Public General Hospital Research Articles

Lived experiences of Iranian nursing managers in organizing and confronting the COVID-19 pandemic.

The prevalence of the new infectious disease is a global health issue and a threat to nurses and other health care workers. In addition to nurses who have been directly involved in the care of patients with coronavirus disease 2019 (COVID-19), nursing managers have also played a key role in the management and control of this disease. The present study aimed to investigate the lived experiences of nursing managers in organizing and confronting COVID-19 in Iran. This study was a qualitative research design conducted by descriptive phenomenology based on Husserl philosophy. Participants consisted of 32 nursing managers working in general public hospitals in East Guilan, north of Iran, selected using purposive sampling. In-depth and semi-structured interviews were used to collect data. Colaizzi's strategy was used to analyze the data. Coding was done with MAXQDA 2007 software. Lincoln and Guba trustworthiness criteria were used to achieve accuracy and reliability of the data. Data analysis led to the emergence of a main theme called "Management in the COVID-19 Crisis" and three sub-themes: "Dealing with the unknown", "Managing deficiencies and assets" and "Structural challenges". In this study the nursing managers experienced how to deal with the COVID-19 crisis. By examining the experiences of managers involved in the COVID-19 pandemic, a rich set of managerial experiences can be gathered that prepare them for other infectious diseases in the future.

Investigating Mobbing Syndrome's Incidence in the Working Environment of a Public and a Private Greek Hospital.

To investigate the phenomenon of moral harassment (mobbing) as well as the effect of demographic and occupational characteristics of healthcare professionals working in a public provincial general hospital and a private hospital in Athens a cross-sectional survey was designed. The study was conducted from November to December 2021 through the application of the Leymann Inventory of Psychological Terror (LIPT) a widely recognized research tool for the quantitative investigation of ethical harassment in the workplace. 264 fully completed questionnaires were collected out of the 300 that were distributed in both hospitals (response rates: 92% for the public hospital and 83.3% for the private). It was observed that private hospital's employees were morally harassed to a greater extent and for a longer time than the employees of a public hospital. The levels of moral harassment were quite high, indicating the necessity of thorough audit by the management in both hospitals.

Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in public hospitals of Sidama Region, Sidama, Ethiopia, 2022: an unmatched case-control study.

neonatal jaundice appears in most neonates as "physiological jaundice" in the first few weeks of life; however, pathological jaundice is associated with an increased risk of long-term complications and mortality only a few studies have been conducted on the determinants of neonatal jaundice in Ethiopia. The aim of this study was to identify the determinants of neonatal jaundice (pathological) among neonates admitted to neonatal intensive care units in Sidama Region general and referral public hospitals. a hospital-based unmatched case-control study was conducted among 270 neonates in public hospitals of Sidama Region from June 23 to August 8, 2022. We used a pre-tested interviewer-administered questionnaire and collected by open data kit (ODK) then the data was downloaded and exported to Microsoft Excel worksheets (XLS) and imported to SPSS version 26 for further analysis. Bi-variable logistic regression analysis was performed. Variables with a P-Value of less than 0.25 were included in multivariable logistic regression. Multi-variable logistic regression was performed and Adjusted Odds ratio (AOR) with a 95% confidence interval was computed and statistical significance was declared at a p-value <0.05. a total of 270 neonates with mothers (90 cases and 180 controls) with a response rate of 100% were included in this study. Factors significantly increased the odds of developing neonatal jaundice were multiparty (AOR=2.869(95%CI 1.426-5.769)), prolonged duration of labor (AOR=4.618(95%CI 1.689 - 12.625)). ABO incompatibility (AOR=3.362(95%CI, 1.185 - 9.537)). Preterm (AOR=2.936(95%CI, 1.2456.923)), birthasphyxia (AOR=2.278(95%CI,1.1454.531)) and polycythemia (AOR=3.397(95%CI, 1.147-10.061)). in this study multiparty, prolonged duration labor, ABO incompatibility, preterm gestational age, birth asphyxia, and polycythemia were factors that significantly increased the odds of developing neonatal jaundice.

