized as "high" or above at roadside station was twice more than that in the urban station during the past ten years. Thus, more policies and attentions should be given to the roadside air quality and its adverse health effect to pedestrians on street.

Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early onset colorectal cancer.

American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20-49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.

Construction of AQHI based on joint effects of multi-pollutants in 5 provinces of China / 环境与职业医学

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO2, NO2, CO, PM2.5, PM10, and maximum 8 h O3 concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM2.5, NO2, SO2, and O3 were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM2.5, NO2, SO2 and O3 were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Notificação de incidentes e a segurança do paciente em tempos de pandemia / Notificación de incidentes y la seguridad del paciente en tiempos de pandemia / Incident notification and patient safety in times of a pandemic

Resumo Objetivo Analisar as notificações de incidentes ocorridos durante a pandemia de COVID-19. Métodos Estudo com delineamento transversal de abordagem quantitativa do tipo descritivo exploratório. Foram analisadas 1.466 notificações à gerência de risco de um hospital privado, no período de setembro de 2020 a setembro de 2021. Utilizou-se a análise estatística descritiva, aplicando o teste Qui-quadrado de Pearson ou o teste da Razão de Verossimilhança. A margem de erro utilizada foi de 5%. Resultados Identificou-se como incidentes prevalentes a falha na comunicação (358 - 24,5%), falha no uso de sondas e cateteres (232 - 15,9%) e falha no uso de artigos e equipamentos (132 - 9,1%). A circunstância notificável totalizou (55,9%) dos relatos e destas, (33,4%) eram falha na comunicação. Os eventos adversos foram em número de 416 (28,6%) e a queda esteve relacionada a dano leve (43,9%); Infecção relacionada à assistência à saúde ao dano moderado (31%) e a falha no uso de medicamentos a (50%) como dano grave e óbito. Conclusão Falha na comunicação foi a circunstância de risco mais notificada, seguida de falha no uso de medicamentos como evento adverso com dano grave. A unidade de enfermaria evidenciou a possibilidade de maior número de eventos adversos; enquanto que nas unidades de terapia intensiva o grau de dano dos eventos adversos foi superior.

Resumen Objetivo Analizar las notificaciones de incidentes ocurridos durante la pandemia de COVID-19. Métodos Estudio con diseño transversal de enfoque cuantitativo del tipo descriptivo exploratorio. Se analizaron 1.466 notificaciones de la gestión de riesgo de un hospital privado, en el período de septiembre de 2020 a septiembre de 2021. Se utilizó el análisis estadístico descriptivo, aplicando la prueba χ2 de Pearson o la prueba de razón de verosimilitud. El margen de error utilizado fue del 5 %. Resultados Se identificaron como incidentes prevalentes la falla en la comunicación (358 - 24,5 %), falla en el uso de sondas y de catéteres (232 - 15,9 %) y falla en el uso de artículos y equipos (132 - 9,1 %). Las circunstancias que pueden ser notificadas totalizaron (55,9 %) de los relatos y, entre ellas, (33,4 %) era una falla en la comunicación. Los eventos adversos totalizaron 416 (28,6 %) y la disminución estuvo relacionada con el daño leve (43,9 %); infección relacionada con la atención a la salud al daño moderado (31 %) y a la falla al usar medicamentos (50 %) como daño grave y defunción. Conclusión La falla en la comunicación fue la circunstancia de riesgo más notificada, seguida de falla al usar medicamentos como evento adverso con daño grave. La unidad de enfermería evidenció la posibilidad de un número más elevado de eventos adversos; mientras que en las unidades de terapia intensiva el grado de daño de los eventos adversos fue superior.

