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The assessment of low flow at El Abid river basin for a good management of water resource (High Atlas/Morocco)

Abstract In a scenario where pressures on aquatic ecosystems and the water demands of communities are on the rise, coupled with the impacts of global changes, understanding low water flows becomes a critical concern. Low flow is characterized as a natural and seasonal phenomenon, typically stemming from varying degrees of prolonged and severe rainfall deficits. This phenomenon is prone to temporal and spatial fluctuations, ultimately causing a reduction in streamflow. The El Abid River Basin is located within the big Oum Er Rbia watershed, covering an area of 30.600 km2. El Abid river stands out as the principal tributary of the Oum Er Rbia, boasting an average annual flow of 32 m3/s−1, with a maximum average flow reaching 77 m3/s−1 and a minimum average flow of 10 m3/s−1. The hydrological regime of this river exhibits a pattern of intermittent and extreme floods, as well as periods of low flow sustained by water from the karst hydrosystems of the central High Atlas. The aim of this study is to characterize the low flow rates within the upstream part of El Abid river basin, intending to enhance the management of water resources in this basin. The methodology employed involves extracting the minimum flows, calculating the severity thresholds for low flow, determining the lowest average monthly flow of the year, computing low flow rates based on monthly flow averages, and calculating low flow values for specific return periods. Monthly discharge data from two hydrometric stations within our study area, namely Ait Ouchéne and Tizi Nisly, were utilized. The dataset spans the period from 1976 to 2018.

Regional epidemiological features of infectious diseases with fecal-oral transmission in the socialist republic of Vietnam

Aim: To identify regional epidemiological features of infectious diseases spread by fecal-oral transmission and the factors influencing them in four regions of Vietnam.Materials and methods: Retrospective epidemiological analysis of data of 10 infectious diseases spread by fecal-oral transmission in Vietnam for the period 2017-2022. Maps of incidence by province was created using the QGIS 3.28 program. Correlation coefficients between the incidence of the studied diseases and socio-economic factors were established.Results: It was revealed that the incidence of the 10 studied diseases was 443.1±113.5 0 /0000 and tends to decrease. The highest incidence was recorded in Tay Nguyen. Cases of diarrheal syndrome (330.1±73.8 0 /0000) and enteroviral vesicular stomatitis (HMFD) (93.6±33.4 0 /0000) accounted for 95.65% of all registered cases. Diarrhea is distributed mainly among children under 4 years of age (1090.3±384.8 0 /0000) and 5-9 years old (60.9±18.5 0 /0000). Regional epidemiological features of diarrhea and HMFD are shown. The highest incidence of the HMFD was recorded among children under 4 years of age in Dong Thap (4635.8 0 /0000) and Ho Chi Minh City (4210.5 0 /0000), and the highest incidence of diarrheal syndrome was in Kon Tum (2621.2 0 /0000), Thai Binh (2556.6 0 /0000) and Dien Bien (1461.9 0 /0000). Relationships were established between the incidence of diarrhea and levels of access to safe water (rSpearman = – 0.393; p = 0.001), to the sanitation system (rSpearman = – 0.267; p = 0.035), average monthly income (rSpearman = – 0.424; p = 0.001), poverty levels (rSpearman = 0.403; p = 0.001).Conclusion: The high incidence of infectious diseases spread by fecal-oral transmission in Vietnam is due to the high incidence of diarrhea and HMFD. A high incidence of diarrhea is typical for provinces with low levels of access to safe water and sanitation systems, high levels of poverty and low average monthly income. Incidence of HMFD is high among children under 4 years old, especially in the southern provinces with high population density in the summer and autumn seasons.

Epidemiological Characteristics and Trends of Scarlet Fever in Zhejiang Province of China: Population-Based Surveillance during 2004-2022.

