Public Medical System Research Articles

Perception of the quality of medical care in patients from the LGBT+ community

Abstract Background Mexico does not have comprehensive care services for members of the LGBT+ community, who also still suffer from a social context that still develops between traditions of inequality and lack of inclusion. Objective: To determine the factors associated with the perception of good quality of medical care in patients from the LGBT+ community Methods A cross-sectional, observational, prospective and analytical study was carried out between November and April 2023. Members of the LGBT+ community of Veracruz, Mexico were included; Subjects with visual or hearing disabilities or some psychological disorder that affects the perception of behavior were excluded. Data collection was done through Google Forms. The SPSS v22 program was used, X2 test, Odds Ratio (OR) and confidence interval (CI95%). Results 489 subjects were included, 295 (60.6%) use the public medical system, 155 (31.7%) consider a medical specialty is necessary to care for the LGBT+ community and 150 (30.7 %) indicates that the specialty should only be for care of patients with gender change; 297 (60.7%) perceive that they receive good quality medical care and 69 (14.1%) have perceived that they have been denied consultation because they belong to the LGBT+ community. The factors associated (OR/CI95%) to the perception of good medical care is the lack of: a family doctor (0.4/0.3-0.6), discomfort on physical examination (13.1/6.9-24.0), verbal abuse (13.3 /6.7-26.0), sexual harassment (5.1/2.7-9.5), physical harassment (11.5/4.7-28.0), discomfort of the doctor during the consultation (10/6.0-19.2), breach of confidentiality (7.2/3.7-14.1), denying care (12.7/6.3-25.6) (p < 0.05). Conclusions The factors associated with the perception of a good quality of care in patients from the LGBT+ community are similar to those reported in the literature within any community, which invites health institutions to reinforce their inclusion programs, to reduce acts of discrimination. Key messages • Health systems need to consider care for the LGBT+ community from specialists who can make a comprehensive assessment that favors adequate medical care. • Discrimination is still present within the medical care of patients from the LGBT+ community, so it is essential that the doctor is trained and sensitized in the processes of inclusion.

Unity or Estrangement Under Crises? Perceived Resource Scarcity Moderates the Effect of a Common Threat on Intergroup Cooperation

Human history and recent empirical studies have documented many cases of human unity or estrangement during global crises. This reflects that a common threat may not always promote intergroup cooperation. An intriguing question arises: What determines the effect of a common threat on intergroup cooperation? In response, we proposed and tested the moderating role of perceived resource scarcity in the effect of a common threat on intergroup cooperation. We found that when perceived resource scarcity was low, common threats posed by pandemics (Studies 1 and 2) and earthquakes (Study 3) promoted intergroup cooperation in controlling outbreaks, building public medical systems, and reducing public resource depletion. However, the effect attenuated when perceived resource scarcity was high. The findings broaden our understanding of common threats and provide avenues to enhance intergroup cooperation in the face of interminable global crises.

A provably-secure authenticated key agreement protocol for remote patient monitoring IoMT

With the continuous improvement of the public medical system, the current medical service industry is more intelligent. The Internet-of-Medical-Things (IoMT) plays a significant role in smart medicine. The emergence of remote wireless monitoring platforms in the IoMT systems has significantly reduced the risk of virus infection among medical staff. However, data may be easily stolen by criminals during the transmission process. We propose a three-factor enhanced protocol to monitor patient body information and mitigate the issues. The proposed protocol can provide the confidentiality of transmitted data and the privacy of doctors and patients. The security of the proposed protocol is demonstrated in the Random Oracle Model (ROM) for computational security. In addition, by comparing the proposed protocol with other related works, our designed protocol has efficient performance both in execution time and communication costs.

