Hospital Authority Research Articles

Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study

The effect of nirmatrelvir-ritonavir on post-COVID-19 outcomes for individuals who are immunocompromised is understudied. We aimed to examine the association of nirmatrelvir-ritonavir with post-acute sequelae and mortality among patients who are immunocompromised and admitted to hospital with COVID-19. We did a retrospective cohort study using territory-wide electronic health records from the Hong Kong Hospital Authority and Hong Kong Department of Health. Eligible patients were adults aged 18 years or older who tested positive for SARS-CoV-2 during the study period (March 11, 2022, to Nov 9, 2023) and were admitted to hospital with COVID-19. Four exposure groups were formed based on immune status (immunocompromised or immunocompetent) and nirmatrelvir-ritonavir status (yes or no). The primary outcome was post-acute inpatient death, starting from 21 days after the positive RT-PCR date. Standardised mortality ratio weighting with doubly robust adjustment was applied to control for confounders. Cox models were used to estimate hazard ratios (HRs) for the outcomes. Between March 11, 2022, and Nov 9, 2023, there were 89 772 individuals with positive RT-PCR tests, of whom 39 923 met eligibility criteria and were included in the study cohort. 19 914 (49·9%) of 39 923 patients were female, 20 009 (50·1%) were male and the median age was 75·0 years (IQR 63·0-85·0). 846 (38·2%) of 2217 patients who were immunocompromised and 14 586 (38·7%) of 37 706 patients who were immunocompetent were prescribed nirmatrelvir-ritonavir. Among the patients who were immunocompromised, those patients who received nirmatrelvir-ritonavir had significantly lower risk of post-acute inpatient death (HR 0·58, 95% CI 0·45-0·74; p<0·0001) and hospitalisation for acute respiratory distress syndrome (0·43, 0·20-0·90; p=0·024) than those who did not. A significant negative interaction was found between immune status and nirmatrelvir-ritonavir on post-acute all-cause hospitalisation (relative excess risk due to interaction -0·84, 95% CI -1·30 to -0·37; p=0·0004). Nirmatrelvir-ritonavir was associated with reduced risk of post-acute inpatient death among patients who were immunocompromised and admitted to hospital with COVID-19. However, the effectiveness of nirmatrelvir-ritonavir on post-acute hospitalisation outcomes was less pronounced in patients who were immunocompromised than in patients who were immunocompetent. Health and Medical Research Fund, Research Grants Council theme-based research schemes, and Research Grants Council Collaborative Research Fund.

Nurses’ experiences in neonatal sepsis prevention and management: a qualitative cross-sectional study at selected hospitals in a metropolitan area

BackgroundNeonatal sepsis represents a significant cause of morbidity and mortality among infants in healthcare settings. This study explored nurses’ experiences in preventing and managing neonatal sepsis in the Tamale metropolis.MethodsAn exploratory, descriptive qualitative cross-sectional study design was used, and data was collected using semi-structured interviews. The sample size was determined at the point of data saturation of fifteen participants. Thematic analysis was employed to identify codes, subthemes, and themes within the interview transcripts.ResultsThree major challenges nurses face in preventing and managing neonatal sepsis, including (1) the absence of a protocol for handling newborns upon admission, (2) an excessive workload that made it difficult for staff to follow infection prevention protocols, and (3) inadequate, obsolete and/or lack of equipment that caused devices to be overused. The nurses also identified critical psychological and emotional difficulties they encounter as a result of working within such a stressful environment. Other activities nurses conducted were handwashing before and after every procedure, infection prevention, and separating the babies in the incubator. In managing babies with neonatal sepsis, nurses provided daily treatment, hygiene care, and supported activities of living. The nurses also assert that the availability of resources, appropriate staff, and critical skills are important for preventing and managing neonatal sepsis.ConclusionThe lack of basic working consumables like gloves, syringes, and needles, inadequate staff, and lack of defined protocol of care were identified as critical challenges that hamper the care provided in neonatal care units. Hospital authorities must focus attention on addressing the critical challenges faced by neonatal care units. Also, measures should be instituted to address the emotional and psychological concerns associated with nursing care. Future research must consider the level of influence of each of the challenges enumerated on nurses’ overall health.

