Provincial Survey Research Articles

Geographical variation in dementia prevalence across China: a geospatial analysis

Dementia poses great health and social challenges in China. Dementia prevalence may vary across geographic areas, while comparable estimations on provincial level is lacking. This study aims to estimate dementia prevalence by provinces across China, taking into account risk factors of individual level and potential spatial correlation of provinces. In this study, 17,176 adults aged 50 years or older were included from the fourth wave of the ChinaHealth and Retirement Longitudinal Study (CHARLS 2018), covering 28 provinces, autonomous regions and municipalities. To improve provincial representativeness, we constructed provincial survey weights based on China 7th census (2020). The prevalence of dementia and 95% Bayesian credible intervals (BCIs) were estimated using a Bayesian conditional autoregressive (CAR) model with spatially varying coefficients of covariates. The weighted prevalence of dementia at provincial level in China in 2018 ranged from 2.62% (95%BCI: 1.70%, 3.91%) to 13.53% (95%BCI: 8.82%, 20.93%). High dementia prevalence was concentrated in North China, with a prominent high-high cluster, while provinces of low prevalence were concentrated on East and South China, characterized by a low-low cluster. Ordered by the median estimation of prevalence, the top 10% of provinces, include Xinjiang, Jilin, and Beijing. Meanwhile, Fujian, Zhejiang, and Guangdong rank among the last. The association between dementia prevalence and drinking, smoking, social isolation, physical inactivity, hearing impairment, hypertension, and diabetes exhibits provincial variation. Our study identifies a geospatial disparity in dementia prevalence and risk factor effects across China's provinces, with high-high and low-low clusters in some northern and southern provinces, respectively. The findings emphasize the need for targeted strategies, such as addressing hypertension and hearing impairment, in specific regions for more effective dementia prevention and treatment. National Science Foundation of China/the Economic and Social Research Council, UK Research and Innovation joint call: Understanding and Addressing Health and Social Challenges for Ageing in the UK and China. UK-China Health And Social Challenges Ageing Project (UKCHASCAP): present and future burden of dementia, and policy responses (grant number 72061137003, ES/T014377/1).

CARDIOVASCULAR RISK FACTORS AND ARTERIAL HYPERTENSION IN QOM (TOBA) POPULATIONS OF TWO PUBLIC INSTUTIONS IN NORTHERN ARGENTINE

Objective: To evaluate cardiovascular risk factors and control of high blood pressure in Qom (indigenous) populations of northern Argentina. Design and method: A descriptive, prospective and observational study was carried out through a survey directed at patients who attended 2 public institutions in the Province of Formosa: one carried out in the city of Formosa (Capital) and another in the town of Las Lomitas, in the interior of the province. It was carried out between the months of July and December 2023. A survey was carried out based on the risk factor variables of the Heart study and others useful for the population studied. The study was carried out under local and international ethical standards and under signed informed consent. Results: Of 34 patients surveyed (80% women), 25% were from the capital of Formosa and 75% from the rural area of Las Lomitas. Of the CVRFs, it was observed that 50% had high blood pressure (HTN) at some point, although 22% assumed that they currently had it and the rest did not know it. 97% of the population took their blood pressure at some point and 61% did so in the last year. 51% of hypertensive patients take medication regularly, using one (1) drug in 14%, two (2) drugs in 28% and three (3) drugs in 42%. Regarding the body mass index, it was observed that 55% were obese, having values above provincial and national surveys. In addition, it was found that 8% are active smokers, 23% are diabetic and the same percentage (23%) had cholesterol alterations. 2.9% had chronic renal failure and 5.9% had atrial fibrillation. Conclusions: The present study highlights adherence to treatment, the high proportion of diabetes and the lack of cholesterol controls, taking into account the percentage of obese individuals. Although the number of patients is limited, the present study retrieves valuable information to continue with future research that can improve the cardiovascular quality of life of this specific population.

Application of the Human Opportunity Index in Evaluating the Effectiveness of the Administration Process and Its Implication on Service Quality in Healthcare Units

This research aims to determine the inequality of opportunities in the health sector. Researchers identified three primary sources of information in a database search to construct the organizational health index: the permanent continuous household survey, the quarterly provincial household survey, and the administrative records of the Department of Health Statistics system. The study employed a data matching mechanism to merge the two databases but discovered discrepancies in the live birth and death data, leading to a lack of confidence in the data's quality. The results show that the evolution of health opportunities in the last decade is generally positive, although there are still gaps in access to health insurance and health checks during pregnancy. The study found that the gap was primarily due to socioeconomic differences between individuals. An analysis of changes in the organizational health index in the health sector shows that sectoral policies play a significant role in improving access to health services. This increase in access was primarily achieved by the region's health policies, which ensured proportional increases for all individuals. However, there needs to be a greater focus on equal opportunities for access to health services to ensure that all individuals have equal access to quality health services.