Impacts of comprehensive reform on the efficiency of Guangdong's County public hospitals in 2014–2019, China

ObjectivesWe conducted a comparative analysis on the performance of 57 county public medical systems in Guangdong Province in 2014–2019 and tried to find out how vastly the performance differed across counties and what might cause these differences. Answers to these questions could serve as the basis for policymaking in the current reform of China's rural medical systems, helping policymakers to identify the inefficient counties and giving suggestions on possible further reformation of the rural medical system. MethodsOutput-oriented SBM DEA models were employed to measure efficiency performance and a Tobit regression model was employed to explore determinants of efficiency. ResultsThe Pearl River Delta region had the most medical resources while the East region had the least. Average efficiency scores in 2014–2019 show a slight increase of around 1%, i.e., 0.798, 0.766, 0.781, 0.781, 0.779 and 0.802, respectively. 96.5% of counties experienced inefficiency problems and 36.8% of counties were worsened with declined score trends. Average efficiency scores in the Pearl River Delta region decreased mildly. Economic, government, and population factors were related to efficiency scores positively and significantly. ConclusionsMost county public hospitals experienced inefficiency problems and substantial regional disparities existed in Guangdong's county-level medical efficiency, which should be noticed by policymakers. Issues in the reform like insufficient revenues and government subsidies, higher surgical expenses, inadequate technology, and unbalanced regional policies may have hindered medical efficiency, which should be addressed in future reforms.

Developing sensor materials for screening intestinal diseases

Abstract Intestinal diseases that have high mortality and morbidity rates and bring huge encumbrance to the public medical system and economy worldwide, have always been the focus of clinicians and scientific researchers. Early diagnosis and intervention are valuable in the progression of many intestinal diseases. Fortunately, the emergence of sensor materials can effectively assist clinical early diagnosis and health monitoring. By accurately locating the lesion and sensitively analyzing the level of disease markers, these sensor materials can help to precisely diagnose the stage and state of lesions, thereby avoiding delayed treatment. In this review, we provide comprehensive and in-depth knowledge of diagnosing and monitoring intestinal diseases with the assistance of sensor materials, particularly emphasizing their design and application in bioimaging and biodetection. This review is dedicated to conveying practical applications of sensor materials in the intestine, critical analysis of their mechanisms and applications and discussion of their future roles in medicine. We believe that this review will promote multidisciplinary communication between material science, medicine and relevant engineering fields, thus improving the clinical translation of sensor materials.

Health-Seeking Behaviors in Mozambique: A Mini-Study of Ethnonursing.

In settings where traditional medicine is a crucial part of the healthcare system, providing culturally competent healthcare services is vital to improving patient satisfaction and health outcomes. Therefore, this study sought to gain insight into how cultural beliefs influence health-seeking behaviors (HSBs) among Mozambicans. Participant observation and in-depth interviews (IDIs) were undertaken using the ethnonursing method to investigate beliefs and views that Mozambicans (living in Pemba City) often take into account to meet their health needs. Data were analyzed in accordance with Leininger’s ethnonursing guidelines. Twenty-seven IDIs were carried out with 12 informants from the Makonde and Makuwa tribes. The choice of health service was influenced by perceptions of health and illness through a spiritual lens, belief in supernatural forces, dissatisfaction with and dislike of the public medical system on grounds of having received poor-quality treatment, perceived poor communication skills of health professionals, and trust in the indigenous medical system. This study confirmed the need for health professionals to carefully take cultural influences into consideration when providing care for their patients. We recommend an educational intervention that emphasizes communication skills training for healthcare workers to ensure successful physician/nurse–patient relationships.

The history and influence of Losheng Sanatorium in Taiwan area

Losheng Sanatorium, as a prophylactic-therapeutic institution for isolation, treatment, rehabilitation and social control of leprosy patients, was established by the Japanese colonial government in Taiwan in 1930. Losheng Sanatorium effectively carried out the compulsory isolation of leprosy patients, under the assistance of the public medical system with the help of police and the Bao-Jia management in the Japanese colonial period in Taiwan. Losheng sanatorium imported DDS, a therapeutic drug for leprosy, popularised an outpatient treatment model of leprosy, and developed mobile medical services after the Second World War. Losheng detected and treated leprosy patients successfully through the support of special skin clinics in public hospitals and missionary hospitals after Multi-drug Therapy was introduced in Taiwan in 1984. The Department of Health, Executive Yuan of the Taiwan area in commenced administration of Losheng Sanatorium in 1999 transformed it into a community-based general hospital. Losheng sanatorium adopted different control strategies in different historical periods based on the requirements of health, epidemic prevention systems and leprology developments to achieve its goals of leprosy control. The Sanatorium provides an example to understand and further study epidemical control and public health practice in the Taiwan area.