Harassment of interns, medical interns and residents: consequences and complaints

Abstract Introduction Workplace harassment manifests in various forms for healthcare students, potentially leading to modifications in their lives and academic activities. Objectives To describe the type of harassment experienced by interns, medical interns, and residents, and its consequences. Methods A cross-sectional and prospective study was conducted, including medical interns, social service interns, and residents from Veracruz who reported experiencing harassment in their assigned areas during their last academic year. Direct and virtual invitations were sent through various electronic means. Results 58 students were included, with 39 (67.2%) being women. 50% reported experiencing psychological abuse, and 65.5% reported experiencing sexual harassment. The most severe sexual harassment incidents included sexual assault with physical force (1.7%) and three instances of non-consensual sexual relations (5.2%), while the most common were sexual jokes/comments (72.4%). Following harassment experiences, 25% of participants reported feeling anxious, 22% stressed, and 17% angry. Students who perceived psychological abuse reported anger (69%), stress (58.6%), and anxiety (58.6%) as the most frequent consequences, while those reporting sexual abuse indicated anger (73.7%), shame (68.4%), and anxiety as primary consequences. The most frequently identified harassers were attending physicians (56.9%), senior students (34.5%), and non-medical personnel (34.5%). Students filed complaints with hospital authorities (6.9%), university authorities (6.9%), and external agencies (5.2%). The individual who experienced sexual assault with physical force did not file any complaint, while only one person reported non-consensual sexual relations to hospital authorities. Conclusions It is crucial to establish safe spaces for students within the hospital environment to promote their overall well-being and academic success, as well as to encourage a culture of reporting. Key messages • Highlighting the need for intervention within the work teams where our students are placed, promoting a violence-free environment. • Annexing a therapist as part of the work team could favor the well-being of students, since mental health is one of the main points affected within a violent environment.

Association of COVID-19 with acute and post-acute risk of multiple different complications and mortality in patients infected with omicron variant stratified by initial disease severity: a cohort study in Hong Kong

BackgroundFew studies have attempted to use clinical and laboratory parameters to stratify COVID-19 patients with severe versus non-severe initial disease and evaluate age-specific differences in developing multiple different COVID-19-associated disease outcomes.MethodsA retrospective cohort included patients from the electronic health database of Hong Kong Hospital Authority between 1 January 2022 and 15 August 2022 until 15 November 2022. The cohort was divided into three cohorts by age (≤ 40, 41–64, and ≥ 65 years old). Each age cohort was stratified into four groups: (1) COVID-19 critically exposed group (ICU admission, mechanical ventilation support, CRP > 80 mg/L, or D-dimer > 2 g/mL), (2) severely exposed group (CRP 30–80 mg/L, D-dimer 0.5–2 g/mL, or CT value < 20), (3) mildly–moderately exposed group (COVID-19 positive-tested but not fulfilling the criteria for the aforementioned critically and severely exposed groups), and (4) unexposed group (without COVID-19). The characteristics between groups were adjusted with propensity score-based marginal mean weighting through stratification. Cox regression was conducted to determine the association of COVID-19 disease severity with disease outcomes and mortality in the acute and post-acute phase (< 30 and ≥ 30 days from COVID-19 infection) in each age group.ResultsA total of 286,114, 320,304 and 194,227 patients with mild–moderate COVID-19 infection; 18,419, 23,678 and 31,505 patients with severe COVID-19 infection; 1,168, 2,261 and 10,178 patients with critical COVID-19 infection, and 1,143,510, 1,369,365 and 1,012,177 uninfected people were identified in aged ≤ 40, 40–64, and ≥ 65 groups, respectively. Compared to the unexposed group, a general trend tending towards an increase in risks of multiple different disease outcomes as COVID-19 disease severity increases, with advancing age, was identified in both the acute and post-acute phases. Notably, the mildly–moderately exposed group were associated with either insignificant risks (aged ≤ 40) or the lowest risks (aged > 40) for the disease outcomes in the acute phase of infection (e.g., mortality risk HR (aged ≤ 40): 1.0 (95%CI: 0.5,2.0), HR (aged 41–64): 2.1 (95%CI: 1.8, 2.6), HR (aged > 65): 4.8 (95%CI: 4.6, 5.1)); while in the post-acute phase, these risks were largely insignificant in those aged < 65, remaining significant only in the elderly (age ≥ 65) (e.g., mortality risk HR (aged ≤ 40): 0.8 (95%CI: (0.5, 1.0)), HR (aged 41–64): 1.1 (95%CI: 1.0,1.2), HR (aged > 65): 1.5 (95%CI: 1.5,1.6)). Fully vaccinated patients were associated with lower risks of disease outcomes than those receiving less than two doses of vaccination.ConclusionsThe risk of multiple different disease outcomes in both acute and post-acute phases increased significantly with the increasing severity of acute COVID-19 illness, specifically among the elderly. Moreover, future studies could improve by risk-stratifying patients based on universally accepted thresholds for clinical parameters, particularly biomarkers, using biological evidence from immunological studies.

