Health Care Crisis Research Articles

Towards understanding accountability for physicians practice in India.

The lack of accountability is considered to be a major cause of the crisis in health care in India. Physicians as key stakeholders in the health care delivery system have traditionally been accountable for health concerns at the doctor-patient interface. Following social and organizational dynamics, the interpretations of accountability have broadened and shifted in the recent literature, expanding accountability to the community, national and global levels and to social domains. The objective of this study is to provide a comprehensive framework of accountability in medical practice that can be used as a vehicle for further contextualized research and policy input. Through literature review, this paper is presented in two parts. First, a description of accountability of a physician inclusive of the social domains is extracted by posing three pertinent questions: who is accountable? accountability to whom? and accountability for what? which addresses the roles, relationships with other stakeholders and domains of accountability. Second, a framework of accountability of a physician is designed and presented to illustrate the professional and social domains. This study revealed a shift from individual physician's accountability to collective accountability involving multiple stakeholders through complex reciprocal and multi-layered mechanisms inclusive of the social dimensions. We propose a comprehensive framework of accountability of the physician to include the social domains that its multidimensional and integrative of all stakeholders. Furthermore, we discuss the utility of the framework in the Indian health care system and how this can facilitate further research in understanding the social dimensions of all stakeholders.

Insurance medicine in Belarus in the first third of the twentieth century

Objective. To characterize the process of development of insurance medicine in Belarus in the first third of the twentieth century.Materials and methods. Archival, periodical and narrative sources processed using general scientific and special historical research methods.Results. Insurance medicine in Belarus originated in the early twentieth century in the form of hospital sick funds, which provided medical care to workers in case of illness, but was actually destroyed during the First World War. In Soviet Belarus the development of insurance medicine began during a period of massive reduction in healthcare funding associated with the New Economic Policy. In fact, insurance medicine became only a financial donor to the People’s Commissariat for Healthcare, but it was not distinguished as an independent branch, which was typical for the pre-revolutionary period, so the principle of unity of Soviet medicine was preserved. A characteristic feature of the studied period was the small social coverage of medical insurance, which applied only to workers and employees, who constituted a small part of the population of Soviet Belarus, where the rural population was greatly dominated.Conclusion. Despite the successful experience of organizing insurance medicine, it was only a temporary measure to maintain the resources of unified Soviet state medicine and in reality covered an extremely small percentage of the population, so after the crisis in health care was overcome it was abolished.

Reducing turnover intentions among first-year nurses: The importance of work centrality and coworker support.

Turnover among nurses has been recognized as a frequent and enduring problem in healthcare worldwide. The widespread nursing shortage has reached the level of a healthcare crisis. The COVID-19 pandemic has illustrated the importance of understanding the contributing factors of nurse turnover, and more importantly how to mitigate the problem. Using cross-sectional survey data collected from 3370 newly licensed nurses working across 51 metropolitan areas within 35 U.S. states, we explore how role overload and work constraints can both diminish job satisfaction and increase turnover intentions of new nurses. Coworker support and work role centrality are identified as moderators of these relationships which show potential to mitigate these negative outcomes. This study highlights the importance of coworker support and work centrality in improving job satisfaction and subsequent turnover intentions among newly licensed nurses.

Digital solutions to the mental healthcare crisis

With huge demands being placed on mental healthcare services, innovative solutions are required to address this growing need. Digital solutions offer wider accessibility and a patient-focused process for a range of people with mental ill health, freeing healthcare staff to focus on those with the most severe mental health needs and The National Institute for Health and Care Excellence has now issued conditional recommendations on technologies which can be used.

Longitudinal characterization of cerebral hemodynamics in the TgF344-AD rat model of Alzheimer's disease.

Alzheimer's disease (AD) is a global healthcare crisis. The TgF344-AD rat is an AD model exhibiting age-dependent AD pathological hallmarks. We confirmed that AD rats developed cognitive deficits at 6months without alteration of any other major biophysical parameters. We longitudinally characterized cerebral hemodynamics in AD rats at 3, 4, 6, and 14months. The myogenic responses of the cerebral arteries and arterioles were impaired at 4months of age in the AD rats. Consistent with the ex vivo results, the AD rat exhibited poor autoregulation of surface and deep cortical cerebral blood flow 2months preceding cognitive decline. The dysfunction of cerebral hemodynamics in AD is exacerbated with age associated with reduced cerebral perfusion. Further, abolished cell contractility contributes to cerebral hemodynamics imbalance in AD. This may be attributed to enhanced ROS production, reduced mitochondrial respiration and ATP production, and disrupted actin cytoskeleton in cerebral vascular contractile cells.