청년여성의 출산·육아서비스만족도와 지역생활만족도가 삶의 만족도에 미치는 영향

The purpose of this study is to examine the moderated mediating effect of perception of social safety and the mediating effect of satisfaction with community life on the relationship between satisfaction with childbirth·childcare social service and life satisfaction among young women. To do this, this study used the 2022 Gangwon provincial social survey data conducted by Gangwon provincial office. The sample consisted of 296 young women(20s-30s), and the data were analyzed using SPSS 21.0 and PROCESS Macro 4.2(Model 4 and Model 14). The main results of this study are as follows: First, this study found that a higher level of satisfaction with childbirth·childcare social service was associated with a higher level of life satisfaction among young women. Second, a fully mediating effect of satisfaction with community life was found on the relationship between satisfaction with childbirth·childcare social service and life satisfaction among young women. Third, the mediating effect of satisfaction with community life on the relationship between satisfaction with childbirth·childcare social service and life satisfaction was moderated by perception of social safety. Based on those study results, this study discussed practical and policy implications for enhancing life satisfaction among young women.

High-resolution land surface modeling of the irrigation effects on evapotranspiration over the Yellow River basin

Accurate estimation of irrigation-induced evapotranspiration (ET) is critical for understanding the terrestrial water cycle. However, current estimation has large uncertainties due to the model limitations and the lack of accurate water use data. In this study, a water-energy balanced irrigation scheme is incorporated into the Conjunctive Surface-Subsurface Process version 2 (CSSPv2) model to improve the hydrological simulations over the Yellow River basin (YRB) where irrigation is extensive. The coupled model (CSSPv2-IRR) is calibrated against long-term water use data from provincial survey, and it is used to perform a 6-km resolution simulation over the YRB during 1991–2017. The results show that the coupled model can well reproduce hydrological processes within the basin, and the simulated irrigation amount, ET and surface soil moisture largely agree with the validation datasets. Specifically, the annual irrigation amount and irrigation-induced ET changes from the CSSPv2-IRR are more reasonable than ISIMIP2a and reanalysis products, with a reduction in bias by 79.5–97.3 % and 81.2–98.8 % respectively. The CSSPv2-IRR model simulation suggests that irrigation-induced annual ET change is 26.4 mm/year during 1991–2017, contributing to an 8.9 % increase in annual ET over the YRB, and the increase can reach 44.3 % over major irrigation districts. In addition, the contribution of irrigation to long-term increasing trend in ET over the irrigation districts in the upper reach is greater than the contribution of climate change. This study suggests a growing control of irrigation on the ET over the YRB, which has implications for regional water cycle and water resources management.

Evaluation of branch sampling, ocular assessments, and aerial surveys for estimating spruce budworm defoliation

We compared three methods for estimating current-year spruce budworm ( Choristoneura fumiferana (Clem.)) defoliation from 2014 to 2021 using a network of 99 permanent sample plots in central Gaspé Peninsula, Québec. Percent current-year defoliation was measured by assessing shoots from mid-crown branches, ocular ratings of all individual trees using binoculars, and provincial government aerial surveys. Ocular survey defoliation differed from branch sample defoliation in 5–6 out of 7 years, consistently underestimating defoliation, across the full range of defoliation severity observed. Nested mixed-effect models for fir–spruce combined, balsam fir, white spruce, and black spruce ocular survey defoliation bias resulted in marginal R2 of 0.40, 0.47, 0.82, and 0.86, respectively. Current defoliation severity and its interaction with previous year defoliation and weather conditions significantly affected ocular survey bias. Correspondence of aerial survey estimates and mean plot defoliation occurred in only 43% of all plot-years and ranged from 14%–58% in individual years. Differences between aerial survey defoliation and plot values mainly resulted from assigning an adjacent class (e.g., light <30% assigned as moderate 31%–70% defoliation) or misplaced defoliation polygon boundaries, suggesting that assignment of aerial survey defoliation to plots or specific ground areas needs ground truth sampling.