Comparison and analysis of ophthalmic resources and service ability in Shanxi Province in 2014 and 2021

Objective: To compare and analyze the ophthalmic resources and service ability in Shanxi Province in 2014 and 2021, and to provide reference for the development planning of ophthalmology and eye care. Methods: In this cross-sectional study, a questionnaire survey was conducted among all ophthalmic institutions registered in the health administrative department in 11 cities of Shanxi Province by the end of 2014 and 2021 by using the National Ophthalmology Competency Resource Questionnaire (compiled by the Medical Administration and Hospital Authority of the National Health and Wellness Commission). The basic situations of ophthalmic institutions in 2014 and 2021, as well as the human resources, ophthalmic equipment configuration, technology and medical service capabilities, were recorded and compared. The chi-square test was used for statistical analysis. Results: A total of 270 questionnaires for 2014 were collected from 270 ophthalmic institutions, and 292 questionnaires for 2021 from 292 ophthalmic institutions. The institution categories in 2014 (197 general hospitals, 31 eye hospitals and 42 others) were statistically different from those in 2021 (182 general hospitals, 45 eye hospitals and 65 others) (P<0.05). The proportion of doctors with senior titles in ophthalmic institutions increased from 25.5% (346/1 358) in 2014 to 41.7% (580/1 391) in 2021, the proportion of senior technicians increased from 9.4% (14/148) to 25.3% (110/435), the proportion of doctors with junior titles decreased from 42.1% (572/1 358) to 26.5% (369/1 391), and the proportion of junior technicians decreased from 45.3% (67/148) to 39.1% (170/435). There was a significant difference in the distribution of professional titles between doctors and technicians in ophthalmic institutions (P<0.05). The number of doctors (130 to 28), nurses (152 to 50), technicians (33 to 11) and full-time optometrists (44 to 12) in the first-class ophthalmic institutions decreased, the increase of equipment with the ophthalmic A-ultrasound scan system, fundus camera and coherent optical tomography system (35.1%, 28.9% and 25.4%; P<0.05) ranked the top three, and the increase of performing the phacoemulsification procedure, intraocular lens implantation, intravitreal injection and iris surgery (30.2%, 24.7% and 20.7%; P<0.05) ranked the top three in 2021 as compared to 2014. Conclusions: The resources and service ability of ophthalmology in Shanxi Province developed in 2021 in comparison with 2014. However, there were some problems, such as changes in the type and structure of eye institutions, unreasonable proportions of professional titles, insufficient human resources in primary ophthalmic institutions, and slow improvement in the allocation of ophthalmology equipment and technical capabilities.

