Medical Care Institutions Research Articles

Addressing the burden and detection gap of latent tuberculosis infection in schoolchildren and adolescents in China: a cross-sectional study

BackgroundThe latent tuberculosis infection (LTBI) burden is still unclear in schoolchildren and adolescents in China. Previous study and daily surveillance data indicate a LTBI detection gap. The research objective was to evaluate the LTBI burden and detection gap among schoolchildren and adolescents in China.MethodsA cross-sectional study was conducted among 69,667 schoolchildren and adolescents in Chongqing, China between September 2022 and December 2023 implemented by Chongqing Municipal Institute of Tuberculosis using tuberculin skin test (TST) and creation tuberculin skin test (C-TST). To evaluate the LTBI detection gap, the pulmonary tuberculosis (PTB) screening data implemented by Chongqing Municipal Institute of Tuberculosis have been compared with the data in 2021 implemented by community-level medical and health care institutions.ResultsThe LTBI prevalence rate using TST and C-TST implemented by Chongqing Municipal Institute of Tuberculosis was 12.8% (95%CI, 12.5-13%) and 6.4% (95%CI, 6-6.8%) respectively. The LTBI prevalence rate by Chongqing Municipal Institute of Tuberculosis was 9.6% higher than that by community-level medical and health care institutions (χ2 = 2931.9, P < 0.001).ConclusionsThe LTBI detection gap existed among schoolchildren and adolescents in Chongqing, and it also may exist in other similar countries and regions. National screening strategy needs improvement. Regular training and quality assurance could improve the performance of TST and C-TST and close the detection gap of LTBI.

The evaluation and enhancement strategies of core competencies for older adult caregivers in integrated medical and older adult care institutions.

The study aimed to understand the main skills of older adult caregivers and find ways to improve these skills. We selected participants using a method called random cluster sampling, where caregivers from 17 different medical and nursing care facilities across seven districts in Hangzhou were chosen. We collected 492 valid questionnaires and conducted interviews with 150 people. To analyze the data, we used T-tests and Analysis of Variance (ANOVA) to identify what factors affect caregivers' skills. We also performed multiple regression analysis to explore these factors in more depth. The analysis showed that age (p = 0.041), annual income (p < 0.001), and having a training certificate (p < 0.001) significantly influence the skills of older adult caregivers. Specifically, caregivers' age and whether they had a training certificate were linked to how competent they were, with income being a very strong factor. The study highlighted a gap between the caregivers' current skills and the skills needed for high-quality care. This gap shows the need for training programs that are specifically tailored to the caregivers' diverse needs and cultural backgrounds. Medical and eldercare facilities should adjust their work and educational programs accordingly. It's also important to look at how caregivers are paid to make sure their salary reflects their skills and the quality of care they provide. Finally, it's crucial to integrate a comprehensive training program that leads to certification within eldercare organizations.

Тактика врача первичного звена при выявлении очаговых образований в легочной ткани

In order to provide timely and quality medical care to the population within the framework of improving the material base of medical organizations, many treatment and preventive care institutions have been equipped with modern X-ray equipment in the last three years. A large number of patients have been subjected to computed tomography of the chest organs, which has made it possible to detect asymptomatic pulmonary masses in a number of individuals. Taking into account the necessity of timely differential diagnostics of such masses and, first of all, in order to exclude malignant pulmonary neoplasms, the question arises what tactics should be followed by a primary care physician in case of detection of pulmonary neoplasms in a patient for the first time. The article presents a Clinical case demonstrating the detection of pulmonary neoplasm, which required active tactics of patient management, and presents tools, the use of which gives the doctor confidence in his actions for early diagnosis of malignant neoplasms.

Spatial Function Diversification: A Case Study of Medical Care Institutions

With the continuous improvement of living levels, people's health needs and psychological needs are getting higher and higher. the functional needs of living conditions and lifestyles are becoming more and more refined, so that the design of diversified spatial functions has emerged. In a limited space, the diversified design is rich in functions, efficient and coordinated, and has the characteristics of adaptability, richness, harmony, unity and intensification of multiple orders. This article explores the human activities, time dimensions and space dimensions in the design of diversified spatial functions. Taking the medical care institution—postpartum rehabilitation center as an example, the design reflects the diversified characteristics of spatial functions.

Current status and influencing factors of health literacy among older adults in combined medical and nursing care institutions: a cross-sectional study.