Physical activity participation, use and cost of recreation facilities on life satisfaction: evidence from Engage Nova Scotia

ABSTRACT This paper examines the relationship between physical activity participation, use of recreation facilities, and perceived accessibility to recreation facilities and levels of life satisfaction. We use a unique provincial survey established in collaboration with the Canadian Index of Wellbeing (CIW) to study the changes on levels of life satisfaction across Nova Scotians. The results from our empirical analysis show that individuals who engage in individual sports report higher levels of life satisfaction. In examining the effect of recreation and cultural facilities, we find levels of life satisfaction to increase with higher use of outdoor sports facilities. Additionally, our results demonstrate that the ease of accessing facilities and the convenience of having local parks are both positively significant factors affecting life satisfaction. Furthermore, if individuals view costs to be prohibitive in accessing facilities, we find that this negatively affects individuals’ life satisfaction levels.

Secondhand Smoke and Socio-Demographic Associated Factors: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022.

Background: Secondhand smoke (SHS) has detrimental effects on community health, including coronary heart diseases, stroke, lung cancer etc. This manuscript exploited data from the Vietnam Population-based Provincial Global Adult Tobacco Survey (PGATS) in 2022 to update the prevalence of adult exposure to SHS and associated socio-demographic factors. Methods: With the sample size of 71,981 adults aged 15+ throughout 30 provinces and cities in Vietnam, data was collected using the Global Adult Tobacco Survey (GATS) questionnaire. Bivariate analysis and multivariate logistic regression modelling were performed. Results: In the past 30 days, 44.4% (95% CI: 44.0%-44.9%) adults aged 15+ exposed to SHS at home while 23.1% (95% CI: 22.6%-23.6%) exposed to SHS at work. Female exposure to SHS in the past 30 days was higher at homes but lower at indoor workplaces. Participants aged 15-24 were likely to have higher odds of SHS exposure in the past 30 days to other age groups. Those living in the urban areas had 1.15 times higher odds (95% CI: 1.08-1.22) of exposure to SHS than those in the rural areas. Current smokers tended to have 2.2 times higher odds of exposure to SHS at the indoor workplaces compared to non-smokers (95% CI: 2.05-2.37). Conclusions: The prevalence of exposure to SHS at home was still relatively high amongst the adult population. While there was a significant reduction of SHS exposure at indoor workplaces, there was a higher prevalence of women being exposed to SHS at home. The Government of Vietnam should continue to strictly implement the smoke-free environment resolution at indoor workplaces and appropriate communication campaigns to protect people, especially women from SHS exposure at homes.

Improving business environment for information technology adoption in small business: evidence from a transition economy

ABSTRACT Adoption of information technology is widely known to be important for firm development. Nonetheless, little has been revealed about how to promote micro-sized firms to adopt information technology. Using the zero-inflated Poisson model to analyse longitudinal data adopted from the biennial Small and Medium Enterprises Surveys in the manufacturing sectors and data on the quality of the local business environment from the annual Provincial Competitiveness Index surveys in Vietnam, this study shows that while better infrastructure readiness is associated with more adoption of information technology among larger firms, it is not enough for micro-sized firms. These micro-sized firms need to be further supported by the improved quality of the local business environment. These findings suggest that policies on information technology should be complemented with policies to improve the business environment to facilitate adoption of information technology among micro-sized firms in transition economies.

“There should be one spot that you can go:” BRCA mutation carriers’ perspectives on cancer risk management and a hereditary cancer registry

Individuals who carry BRCA1 or BRCA2 pathogenic variants are recommended to have extensive cancer prevention screening and risk-reducing surgeries. Uptake of these recommendations is variable, and there remains room for improvement in the risk management of BRCA carriers. This paper explores female BRCA carriers’ experiences with the current model of care and their perspectives on (and interest in) an inherited cancer registry. Findings can inform the development of a dedicated high-risk screening and management program for these patients. Quantitative and qualitative data were gathered through a provincial descriptive survey and semi-structured qualitative interviews to assess BRCA carriers’ opinions toward risk management services in the province of Newfoundland and Labrador (NL), Canada. Survey (n = 69) and interview data (n = 15) revealed continuity and coordination challenges with the current system of care of high-risk individuals. Respondents suggested an inherited cancer registry would help identify high-risk individuals and provide a centralized system of risk management for identified carriers. Respondents identified concerns about the privacy of their registry data, including who could access it. Findings suggest BRCA carriers see great value in an inherited cancer registry. Specifically, participants noted it could provide a centralized system to help improve the coordination of burdensome, life-long risk management. Important patient concerns about protecting their privacy and their health data confidentiality must be addressed in patient and public information and informed consent documents about a registry.