Risk factors for long-term cardiovascular post-acute sequelae of COVID-19 infection: A nested case-control study in Hong Kong

People with COVID-19 can experience post-acute sequelae of SARS-CoV-2 (PASC). Studies on risk factors of PASC outcomes are ongoing, especially for endocrine system-related diseases that may impact the cardiovascular system. Cardiac-related PASC is one of the burdens after COVID-19 infection. This study aimed to examine the risk factors of cardiac-related PASC. In this nested case-control study, we obtained electronic health records (EHRs) database from the Hong Kong Hospital Authority. We defined cases as patients with at least one cardiac-related PASC and controls as patients without any cardiac-related PASC. We applied the incidence density sampling and matched controls to cases on age and sex at a 1:10 ratio. Multivariable conditional logistic regression was used to determine the associations between risk factors and cardiac-related PASC. A total of 455 individuals with cardiac-related PASC and matched 3,423 controls were obtained in the underlying cohort. COVID-19-associated hospitalisation (aOR: 1.41, 95% CI: 1.03–1.93) and peripheral vascular disease (aOR: 2.98, 95% CI: 1.31–6.79) were associated with an increased likelihood of cardiac-related PASC. Higher doses of the COVID-19 vaccine (2 doses: 0.68 [0.52–0.89]; ≥3 doses: 0.56 [0.40–0.78]) and more frequent healthcare utilization visits (aOR: 0.95, 95% CI: 0.92–0.97) were associated with a lower likelihood of cardiac-related PASC. This is the first study to examine risk factors of cardiac-related PASC among the Chinese population. We identified peripheral vascular disease and COVID-19-associated hospitalisation as the risk factors for cardiac-related PASC. COVID-19 vaccination was protective against cardiac-related PASC, which should be prioritized for high-risk patients.

Causal Effect Estimation on Imaging and Clinical Data for Treatment Decision Support of Aneurysmal Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage is a medical emergency of brain that has high mortality and poor prognosis. Causal effect estimation of treatment strategies on patient outcomes is crucial for aneurysmal subarachnoid hemorrhage treatment decision-making. However, most existing studies on treatment decision-making support of this disease are unable to simultaneously compare the potential outcomes of different treatments for a patient. Furthermore, these studies fail to harmoniously integrate the imaging data with non-imaging clinical data, both of which are useful in clinical scenarios. In this paper, we estimate the causal effect of various treatments on patients with aneurysmal subarachnoid hemorrhage by integrating plain CT with non-imaging clinical data, which is represented using structured tabular data. Specifically, we first propose a novel scheme that uses multi-modality confounders distillation architecture to predict the treatment outcome and treatment assignment simultaneously. With these distilled confounder features, we design an imaging and non-imaging interaction representation learning strategy to use the complementary information extracted from different modalities to balance the feature distribution of different treatment groups. We have conducted extensive experiments using a clinical dataset of 656 subarachnoid hemorrhage cases, which was collected from the Hospital Authority Data Collaboration Laboratory in Hong Kong. Our method shows consistent improvements on the evaluation metrics of treatment effect estimation, achieving state-of-the-art results over strong competitors. Code is released at https://github.com/med-air/TOP-aSAH.