Deep learning for predicting COVID-19 malignant progression.

As COVID-19 is highly infectious, many patients can simultaneously flood into hospitals for diagnosis and treatment, which has greatly challenged public medical systems. Treatment priority is often determined by the symptom severity based on first assessment. However, clinical observation suggests that some patients with mild symptoms may quickly deteriorate. Hence, it is crucial to identify patient early deterioration to optimize treatment strategy. To this end, we develop an early-warning system with deep learning techniques to predict COVID-19 malignant progression. Our method leverages CT scans and the clinical data of outpatients and achieves an AUC of 0.920 in the single-center study. We also propose a domain adaptation approach to improve the generalization of our model and achieve an average AUC of 0.874 in the multicenter study. Moreover, our model automatically identifies crucial indicators that contribute to the malignant progression, including Troponin, Brain natriuretic peptide, White cell count, Aspartate aminotransferase, Creatinine, and Hypersensitive C-reactive protein.

Research on Financial Management and Information Construction of Public Hospitals

With the continuous progress of modern information technology in the economic and social development, information construction has been widely used in the public medical system. In public hospitals, modern information construction has not only improved the overall medical service level and efficiency, but also strengthened Hospital internal control and management. The application level of information technology is an important factor in the financial management of public hospitals, and the construction of information has a profound impact on the improvement of the financial management of public hospitals. Through the extensive influence and necessity between the financial management and information construction of modern public hospitals, this paper analyzes the main problems existing in the process of financial management and information construction of public hospitals, and studies the suggested measures to solve the problems, in order to optimize the financial management of public hospitals, and provide reference for information construction.

Determinants of fruits, vegetables, and ultra-processed foods consumption among infants.

The objective was to evaluate the influence of individual and contextual determinants on infant's consumption of fruits and vegetables (FV), and ultra-processed foods (UPF). The data was obtained from the Survey of Prevalence of Breastfeeding in Brazilian Municipalities, 2008. A representative sample of 14,326 infants 6-11.9 months old, from seventy-five municipalities of São Paulo state was evaluated. The influence of determinants on FV and UPF consumption was analyzed using Poisson multilevel regression. Mother's educational level and maternal age had positive dose-response effect for the consumption of FV (p trend < 0.001) and negative for UPF (p trend < 0.001). Infants of multiparous women and those who received outpatient care in public medical system showed lower prevalence of FV (p < 0.001 for both) and higher prevalence of UPF (respectively, p < 0.001 and p = 0.001). Moreover, the contextual variable related to population size indicated that the prevalence of consumption of FV decreased (p < 0.001) and UPF increased (p = 0.081) with decreased population size. Therefore, infants born to women with low education levels, who received outpatient care in the public health network, and who reside in small municipalities should be prioritized for educational programs related to feeding practices.