Over the past two decades, scarlet fever has resurged in some countries or areas. Nationwide nonpharmaceutical interventions changed the patterns of other infectious diseases, but its effects on the spread of scarlet fever were rarely studied. This study aimed to evaluate the changes in scarlet fever incidence in Zhejiang Province, China, before and during the COVID-19 pandemic periods and to provide references for scarlet fever prevention and control. Scarlet fever surveillance data in Zhejiang, China (2004-2022), were analyzed in three stages. Two-sample z test, ANOVA, and Tukey's test were used to compare and analyze the characteristics of disease spread at different stages. The ARIMA model was used to predict the overall trend. The data were obtained from the National Infectious Disease Reporting Information System. A total of 28,652 cases of scarlet fever were reported across Zhejiang Province during the study period, with the lowest average monthly incidences in 2020 (0.111/100,000). The predominant areas affected were the northern and central regions of Zhejiang, and all regions of Zhejiang experienced a decrease in incidence in 2020. The steepest decline in incidence in 2020 was found in children aged 0-4 years (67.3% decrease from 23.8/100,000 to 7.8/100,000). The seasonal pattern changed, with peak occurrences in April to June and November to January during 2004-2019 and 2021 and a peak in January in 2020. The median duration from diagnosis to confirmation was highest before COVID-19 (4 days); however, it decreased to 1 day in 2020-2022, matching the other two medians. In 2020, Zhejiang experienced an unprecedented decrease in scarlet fever, with the lowest incidence in nearly 18 years, but it rebounded in 2021 and 2022. The seasonal epidemiologic characteristics of scarlet fever also changed with the COVID-19 outbreaks. This suggested that nationwide nonpharmaceutical interventions greatly depressed the spread of scarlet fever. With the relaxation of non-pharmaceutical intervention restrictions, scarlet fever may reappear. Government policymakers should prioritize the control of future scarlet fever outbreaks for public health.

Factors associated with caregiver burden in early onset dementia: the LEAF study

AbstractBackgroundEarly‐onset dementia is often predicted to have a greater care burden than late‐onset dementia. Indeed, previous studies have reported that caregivers of early‐onset dementia suffer more than those of late‐onset dementia. We explored the factors that determine care burden in early‐onset dementia.MethodCaregivers whose patients participated in a longitudinal study of early onset dementia and family members (LEAF) were asked to respond to questionnaires regarding caregiver features and care burden such as CAS‐K (Korean Version of Caregiver Activity Survey), ZBI (Zarit Burden Interview), and SF‐36v2® (Short‐Form Health Survey 36 version 2). Correlation and linear regression analyses were conducted to clarify the factors affecting care burden, using commercial software (SPSS 23.0;SPSS Inc. Chicago,IL,USA).ResultA total of 255 caregivers (54.5±25.3 years old, 54.9% female) were divided into three groups depending on the clinical diagnosis of the patients they cared for (EOAD 181; FTD 53; other EOD 21). There were no statistical differences of demographic characteristics and care burden related variables among three groups of caregivers. The general burden for caregivers and time spent in caregiving were higher in patients with shorter education years, lower mini‐mental state examination(MMSE) scores (‐0.381, p<0.001), higher clinical dementia rating(CDR) (0.359, p<0.001), higher CDR sum of boxes (0.418, p<0.001), decreased level of activities of daily living (ADL, basic ‐0.334, p<0.001; instrumental 0.527, p<0.001), higher geriatric depression scale (GDS, 0.245, p<0.001) and higher body mass index(BMI, 0.149, p<0.05). Caregivers with a high Beck depression inventory(BDI) (0.218, p<0.001) spent more time for caring patients. The general care burden was greater in younger caregivers (‐0.142, p<0.05) and in caregivers with lower average monthly income(‐0.166, p<0.001), decreased physical function (‐0.142, p<0.05), poorer mental health (‐0.150, p<0.05), and more physical/emotional role limitation (‐0.464, p<0.001).ConclusionThis study is expected to have implications in that it also reviews the economic status of caregivers and ongoing personal and social changes according to the care burden. Demographic and clinical factors of patients and caregivers predict care burden in early‐onset dementia. This suggests that it is possible and necessary to attempt to reduce care burden through adjustment and support for related factors.

THE RELATIONSHIP BETWEEN SOCIOECONOMIC STATUS AND THE PREVALENCE OF OBESITY, HYPERTENSION AND DIABETES IN POPULATION LIVING IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE

Objective: Hypertension, diabetes and obesity are becoming increasingly common nowadays. Socioeconomic status differences and their effects on the prevalence of those conditions are, however, still unknown. The aim of the study was to determine the effect of monthly income on the prevalence of hypertension, diabetes and obesity in the rural population from the earthquake damaged area. Design and method: This study included 249 patients who were a part of the Croatian Project ‘Chasing the Silent Killer’, a hypertension screening intervention in rural areas. Various anthropometric measurements were performed and a questionnaire was given to the participants. The participants were divided into two groups: those with an average monthly income of more than 500 Eu and those with less. Results: The average BMI was 28.9 kg/m2. Out of the 249 patients, 100 of them had a BMI > 30 kg/m2. The average blood pressure was 142/81 mmHg. Average systolic blood pressure was 6 mmHg lower in participants with a higher average monthly income in comparison to patients with a lower average monthly income (p = 0.056). Out of the total participants, 21 have type 2 diabetes. No significant association between BMI (p = 0.529), diabetes (p = 0.759) and the participants’ monthly income was proven. Conclusions: In this rural population we found a tendency for people with a higher average monthly income to have lower systolic blood pressure but no significant association between BMI, diabetes, and monthly income was noted. Lower monthly income, i.e. poor socioeconomic status is associated with higher systolic blood pressure, but not with obesity and diabetes. This result warrants further research.

Characteristics and influencing factors of social isolation in patients with breast cancer: a latent profile analysis.

The goal of this study is to investigate the social isolation (SI) subtypes of patients with breast cancer (BC) and to explore its influencing factors. A sample of 303 BC patients participated in the study from September to December, 2021. Latent profile analysis (LPA) was performed to identify SI clusters based on the three sub-scales of the Chinese version of the Social Anxiety Scale, the Chinese version of the Social Avoidance and Distress Scale, and the Chinese version of the Loneliness Scale. We found that SI can be divided into three categories: high-level (Class 1), middle-level (Class 2), and low-level (Class 3), accounting for 20.46%, 33.00%, and 46.54%, respectively. Compared to Class 3, Class 1, which had the lower average monthly income per family member (RMB) (< 3000: OR = 5.298, P = .021; 3000 ~ 5000: OR = 5.320, P = .018), was more likely to suffer from SI due to occupation (Laborer: OR = 12.023, P = .009). Surgery (OR = 14.138, P < .001; OR = 2.777, P = .020), chemotherapy (OR = 10.224, P = .001; OR = 3.545, P = .001); poorer family functioning (OR = .671, P < .001; OR = .801, P = .002), and lower levels of self-transcendence (OR = .806, P < .001; OR = .911, P < .001) were important influencing factors for SI in Class 1 and Class 2 compared toClass3. SI is classifiably heterogeneous among patients with BC. Strategies that identify characteristics of SI and give targeted intervention focusing on family functioning and improving self-transcendence levels contribute to the prevention of SI among patients with BC.

Food Insecurity and Dietary Diversity of the Vulnerable Group in Nigeria: Drivers and Coping Strategies

The vulnerable group is the most prone to artificial or natural shocks, which could expose them food insecurity. Yet, there exists a dearth of practical information on their dietary diversity and food security status. This study, therefore, assessed the food security status and dietary diversity of the vulnerable group of Fadama III Additional Financing in Nigeria. Primary data collected from 165 respondents were analyzed using descriptive statistics, cost-of-calories, logit model, household dietary diversity score and Tobit model. The results revealed that the vulnerable group was aged smallholder farmers with a low average monthly income of N13,718 (USD 37.13). The majority (88.5%) were food insecure, while only 11.5% met the daily calorie intake of 2,260 kcal per capita. Educational level, income, and value of productive assets positively influenced their food security status, while household size negatively impacted them. Most of the vulnerable group had low dietary diversity, with a range of 0.31 to 0.40, indicating poor nutrition among them. The determinants of dietary diversity among them were gender, educational level, and household size. The most commonly employed food insecurity coping strategies were allowing children to eat first, collecting food from the wild, selling assets to buy food, eating once a day and purchase food on credit. This study suggests policy measures for educating the vulnerable group ,providing production assets and better family planning for the vulnerable group to enhance their dietary diversity and food security.

Changes in physical activity around the time of major adverse cardiac events in patients with implantable cardioverter-defibrillators.