THE RISE OF PRIVATIZATION IN HEALTH SECTOR: EXPLORING THE RELATIONSHIP BETWEEN PRIVATE HEALTH CARE AND THE UPPER CLASS

In the past twenty years, the transfer of health care services from public to private ownership has been a topic of significant interest in almost every country worldwide. Privatization and the free-market system have become attractive options for countries dealing with rising healthcare costs, growing dissatisfaction with the effectiveness and quality of care in public health facilities, and limited public resources to support healthcare services. The purpose of the research to explore the relationship between private health care and the upper class. The study identifies the causes of privatization, including globalization, modernization, urbanization, capitalism, neoliberal policy formation, and people's access to it. This study is based on primary data. In order to collect primary data, a comprehensive study questionnaire was designed, including both structured closed-ended and open-ended questions, and data have been collected randomly from ten private hospitals in Madaripur. The research included a sample size of 130 respondents, consisting of 110 patients, 20 nurses, and hospital authorities. The findings conclude that private health care is the outcome of elites’ demand, which is decorated with advanced facilities. In a public hospital, it is impossible for a patient to anticipate a simple pathological or radiological examination. Patients ultimately find themselves compelled to visit private clinics. However, the high cost of these clinics often restricts people's access to them. Aside from this, capitalism has given birth to private ownership and class categorization in society, while neoliberal policy has reduced government control over public expenditure. Market competition, individual responsibility, consumer choice, and lifestyle change have also increased the privatization of health services in Madaripur, as well as in the larger cities of Bangladesh. KEYWORDS: privatization, health care, globalization, capitalism, public health, neoliberal policy

Changes in the incidence, clinical features and outcomes of tuberculosis during COVID-19 pandemic

BackgroundCOVID-19 pandemic has disrupted tuberculosis (TB) services in many countries, but the impacts on sites of involvement, drug susceptibility, smear positivity and clinical outcomes, and clinical outcomes of co-infection with influenza and COVID-19 remain unclear. MethodsDescriptive epidemiological study using episode-based and patient unique data of tuberculosis from Hospital Authority’s territory-wide electronic medical record database, comparing baseline (January 2015-December 2019) and COVID-19 period (January 2020-December 2022), followed by univariate and multivariate analyses. Effects of co-infection with influenza and COVID-19 were investigated. ResultsThe study included 10,473 episodes of laboratory-confirmed TB, with 6818 in baseline period and 3655 during COVID-19 period. During COVID-19 period, TB patients had a lower proportion of smear positivity (49.2 % vs 54.7 %, P < 0.001), and fewer cases of extrapulmonary TB (7.0 % vs 8.0 %, P = 0.078) and multidrug resistant TB (1.0 % vs 1.6 %, P = 0.020). Mortality was higher in TB patients with COVID-19 coinfection (OR 1.7, P = 0.003) and influenza coinfection (OR 2.6, P = 0.004). During COVID-19 period, there were higher rates of treatment delay (20.5 % vs 15.5 %, P < 0.001) and episodic death (15.1 % vs 13.3 %, P = 0.006). Factors associated with higher mortality included age ≥ 70 years (OR 7.24), treatment delay (OR 2.16), extrapulmonary TB (OR 2.13). smear positivity (OR 1.71) and Charlson comorbidity index score ≥ 3 (OR 1.37). Higher mortality was observed with co-infection by influenza (OR 1.18) and COVID-19 (OR 1.7). ConclusionsThe epidemiology and outcomes of TB were changed during COVID-19 period. Mortality was higher during COVID-19 period and with co-infection by influenza and COVID-19.

Direct oral anticoagulants versus low-molecular-weight heparin in patients with cancer-associated venous thrombosis: a cost-effectiveness analysis.

Direct oral anticoagulants (DOACs) have demonstrated clinical benefits and better patient adherence over low-molecular-weight heparin (LMWH) in treating patients with cancer-associated venous thrombosis (CAT). We aimed to compare the cost-effectiveness of DOACs against LMWH in patients with CAT from the perspective of the Hong Kong healthcare system. A Markov state-transition model was performed to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) for DOACs and LMWH in a hypothetical cohort of 10,000 patients with CAT over a 5-year lifetime horizon. The model was primarily based on the health states of no event, recurrent venous thromboembolism, bleeding, and death. Transition probabilities, relative risks, and utilities were derived from the literature. Resource cost data were obtained from the Hong Kong Hospital Authority. Deterministic and probabilistic sensitivity analyses tested the robustness of the results. Relative to LMWH, DOACs were associated with increased QALYs (1.52 versus 1.50) at a lower medical cost of USD 2,232 versus 8,224 in five years. The cost of LMWH was the main contributor to the outcome. Out of 10,000 simulated cases, DOACs were dominant in 15.8% and cost-effective in 42.1%, at the willingness-to-pay threshold of USD 148,392 per additional QALY. DOACs were associated with greater QALY improvements and lower overall costs compared to LMWH. Accounting for uncertainty, DOACs were between cost-effective and dominant in 57.9% of cases. DOACs are a cost-effective alternative to LMWH in the management of CAT in Hong Kong.

