Readiness Scores Research Articles

Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 Countries.

Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools-which break down health systems into measurable, trackable components-are one useful way to assess service readiness and the ability of health institutions to deliver FP services. Using data from nationally representative SPA surveys, we conducted a study that aimed to: (1) evaluate healthcare facilities' readiness to provide FP services; and (2) identify the factors that affect FP service readiness. Using a cross-sectional survey design, we used data from SPA surveys conducted in 10 low-resource SA and SSA countries: Afghanistan, Bangladesh, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and the Democratic Republic of the Congo (DRC). We analyzed data from public and private health facilities in Afghanistan (84), Bangladesh (1,303), Kenya (567), Malawi (810), Namibia (357), Nepal (899), Rwanda (382), Senegal (334), Tanzania (933), and the DRC (1,061) for a total of 6,730 facilities. We used 17 items/indicators recommended by the Service Availability and Readiness Assessment to measure a health facility's readiness to provide FP services across four domains. Only 3.6% to 34.1% of the health facilities were reporting at least 75% (12-13 of 17) of the relevant items for FP service provision. Most of the health facilities in the countries under investigation suffered from lack of readiness, meaning that they did not fulfill at least 75% of the standards (12-13 items of 17 items on the availability of trained staff and guidelines, equipment, and commodities components). The factors associated with higher readiness scores varied among the 10 countries analyzed. Regression models showed that increases in the number of FP healthcare providers available at a health facility and infection control measures for FP exams were factors linked to increased readiness scores in all 10 countries. The low readiness of health facilities to provide FP services in the countries studied showed that the health systems in these low-resource settings faced significant problems with providing FP services. Differences in country-specific variability in the characteristics linked with better preparedness ratings could be attributed to data collected across different years in different nations or to country-specific healthcare financing policies. To increase a health facility's readiness to offer FP services, country-specific factors must be addressed, in addition to common factors found in all 10 countries. Further research is required to determine the causes of country-level differences in FP tracer item availability to develop targeted and effective country-specific strategies to improve the quality of FP services in the SA and SSA regions and address unmet need for FP.

Evaluation of Pediatric Readiness Using Simulation in General Emergency Departments in a Medically Underserved Region.

Regionalization of pediatric care in the United States was developed to improve care by directing patients to hospitals with optimal pediatric resources and experience, leading to less pediatric-trained providers in medically underserved areas. Children with emergencies, however, continue to present to local general emergency departments (GEDs), where pediatric emergencies are low-frequency, high-risk events. The goals of this project were to: increase exposure of GEDs in the southeast United States to pediatric emergencies through simulation, assess pediatric emergency clinical care processes with simulation, describe factors associated with readiness including volume of pediatric patients and ED location (urban/rural), and compare these findings to the 2013 National Pediatric Readiness Project. This prospective in situ simulation study evaluated GED readiness using the Emergency Medical Services for Children Pediatric Readiness Score (PRS) and team performance in caring for 4 simulated pediatric emergencies. Comparisons between GED and pediatric ED (PED) performance and PRS, GED performance, and PRS based on pediatric patient volume and hospital location were evaluated. A Composite Quality Score (CQS) was calculated for each ED. Seventy-five teams from 40 EDs participated (39 GED; 1 PED). The PED had a significantly higher volume of pediatric patients (73,000 vs 4492; P = 0.003). The PRS for GEDs was significantly lower (57% [SD, 17] vs 98%; P = 0.022). The CQSs for all GEDs were significantly lower than the PED (55% vs 87%; P < 0.004). Among GEDs, there was no statistically significant difference in PRS or CQS based on pediatric patient volume, but urban GEDs had significantly higher CQSs versus rural GEDs (59.8% vs 50.6%, P = 0.001). This study shows a significant disparity in the performance and readiness of GEDs versus a PED in a medically underserved area. More education and better access to resources is needed in these areas to adequately care for critically ill pediatric patients.

The correlation between death anxiety, loneliness and hope levels in patients treated in the cardiac intensive care unit.

A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well-being. The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU). This is a prospective, descriptive and correlational study. The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA-LS). The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA-LS (r = .337; p < .001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < .05). The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety. It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels.

Psychometric validation of a 7C-model of antecedents of vaccine acceptance among healthcare workers, parents and adolescents in France

Support for vaccine decision-making requires a tailored approach taking into account psychological antecedents of vaccine acceptance. We aimed at validating an extended 7C-model of antecedents in three different target population groups (healthcare workers [n = 3870], parents [n = 2002] and adolescents [n = 7118]) and two vaccinations (COVID-19, HPV) in France. We performed a secondary analysis of questionnaires collecting sociodemographic characteristics, attitudes and knowledge on vaccination, and vaccine status and intention. We used standard psychometric techniques to validate a first and second order latent structure, and evaluated their association with vaccine intentionality in three levels (refusal, indecision, acceptance). In all populations, the 7C-model yielded a very good model fit (CFI and TLI > 0.90) and, in comparison with non-nested and nested 5C-models, significantly improved the model performance (Ω2, p < 0.05; Wald’s test, p < 0.05). The resulting vaccine readiness score was strongly associated with vaccine intentionality (acceptance vs. indecision: βHCW = 2.93, βParents = 2.41, βAdolescents = 1.34; refusal vs. indecision: βHCW = − 1.68, βParents = − 0.16, βAdolescents = − 0.89.). The addition of confidence in the system and social conformism among antecedents of vaccine acceptance allowed a finer understanding of the continuum moving from refusal to indecision and acceptance. To work with these antecedents in interventional research, appropriate questionnaire items should be developed for various vaccines and target populations.