Predicting COVID-19 Malignant Progression with AI Techniques

Background: The coronavirus disease 2019 (COVID-19) has become a worldwide pandemic since mid-December 2019, which greatly challenge public medical systems. With limited medical resources, it is a natural strategy, while adopted, to access the severity of patients then determine the treatment priority. However, our work observes the fact that the condition of many mild outpatients quickly worsens in a short time, i.e. deteriorate into severe/critical cases. Hence, it has been crucial to early identify those cases and give timely treatment for optimizing treatment strategy and reducing mortality. This study aims to establish an AI model to predict mild patients with potential malignant progression. Methods: A total of 133 consecutively mild COVID-19 patients at admission who was hospitalized in Wuhan Pulmonary Hospital from January 3 to February 13, 2020, were selected in this retrospective IRB-approved study. All mild patients at admission were categorized into groups with or without malignant progression. The clinical and laboratory data at admission, the first CT, and the follow-up CT at severe/critical stage of the two groups were compared with Chi-square test, Fisher’s exact test, and t test. Both traditional logistic regression and deep learning-based methods were used to build the prediction models. The area under ROC curve (AUC) was used to evaluate the models. Findings: The deep learning-based method significantly outperformed logistic regression (AUC 0·954 vs. 0·893). The deep learning-based method achieved a prediction AUC of 0·938 by combining the clinical data and the CT data, significantly outperforming its counterpart trained with clinical data only by 0.141. By further considering the temporal information of the CT sequence, our model achieved the best AUC of 0·954. Interpretation: The proposed model can be effectively used for finding out the mild patients who are easy to deteriorate into severe/critical cases so that such patients get timely treatments while alleviating the limitations of medical resources. Funding Statement:This work was supported by National Key R&D Program of China (No. 2018YFB1004600), HUST COVID-19 Rapid Response Call (No. 2020kfyXGYJ093, No. 2020kfyXGYJ094), National Key R&D Program of China (No.2017YFC1309100), National Science Fund for Distinguished Young Scholars (No.81925023), National Natural Science Foundation of China (No.61703049, No. 81771912, No. 81401390) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The authors stated this was an IRB-approved study.

Sphingolipids as mediators of inflammation and novel therapeutic target in inflammatory bowel disease.

Morbidity of inflammatory gastrointestinal (GI) diseases continues to grow resulting in worsen quality of life and increased burden on public medical systems. Complex and heterogenous illnesses, inflammatory bowel diseases (IBDs) encompass several inflammation -associated pathologies including Crohn's disease and ulcerative colitis. IBD is often initiated by a complex interplay between host genetic and environmental factors, lifestyle and diet, and intestinal bacterial components. IBD inflammatory signature was linked to the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α) signaling pathway that is currently targeted by IBD therapies. Sphingolipid signaling was identified as one of the key mediators and regulators of pro-inflammatory conditions, and, specifically, TNF-α related signaling. All GI tissues and circulating immune/blood cells contain activated sphingolipid-metabolizing enzymes, including sphingosine kinases (SphK1 and SphK2) that generate sphingosine-1-phosphate (S1P), a bioactive lipid and ligand for five G-protein coupled membrane S1P receptors (S1PRs). Numerous normal and pathogenic inflammatory responses are mediated by SphK/S1P/S1PRs signaling axis including lymphocyte trafficking and activation of cytokine signaling machinery. SphK1/S1P/S1PRs axis has recently been defined as a target for the treatment of GI diseases including IBD/colitis. Several SphK1 inhibitors and S1PRs antagonists have been developed as novel anti-inflammatory agents. In this review, we discuss the mechanisms of SphK/S1P signaling in inflammation-linked GI disorders. The potential role of SphK/S1PRs inhibitors in the prevention and treatment of IBD/colitis is critically evaluated.

The Effectiveness of Cognitive Behavioral Therapy for People with Depression Following Stroke: A Systematic Review and Meta-Analysis

Post-stroke depression (PSD) is a common psychiatric manifestation of stroke, which has a devastating impact on survivors’ quality of life with an increasing burden on caregivers and the public medical system. Even so, no meta-analysis on specific psychotherapeutic treatment has been conducted. How effective is cognitive behavioral therapy (CBT) in reducing depressive symptoms in randomized-controlled trials (RCTs) targeting community-dwelling stroke survivors with PSD? Through systematic procedures of screening and data extraction, four RCTs were synthesized for meta-analysis (N= 270) on effect size estimates. Overall, CBT groups showed significant improvement in depression compared with controls. Methodological quality, intensity of CBT, and duration of post-treatment follow-up proved critical to treatment effects. Despite the potential threat of external validity, this paper had reviewed their content comprehensively with the implication of facilitating public understanding, research, and service development of PSD using CBT. To fill the knowledge gap, standardized protocol and further subgroup analyses are necessary.