With modern implantable cardioverter-defibrillators (ICDs), biometric measures including physical activity have become readily available to physicians. However, despite the increased availability, applications of these data to the clinical setting remain poorly studied. We sought to investigate whether changes in physical activity occur preceding and following cardiac events in patients with ICDs. We reviewed the electronic medical records of patients with ICDs implanted for any indication in 2018 and 2019 in the University of Pennsylvania health system. Patients with ICDs that reported physical activity were included in the study only if they experienced major adverse cardiac event(s) (MACE) that were preceded by at least 6months without MACE after device implantation. Seventy-four of the 827 charts reviewed met inclusion criteria. Baseline activity levels from 6 to 2months prior to MACE were 2.18-2.21h/day. In the month prior to MACE, average activity decreased significantly to 2.09h/day, and subsequently decreased again during the calendar month in which MACE occurred to 1.96h/day. The lowest average monthly activity levels occurred in the month after MACE, with incremental but non-significant recovery occurring over the subsequent 2months. In a cohort of ICD recipients, a significant decrease in physical activity was observed in the month preceding MACE. To our knowledge, this is the first study that observes time-dependent changes in activity in relation to MACE in a generalizable cohort of ICD recipients. ICD activity monitoring in patients at high risk for MACE may enhance patient care.

Association of household air pollution with glucose homeostasis markers in Chinese rural women: Effect modification of socioeconomic status

BackgroundSocioeconomic status (SES) was a crucial influencing factor of household air pollution (HAP). However, few studies have explored the potential effect modification of SES on the associations of HAP with type 2 diabetes mellitus (T2DM) and glucose homeostasis. MethodsA total of 20900 participants were obtained from the Henan Rural Cohort. HAP reflected by cooking fuel type and cooking duration was assessed via questionnaire. SES was evaluated by two dimensions: educational level and average monthly income. Associations of cooking fuel type, cooking duration with T2DM and glucose homeostasis indices (insulin, fasting plasma glucose (FPG), and HOMA-β) were assessed by the generalized linear model. Analyses were also conducted in different SES groups to explore the potential effect modification. ResultsSignificant negative association of cooking fuel type and cooking duration with T2DM, FPG, and HOMA-β was not observed. However, cooking with solid fuel and long-duration cooking were associated with decreased insulin level in women, and the adjusted coefficients were − 0.35 (95% confidence interval (95% CI): − 0.53, − 0.17) and − 0.36 (95% CI: −0.50, −0.21), respectively. Results from stratified analyses showed that these associations were more prominent in women with low average monthly income, with corresponding coefficient of − 0.57 (95% CI: −0.77, −0.37) for cooking with solid fuel and − 0.34 (95% CI: −0.52, −0.16) for long-duration cooking. Among women with low average monthly income, the largest decreased insulin level was observed in those who cooked with solid fuel, long-duration and poor kitchen ventilation, while the negative association of cooking fuel type and cooking duration with insulin level was slightly alleviated in the good kitchen ventilation group. ConclusionsLow average monthly income aggravated the negative association of HAP and insulin level among rural women, while improving kitchen ventilation may be a practical intervention. Trail registrationThe Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Monitoring gas flaring in Texas using time-series sentinel-2 MSI and landsat-8 OLI images

• A high-resolution inventory of gas flaring in Texas is constructed. • Spatial-temporal characteristics of gas flaring over Texas are analyzed. • The greenhouse gas emissions hotspots from the gas flaring regions are explored. Since the shale Oil/Gas revolution, gas flaring and venting in the United States has garnered increasing attention. There is a pressing need to understand the spatial–temporal characteristics of gas flaring and track the associated greenhouse gas emissions. In this context, we use a thermal anomaly index (TAI) incorporating the Google Earth Engine (GEE) cloud computation and local batch processing for monitoring gas flaring and characterizing its spatial–temporal dynamics. We then apply a quantitative analysis of satellite-based carbon dioxide (CO 2 ) and methane (CH 4 ) in the gas flaring region. Here, we generate a gas flaring sites inventory in Texas from 2013 to 2022 based on > 83,500 multi-source moderate-resolution images (including 74,627 Sentinel-2 Multispectral Instrument [MSI] images and 8,969 Landsat-8 Operational Land Imager [ OLI] images). Validations and comparisons demonstrate that our method is reliable for MSI and OLI images, with an overall accuracy of > 95 % and a low commission rate and omission rate. We detected 217,034 gas flares from 9,296 flaring sites in Texas, and the majority (>92 %) were found in the central and western regions of the Permian Basin and the Eagle Ford Shale. The number of detected gas flaring sites vastly outnumbered the existing Visible Infrared Imaging Radiometer Suite (VIIRS) fire products, with an upward trend from 2013 to 2019 and a downward trend from 2020 to 2022. Notably, the gas flaring sites dropped significantly at the beginning of the COVID-19 pandemic (from December 2019 to May 2020), with the lowest average monthly growth rate of −14.38 %, and fell to the level of mid-2017. Application of gas flaring data identifies the localized greenhouse gas (GHG) emission hotspots in Texas and demonstrates that the increased effect of CH4 released from gas flaring regions was significantly stronger than that of CO 2 . These findings can provide references for monitoring similar small industrial sources in the future, can be used as an essential supplement to low-resolution fire products, and improve our understanding of CO 2 and CH 4 emissions from gas flaring at fine spatial scales.