Magnitude of kangaroo mother care practice and its associated factors in Tigray region, Northern Ethiopia, 2019: cross-sectional study design

kangaroo mother care is an evidence based approach care of preterm and low birth weight infants carried skin-to-skin with the parents that can decrease morbidity and mortality of infant. Country level adoption and practice of kangaroo mother care has been limited and global coverage remains low and few studies have examined the reasons for low practice. The aim of this study was to assess the magnitude of kangaroo mother care practice and its associated factors in Tigray, northern Ethiopia, 2019. an institutional-based cross-sectional study design was conducted in public general hospitals of Tigray, northern Ethiopia, 2019. Two-stage sampling technique was used and an interviewer-administered questionnaire were used to collect the necessary information. The data were cleaned and entered using epi-Data version 3.1 then exported to stoical package for social science (SPSS) version 22.0 for analysis. Bivariate logistic regression and multivariable analysis were carried out at adjusted odds ratios (AOR) with 95% CI and significance level p-value (<0.05). out of the total 844 selected mothers with their infants, 840 were participated in the study yielding to a response rate of 99.5%, of these respondent's kangaroo mother care practice was found to be 70.2%. Being mothers housewife [(AOR=4.12, 95% CI: (1.5, 0.11)], maternal age [(AOR=9.3, 95% CI: (2.5, 33.9 )], currently mode delivery [(AOR=5.39, 95% CI: (2.3, 12.25)], number of children [(AOR=8.38, 95%: (4.6, 15.3)], mother having ≥5 children [(AOR=18.2, 95%CI: (9.4, 35.4)], antenatal care [(AOR=3.299 95%CI: (1.54, 7.07)] were factors at p-value (<0.05) significantly associated with kangaroo mother care practice. in this study, maternal age, parity, antenatal care, occupation and mode of delivery were factors that influence kangaroo mother care practice in the study area, so healthcare providers, policymakers and other stakeholders should give special focuses on those influencing factors.

Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study

ObjectivesSince the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist.DesignWe applied the meta-frontier and slacks-based measurement-undesirable...

Investigating the effects of financial crisis on pregnancy

Introduction: The global economic crisis has affected many European countries and especially Greece, with main feature that in a short time period it has affected rapidly Greeks’ life and especially the field of health. As far as pregnancy is concerned the consequences have manifested with disorder of different perinatal parameters and they concerned equally both mother and fetus. The purpose of this study is the investigation of consequences of financial crisis in pregnancy, the outcome of pregnancies and childbirth, in relationship to the birth weight of neonates and prematurity. Methods: This is a retrospective study, which covered periods before, during and after the crisis (2006, 2011 and 2019) and was carried out in a public General Hospital of Thessaloniki. The data were collected from the birth registers of the delivery room and for their processing were used the x2 test, the t-test, the nonparametric Mann-Whitney U-test, the anova test and the Spearman coefficient. Results: The present study showed an increase in the rate of caesareans sections from 35% (2006) to 53.5% (2019) (p = 0.04) and statistically significant differences between native and non-native women, with foreigners showing more favorable rates of prematurity ( p = 0.03), cesarean section (p = 0.05) and lower maternity age (p = 0.00). Finally, it was found that women who gave birth prematurely (p = 0.04) or by caesarean section (p= 0.02), were older. Conclusions: Immediate need for interventions was deemed necessary in the maternal care and special mention for the mitigation of factors which are affected by the socioeconomic fluctuations (mother’s age, percentage of caesareans sections, prematurity, birth weight of neonates) and constitute insurmountable elements which required to be set in the centre of interest of the Public Health bodies.

Psychological impact after treatment in patients with head and neck cancer.