A qualitative study exploring how patient engagement activities were sustained or adapted in Canadian healthcare organizations during the COVID-19 pandemic.

The COVID-19 pandemic caused disruptions across healthcare systems globally exposing the precarious state of patient engagement across all levels of healthcare. While evidence is emerging to describe how engagement was affected across various settings, insights about how some organizations at the policy and practice level of healthcare were able to sustain or adapt patient engagement activities is lacking. This paper addresses the following research question: "How were healthcare, government, and patient partner organizations able to sustain or adapt patient engagement activities during the COVID-19 pandemic?" A qualitative descriptive study was conducted to understand how patient engagement activities were maintained or adapted in a variety of healthcare, government, and patient partner organizations in Canada throughout the pandemic. This analysis was part of a larger qualitative, multiple case study where one-to-one interviews were conducted with organizational leaders, managers and patient partners. The following themes were identified as key aspects of maintaining or adapting patient engagement activities: 1) having an embedded organizational culture of patient engagement; 2) adapting patient engagement activities to focus on COVID-19 response efforts; 3) having patient partners who exercised leadership and advocacy to support patient care and experiences during the pandemic; and 4) leveraging virtual technology as a communication tool to engage patient partners. This paper highlights important insights that may be useful to other health care organizations on how to sustain or adapt patient engagement activities during a healthcare crisis. Having patient engagement embedded within an organization's culture supported by, but not limited to, infrastructure, resources, investments in dedicated staff and patient partner leadership, and communication strategies and tools enabled continued patient engagement activities during the pandemic.

Resource utilization and preparedness within the COVID-19 pandemic in Tunisian medical intensive care units: A nationwide retrospective multicentre observational study

BackgroundThe worldwide SARS-CoV-2 pandemic represents the most recent global healthcare crisis. While all healthcare systems suffered facing the immense burden of critically-ill COVID-19 patients, the levels of preparedness and adaptability differed highly between countries. Aim: to describe resource mobilization throughout the COVID-19 waves in Tunisian University Medical Intensive Care Units (MICUs) and to identify discrepancies in preparedness between the provided and required resource. MethodsThis is a longitudinal retrospective multicentre observational study conducted between March 2020 and May 2022 analyzing data from eight University MICUs. Data were collected at baseline and at each bed expansion period in relation to the nation’s four COVID-19 waves. Data collected included epidemiological, organizational and management trends and outcomes of COVID-19 and non-COVID-19 admissions. ResultsMICU-beds increased from 66 to a maximum of 117 beds. This was possible thanks to equipping pre-existing non-functional MICU beds (n = 20) and creating surge ICU-beds in medical wards (n = 24). MICU nurses increased from 53 to 200 of which 99 non-ICU nurses, by deployment from other departments and temporary recruitment. The nurse-to-MICU-bed ratio increased from 1:1 to around 1·8:1. Only 55% of beds were single rooms, 80% were equipped with ICU ventilators. These MICUs managed to admit a total of 3368 critically-ill patients (15% of hospital admissions). 33·2% of COVID-19-related intra-hospital deaths occurred within the MICUs. ConclusionDespite a substantial increase in resource mobilization during the COVID-19 pandemic, the current study identified significant persisting discrepancies between supplied and required resource, at least partially explaining the poor overall prognosis of critically-ill COVID-19 patients.

Why New Media app during the Healthcare Crisis? WhatsApp Based Study

WhatsApp is one of the most popular mobile applications providing instant messaging and ease of access. It uses web-based systems to send and receive texts, calls, and videos and even offers video chat. However, during the current healthcare crisis, WhatsApp's role is comparatively more prominent and needs more consideration. In this context, we conducted this research to examine the factors motivating students to rely more on WhatsApp during the Covid-19 pandemic. Based on the Uses and Gratifications Approach, we adopted a cross-sectional design and gathered data from university students in Islamabad, Pakistan. Findings from n= 302 university-level students affirmed communication (p≥ .000), learning (p≥ .002), Teamwork (p≥ .041), and information sharing (p≥ .000) as the motivating factors behind increased WhatsApp usage (p≥ .011) during the healthcare crisis. Similarly, path analysis results also validated a strong correlation between the variables, further affirming the strength of the proposed conceptual framework. Thus, WhatsApp not only provided ease of communication during Covid-19 but also helped sustain educational activities. Here we recommend more studies to examine other different factors, especially personality factors that can affect one's WhatsApp usage.