Low husband involvement in maternal and child health services and intimate partner violence increases the odds of postpartum depression in northwest Ethiopia: A community-based study.

Depression is the most common mental health problem that affects women during pregnancy and after child-birth. Postpartum depression, in particular, has both short and long-term effects on the lives of mothers and children. Women's health is a current global concern, but postpartum depression is a neglected issue in the maternal continuum of care and is rarely addressed. Therefore, this study aimed to assess postpartum depression and associated factors in Gondar city, northwest Ethiopia. A community-based cross-sectional study was conducted from August 1st to 30th, 2021 in Gondar city. A cluster sampling technique was employed to select 794 postpartum women. Data were entered by EPI DATA version 4.6 and exported to SPSS version 25 for further analysis. The multivariable logistic regression analysis was carried out to identify factors associated with postpartum depression. The adjusted odds ratio with its 95% confidence interval at a p-value of ≤ 0.05 was used to declare the level of significance. A total of 794 women were included in the analysis, giving a response rate of 98.5%. The prevalence of postpartum depression was 17.25% (95% CI: 14.5, 20.2). Younger maternal age (AOR = 2.72, 95% CI: 1.23, 5.85), low average monthly income (AOR = 2.71, 95% CI: 1.24, 5.91), low decision-making power (AOR = 2.04, 95%CI: 1.31, 3.18), low husband/partner involvement in MNCH care service (AOR = 2.34, 95%CI: 1.44, 3.81), unplanned pregnancy (AOR = 3.16 95% CI: 1.77, 5.62), and experience of intimate partner violence (AOR = 3.13; 95% CI: 1.96, 4.99) were significantly associated with increased odds of postpartum depression. In this study, nearly 1/5th of the study participants had postpartum depression. Thus, it is important to integrate maternal mental health services with the existing maternal health care services. It is also crucial to advocate the need for husband's involvement in MNCH care services and ensure women's decision-making power in the household. Moreover, community-based sexual and reproductive health education would be better to reduce risk factors of postpartum depression.

Developing a Cold-Related Mortality Database in Bangladesh.

The aim of this study was to develop a database of historical cold-related mortality in Bangladesh using information obtained from online national newspapers and to analyze such data to understand the spatiotemporal distribution, demographic dynamics, and causes of deaths related to cold temperatures in winter. We prepared a comprehensive database containing information relating to the winter months (December to February) of 2009–2021 for the eight administrative divisions of Bangladesh and systematically removed redundant records. We found that 1249 people died in Bangladesh during this period due to cold and cold-related illnesses, with an average of 104.1 deaths per year. The maximum number of cold-related deaths (36.51%) occurred in the Rangpur Division. The numbers were much higher here than in the other divisions because Rangpur has the lowest average monthly air temperature during the winter months and the poorest socioeconomic conditions. The primary peak of cold-related mortality occurred during 21–31 December, when cold fronts from the Himalayas entered Bangladesh through the Rangpur Division in the north. A secondary peak occurred on 11–20 January each year. Our results also showed that most of the cold-related mortality cases occurred when the daily maximum temperature was lower than 21 °C. Demographically, the highest number of deaths was observed in children aged six years and under (50.68%), followed by senior citizens 65 years and above (20.42%). Fewer females died than males, but campfire burns were the primary cause of female deaths. Most mortality in Bangladesh was due to the cold (75.5%), cold-triggered illness (10.65%), and campfire burns (5.8%). The results of this research will assist policymakers in understanding the importance of taking necessary actions that protect vulnerable public health from cold-related hazards in Bangladesh.