Health literacy is linked to the health status of older adults and is a critical component in achieving active aging. This study to characterize the current health literacy status among older adults in combined medical and nursing care institutions, as well as the factors that influenced this status. This cross-sectional study used a convenience sampling method to select 740 older adults who were in 16 combined medical and nursing care institutions in Chengdu, China, from July 2022 to June 2023, using the Health Literacy Management Scale, the Social Support Rating Scale, and the Short Form-36 Health Survey. The results showed a health literacy score of 75.25 ± 12.33, the percentage of older adults with basic health literacy was 6.33%, a social support score of 37.37 ± 6.10, and a health-related quality of life score of 55.34 ± 15.48. Factors influencing health literacy included age, educational level, previous occupation, family size, monthly per capita household income, and health-related quality of life. Health literacy is an essential factor in improving the health status of older adults. Relevant departments should therefore improve health education and health promotion interventions for older adults in combined medical and nursing care institutions to improve health literacy.

Unmet needs for medical care in the Amur region

Based on a survey of the residence of the Amur region, the scale and causes of unmet needs for medical care are analyzed. A relationship has been established between the socio-demographic characteristics of the population, the territory of residence and behavior in receiving medical care. Significant differentiation was found in the ability to seek medical care, both in private and public health care institutions, between settlements in the region. It was revealed that residents of northern territories remote from the regional center with more dispersed settlements have limited access to medical care, which is manifested in failure to go to medical institutions when such a need arises.

Implementation of the cluster approach in the practice of the territorial organization of health care: theoretical, institutional and practical aspects

Introduction. The reform of the health care system in Ukraine ensured the creation of a multi-level provision of medical services, which covered medical institutions of all forms of ownership, which are not only competitors on the regional and local markets, but also had the full opportunity to participate in contractual relations with the National Health Service of Ukraine (NSZU) regarding the provision of medical care packages. Despite the positive consequences of transformational changes, a number of problems arose in the regions regarding the formation of optimal communications between different levels of providing medical services, the availability of services for patients, logistics related to medical care, the effectiveness of the use of budget funds, material and human resources, the availability of special medical care in separate regions (primarily regions of military operations), territorial organization of the network. According to government decisions, to solve these problems, the process of forming hospital districts and hospital clusters has been initiated, which, as practice shows, requires ambiguous management decisions. The above actualizes the problem of scientific support (analytical assessments, monitoring, design of possible further changes) of modern processes of the territorial organization of health care and its public management at the regional and local levels.&#x0D; The purpose of the research is a systematic analysis of the processes of cluster formation in health care and, on this basis, the development of theoretical and methodological provisions and justification of directions for further improvement of the established models of territorial organization of the industry.&#x0D; Methods. Applied methods of system analysis - to evaluate the process of establishing regulatory and legal prerequisites for starting cluster initiatives in health care, comparative analysis - in order to identify theoretical approaches to the interpretation of the phenomenon of territorial clusters in domestic and foreign scientific opinion. General scientific and empirical methods of economic science are used: methods of analysis and synthesis, comparison, summary and grouping - to identify the potential, opportunities and threats in the implementation of management decisions regarding the further functioning and development of clusters in health care of the regions of Ukraine.&#x0D; The results. Using a number of arguments, the expediency of using the cluster approach in the territorial organization of health care has been proven. The process of establishing the institutional basis for the formation of clusters in health care in Ukraine is evaluated. The peculiarities of the organizational structure of the territorial hospital cluster are determined. An empirical analysis of the prerequisites for the formation of hospital clusters in certain regions of Ukraine was carried out. The expected results of the formation of a capable network and the formation of territorial hospital clusters and risks in the implementation of management decisions regarding the selected model of the territorial organization of the medical space are determined. Based on the modeling of the possible influence of institutional, industrial, infrastructural and financial factors on the functioning and development of newly formed structural entities in the health care of the region, possible options for prevention and leveling of negative effects and development of relations between local self-government bodies and medical institutions of various levels are proposed for the purpose of optimization synergistic effect of cluster formation.&#x0D; Prospects. It is advisable to focus further scientific research on the issues of monitoring the work of the network of primary and specialized medical care institutions within the framework of newly formed hospital clusters and the introduction of information systems into the practice of strategic and operational management of a capable health care network.

A comparative analysis on the publicness of medical services in public health institutions: With an empirical analysis of the national health insurance database.