Abstract Objective To review notification of incidents that occurred during the COVID-19 pandemic. Methods This is a cross-sectional, exploratory descriptive quantitative study. A total of 1,466 notifications to risk management of a private hospital were analyzed from September 2020 to September 2021. Descriptive statistical analysis was used, applying Pearson's chi-square test or the likelihood ratio test. The margin of error used was 5%. Results Communication failure (358 - 24.5%), probe and catheter use failure (232 - 15.9%) and article and equipment use failure (132 - 9.1%) were identified as prevalent incidents. The notifiable circumstance totaled 55.9% of reports, and, of these, 33.4% were communication failure. Adverse events were 416 (28.6%), and fall was related to mild damage (43.9%), health care-associated infections, to moderate harm (31%), and medication use failure (50%), to severe harm and death. Conclusion Communication failure was the most reported risk circumstance, followed by medication use failure as an adverse event with severe harm. The nursing unit showed the possibility of a greater number of adverse events, while in Intensive Care Units, the degree of harm from adverse events was higher.

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

Job demands and job resources for job satisfaction and quality health outcomes among nurses during COVID-19: A cross-sectional study in Indian health settings.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for the Indian health-care system. Nurses, being vital partners of health care, experience tremendous challenges and job stress to deliver quality health care with limited resources. Drastic surge in health-care demands during COVID-19 pandemic amplified the challenges for nurses, yet it remains a neglected area of concern. Job resources like working conditions, team support, and job demands like workload, stress, and ethical dilemmas greatly affect the job satisfaction and health outcomes in nurses. The study aims to identify the job demands and resources among nurses in connection to COVID 19. MATERIALS AND METHODS: A quantitative cross-sectional design was adopted to assess the impact of job demands and resources among registered nurses (N = 102). Those in the age group of 21-58 years and working in regular and COVID-19 patient care were included. Semi-structured interview schedule was used, and psychological impact was assessed through DASS-21 scale. Data analysis was done by descriptive and analytical statistical applications using Statistical Package for the Social Sciences (SPSS) 20. The level of significance was P ≤ 0.05. RESULTS: The study findings revealed that 66.67% of the nurses frequently experienced work pressure, 72.55%experienced frequent moral distress, and 80.4%were dissatisfied due to being non-participatory inpatient care decision making. Of all, 67.3% agreed that they hadjob dissatisfaction and 79.4% felt conflicting work climate. CONCLUSION: Nurses, being key players in the health care, experience constant challenges in the delivery of safe and quality patient care. Addressing the challenges of job stress and promoting job resources can positively impact their job satisfaction, perceived autonomy, job morale, and commitment, which directly influence positive health outcomes.

Antenatal care as a risk factor for caesarean section: a case study in Brazil.

BACKGROUND: Antenatal care is an important tool to prevent complications and decrease the incidence of maternal and antenatal morbidity and mortality. In Brazil, quality, access, and coverage of antenatal care are described as insufficient. Consequently, high rates of caesarean section, congenital morbidities such as syphilis, maternal and early neonatal mortality occur, as well as obstetric violence and dissatisfaction with healthcare. It is important to reflect on health disparities in antenatal care. This study aimed to carry out a critical analysis of antenatal care in one city of São Paulo state in Brazil. METHODS: A case study was performed, structured in a descriptive cross-sectional epidemiological study and two qualitative studies. Data for the epidemiological study was obtained from the Informatics Department of the Unified Health System (DATASUS) of Brazil, which was processed in the Epi-info v software 7.2. and treated descriptively and by the Mantel-Haenszel or Fisher's exact tests. Qualitative data was collected through semi-structured interviews with 30 pregnant women and 8 nurses in the primary healthcare service of one city in São Paulo. The qualitative data analysis was based on thematic content analysis. RESULTS: The data revealed a limited quality of antenatal care. More than six antenatal visits increased the probability of a caesarean section by 47% and babies born vaginally had a lower Apgar score. There was little participation of nurses in antenatal care and women described it as "a quick medical appointment", limited by protocols, based on procedures and insufficient in dialogue. Antenatal care appeared to be fragmented and permeated by challenges that involve the need for change in management, performance, and ongoing training of professionals, as well as in the guarantee of women's rights. CONCLUSIONS: Caesarean section was statistically related to the number of antenatal care visits. Interactions between professionals and pregnant women were poor and resulted in dissatisfaction. There is an urgent need to connect health indicators with the findings from professionals and women's experiences to improve the quality of antenatal care.