Cancer is the second cause of death all over the world and it causes considerable morbidity, disability, and treatment sequela, which often lead to post-treatment pain and disfigurement. This study aims to evaluate such physical sequelae, and their psychological, (cognitive and emotional), impact, in a cohort of patients treated for Head and Neck (HNC) cancer, in search for methods to help such patients deal effectively with the psychological effects of their cancer treatments adverse consequences. The sample consists of 56 subjects, 47 men and 9 women, ranging from 47 years to 86 years of age, who were treated for head and neck cancers at Spanish Public General Hospital in the Otolaryngology Unit, Surgery Section. Two types of questionnaires were used in the study: the Questionnaire of Sequelae after Treatment of head and neck carcinoma and the State-Trait Anxiety Inventory (STAI-E and R). With respect to anxiety, the study found high levels of state anxiety which was significantly associated with the degree of perception of social stigma but was not associated with the post-treatment sequelae themselves nor with the level of discomfort that such symptomatic sequelae produced. The presence of a post-surgical stoma with cannula, increased patient's stigma (both components: external rejection and self-rejection) and state anxiety ratings, while there was no difference in state anxiety between cannulated and non-cannulated patients. There are few differences between men and women in terms of the presence of anxiety and their responses are similar in terms of the after-effects of surgery. Our study confirmed that current treatments for Head and Neck carcinoma generate adverse symptomatic sequela that impose significant psychological and physical burden for these patients. We will discuss the various pathways for preventive intervention that these findings open up.

A comprehensive analysis of the readability of consent forms for blood transfusion in Spain.

This study aimed to evaluate the readability of consent forms for blood transfusion in public hospitals in Spain. This was a cross-sectional, national study conducted within the Spanish healthcare system. Data were collected through the online retrieval of consent documents and direct consultation with 223 public hospitals. Consent forms were subjected to readability assessment including typographical, grammatical and lexical dimensions. The INFLESZ scale, a well-validated instrument adapted to the reading habits of Spaniards, was applied to determine the grammatical readability of the documents. The Spanish Mosby's Dictionary and the Dictionary of Spanish were used together to systematically identify the number of medical terms contained in the text. Data were analyzed using descriptive and inferential statistics. Forty-five written consent forms for blood transfusion, in use in 126 general public hospitals were evaluated for various parameters, including font size (=10.41), abbreviations (=10.58), word count (=595, 209 min-1,499 max) and length (1 to 7 pages). The overall readability score (=50.66) was indicative that consent forms are somewhat difficult to read. A heterogeneity of 116 different healthcare terminology words was identified. Word count was statistically and moderately positively related to the number of medical terms identified in the text (rho=0.496, p=0.001) and the INFLESZ score (rho=0.34, p=0.023). In this first national study to assess the ease of reading written information on blood transfusion given to patients, deficiencies were found in the three dimensions of readability (typographical, grammatical and lexical) and a lack of uniformity among the written consent forms is pronounced. Further research is needed to develop more person-centered tools to support patients in the process of consenting for blood transfusion.

Macro environment determinants affecting the availability of artemisinin-based combination therapies in Uganda

PurposeArtemisinin-based combination therapies (ACTs) have been developed to treat uncomplicated malaria. However, scanty studies exist to inform the role of macro factors in explaining the nonavailability of ACT in developing countries. Therefore, this paper aims to evaluate the different macro-environment factors affecting the availability of ACTs in the public hospital setting.Design/methodology/approachThis study applied a quantitative methodological approach and structural equation modeling (SEM) to test hypotheses statistically. SEM examines linear causal relationships among variables while accounting for measurement error. Confirmatory factor analysis (CFA) was used to assess model reliability. CFA and SEM were used to determine the shared variance-covariance of variables, define the latent construct and provide a more precise way to account for the error variances associated with the variables, which, if untested, could lead to biased parameter estimates. This was guided by the data collected from 40 general public hospitals with 283 respondents.FindingsThis study’s results support a model for promoting social-cultural, technological and legal factors. The availability of ACTs is significantly affected by legal factors. Improving legal aspects by a unit can enhance ACT availability by 0.59. Political factors scored the least, and they do not influence the availability of malaria drugs.Research limitations/implicationsThe design was quantitative and cross-sectional. Future research could be longitudinal with a mixed-method approach and consider other external stakeholders.Practical implicationsReducing the impact of the nonavailability of antimalarial drugs in general public hospitals requires a holistic concerted and coordinated supply chain approach that tackles the political, economic, social-cultural norms, technological and legal factors.Originality/valueThe authors develop and test a model using macro factors: political, economic, social, cultural, technological and legal factors. This model is relevant for many developing countries to supply chain coordination perpetually experiencing medicine shortages.