Evaluation of physicians' current practices and awareness regarding the treatment of acute uncomplicated diverticulitis: results of a provincial survey.

International guidelines now recommend nonantibiotic treatment of uncomplicated diverticulitis. We assessed physicians' current management strategies for uncomplicated diverticulitis, their awareness of the updated recommendations, and barriers to practice change. A 21-question web-based survey conducted between 09/2022 and 11/2022 was sent to participants through their respective Quebec provincial associations or working groups. Participants included general surgeons, emergency physicians, gastroenterologists and general practitioners. Physicians who did not treat diverticulitis were excluded. The main outcomes were awareness of guideline recommendations on uncomplicated diverticulitis treatment, the use of nonantibiotic management for uncomplicated diverticulitis and identification of perceived barriers to practice change. The participation rate was 15.9%. The 465 participants consisted primarily of general practitioners (41.7%), general surgeons (29.2%) and emergency physicians (17.8%). Eighty-two percent had heard of the nonantibiotic treatment strategy for uncomplicated diverticulitis; 7.5% were "uncomfortable" and 44.6% "somewhat uncomfortable" with this practice. A third (31.8%) of all physicians had no knowledge of the updated guidelines on uncomplicated diverticulitis treatment. Most reported "never" (41.6%) or "rarely" (25.1%) omitting antibiotics for uncomplicated diverticulitis. When informed about nonantibiotic treatment, 28.7% and 51.4% of all physicians, respectively, indicated that this "will" change or "may" change their practice. Common perceived barriers to nonantibiotic treatment were concerns about treatment failure (69.6%), unawareness of updated recommendations (67.0%), difficulty in ensuring proper follow-up (59.0%) and workplace culture (54.9%). Physicians' awareness of practice guidelines recommending nonantibiotic treatment for uncomplicated diverticulitis and their application are suboptimal. Knowledge transfer activities, educational interventions and optimization of local protocols are needed to ensure the rational use of antibiotics.

Public attitudes towards genomic data sharing: results from a provincial online survey in Canada

BackgroundWhile genomic data sharing can facilitate important health research and discovery benefits, these must be balanced against potential privacy risks and harms to individuals. Understanding public attitudes and perspectives on data sharing is important given these potential risks and to inform genomic research and policy that aligns with public preferences and needs.MethodsA cross sectional online survey measured attitudes towards genomic data sharing among members of the general public in an Eastern Canadian province.ResultsResults showed a moderate comfort level with sharing genomic data, usually into restricted scientific databases with controlled access. Much lower comfort levels were observed for sharing data into open or publicly accessible databases. While respondents largely approved of sharing genomic data for health research permitted by a research ethics board, many general public members were concerned with who would have access to their data, with higher rates of approval for access from clinical or academic actors, but much more limited approval of access from commercial entities or governments. Prior knowledge about sequencing and about research ethics boards were both related to data sharing attitudes.ConclusionsWith evolving regulations and guidelines for genomics research and data sharing, it is important to consider the perspectives of participants most impacted by these changes. Participant information materials and informed consent documents must be explicit about the safeguards in place to protect genomic data and the policies governing the sharing of data. Increased public awareness of the role of research ethics boards and of the need for genomic data sharing more broadly is also needed.

A Diverse Minority of Intolerance: Ethnic Relations in a Multicultural Society

This study contributes to the international literature on ethnic relations and multiculturalism by empirically examining the claim that ethnic diversity can undermine social cohesion. The specific focus is on analyzing the attitudes of Canadians toward different ethnic groups to assess the level of ethnic intolerance. Canada serves as an ideal case study for this investigation due to the long-standing federal policy of multiculturalism. The multicultural we is an ideal, composed of many us which are opposed to others, all of which are themselves composed of individuals manifesting a heterogeneity of attitudes and opinions. By studying out-group attitudes, the study seeks to assess the viability of multiculturalism in addressing the challenges posed by ethnic diversity. The study has three primary objectives: firstly, to examine if the distribution of ethnic intolerance varies across different ethnic groups in Canada; secondly, to investigate whether Canadians perceive the Canadian mosaic in a vertical (hierarchical) or horizontal (egalitarian) manner, drawing from group position theory; and finally, to explore whether ethnic groups in Canada hold their own subjective group position hierarchies distinct from the national average. To achieve these objectives, the paper conducts an original quantitative analysis of the 2014 Provincial Diversity Project Survey.