The purpose of this study is to analyze the publicness of medical services in public and private medical institutions, with a focus on treatment performance using National Health Insurance data. Data from the National Health Insurance Service were used to compare the publicness of medical services in public and private medical institutions. Beta regression analysis was conducted after adjusting for the relevant characteristics to identify the impact on the public treatment performance of medical institutions. The public case rate of public health institutions was higher than that of private medical institutions. According to the type of medical care institution, the public case rate was higher in general hospitals and tertiary hospitals than in hospitals. Recently, it has often highlighted that increasing emphasis of profitability in the evaluation of public health institutions is damaging the publicness of medical services. Even in this study, it can be evaluated that the public case rate of public health institutions is not higher than that of private medical institutions.

An Impact of Motivational Factors to Enhance Human Productivity: A Case study of Private Healthcare Institution of Karachi

Worker motivation is a crucial factor for an organization's success, as it affects productivity and helps achieve its vision and objectives. Supervisors at specialized medical care institutions in Karachi face a challenge in achieving ideal motivation for their staff, which would significantly improve hierarchical execution. This study aims to understand the components that impact representative motivation and how it influences worker performance in these institutions. &#x0D; The research used an expressive exploration approach, with workers from Karachi's specialized medical care institutions as the focus. A Non-likelihood judgment analysis was used, and data was collected through Google structures and analyzed using SPSS software. Inferential measurements were used to assess the information. Results showed that worker motivation and the viability of data trade, as well as the nature of the workplace, had the most strong connection for external components, while representative motivation and occupation impact by partners had the least. The relationship between decency of treatment at work and worker motivation was the most strong, while the relationship between input on presentation and strengthening and representative independence and worker motivation was the most precarious. In conclusion, the study reveals significant strengths in the relationship between dependent and autonomous components, the significant impact of external and internal variables on worker motivation, and a basic impact of worker motivation on worker performance.

Evaluation of family physicians’ attitude towards primary healthcare consultations

Abstract Background The quality of services in the health care system is very important for both patients’ health and health care providers. In the past decade, good service ratings from the patient's perspective have become crucial in evaluating the work of medical professionals and health care institutions. However, it is also important to consider the opinions of health care specialists, especially when it comes to medical consultation, which is one of the most important components of primary health care (PHC) chain. Aim To evaluate the attitude of family physicians (FP) towards consultations provided in PHC. Methods The study was conducted in 2022. December - 2023 in February. The research contingent is FP of Lithuania. Research method - quantitative momentary research, anonymous questionnaire survey, 206 subjects were interviewed. Calculated chi-square (χ2) and z-criterion. Results The majority of FP indicated that they involve the patient in the decision-making process (68.0%), those working in private institutions said so more often than those working in public institutions (p &amp;lt; 0.05). 89.3% of the subjects stated that the consultation time with the patient is not enough, and 70.4% respondents receive many unregistered patient visits per day. E-health makes it difficult for 81.1%, 86.4% of the respondents indicated that there is too much of a workload and this was mostly said by respondents working in public institutions (p &amp;lt; 0.05). Remote consultations facilitate the workflow (76.2%). The older age of the respondents and greater work experience lead to lower self-confidence during remote consultation, longer consultation time and less belief in the benefits of remote consultation (p &amp;lt; 0.05). Conclusions Most FP positively evaluate the consultation they provide, but they also said that the consultation time is insufficient, they must consult a number of unregistered patients, e-health complicates the work. Remote consultations facilitate the workflow. Key messages • The consultation time is insufficient. • Remote consultations facilitate the workflow.

Legal Responses to Violence against Medicare Service Persons and Institutions during COVID- 19 Pandemic in India

Background: The COVID-19 pandemic and virility of the violence against medical personnel have been parallel phenomena in Indian public health administration. The safety and security medical and paramedical have been attracting attention for quite a long time. Still, no central legislation has piloted to enhance their therapeutic and surgical acumen in epidemics and pandemics. The health care of the patients and the covenant of Medicare service persons and institutions doctors missed in the myopic perception of the health administration’s tilt towards the criminal administration of justice. Method: The clasping of 125 years of age epidemic control law and 162 years of age criminal statute stinks the Indian feel in the present context. Result: The significant outcome of the COVID-19 pandemic is showcased in the Epidemic Diseases (Amendment) Ordinance, 2020, ensuring harassment-free workplaces for the medical fraternity. The criminal sanction afforded by the 23 state enactments on the protection of medical care personnel and institutions in states in India, but there is no central legislation. Despite the Indian Medical Association’s recommendation for the Protection of Medical Service Persons and Medical Service Institutions (Prevention of Violence and Damage or Loss of Property) Act, 2017, we witnessed Epidemic Diseases (Amendment) Ordinance, 2020 in enhancing the robust workplace for the doctors during the pandemic. The legal strategy camouflaging ‘disaster’ under Section 2 (d) of the Disaster Management Act, 2005 in pandemic and lockdown is sobering but astonishing. Conclusion: The paper locates the legal response to violence against the doctors in the sociology of medicine and medical professions as professional socialization and social system during the COVID-19 pandemic. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 734-742