Nurses' perceptions about patient safety culture in public hospital in Vietnam

AimThis paper is aimed to assess nurses' perceptions of patient safety culture in four public general hospitals in Hanoi, Vietnam. BackgroundPatient safety culture is a vital component in ensuring high quality and safe patient care. Assessment of nurses' perceptions on existing hospital patient safety culture (PSC) is the first step to promote PSC. MethodsThe cross-sectional study surveyed 705 nurses utilizing the validated Hospital Survey on Patient Safety Culture (HSOPSC) in an online format. ResultsThe average positive response rate was high at 72.8 % and varied from 52.9 % to 93.4 %. The strongest areas are teamwork within units (93.7 %) and supervisor/manager expectations and actions promoting patient safety (85.0 %). The areas for improvement are staffing (52.9 %) and non-punitive response to error (57.6 %). The communication openness, staffing, frequency of events reported, lengths of services in hospital and unit are significant factors that predict the overall patient safety grade. ConclusionsInitiatives are necessary to improve response to errors, staffing, and error reporting. Nurse managers could develop and implement interventions and program to improve patient safety, including providing education related to patient safety culture, encouraging staff to notify incidents and avoiding punitive responses.

Intimate partner violence, adverse childhood experiences and prenatal substance use in South Africa.

Intimate partner violence (IPV) is one of the most pressing public health conditions among women worldwide, particularly in sub-Saharan Africa. Intimate partner violence in South Africa, along with human immunodeficiency virus (HIV), is an epidemic that is closely linked to trauma and substance use in women. This study aimed to identify factors associated with IPV among pregnant women, with a specific focus on adverse childhood experiences (ACE), prenatal substance use, and HIV status. A large public general hospital in the KwaZulu-Natal province. The sampled study participants included 223 adult postpartum women (18 - 45 years) based on convenience sampling who recently gave birth. Four separate logistic regression models were fitted to examine the role of ACE, perinatal substance abuse and HIV against threat (model 1), physical violence (model 2), sexual violence (model 3) and any IPV (model 4) outcomes (threat and/or physical and/or sexual violence). The prevalence of threat, physical violence, sexual violence and any IPV were 19.7%, 16.6%, 1.8% and 20.2%, respectively. The total ACE scores ranged from 0 to 11 (of 13 possible events) with a mean of 3.28 (standard deviation [s.d.] = 2.76), where 14.4% reported using substances during pregnancy (n = 32) as well as 47.1% (n = 105) of participants living with HIV. The authors found that the presence of family support was protective against IPV physical. It is essential that obstetric services screen and address potential risk factors along the life course pathways from early adversity to adult maternal health that drive IPV, particularly in young women who may lack family support during pregnancy. This research gives insight into the dynamics between IPV, HV, ACE and perinatal substance use facing young women in South Africa.

Quality of Life in Oral Cancer Patients in Greek Clinical Practice: A Cohort Study.