Evaluation of acceptance, attitude, and knowledge towards artificial intelligence and its application from the point of view of physicians and nurses: A provincial survey study in Iran: A cross-sectional descriptive-analytical study.

The prospect of using artificial intelligence (AI) in healthcare is bright and promising, and its use can have a significant impact on cost reduction and decrease the possibility of error and negligence among healthcare workers. This study aims to investigate the level of knowledge, attitude, and acceptance among Iranian physicians and nurses. This cross-sectional descriptive-analytical study was conducted in eight public university hospitals located in Tehran on 400 physicians and nurses. To conduct the study, convenient sampling was used with the help of researcher-made questionnaires. Statistical analysis was done by SPSS 21 The mean and standard deviation and Chi-square and Fisher's exact tests were used. In this study, the level of knowledge among the research subjects was average (14.66 ± 4.53), the level of their attitude toward AI was relatively favorable (47.81 ± 6.74), and their level of acceptance of AI was average (103.19 ± 13.70). Moreover, from the participant's perspective, AI in medicine is most widely used in increasing the accuracy of diagnostic tests (86.5%), identifying drug interactions (82.75%), and helping to analyze medical tests and imaging (80%). There was a statistically significant relationship between the variable of acceptance of AI and the participant's level of education (p = 0.028), participation in an AI training course (p = 0.022), and the hospital department where they worked (p < 0.001). In this study, both the knowledge and the acceptance of the participants towards AI were proved to be at an average level and the attitude towards AI was relatively favorable, which is in contrast with the very rapid and inevitable expansion of AI. Although our participants were aware of the growing use of AI in medicine, they had a cautious attitude toward this.

The Impact of the Covid-19 Pandemic on Assertive Community Treatment Team Functions, Clinical Services, and Observable Outcomes—A Provincial Survey in Ontario, Canada

Assertive Community Treatment (ACT) teams provide the most intensive care for patients with serious mental illness. This online study surveyed the 88 ACT and Flexible ACT (FACT) teams in Ontario, Canada (144/232 surveys, 62.1%) during the height of Covid-19 in 2021, and qualitative thematic analysis on impact of team function and patient outcome showed challenges of teams switching to virtual care, reduced psychosocial services, division to smaller groups, staff redeployment, having unequal compensations, and exacerbated regional differences; there were also increased patient stress, loneliness, hospital and ER visits, substance use and related deaths, and police/crisis team involvement. There was limited morbidity related to actual Covid-19; and positive adaptations included observed independence and resilience, increased interdependence with community partners, and new communication formats.

Prevalence and Risk Factors Underlying Occupational Stress and Depression Among Clinical Nurses in Secondary and Tertiary Hospitals of China During COVID-19 Setting.

This study was designed to develop an effective measurement tool for occupational stress among medical staff and to identify the underlying risk factors among clinical nurses in China under depression during and after COVID-19. In the first stage, an occupational stress scale was developed for medical staff based on qualitative and quantitative methods. The dimensions of the scale were based on childhood stress and seven other parameters of working stress. In the second stage, a provincial survey was conducted among clinical nurses in Hainan. The structure of Medical Staff Occupational Stress Scale was tested in secondary and tertiary hospitals. The socio-demographic information, occupational stress (measured using the developed scale), and current depression symptoms (assessed with the nine-item Patient Health Questionnaire) were evaluated. The risk factors for occupational stress-induced depression were tested using multivariate logistic regression. The Medical Staff Occupational Stress Scale consisted of 42 items under eight dimensions with strong reliability and validity. Almost 80% of the clinical nurses reported obvious symptoms of depression. Based on multivariate logistical regression analysis, the significant risk factors for depression in nurses at secondary hospitals and tertiary hospitals were childhood stress, teaching stress, relationship with patient stress, and administration stress. The Medical Staff Occupational Stress Scale utilized in nursing population is based on strong psychometric features. Childhood stress contributes to occupational stress in nurses. The selection of nurses for clinical work may require evaluation of past history for childhood stress to prevent occupational depression. Teaching stress, relationship with patient stress and administration stress play significant roles in the prevention of depression among clinical nurses.