Vascular access specialist teams versus standard practice for catheter insertion and prevention of failure: a systematic review

ObjectiveBillions of vascular access devices (VADs) are inserted annually for intravenous therapy worldwide. However, their use is not without challenges. Facilitating the process and enhancing results, hospital authorities have created...

Abusive supervision and helping behavior among nursing staff: a moderated mediation model

PurposeThis study aims to explore the adverse impacts of abusive supervision on helping behaviors among employees, as mediating by intention to leave and moderating by Islamic work ethics (IWE).Design/methodology/approachA quantitative approach was employed, and the sample consisted of 283 nurses working in various public sector hospitals in Pakistan. The data analysis was conducted using SPSS and AMOS with the PROCESS macro.FindingsThe results suggest that abusive supervision diminishes helping behavior among nurses. Additionally, the study reveals that intention to leave mediates the relationship of abusive supervision and nurses' helping behavior. Moreover, the introduction of IWE as a boundary condition reveals that the mediated link is weaker when IWE is higher, and vice versa.Practical implicationsThis study provides valuable insights for hospital authorities to develop intervention strategies and policies aimed at reducing abusive supervision in hospitals. Hospital management should also be aware of the detrimental effects of abusive supervision on nurses' helping behaviors, which can be mitigated by promoting ethical values aligned with IWE.Originality/valueThis study makes a valuable contribution to the limited research on the link between abusive supervision and helping behaviors in hospital settings. It offers new perspectives by incorporating the Conservation of Resources theory, particularly within the healthcare sector. Furthermore, this research expands the current knowledge by investigating the mediating influence of intention to leave and the moderating effect of IWE in mitigating the adverse impact of abusive supervision on nurses' helping behavior in Pakistan's public sector hospitals.

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation

ObjectivesOlder individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals...

Implementation of Outpatient Automated Stewardship Information System (OASIS©) Audit and Feedback in Two Healthcare Systems

Background: Combating antibiotic resistance, exacerbated by widespread unnecessary outpatient antibiotic prescriptions, necessitates innovative stewardship solutions. Audit and feedback reports are effective but often resource heavy. We introduced a free, open-source system, Outpatient Automated Stewardship Information System (OASIS©), for automating the creation and distribution of recurring audit and feedback reports to clinicians to improve antibiotic prescribing. Methods: We used mixed methods to evaluate implementation of OASIS© across 11 clinics at Denver Health and Hospital Authority (DHHA) and Children’s Hospital Colorado (CHCO) from July 2022 to August 2023. Both sites host their own Epic® electronic healthcare and enterprise data warehouse systems. R statistical software was utilized to retrieve and process the data needed to create individual[HCM1] clinician audit and feedback reports with peer comparison. Reports were provided for 1) antibiotics prescribed for respiratory diagnoses, 2) antibiotics prescribed for respiratory diagnoses where antibiotics are never indicated, 3) first-line antibiotic prescribing for acute otitis media (AOM), and 4) five-day duration of antibiotics for children two years and older with AOM. Feedback reports for each metric were emailed to clinicians for three consecutive months. The primary outcome was adaptations needed to implement OASIS©. Secondary outcomes included fidelity (measured by email readership), time to set up and maintain the program, and barriers and facilitators to implementation (assessed by four qualitative interviews with OASIS© stakeholders). Results: The most significant adaptations made pertained to the automation of OASIS© reports for organizations not using R for data retrieval and reporting, setting up OASIS© specific email addresses, and validating clinician fidelity via read receipts. Fidelity was higher at DHHA (91-100%) compared to CHCO (10-30%). When interviewed, data analysts expressed that time for initial setup ranged from 1-6 hours. After reporting was automated, the estimated monthly time to send reports was 10 minutes. Views on setup complexity were split, but all recognized the readability of the reports and OASIS©’s value for improving prescribing behaviors. The greatest barriers to implementation included obtaining analytic resources for initial setup and the need to download additional R packages. No interviewee had prior experience creating audit and feedback reports. Conclusions: Implementing OASIS© requires addressing system diversity and knowledge gaps in outpatient informatics and antibiotic stewardship. Despite these challenges, the tool proved efficient and beneficial for monitoring and reporting antimicrobial prescribing. This free tool could likely be effectively disseminated to other health systems given the limited time and resources required for adaptations, setup, and monitoring. [HCM1]I