Cancer of the oral cavity is one of the most common cancers all over the world. Oral cancer and its treatment impacts on patients' Quality of Life (QOL). The purpose of the present study was to assess oral cancer patients' QOL after the completion of surgical therapy, and to investigate factors affecting it. This was a prospective cohort study, conducted at the Department of Oral & Maxillofacial Surgery, of a large general public hospital in Northern Greece. The sample consisted of 135 consecutive eligible cancer patients. Three distinct questionnaires were used. The first one included questions regarding the participants' demographic characteristics and relevant clinical information. The second comprised the European Organization for Research and Treatment core module (EORTC QLQ-C30) and its head and neck module EORTC QLQ-H&N35. The third was the Functional Assessment of Cancer Therapy-General (FACT-G) assessment of quality of life. We also included the physician-completed Karnofsky scale to assess the functional status of the participants. We found that location of the tumor affects QOL and specifically social contact (H = 17.89, p = 0.001), on the first assessment, and nutritional supplements (H = 22.49, p = 0.000), on the fourth assessment. QOL in patients deteriorates immediately after treatment but significantly improves over time. Health care professionals should take into account these results and arrange care plans in order to find ways to increase patients' QOL.

Treatment Evaluation of Hemodialysis Patients In General Public Hospital In Indonesia

Patients with Chronic Kidney Disease (CKD) in the final stages are indicated to obtain renal replacement therapy, namely dialysis. Dialysis is meant both peritoneal dialysis and hemodialysis. The purpose of this study is to analyze treatment in CKD patients undergoing outpatient hemodialysis at RS X. This type of research is an observational study with a cross sectional (retrospective) approach using medical record documents and patient treatment data. Analysis of the treatment uses descriptive statistic. Research data is quantitative data. The sample of the study is 74 patients. The results indicate the accuracy of the indication (100%), the accuracy of the patient (76,65%), the accuracy of the drug (79.55%), and the accuracy of the dose (96.57%).

IMPLEMENTATION OF THE RIGHTS AND OBLIGATIONS OF PUBLIC AND PRIVATE GENERAL HOSPITALS IN MAKASSAR

This study examines the extent to which the implementation of the rights and obligations of Public and Private General Hospitals in Makassar City and the obstacles that make these rights and obligations difficult to implement. The research method used in this study is the empirical method. The results of this study indicate that the implementation of the rights and obligations at the Regional General Hospital (Rumah Sakit Umum Daerah/RSUD) of Makassar City and the Mother and Child Hospital (Rumah Sakit Ibu dan Anak/RSIA) Ananda has carried out the rights and obligations of the hospital simultaneously. However, in the implementation of these rights and obligations, there are still several obstacles, such as community habits, administrative completeness that does not meet minimum service standards, and other supporting infrastructure. Especially for Makassar City Hospital, the data for health personnel has not been updated as mandated by the Government Regulation on the Implementation of the Hospital Sector. Meanwhile, RSIA Ananda must improve the facilities and infrastructure of the hospital parking lot so that health services can be more optimal and effective, and efficient to carry out.

Antibiotic Resistance: An upcoming Pandemic

Antibiotics are medications that are used to both prevent and treat bacterial infections. Antibiotic resistance arises when bacteria adapt to the usage of antibiotics. Antibiotic resistance develops in bacteria rather than in humans or other animals. These germs can infect both humans and animals, and their infections are more difficult to treat than those caused by non-resistant bacteria. Antibiotic resistance causes greater mortality, longer hospital stays, and higher medical expenses. Our capacity to cure widespread infectious illnesses is being threatened by the emergence and worldwide dissemination of new resistance mechanisms. As antibiotics lose their potency, an increasing range of ailments, such as gonorrhoea, blood poisoning, pneumonia, and tuberculosis (TB), become difficult to treat and, in some cases, incurable. In every region of the globe, antibiotic resistance is increasing to dangerously high levels. It poses a serious danger to public health on a global scale, killing at least 1.27 million people and contributing to approximately 5 million deaths in 2019 [1]. More than 4.6 billion dollars a year is the projected cost to treat infections brought on by six multidrug-resistant pathogens that are often seen in healthcare settings. Escherichia coli is the pathogen that is most commonly reported in Pakistan (68.8% in 2018) [2, 3].&#x0D; Antibiotic resistance jeopardizes advances in contemporary medicine. The main issues and concerns in Pakistan are a large number of surplus registered drugs (approximately 50,000), self-medication by more than 50% of the population, and a substantial number of quacks in the country. On average, each patient is given more than three drugs, and antibiotics are given to 70% of patients which is the highest number of prescriptions as compared to rest of the world. General practitioners (GPs) and public hospitals, which favor expensive broad-spectrum antibiotics, are more prone to prescribe these medications impulsively and without consideration [3]. Antibiotic abuse and misuse, as well as inefficient infection prevention and control, all contribute to the rapid spread of antibiotic resistance. Actions can be taken at all societal levels to mitigate the consequences and prevent resistance. Antibiotics should only be used as advised by a licensed healthcare provider. Doctors should only prescribe and give antibiotics when absolutely required, according to current recommendations. To address antibiotic resistance, the government must implement a comprehensive national action plan.