Impact of COVID-19 on the lives of people with severe mental illness—front-line community psychiatry workers observation from a provincial survey of assertive community treatment teams in Ontario, Canada

Using an online survey distributed to members of the provincial organization that represents the 88 Assertive Community Treatment (ACT) and Flexible ACT teams in Ontario, Canada, this descriptive study relied on the unique vantage points and observations of the front-line community psychiatry workers who maintained contact with patients through outreach and telecommunication during the height of COVID-19. The patients who suffer from serious mental illness (SMI) were uniquely affected by COVID-19 due to the changes, reduction or shut down of many essential clinical and community support services. Thematic and quantitative analyses of the workers’ observations highlighted 6 main areas of note, including significant social isolation and loneliness, clinical course deterioration and life disruption, increased hospital and ER use, police and legal contacts, and substance abuse and related deaths. There were also encouraging signs of positive adaptations in terms of independence and resilience. Reflections of these impacts and potential ameliorating approaches are further discussed.

Geographic Variations in the Prevalence, Awareness, Treatment, and Control of Dyslipidemia among Chinese Adults in 2018–2019: A Cross-sectional Study

ObjectiveTo investigate the spatial patterns of the prevalence, awareness, treatment, and control rates of dyslipidemia at the provincial level in China. MethodsA national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in mainland China in 2018–2019, using a multi-stage, stratified, cluster-randomized sampling design. Subjects, as households, were selected, followed by a home visit to collect information. Both descriptive and linear regression procedures were applied in the analyses. ResultsThe overall prevalence of dyslipidemia was 35.6%, and wide geographic variations of prevalence, treatment, and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1 ± 13.8 years. The highest-lowest difference regarding the provincial level prevalence rates were 19.7% vs. 2.1% for high low-density lipoprotein cholesterol, 16.7% vs. 2.5% for high total cholesterol, 35.9% vs. 5.4% for high triglycerides, and 31.4% vs. 10.5% for low high-density lipoprotein cholesterol. The treatment rate of dyslipidemia was correlated with the socio-demographic index (P < 0.001), urbanization rate (P = 0.01), and affordable basic technologies and essential medicines (P < 0.001). ConclusionPrevailing dyslipidemia among the Chinese population and its wide geographic variations in prevalence, treatment, and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.

Pharmacy Practice in Quebec Emergency Departments: A Survey Study.

According to a Canadian survey conducted in 2013, 37 of the 67 Quebec emergency departments (EDs) in hospitals with more than 50 beds reported having a pharmacist within the department. However, based on the 17 responses to the survey, it was not possible to determine patient care services offered by Quebec ED pharmacists, because the data were aggregated across all Canadian respondents. A provincial survey was undertaken to further define ED pharmacy practice within Quebec. To measure pharmacist involvement in EDs in the province of Quebec and to describe patient care services and interventions offered by these pharmacists. A 47-question survey was sent to 33 directors of pharmacy departments, representing 90 hospitals and institutes with EDs in the province of Quebec. The directors of pharmacy were asked to forward the survey to an ED pharmacist for completion or to partially answer the survey themselves if their facilities had no pharmacists practising in the ED. The survey evaluated the presence of pharmacists in the ED, their training, the interventions they performed, and their involvement within the department. The presence and role of ED pharmacy technical staff were also evaluated. Of the 43 completed surveys received, 30 reported at least 1 pharmacist providing patient care within the facility's ED. The most common tasks performed by ED pharmacists were, in decreasing order of frequency, answering questions from the multidisciplinary team, adjusting medications according to patients' allergies or their renal or hepatic function, managing drug interactions, and clarifying prescriptions. Pharmacists also reported teaching pharmacy students and residents and supporting the team in the resuscitation area. The majority of respondents reported having at least 1 pharmacist in the ED. Compared with previous Canadian results, this survey had more respondents from Quebec with better representation of ED pharmacy practice in the province. Patient care services provided by pharmacists were variable, possibly because of a lack of standardized practice guidelines.

Effects of non-technological innovation on technological innovation of small- and medium-sized enterprises: The role of the local business environment

Although non-technological innovation has been found to have influences on technological innovation of firms in the literature, some studies suggest it has no effect on technological innovation. It is unclear why these inconsistent findings have emerged. This study utilises longitudinal data from the biennial surveys of Vietnamese manufacturing small- and medium-sized enterprises and data from the Provincial Competitiveness Index surveys during the period from 2011 to 2015 and applies various estimation techniques. Findings demonstrate that the effects of non-technological innovation, which includes organisational and marketing innovation, on product and process innovation vary with the quality of the local business environment. Enterprises operating in a higher-quality local business environment have a higher probability of adopting product and process innovation than others. These findings suggest that policies to improve the business environment should be combined with other innovation policies to facilitate innovation of small- and medium-sized enterprises in transition economies.