Comparing Statistical Downscaling and Arithmetic Mean in Simulating CMIP6 Multi-Model Ensemble over Brunei

The climate is changing and its impacts on agriculture are a major concern worldwide. The impact of precipitation will influence crop yield and water management. Estimation of such impacts using inputs from the General Circulation Models (GCMs) for future years will therefore assist managers and policymakers. It is therefore important to evaluate GCMs on a local scale for an impact study. As a result, under the Shared Socioeconomic Pathways (SSPs) future climate scenarios, namely SSP245, SSP370, and SSP585, simulations of mean monthly and daily precipitation across Brunei Darussalam in Phase 6 of the Coupled Model Intercomparison Project (CMIP6) were evaluated. The performance of two multi-model ensemble (MME) methods is compared in this study: the basic Arithmetic Mean (AM) of MME and the statistical downscaling (SD) of MME utilizing multiple linear regression (MLR). All precipitation simulations are bias-corrected using linear scaling (LS), and their performance is validated using statistical metrics such as Root Mean Square Error (RMSE) and coefficient of determination (R2). The adjusted mean monthly precipitation during the validation period (2010–2019) shows an improvement, especially for the SD model with R2 = 0.85, 0.86 and 0.84 for SSP245, SSP370 and SSP585, respectively. Although the two models produced unsatisfying results in producing annual precipitation. Future analysis under the SD model shows that there will be a much lower average monthly trend in comparison with the observed trend. On the other hand, the forecasted monthly precipitation under AM predicted the same rainfall trend as the baseline period in the far future. It is projected that the annual precipitation in the near future will be reduced by at least 27% and 11% under the SD and AM models, respectively. In the long term, less annual precipitation changes for the SD model (17%). While the AM model estimated a decrease in precipitation by at least 14%.

Wpływ pandemii COVID-19 na poziom wykluczenia finansowego mieszkańców południowo-wschodniego regionu Polski

The main goal of the research was to assess the impact of the pandemic crisis on the level of financial exclusion of the inhabitants of the south-eastern region of Poland and to identify the factors determining this financial exclusion. The detailed scope of the research covers the administrative area of the Podkarpackie Voivodeship. The pandemic period adversely affected many areas of social and economic life. One such area is the level of financial exclusion, which has significantly affected people on low incomes, often living in villages and small towns. South-eastern Poland, including the Podkarpackie Voivodeship, is still one of the economically weaker regions. It should be emphasised that the Podkarpackie Voivodeship has an agricultural and industrial character. It has the largest percentage of people living in villages in the country (58.6%). Following this line of reasoning, the study covered the inhabitants of the Podkarpackie Voivodeship whose places of residence are located in counties with the lowest average monthly gross salary in relation to the national average, and for the purpose of a comparative analysis, inhabitants of the largest voivodeship city – Rzeszów. The research used the diagnostic survey method, and the responses were statistically analysed to observe the relationship between the features: age, sex, education, etc. and a comparative analysis of individual counties. In addition, the method of literature analysis was used, including previous research on similar topics from the period before the pandemic. Based on the research, it can be concluded that people from the counties selected for the study much more often combine financial exclusion with unemployment and low wages. They are concerned about the stability of their income and believe that they are financially excluded. Similar relationships were observed for people over 46 years of age and for people whose average monthly net income per person in the household is less than PLN 1,000.

Associations between healthy lifestyle score and health-related quality of life among Chinese rural adults: variations in age, sex, education level, and income.

This study aimed to investigate the associations between overall lifestyles and HRQoL, as well as the variations in age, sex, education level, and income. A total of 23,402 participants from the Henan rural cohort were included. The healthy lifestyle score (HLS) consists of five lifestyle factors: smoking, alcohol drinking, physical activity, diet, and body mass index. HRQoL was assessed by the EQ-5D-5L questionnaire. The general linear model and Tobit regression model were utilized to assess the associations of HLS with visual analogue score (VAS) and utility index. Compared with participants with an HLS of 0-2, the corresponding regression coefficients (β) and 95% confidence intervals (CI) of participants with an HLS of 3, 4, and 5 for VAS score were 1.09 (0.59, 1.59), 1.92 (1.38, 2.46), and 2.60 (1.83, 3.37); the corresponding β and 95% CI for utility index were 0.02 (0.01, 0.03), 0.05 (0.03, 0.06), and 0.06 (0.04, 0.07). Notably, these positive associations were greater among the elderly, female, and those with lower education level and average monthly income (p for interaction < 0.05). For instance, the corresponding β and 95% CI of individuals with an HLS of 5 for utility index in average monthly income < 500 RMB, 500-999 RMB, and ≥ 1000 RMB groups were 0.08 (0.05, 0.11), 0.06 (0.03, 0.09), and 0.02 (-0.00, 0.05). Engaging in healthier lifestyle habits was associated with a higher level of HRQoL, especially in the elderly, females, and those with low education level and average monthly income.