노인 돌봄의 전문성 향상을 위한 인력정책 비교연구: 독일, 일본, 한국을 중심으로

labor policy among the long-term care insurance policies for the elderly in Germany, Japan, and Korea. To this end, previous studies examined changes in the policy environment and the framework of policy calculation in the global historical trend of elderly care policies in countries that first experienced an aging society. As a result, various policies appeared from country to country between tax-based care and social insurance-based care. Germany and Japan, which first chose the same route as Korea, advanced the professionalism of care workers, while dualizing them into auxiliary workers at the level of daily care. Strengthening the professionalism of elderly care workers is a must-achieve goal in the long run, but it can be seen that various real conditions have also been linked to an important part of the elderly care labor policy. Based on this study, suggestions were included at the level of policy, education, and medical care institutions. First, at the policy level, the minimum line should be maintained in the professionalism of caregivers. Second, at the educational level, it is necessary not only to deliver knowledge and skills, but also to build the pride of care workers. Third, even if it is not a salary, at the medical care institution level, if expertise is developed and awareness is raised through self-education and the possibility of promotion, the effect of long-term tenure can be seen.

Elective surgery cancellations in pediatric surgery: rate and reasons

IntroductionCanceling pediatric elective surgery leads to multiple disturbances regarding the inefficient operating room (OR) management, the financial repercussions, and the psychological impact on the patient and his family. This study aims to identify the reasons for cancellations among the pediatric population in our setting and suggest some convenient solutions.MethodsWe carried out a prospective and descriptive study over 12 months in the pediatric surgery department of Fattouma Bourguiba University Hospital.ResultsOne thousand four hundred twenty-six patients were scheduled for surgery at the pediatric surgery department, of whom 131 (9.2%) were canceled. Medical and anesthesia-related reasons accounted for 62.5% of all cancellations, followed by surgical reasons at 16%, organizational or administrative issues at 11.5%, and patient-related reasons at 10%. The most significant causes were upper respiratory tract infections (URTIs) in 36.6%, abnormal blood test results in 16%, and non-adherence to preoperative fasting in 9.2%.ConclusionsThe rate of pediatric elective surgery cancellations at Fattouma Bourguiba University Hospital was higher than the accepted average rate (5%). Therefore, to prevent these cancellations as much as possible, efforts should be made to promote children’s medical care, operation scheduling, and efficient institution resource utilization.

Multilevel analysis identifying the factors associated with RSV detection in infants admitted for viral bronchiolitis in the era of the COVID-19 pandemic.

To identify factors independently associated with respiratory syncytial virus (RSV) detection in infants admitted for viral bronchiolitis during 3 consecutive years, before and during the COVID-19 pandemic, in Bogota, Colombia, a middle-income country with a subtropical highland climate. An analytical cross-sectional study was conducted before and during the COVID-19 pandemic, including patients with a diagnosis of viral bronchiolitis admitted to all the hospitals of the city between January 2019 and November 2021. We evaluated a set of a priori-selected predictor variables that included individual, healthcare system, meteorological, air pollutant, and COVID-19 variables. Since the variables analyzed are hierarchical in nature, multilevel modeling was used to identify factors independently associated with detection of RSV as the causative agent of viral bronchiolitis. A total of 13,177 patients were included in the study. After controlling for potential confounders, it was found that age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.76-0.97), a third level of medical care institution (OR 3.05; 95% CI 1.61-5.76), temperature (OR 1.60; 95% CI 1.24-2.07), rainfall (OR 1.003, 95% CI 1.001, 1.005), NO2 (OR 0.97; 95% CI 0.95-0.99), CO (OR 0.99; 95% CI 0.99-0.99), and COVID-19 pandemic period (OR 0.84, 95% CI 0.71-0.99) were independently associated with RSV detection in our sample of patients. The identified factors associated with RSV detection provide additional scientific evidence that may be useful in the development of specific interventions aimed at ameliorating or preventing the impact of RSV in Bogota and probably other similar low- to middle-income countries in high-risk infants.