Multi-modal approach for COVID-19 detection using coughs and self-reported symptoms

COVID-19 (Coronavirus Disease of 2019) is one of the most challenging healthcare crises of the twenty-first century. The pandemic causes many negative impacts on all aspects of life and livelihoods. Although recent developments of relevant vaccines, such as Pfizer/BioNTech mRNA, AstraZeneca, or Moderna, the emergence of new virus mutations and their fast infection rate yet pose significant threats to public health. In this context, early detection of the disease is an important factor to reduce its effect and quickly control the spread of pandemic. Nevertheless, many countries still rely on methods that are either expensive and time-consuming (i.e., Reverse-transcription polymerase chain reaction) or uncomfortable and difficult for self-testing (i.e., Rapid Antigen Test Nasal). Recently, deep learning methods have been proposed as a potential solution for COVID-19 analysis. However, previous works usually focus on a single symptom, which can omit critical information for disease diagnosis. Therefore, in this study, we propose a multi-modal method to detect COVID-19 using cough sounds and self-reported symptoms. The proposed method consists of five neural networks to deal with different input features, including CNN-biLSTM for MFCC features, EfficientNetV2 for Mel spectrogram images, MLP for self-reported symptoms, C-YAMNet for cough detection, and RNNoise for noise-canceling. Experimental results demonstrated that our method outperformed the other state-of-the-art methods with a high AUC, accuracy, and F1-score of 98.6%, 96.9%, and 96.9% on the testing set.

Applying Structural Equation Modelling to Understand the Implementation of Social Distancing in the Professional Lives of Healthcare Workers.

This study, based on the normalization process theory (NPT), explores the implementation of nonpharmaceutical interventions (NPIs)-specifically social distancing (SD)-in the professional lives of healthcare workers in three Pakistani hospitals. We collected and analysed health workers' data using partial least squares structural equation modelling (PLS-SEM) and assessed the policy implications of the results. Violations of normality assumptions in the quantitative data and the need for scores of independent variables for follow-up analysis guided the researchers to adopt a structural equation modelling process that involved a stepwise evaluation process for convergent validity, individual item validity, discriminant validity, the structural model relationship, and overall model fitness. Theoretical constructs coherence, cognitive participation, collective action, and reflexive monitoring were found to influence the normalization of SD. The results show that SD was normalized in the professional lives of healthcare workers through strong collective action (resources required) and reflexive monitoring (appraisal) but weak cognitive participation (actors' engagement) and coherence (sense-making). Low and middle-income countries (LMICs) should work more on actors' sense-making and engagement in dealing with healthcare crises that require SD. The research findings can aid policy institutions in better understanding the loopholes in the implementation process and making better policies.

The psychological impact of Covid on health care professionals during the third wave

IntroductionThe COVID-19 pandemic is a healthcare crisis, with unprecedented impact on healthcare services, notable morbidity and mortality of the public and healthcare workers, economic impact and significant psychosocial impact. Besides, this pandemic has had a profound negative effect on the mental health of people worldwide, particularly among those who are faced with combating the virus.ObjectivesThe aim of this research was to examine the impact of the COVID-19 pandemic on healthcare workers’ mental health (HCWs), as they are on the front line of the pandemic.MethodsAn internet-based questionnaire was created including the following scales: (1)Posttraumatic Stress Disorder Checklist (PCL-5), (2) Secondary Traumatic Stress Scale (STSS) (3) Quality of Professional Life (ProQOL) (4) Post-Traumatic Growth Inventory, (PTGI), (5) Brief Resilience Scale (BRS), (6) Brief Orientation to Problems Experienced Inventory (Brief Cope)], (7) Self-Compassion Scale (SCS-SF). It was distributed to 120 Greek health professionals, including nurses, doctors, midwives and physiotherapists.ResultsMost of the participants were female with an average age of 46 years. HCWs had low levels of both primary and secondary traumatic stress . They presented post-traumatic growth in the dimension of relationship with others. They used predominantly the coping strategies of positive reframing, acceptance of the situation, venting, and instrumental support.Females had statistically significant higher levels of post-traumatic growth, better quality of life, and used more positive coping strategies compared to males. Humor and acceptance were coping strategies used mainly by physicians. Nurses and midwives had worse quality of professional life potentially due to increased workload. HCWs with more functional ways of coping were more resilient and seemed to have better quality of life, such as higher compassion, satisfaction, lower burnout, and lower post-traumatic stress.ConclusionsThe experience of the COVID-19 pandemic highlights the need to implement some strategies to protect health care workers’ mental health and to take extensive prevention measures in highly stressful situations.Further research is needed to clarify the long-term negative and positive psychological effects of the pandemic on healthcare personnel’s mental health.Disclosure of InterestNone Declared