Organizational commitment of emergency physician and its related factors: A national cross-sectional survey in China.

BackgroundOrganizational commitment is important for job performance and employee retention. However, studies on the level of organizational commitment and its related factors among emergency physicians in China are scarce. Therefore, this study aimed to identify the factors associated with organizational commitment among emergency physicians in China.MethodsA national cross-sectional study was conducted in 2018 among emergency physicians in China. Data were collected from 10,457 emergency physicians using a standard structured anonymous questionnaire, including demographic characteristics, organizational structure factors and work environment factors. A generalized linear model was used to explore the correlation between the independent variables and organizational commitment.ResultsIn this study, 55.3% of emergency physicians reported a moderate level of organizational commitment. The physicians who were male, younger than 40 years old, had a mid-level title and had a lower average monthly income were more likely to show lower organizational commitment levels. Conversely, the organizational commitment was higher among physicians who perceived that promotion is easy and the number of emergency physicians meet their daily work or had not experienced workplace violence in the last year.ConclusionsThe study showed that organizational commitment among Chinese emergency physicians was moderate and related to gender, age, monthly income, frequency of daily visits, departmental promotion mechanism and workplace violent. Targeted interventions are needed to improve the organizational commitment of emergency physicians in a comprehensive way.

A Latent Profile Analysis of Chinese Physicians' Workload Tethered to Paperwork During Outpatient Encounters.

BackgroundPhysician dissatisfaction with more time spent on related paperwork but less time available for direct interaction with patients is increasing internationally. Increased physician workload resulting from paperwork might negatively affect their interaction with patients and increase the risk for burnout. This study aimed to investigate the level of physician workload tethered to paperwork during outpatient encounters and explore its latent workload subgroups among Chinese physicians.MethodsA cross-sectional survey was conducted via online questionnaire primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China from November 2020 to February 2021. The Chinese physician mental workload scale developed by our research team was used for assessment of physician workload tethered to paperwork. Physicians were categorized into different subgroups of workload via latent profile analysis. Multinomial logistic regression was subsequently performed to examine how demographic variables differ among physicians belonging to different subgroups.ResultsA total of 1,934 valid questionnaires were received. Chinese physicians reported medium levels of workload while performing non-physician-patient communication work tasks characterized by paperwork during outpatient encounters. Four latent workload subgroups were identified: “low workload group” (8.8%), “medium workload group” (34.0%), “high workload group” (42.1%) and “very high workload group” (15.1%). Compared with the other latent workload subgroups, physicians belonging to the “very high workload group” were more likely to be younger, married, those who had worse health status, lower educational levels and lower average monthly incomes, those who worked more years in the current institution, more hours per week and longer outpatient hours per week, and those who worked in public general hospitals, tertiary B hospitals and Obstetrics and Gynecology, and saw more than 50 outpatients per day, with more time spent on per patient.ConclusionsThere exit four latent workload subgroups among Chinese physicians tethered to paperwork during outpatient encounters along with great individual variations among these subgroups. The characteristics of the latent “very high workload group” can help permit more targeted guidance for developing interventions with optimized human resource allocation to, in turn, increase the time available for direct interaction with patients, thereby resulting in improved quality of physician-patient interactions and decreased risk for physician burnout.

Evaluating Completeness of Foodborne Outbreak Reporting in the United States, 1998-2019.