Pediatric Viral and Bacterial Skin Infection Profile

Background: Viral and bacterial skin infection is a common condition amongst children. In developing countries, it is a complex major health problem. However, epidemiological study on viral and bacterial skin infection in the pediatric population is still lacking, especially in Indonesia. Purpose: This study aimed to evaluate bacterial and viral skin infection amongst children and its association with age and sex. Methods: This study used a cross-sectional design with a retrospective approach. We retrieved medical records of pediatric patients admitted to Dr. Harjono S Ponorogo General Public Hospital between 2016 and 2020. Result: Of the 1,427 collected medical records, we found that the viral infection prevalence was 4.9% (n=70) and 7.5% (n= 107) for bacterial skin infection. Viral infection was most observed amongst subjects in the &gt;12-year age group and 2–12-year for bacterial infection. Infection was more commonly observed amongst boys. Conclusion: The skin infection prevalence in Dr. Harjono S. Ponorogo General Hospital is lower compared to other studies. Skin infection of viral origin was most reported in children aged &gt;12 years and bacterial infection in children aged 2–12. Both skin infections were more commonly observed in boys than girls.

Knowledge, Attitude and Practice towards the COVID-19 Pandemic: A Cross-Sectional Survey Study among the General Public in the Kingdom of Saudi Arabia.

Background: The novel coronavirus disease 2019 (COVID-19) is an infectious disease that has been spreading worldwide in an unprecedented manner. The knowledge, attitude and practices of the general population play a vital role in prevention of COVID-19. Objectives: The present study aimed to assess the COVID-19-related knowledge, attitudes and practices of the general public of Sakaka, Saudi Arabia, to identify which populations show low levels of knowledge, attitudes and practices towards COVID-19, making them highly likely to remain vulnerable during the pandemic. Methodology: For this study, a nineteen-item closed-ended questionnaire was hand delivered to the general public, including patients and other hospital attendees attending the Outpatient Department of the College of Dentistry, Jouf University, Saudi Arabia. The research questions focused on the demographic information, knowledge, attitude and practices related to COVID-19. Data analysis is presented through tables and descriptive methods. Results: A total of 722 participants took part in the survey questionnaire. The majority of the respondents belonged to the age group of 28-37 years (n = 320; 44.3%), with female participants (n = 419; 58.0%) outnumbering the male participants (n = 303; 42.0%). Most of the respondents had good knowledge, attitudes and practices towards COVID-19. Patients aged 28-37 years (p = 0.000) with a master's degree (p = 0.011) and government employees (p = 0.000) had significantly better knowledge than their counterparts. Significantly optimistic attitudes were noticed in participants aged 28-37 years (p = 0.000) with a master's degree (p = 0.000), the married (p = 0.047) and government employees (p = 0.000). Government employees (p = 0.014) had significantly better practices. Conclusions: Overall, the participants of this study had good COVID-19-related knowledge, attitudes and practices. These findings would be useful in motivating the general population to follow the precautionary measures that will aid in prevention of COVID-19. Furthermore, the findings may help policymakers identify the target populations, especially the less educated and older adults, for COVID-19 prevention and health education.