Social Assessment of Healthcare Waste Management

Circular economy targets clearly define recovery and recycling as predominant actions for future waste management. However, circularity-oriented actions might not be easily implemented for some types of waste. Healthcare sectors generate non-hazardous municipal waste (up to 80–85 % of all generated waste according to the World Health Organization data) and hazardous infectious waste. Due to public health and the spread of infection risks, healthcare waste treatment needs to be organized in a special manner and moreover, recovered materials need to be tested repeatedly. The present paper aims to analyse the social aspects of health care waste recovery technologies along the supply chain (gate-to-gate approach) – from health care waste collection at medical care institutions to recovered materials at treatment plants. Rotoclave and chemical treatment healthcare waste treatment technologies were analysed as case studies. Methodological approach of the study is based on the UNEP/SETAC guidelines for social life-cycle assessment (S-LCA) of products and questionnaire-based indicators. The results of the assessment will bring the framework for improvement of social aspects of healthcare waste management.

ОСОБЛИВОСТІ ПРОВЕДЕННЯ МЕДИКО-СОЦІАЛЬНОЇ ЕКСПЕРТИЗИ В УМОВАХ ВОЄННОГО СТАНУ

The article describes the process of medical and social examination. It was determined that it consists of a number of successive steps, which involve a significant number of competent persons. It is proposed to divide the process of medical and social examination into three stages: preparatory, direct and final. The first stage includes: firstly, the application of a person claiming to be disabled to a medical and preventive health care institution; secondly, the activities of the representatives of the relevant health care institution, their implementation of the necessary research and the subsequent referral of documentation for medical and social examination. The second stage involves a direct examination (including a second one) of the person who applied for the establishment of disability by the medical and social expert commission. The thirdly, last, stage consists in making an appropriate decision based on the results of a medical and social examination. Separate components of this activity, which underwent changes in connection with the introduction of martial law on the territory of Ukraine, were considered. The relevant normative and legal framework, which regulates the simplified procedure for conducting a medical and social examination, has been analyzed. The peculiarities of its implementation in the conditions of martial law are revealed.

Empanelment of the Population to the Primary Medical Care Institution of Sri Lanka: A Mixed-Methods Study on Outcomes and Challenges.

The registration of individuals with designated primary medical care institutions (PMCIs) is a key step towards their empanelment with these PMCIs, supported by the Primary Health Care System Strengthening Project in Sri Lanka. We conducted an explanatory mixed-methods study to assess the extent of registration at nine selected PMCIs and understand the challenges therein. By June 2021, 36,999 (19.2%, 95% CI-19.0-19.4%) of the 192,358 catchment population allotted to these PMCIs were registered. At this rate, only 50% coverage would be achieved by the end of the project (December 2023). Proportions of those aged <35 years and males among those registered were lower compared to their general population distribution. Awareness activities regarding registration were conducted in most of the PMCIs, but awareness in the community was low. Poor registration coverage was due to a lack of dedicated staff for registration, misconceptions of health care workers about individuals needing to be registered, reliance on opportunistic or passive registration, and lack of monitoring mechanisms; these were further compounded by the COVID-19 pandemic. Moving forward, there is an urgent need to address these challenges to improve registration coverage and ensure that all individuals are empaneled before the close of the project for it to have a meaningful impact.

Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study.

The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.

A Comparative Study on the Characteristic Projects of the Combination of Medical and Elderly Care Institutions in Taizhou City

A Comparative Study on the Characteristic Projects of the Combination of Medical and Elderly Care Institutions in Taizhou City

An observational study of role of medical record department in tertiary care teaching hospital

Background: Medical record document explains all the details about the patient’s history, clinical findings, diagnostic test results, pre- and post-operative care, patient’s progress, and medication given. If written correctly, notes will support the doctor about the correctness of treatment. Aim and Objectives: Our objective was to study effectiveness and utility of medical record department at our medical college affiliated tertiary care institution. Materials and Methods: We did an observational study to determine various parameters of medical records such as consent, history and examination findings, pre-operative and intraoperative records, investigation documentation, nursing care chart, and concerned medical person’s signature. The study included 300 files. A medical record checklist was used as a tool for data collection. The study was conducted between January 2021 and January 2022. Data were collected, entered in Microsoft Excel spread sheet, and analyzed using percentage. Results: Out of the 300 files, 186 files belonged to different surgical specialties while the rest were of non-surgical fields. It was found that nursing assessment document was present in 78%, while discharged card copy was found attached in 75.33% files. Furthermore, surgical safety checklist was found in 89.24%, while signature of faculty was absent in 38.3% files. Conclusion: Medical record maintaining and keeping is an essential and vital part of health-care infrastructure, not only for data collection but also for calculating use of resources needed for better delivery of quality services to patients.