Effectiveness of a home-based peer support programme for Chinese mothers with low breastfeeding self-efficacy to increase the exclusivity and duration of breastfeeding: study protocol of a randomised control trial

IntroductionBreastfeeding is associated with many health benefits for both women and their newborns. Exclusive breastfeeding has been recommended for at least 6 months to optimise infant growth, development and health....

The negative spillover impact of the COVID-19 pandemic on Hong Kong diabetes patients' mortality and cardiovascular disease.

The spillover impact from disrupted healthcare services for non-COVID-infected diabetes mellitus (DM) patients caused by the reshuffling of the manpower during the pandemic remains understudied, especially in Hong Kong where healthcare resources were already strained before the pandemic. To evaluate the spill-over effect of the Pandemic on Hong Kong diabetes patients, we examined the change in all-cause mortality and the incidence of cardiovascular disease (CVD) from 2012 to 2021. This retrospective cohort study analyzed data from Hong Kong Hospital Authority healthcare records covering all publicly provided care. Adults diagnosed with DM on/before December 31, 2010, without CVD before January 2012 were included. The 2016-2019 average all-cause mortality and the incidence of CVD after age-standardization represented the pre-pandemic levels. Subjects would leave the cohort after being infected with COVID-19. A cohort of 159,693 patients with diabetes was identified and followed up for 10 years from January 2012 to December 2021. Compared to the pre-pandemic levels, 2020 saw a 12% increase in age-standardized mortality per 10,000 diabetic patients (incidence rate ratio [95% CI]: 1.12 [1.10 - 1.14]), but no significant change in age-standardized CVD incidence. However, in 2021, there were 11% (1.11[1.10 - 1.13]) and 13% (1.13 [1.11 - 1.15]) more new CVD cases and deaths, respectively, versus the pre-pandemic period. The COVID-19 outbreak in 2020 had negative spillover impacts on DM patients without COVID-19 in Hong Kong, with a higher mortality in 2020 and 2021 compared with the pre-pandemic level.

The Effect of Transformational Leadership on Crisis Management at Al-Thawra General Hospital Authority, Hodeidah Governorate, Republic of Yemen

This study aimed to investigate the impact of transformational leadership on crisis management at Al-Thawra General Hospital Authority in Hodeidah. It also explored potential variations in crisis management perception based on employee demographics (gender, qualification, job title, and experience). A descriptive analytical approach was employed. The target population consisted of all Al-Thawra Hospital employees (n=1362). A sample of 300 individuals (22%) was selected. A pilot study (n=30) assessed validity and reliability before main data collection. Data analysis using SPSS revealed a significant positive impact of transformational leadership dimensions on crisis management. Besides, during a crisis, male employees exhibited higher confidence in crisis response compared to females. Additionally, employees with less than five years of experience displayed a stronger perception of their ability to contribute to crisis management across various phases. Based on these findings, the study recommends that Al-Thawra leadership prioritize the development of transformational leadership skills and implement a comprehensive crisis management plan encompassing all crisis stages.