CLONING OF THE MAJOR OPEN READING FRAMES OF SARS-COV-2, THEIR EXPRESSION IN ESСHERICHIA COLI AND PURIFICATION OF SARS-S-6HIS, SARS-S1-6HIS, SARS-N-6HIS, SARS-M-6HIS AND SARS-E-6HIS PROTEINS

A novel coronavirus SARS-CoV-2 has been associated with the COVID-19 atypical pneumonia pandemic, which caused a devastating healthcare and socioeconomic crisis worldwide. Effective diagnosis of the disease is important to prevent the spread of infection. Since the detection of antigens and antibodies against SARS-CoV-2 by enzyme-linked immunosorbent assay is of great importance in the diagnosis of COVID-19, we developed recombinant analogs of the main structural proteins of the SARS-CoV-2 virus. The genes of the main open reading frames, including the surface spike (S) glycoprotein, the small membrane (M) protein, the envelope (E) glycoprotein and nucleocapsid (N) protein, were cloned in expression plasmids pET23c in polyhistidine reading frames. We obtained the strains of Esсherichia coli BL-21(DE3) that produce recombinant S-6His, M-6His, E-6His и N-6His proteins. N-6His protein was produced in sufficient quantities, for the purification of which the conditions of dialysis and its concentration were optimized. We obtained pure preparation of N protein (the target protein concentration is 80%). Further studies should be performed to identify its antigenic activity.

The impact of the COVID-19 pandemic on primary care physicians and nurses in Nova Scotia: a qualitative exploratory study.

The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers' ability to provide care, their information pathways, and the personal and professional impact of the pandemic. We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data. Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work-life balance, disruptions to "non-COVID-19" patient care, impact of provincial and centralized policies, and filtering and processing an influx of information. Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises.

The Evolving Ukrainian Refugee Health Care Crisis - A Platform for the True Meaning of the Physician's and Health Care Professional's Healing Work

The Evolving Ukrainian Refugee Health Care Crisis - A Platform for the True Meaning of the Physician's and Health Care Professional's Healing Work

Rapid Convergence: The Outcomes of Making PPE During a Healthcare Crisis

The U.S. National Institute of Health (NIH) 3D Print Exchange is a public, open-source repository for 3D printable medical device designs with contributions from clinicians, expert-amateur makers, and people from industry and academia. In response to the COVID-19 pandemic, the NIH formed a collection to foster submissions of low-cost, locally manufacturable personal protective equipment (PPE) . We evaluated the 623 submissions in this collection to understand: what makers contributed, how they were made, who made them, and key characteristics of their designs. We found an immediate design convergence to manufacturing-focused remixes of a few initial designs affiliated with NIH partners and major for-profit groups. The NIH worked to review safe, effective designs but was overloaded by manufacturing-focused design adaptations. Our work contributes insights into: the outcomes of distributed, community-based medical making; the features that the community accepted as “safe” making; and how platforms can support regulated maker activities in high-risk domains.

Routine healthcare disruptions: a longitudinal study on changes in self-management behavior during the COVID-19 pandemic

BackgroundThe outbreak of COVID-19 had a significant impact on routines and continuity of professional care. As frequent users of this professional care, especially for people with chronic diseases this had consequences. Due to barriers in access to healthcare, an even greater appeal was made on the self-management behaviors of this group. In the present study, we aim to investigate the extent to which self-management changed during the recent pandemic, and which factors contributed to these changes.MethodsThe Dutch ‘National Panel of people with Chronic Illness or Disability’ was used to collect self-reported data of people with at least one chronic disease. Self-management was assessed with the Partners in Health questionnaire at two time points: before the crisis in 2018 and during the second wave of crisis in Autumn 2020. Paired t-tests were used to analyze changes in self-management. Potential associating factors on three levels – patient, organization and environment – were assessed in 2020 and their impact on self-management changes was tested with multinomial logistic regression.ResultsData from 345 panel members was available at two time points. In the majority of people, self-management behaviors were stable (70.7%). About one in seven experienced improved self-management (15.1%), and a similar proportion experienced deteriorated self-management (14.2%). Sex, physical disability, mental health and daily stressors due to COVID-19 (patient level), changes in healthcare access (organization level), and social support (environment level) were significantly associated with experienced changes in self-management.ConclusionsPeople with chronic diseases experienced different trajectories of self-management changes during COVID-19. We need to be aware of people who seem to be more vulnerable to a healthcare crisis and report less stable self-management, such as those who experience mental health problems or daily stressors. Continuity of care and social support can buffer the impact of a healthcare crisis on self-management routines of people with chronic diseases.

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.

Air pollution and increasing asthma hospitalizations: a looming healthcare crisis?