Public health agencies routinely collect time-referenced records to describe and compare foodborne outbreak characteristics. Few studies provide comprehensive metadata to inform researchers of data limitations prior to conducting statistical modeling. We described the completeness of 103 variables for 22,792 outbreaks publicly reported by the United States Centers for Disease Control and Prevention’s (US CDC’s) electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS). We compared monthly trends of completeness during eFORS (1998–2008) and NORS (2009–2019) reporting periods using segmented time series analyses adjusted for seasonality. We quantified the overall, annual, and monthly completeness as the percentage of outbreaks with blank records per our study period, calendar year, and study month, respectively. We found that outbreaks of unknown genus (n = 7401), Norovirus (n = 6414), Salmonella (n = 2872), Clostridium (n = 944), and multiple genera (n = 779) accounted for 80.77% of all outbreaks. However, crude completeness ranged from 46.06% to 60.19% across the 103 variables assessed. Variables with the lowest crude completeness (ranging 3.32–6.98%) included pathogen, specimen etiological testing, and secondary transmission traceback information. Variables with low (<35%) average monthly completeness during eFORS increased by 0.33–0.40%/month after transitioning to NORS, most likely due to the expansion of surveillance capacity and coverage within the new reporting system. Examining completeness metrics in outbreak surveillance systems provides essential information on the availability of data for public reuse. These metadata offer important insights for public health statisticians and modelers to precisely monitor and track the geographic spread, event duration, and illness intensity of foodborne outbreaks.

The prevalence of turnover intention and influencing factors among emergency physicians: A national observation

BackgroundHigh turnover among physicians in emergency department is a great challenge in China. However, the rate and the reasons why physicians intend to leave have not been extensively studied yet. Therefore, this study aimed to identify the risk factors of turnover intention among physicians in emergency department.MethodsA national cross-sectional survey was conducted from July to August 2018 in China. A total of 10 457 physicians in emergency department were investigated using a structured self-administered questionnaire, which included demographic characteristics, work-related factors, turnover intention, the Patient Health Questionnaire and Positive and Negative Affect Scale. The stepwise logistic regression analysis was applied to identify the risk factors of turnover intention among physicians.ResultsA total of 55.18% of the physicians in emergency department reported turnover intention in China. Turnover intention were more likely to be reported among physicians who were male (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.13-1.38); who perceived medical errors (OR = 1.35, 95% CI = 1.23-1.47); who had a lower average monthly income; who provided out-of-hospital resuscitation services; who experienced physical violence (OR = 1.39, 95% CI = 1.26-1.54) and who reported higher score on negative affect and depressive tendency (OR = 1.06, 95% CI = 1.05-1.08; OR = 1.10, 95% CI = 1.09-1.12). Conversely, physicians who perceived shortage of manpower (OR = 0.74, 95% CI = 0.66-0.81), or reported higher score on positive affect (OR = 0.96, 95% CI = 0.94-0.97) were inclined to stay in emergency department.ConclusionThis study shows that turnover intention among physicians in emergency department is high in China and was significantly associated with gender, average monthly income, perceived shortage of physicians, the times for provide out-of-hospital resuscitation services, exposure to workplace violence, depressive tendency, positive affect and negative affect. Targeted interventions are required to improve the retention rate among physicians in emergency department from the comprehensive aspects.

The prevalence of turnover intention and influencing factors among emergency physicians: A national observation.

High turnover among physicians in emergency department is a great challenge in China. However, the rate and the reasons why physicians intend to leave have not been extensively studied yet. Therefore, this study aimed to identify the risk factors of turnover intention among physicians in emergency department. A national cross-sectional survey was conducted from July to August 2018 in China. A total of 10 457 physicians in emergency department were investigated using a structured self-administered questionnaire, which included demographic characteristics, work-related factors, turnover intention, the Patient Health Questionnaire and Positive and Negative Affect Scale. The stepwise logistic regression analysis was applied to identify the risk factors of turnover intention among physicians. A total of 55.18% of the physicians in emergency department reported turnover intention in China. Turnover intention were more likely to be reported among physicians who were male (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.13-1.38); who perceived medical errors (OR = 1.35, 95% CI = 1.23-1.47); who had a lower average monthly income; who provided out-of-hospital resuscitation services; who experienced physical violence (OR = 1.39, 95% CI = 1.26-1.54) and who reported higher score on negative affect and depressive tendency (OR = 1.06, 95% CI = 1.05-1.08; OR = 1.10, 95% CI = 1.09-1.12). Conversely, physicians who perceived shortage of manpower (OR = 0.74, 95% CI = 0.66-0.81), or reported higher score on positive affect (OR = 0.96, 95% CI = 0.94-0.97) were inclined to stay in emergency department. This study shows that turnover intention among physicians in emergency department is high in China and was significantly associated with gender, average monthly income, perceived shortage of physicians, the times for provide out-of-hospital resuscitation services, exposure to workplace violence, depressive tendency, positive affect and negative affect. Targeted interventions are required to improve the retention rate among physicians in emergency department from the comprehensive aspects.