Introducing voluntary private health insurance in a mixed medical economy: are Hong Kong citizens willing to subscribe?

BackgroundStruggling to correct the public-private imbalance in its health care system, the Hong Kong SAR Government seeks to introduce a government-regulated voluntary health insurance scheme, or VHIS, a distinctive financing instrument that combines the characteristics of private insurance with strong government regulation. This study examines citizens’ responses to the new scheme and their willingness to subscribe.MethodsFirst-hand data were collected from a telephone survey that randomly sampled 1793 Hong Kong adults from September 2014 to February 2015. Univariate and multivariate methods were employed in data analysis.ResultsMore than one third of the respondents explicitly stated intention of subscribing to the VHIS, a fairly high figure considering the scheme’s voluntary nature. Multivariate analysis revealed moderate evidence of adverse selection, defined as individuals’ opportunistic behaviors when making insurance purchasing decision based on their own assessment of risks or likelihood of making a claim.ConclusionThe excellent performance of Hong Kong’s public medical system has had two parallel impacts. On the one hand, high-risk residents, particularly the uninsured, do not face a pressing need to switch out of the overloaded public system despite its inadequacies; this, in turn, may reduce the impact of adverse selection that may lead to detrimental effects to the insurance market. On the other hand, high satisfaction reinforces the interests of those who have both the need for better services and the ability to pay for supplementary insurance. Furthermore, the high-risk population demonstrates a moderate interest in the insurance despite the availability of government subsidies. This may offset the intended effect of the reform to some extent.

From risk charts to guidelines: tools for evaluation and management of cardiovascular risk

Despite the wide improvement of diagnostic techniques and the introduction of effective pharmacological and instrumental therapeutic strategies aimed to the treatment of cardiovascular diseases, their incidence and lethality are still elevated, with economic implications increasingly less sustainable by the public medical systems. The modern practice of cardiovascular prevention requires, thus, that diagnostic and therapeutic interventions, both at population level and on the single patient, should be more and more precise, effective, and appropriate. From this point of view, a correct global cardiovascular risk stratification assumes a preponderant relevance, in order to allow an adequate therapeutical response. For this purpose several work instruments, as risk charts and guidelines, namely dedicated to arterial hypertension and dyslipidemias, were developed and offered to clinicians interested in cardiovascular prevention. The aim of this review is to illustrate, in synthesis, those instruments, aiming to facilitate their implementation, thus reducing the actual gap between theoretical indications and the real world.

WS19.5 Alginate phenotypes of Pseudomonas aeruginosa from a Brazilian CF center compared to Scandinavian CF centers

Objectives Alginate production (mucoid phenotype) of P. aeruginosa is a marker of chronic biofilm infection in the lungs of CF patients. Little is known about the occurrence of alginate-producing P. aeruginosa in CF patients outside Europe and North America. We therefore decided to study the occurrence of the alginate phenotype in P. aeruginosa from chronically infected CF patients in a CF center in Brazil and CF centers in Scandinavia (Ciofu et al., 2008). Methods The phenotype was classified according to Schurr et al. (1994): Type I: mucoid (M) on PIA ( Pseudomonas isolation agar) and LB agar, type II: mucoid on PIA but non-mucoid (NM) on LB, type III: non-mucoid on both, type IV: very slight but detectable mucoidy on both media after ≥4 days incubation. Results See the table. TableDistribution of different alginate phenotypesType I TypeII Type III Type IVBoth M&NM isolates from 20 Brazilian patients95%40%65%Both M&NM isolates from 83 Scandinavian patients89%17%87%6%Only NM isolates from 12 Brazilian patients92%8%Only NM isolates from 8 Scandinavian patients75%25% Conclusion Generally, the results show rather similar distributions of the Brazilian and Scandinavian isolates on the different phenotypes (Table). This probably reflects common selective environment in the lungs of CF patients in Brazil and Scandinavia, since the countries are widely separated and have completely different climate and geography, whereas the public medical systems are tax-based in all 4 countries. We are now sequencing the mucA and algT genes of the isolates which are responsible for the alginate phenotypes.