Asthma is a major non-communicable disease (NCD) affecting adults and children, among whom it is the most common chronic disease reported all around the globe1 Asthma has been a significant cause of hospitalizations and financial burdens for low and lower- middle -income countries like Pakistan. According to the latest WHO data published in 2020, asthma deaths in Pakistan reached a staggering 20,750 or 1.42% of total deaths.2 Many etiologies including social and environmental factors, genetic predispositions, and ambient air pollution, influence asthma morbidity and mortality. In particular, the worsening air quality index in the country needs to be a point of focus as a significant cause of asthma related morbidity. The rapid decline in air quality levels in Pakistan, particularly in major industrial cities such as Lahore and Karachi, is a cause of grave concern. For example, air quality in Lahore has declined over the last two decades: in 1998, its pollution concentration was 33 µg/m³. By 2016, it had doubled to 64 µg/m³—more than six times the WHO guideline.3 Similarly, Karachi, the largest city in Pakistan, has a PM2.5 concentrations, which is 3.4 times the WHO annual air quality guideline value, an alarming scenario for a city where environmental policies and infrastructure is not in place.4 A study in Lahore noted the role of ambient air pollution among various population groups of the city. The research showed a positive Pearson correlation between environmental air pollutants and the number of asthma patients visiting the OPD.5 However, a similar, comprehensive study has not been conducted in Karachi on the same level. As in most cases, the first step toward solving a problem is to recognize it. Hence there’s a need for more research to be conducted to determine the number of hospitalizations of asthmatic patients caused by low air quality as it will give us a better understanding of the true extent of the issue at hand and allow more appropriate prioritization, in the context of public health by the government. Once this is done, resources can be allocated more efficiently towards areas and populations suffering more acutely to relieve the suffering of the majority. In addition, educational campaigns can be designed considering the population’s educational demographics and general knowledge regarding the exact reasons for the worsening air quality in those areas. ---Continue

Illuminating neurodegeneration: a future perspective on near-infrared spectroscopy in dementia research.

Dementia presents a global healthcare crisis, and neuroimaging is the main method for developing effective diagnoses and treatments. Yet currently, there is a lack of sensitive, portable, and low-cost neuroimaging tools. As dementia is associated with vascular and metabolic dysfunction, near-infrared spectroscopy (NIRS) has the potential to fill this gap. This future perspective aims to briefly review the use of NIRS in dementia to date and identify the challenges involved in realizing the full impact of NIRS for dementia research, including device development, study design, and data analysis approaches. We briefly appraised the current literature to assess the challenges, giving a critical analysis of the methods used. To assess the sensitivity of different NIRS device configurations to the brain with atrophy (as is common in most forms of dementia), we performed an optical modeling analysis to compare their cortical sensitivity. The first NIRS dementia study was published in 1996, and the number of studies has increased over time. In general, these studies identified diminished hemodynamic responses in the frontal lobe and altered functional connectivity in dementia. Our analysis showed that traditional (low-density) NIRS arrays are sensitive to the brain with atrophy (although we see a mean decrease of 22% in the relative brain sensitivity with respect to the healthy brain), but there is a significant improvement (a factor of 50 sensitivity increase) with high-density arrays. NIRS has a bright future in dementia research. Advances in technology - high-density devices and intelligent data analysis-will allow new, naturalistic task designs that may have more clinical relevance and increased reproducibility for longitudinal studies. The portable and low-cost nature of NIRS provides the potential for use in clinical and screening tests.

Using Rapid-Cycle Change to Improve COVID-19 Vaccination Strategy in Primary Care.

During the COVID-19 pandemic, misinformation and distrust exacerbated disparities in vaccination rates by race and ethnicity throughout the United States. Primary care, public health systems, and community health centers have shifted their vaccination outreach strategies toward these disparate, unvaccinated populations. To support primary care, we developed the SAVE Sprint model for implementing rapid-cycle change to improve vaccination rates by overcoming community outreach barriers and workforce limitations. Participants were recruited for the 10-week SAVE Sprint program through partnerships with the National Association of Community Health Centers (NACHC) and the Resilient American Communities (RAC) Initiative. The majority of the participants were from community health centers. Data were evaluated during the program through progress reports and surveys, and interviews conducted three months post-intervention were recorded, coded, and analyzed. The SAVE Sprint model of rapid-cycle change exceeded participants' expectations and led to improvements in patient education and vaccination among their vulnerable populations. Participants reported building new skills and identifying strategies for targeting specific populations during a public health emergency. However, participants reported that planning for rapid-pace change and trust-building with community partners prior to a health care crisis is preferable and would make navigating an emergency easier.