Open pollution routing problem of logistics distribution in medical union based on differential search algorithm

Medical care is a guarantee of people's daily life. Improving healthcare contributes to people's well-being. However, healthcare resources are characterized by uneven distribution. Financially well-off areas will have higher quality health care resources. Most of the medical resources are concentrated in public general hospitals, however, primary care institutions can hardly meet the growing needs of people. To solve this problem, Medical Union achieves efficient deployment of resources by integrating various medical institutions in the same area. In the process of logistics integration of the medical union, the scale of logistics distribution expands accordingly. Transportation vehicles have high operating costs and produce greenhouse gases in the process of distribution. The optimization of the driving path of logistics distribution vehicles can reduce the operating cost, fuel consumption and carbon emission. To solve this kind of decentralized and complex vehicle routing problem, this paper proposes a pollution routing problem model considering electrical vehicle usage, customer's soft time window expectation, open path and carbon cost. A modified Differential Search Algorithm with the comprehensive learning strategy and dynamic Cauchy variation strategy is advanced to solve the problem. Results show that the improved algorithm has good solving performance, and verifies the rationality of the proposed model, which will help to reduce carbon emissions and save the logistics and operating costs of medical devices.

Severe maternal morbidity and mortality during the COVID-19 pandemic: a cohort study in Rio de Janeiro

To identify factors associated with adverse maternal outcomes during the coronavirus disease 2019 (COVID-19) pandemic. This was a single-centre prospective cohort study at a maternity department in a public general hospital in Rio de Janeiro. All pregnant women evaluated for emergency care, labour and delivery, respiratory symptoms, obstetric reasons or medical reasons between May 2020 and March 2022 at the study institution were invited to enrol in this study. The endpoint was maternal mortality or intensive care unit (ICU) admission. In total, 1609 pregnant women were enrolled in this study. Of these, 25.5% (n=410) were infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) based on reverse transcription polymerase chain reaction or an antigen test. There were 21 deaths and 67 ICU admissions in 4% of the cohort. The incidence of severe maternal morbidity and mortality was higher during the Gamma wave than during the Delta wave (P=0.003). Vaccination conferred protection against the endpoint [relative risk (RR) 0.4, 95% confidence interval (CI) 0.1-0.9; P=0.0169]. Factors associated with severe morbidity and mortality included caesarean section (RR 3.7, 95% CI 1.7-7.9; P=0.0008), SARS-CoV-2 infection in the third trimester (RR 2.4, 95% CI 1.1-5.6; P=0.0006) and comorbidities (RR 3, 95% CI 1.8-5.2; P<0.0001). COVID-19 was significantly associated with the risk of severe maternal morbidity and mortality. Immunization of pregnant women against COVID-19 was highly protective against adverse outcomes, and should be encouraged during pregnancy.

The Impact of County Medical Community Reform on the Medical Service Efficiency of County-Level Public General Hospitals in China: A Case Study of Shanxi Province.

China introduced the county medical community (CMC) reform, aimed to provide high-quality medical resources to rural citizens, in 2017. This study examines the impact of the reform on the medical service efficiency of county-level public general hospitals in Shanxi Province, China. In total, 92 county-level public general hospitals from Shanxi Province were taken as the research objective, and the super-efficiency SBM-DEA model was applied to measure medical service efficiency. Further, a two-way fixed-effect model was used to evaluate the impact of CMC reform on the medical service efficiency of county-level public general hospitals by using health statistics data from 2014 to 2018. The study reveals that the CMC reform improved the medical service efficiency of county-level public general hospitals by 15.6%. Moreover, the CMC reform had regional heterogeneity in its impact on the medical service efficiency of county-level public general hospitals. The CMC reform improved the medical service efficiency of hospitals in the southern region more than in the northern region of the province. The medical service efficiency of hospitals in the central region was also improved by CMC reform, but the causal relationship was not found significant. Further, hospital-level factors (e.g., fixed assets, hospital stay, and regional health center) and environmental factors (e.g., GDP, population, urbanization rate, and government subsidies) affected the medical service efficiency of county-level public hospitals during the process of promoting the CMC reform.