Prevalence of Hypertension and Its Associated Risk Factors Among Adults Attending Medical Outpatient Clinics at Ibn Sina General Hospital Authority in Mukalla City, Yemen.

Hypertension (HTN) is the most generally acknowledged modifiable risk factor for cardiovascular disease, cerebrovascular disease, and end-stage renal disease. Accordingly, the World Health Organization has listed HTN as the third greatest cause of death globally. The objective of this study was to assess the prevalence of HTN and its associated risk factors among adults attending medical clinics at Ibn Sina Hospital Authority in Mukalla City, Yemen. A cross-sectional descriptive survey was conducted using a self-administered questionnaire applied to 384 male and female adults aged ≥18 years attending Ibn Sina General Hospital Authority outpatient clinics in Mukalla City, Yemen, between December 2022 and May 2023. The participant's body weight, height, and waist circumference were measured. The data were analyzed using StatisticalPackage for the Social Sciences (IBMSPSSStatisticsforWindows,IBMCorp., Version 25.0, Armonk,NY). P values of <0.05 were considered statistically significant. Among the 384 participants, 20.5% had HTN, and the remaining (79.5%) did not have HTN, with a substantial proportion (47.2%) reporting a positive family history of HTN. Diabetes mellitus was present in 16.1% of the participants, whereas dyslipidemia and other chronic diseases were reported by 9.3% and 15.8% of the participants, respectively. A total of 75.6% of the participants had never smoked, and 11.7% were past smokers. More than half of the participants (57.29%) had never chewed khat, 20.57% were former khat chewers, and 22.14% were currently chewing khat. Nutritional status, as indicated by body mass index, showed that 29.8% were overweight. HTN was found to be prevalent among the study participants. However, the respondents' awareness of the problem and the overall control rates were very low. Certain factors, such as family history of HTN, diabetes mellitus, and high body mass index, were found to be associated with HTN. Therefore, intervention measures are warranted emphasizing modifiable risk factors to prevent HTN.

SABINA + Hong Kong: a territory wide study of prescribing trends and outcomes associated with the use of short-acting β2 agonists in the Chinese population

BackgroundExcessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population.MethodsRetrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3–6, 7–10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma.Results17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3–6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7–10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37).ConclusionsSABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.

Evaluating the impact of school-based influenza vaccination programme on absenteeism and outbreaks at schools in Hong Kong: a retrospective cohort study protocol

IntroductionSeasonal influenza causes annual school breaks and student absenteeism in Hong Kong schools and kindergartens. This proposal aims to conduct a retrospective cohort study to evaluate the impact of a school-based influenza vaccination (SIV) programme on absenteeism and outbreaks at schools in Hong Kong.MethodsThe study will compare schools that implemented the SIV programme with schools that did not. The data will be sourced from school records, encompassing absenteeism records, outbreak reports, and vaccination rates. We will recruit 1000 students from 381 schools and kindergartens in 18 districts of Hong Kong starting June 2024. The primary outcome measures will include absenteeism rates due to influenza and school influenza outbreaks. Secondary outcomes will consist of vaccination coverage rates and the impact of the SIV programme on hospitalisations due to influenza-like illness. A t-test will be conducted to compare the outcomes between schools with and without the SIV programme.Ethics and disseminationThe school completed signing the participants’ informed consent form before reporting the data to us. Our study has been approved by the Hospital Authority Hong Kong West Cluster IRB Committee (IRB No: UW 17–111) and was a subtopic of the research “The estimated age-group specific influenza vaccine coverage rates in Hong Kong and the impact of the school outreach vaccination program”.Trial registrationThis study will be retrospectively registered.