Epidemiology of primary Sjögren's syndrome: a systematic review and meta-analysis

ObjectiveEpidemiological studies of primary Sjögren's syndrome (pSS) are crucial for describing the burden to society and the public medical system and for shedding light on aetiology. Previous reports of the...

Redução da prevalência de úlcera duodenal: um estudo brasileiro (análise retrospectiva na última década: 1996-2005)

The duodenal ulcer always represented a very prevalent pathology among the gastrointestinal tract diseases worldwide. The average prevalence is approximately 10% of the world population. In the 90s the literature (both European and North American) begin to show a crescent reduction of this prevalence in many countries. To show through a retrospective analysis the annual prevalence of the duodenal ulcer in the last 10 years in a Digestive Endoscopy Service which is referred to public medical system in Porto Alegre and its suburban area and countryside of the State of Rio Grande do Sul, Brazil. The data analyzed is from March 1996 to December 2005. Specific data: transversal retrospective study with documented analysis of endoscopic diagnosis of upper gastrointestinal endoscopy. A retrospective analysis of the diagnosis of the 13.130 procedures of upper gastrointestinal endoscopy between 1996 and 2005. The Sakita classification was used to verify the duodenal ulcer activity taking into consideration the patients who have lesions on A1 to S1 levels. To verify if there was a statistical significant results, a linear regression test was done (linear regression model). A graduate decrease of the prevalence percentuals was observed, year after year, it began with 8.3% of prevalence in 1996 and finished with 3.3% in the beginning of 2006. The average annual reduction of this prevalence was calculated following the regression test and it was placed in the 1.3% a year in the studied period of time. In 2003, in an isolated way, it was an exception in the decrease of the percentage because it presented a prevalence increase of (6.5%) comparing to the first 6 years of study. In this study it was observed a decrease of duodenal ulcer prevalence, 1.3% a year to be more accurate in 10 years of study, showing a statistical significance in the linear regression test.

Doctoring as business: A study of entrepreneurial medicine in Nigeria

Medicine is often regarded as a philanthropic science in the service of humanity. Rather than universalistic humanitarian service (à la Hippocrates), this study of private practice illustrates that medicine has been commoditised and is now a lucrative business much like the sale of beer and other commodities. This growing medical enterprise is explained against the backdrop of the wider dynamics of the Nigerian political economy. The implications of this growing privatisation and commercialisation, of which the doctoring business is a part, are examined. It is concluded that it is only a question of time before entrepreneurial medicine completely eclipses the beleaguered public medical system.

Health-related outcomes of war in Nicaragua.

Since 1983, war in Nicaragua has slowed improvements in health which had developed rapidly from 1979-82. The rate of war-related deaths among Nicaraguans now exceeds that of the United States citizens in either the Vietnam War or World War II. Forty-two of the 84 documented war-related casualties among Nicaraguan health workers have been deaths. This high case fatality rate reflects the targeting of health workers by contra troops. The number of staff and services of the public medical system decreased by approximately 10 per cent from 1983 to 1985. Population movements, the establishment of new settlements, and war-related destruction of the primary health infrastructure are associated with recent epidemics of malaria, dengue, measles, and leishmaniasis. The estimated rate of infant mortality in Nicaragua, which had declined from 120 per 1,000 in 1978 to 76/1,000 live births in 1983, has since shown no further decline. Internationally mandated protections enjoyed by civilians and health workers during times of war do not appear to operate in this so-called "low intensity" conflict. Further declines in infant mortality, prevention of epidemics, and improvement in other health indicators will likely await the cessation of military hostilities.