Sociodemographic factors influencing discharge readiness among preterm infants’ mothers in China

ObjectiveTo investigate the discharge readiness of premature babies’ mothers and identify the related influencing factors at Dongguan City Maternal and Child Health Hospital. Study designOne hundred and thirty-nine mothers were selected as convenient samples. Demographic characteristics of premature babies and mothers and the discharge readiness of mothers were evaluated by a general information questionnaire and a Chinese version of the Readiness for Hospital Discharge Scale. Univariate analysis and multiple step-based regression analysis were used to analyze the results. ResultsThe average score of discharge readiness was 170.75 ± 31.36. The univariate analysis indicated that there were exhibited significant differences in obstetrical history, educational level, and age of the last child. Education background and distance of home from hospital entered the multiple step-base regression equation, respectively. ConclusionThe discharge readiness was above the upper-middle level. Mothers without an obstetrical history, with a higher educational level, or with a younger age of the last child, or living closer to the hospital were more ready for the preemie’s discharge. Targeted and individualized health education and guidance could help improve discharge readiness.

Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda

BackgroundSubstance use disorders (SUD) pose a significant public health problem in Uganda. Studies indicate that integrating mental health services into Primary Health Care can play a crucial role in alleviating the impact of SUD. However, despite ongoing efforts to integrate these services in Uganda, there is a lack of evidence regarding the preparedness of health facilities to effectively screen and manage SUD. Therefore, this study aimed to assess the readiness of health facilities at all levels of the health system in Mbale, Uganda, to carry out screening, diagnosis, and management of SUD.MethodsA health facility-based cross-sectional study was carried out among all the 54 facilities in Mbale district. A composite variable adapted from the WHO Service Availability and Readiness Assessment manual (2015) with 14 tracer indicators were used to measure readiness. A cut-off threshold of having at least half the criteria fulfilled (higher than the cutoff of 7) was classified as having met the readiness criteria. Descriptive analyses were performed to describe readiness scores across various facility characteristics and a linear regression model was used to identify the predictors of readiness.ResultsAmong all health facilities assessed, only 35% met the readiness criteria for managing Substance Use Disorders (SUD). Out of the 54 facilities, 42 (77.8%) had guidelines in place for managing SUD, but less than half, 26 (48%), reported following these guidelines. Only 8 out of 54 (14.5%) facilities had staff who had received training in the diagnosis and management of SUD within the past two years. Diagnostic tests for SUD, specifically the Uri stick, were available in the majority of facilities, (46/54, 83.6%). A higher number of clinical officers working at the health centres was associated with higher readiness scores (score coefficient 4.0,95% CI 1.5–6.5).ConclusionsIn this setting, a low level of health facility readiness to provide screening, diagnosis, and management for substance use disorders was found. To improve health facility readiness for delivery of care for substance use disorders, a frequent inventory of human resources in terms of numbers, skills, and other resources are required in this resource-limited setting.

Analysis of 3,843 Unrelated Donors (URD) for 455 Allograft Candidates Reveals Low URD Availability with Marked Racial/ Ethnic Disparities: Major Implications for Transplant Center & Registry Operations

Introduction: Although hematologic malignancies patients (pts) often require urgent transplants, the degree to which unrelated donor (URD) availability is a barrier to prompt allografting is not established. Methods: We evaluated availability of requested URDs 1/2020-12/2022, overall &amp; by pt ancestry, in 455 consecutive adults with acute leukemia, MDS or MPN who had a formal URD search &amp; for whom ≥ 1 URDs were pursued for confirmatory typing (CT). We also examined donor location &amp; Donor Readiness Score (DRS; the prediction of a donor's likelihood of availability for CT) by pt ancestry. We hypothesized that URD availability is a major barrier to transplant for underserved racial/ ethnic groups &amp; this has not improved in the post-pandemic era. Results: Of 455 pts [median age 63 yrs, range 21-81; 250/455 (55%) with acute leukemia], 74% (335/455) had European (EURO) &amp; 26% (120/455) non-European (non-EURO) ancestry. For these 455 pts, 3,843 URDs (median age 27 yrs, range 17-61; 1,951/3,843 [51%] male) were requested for CT or simultaneous CT-workup; 71% (2,730/3,843) of URDs were for EURO &amp; 29% (1,113/3,843) for non-EURO pts; &amp; 56% (2,140/3,843) were from domestic &amp; 44% (1,703/3,843) international registries. Of 2,775 URDs with an assigned DRS, the median score was 63% (range 16-94%). URDs requested for non-EURO pts were more likely to be domestic [EUROs: 1,411/2,730 (52%) vs non-EUROs: 729/1,113 (65%), p &amp;lt; .001]. Also, URDs for non-EUROs had markedly lower median DRS (EUROs: 71% vs non-EUROs: 52%) with over 15x the proportion with DRS ≤ 30% [EUROs: 30/2,073 (1.5%) vs non-EUROs: 160/702 (23%), p &amp;lt; .001]. Table 1A-C outlines URD availability at CT &amp; workup, overall &amp; by pt ancestry. In summary: At CT, per pt: More non-EURO pts had greater than 10 URDs requested (p = .045), less than 5 URDs that agreed to CT (p &amp;lt; .001), &amp; at least 5 URDs unavailable (p &amp;lt; .001), compared with EUROs.At workup, per pt: For over one-quarter (134/455, 29%), 3-5 URDs were requested. More non-EURO pts had less than 2 URDs that agreed to workup (p = .007) &amp; at least 2 URDs unavailable (p = .017), compared with EUROs.At CT: Only half (2,036/3,843, 53%) of requested URDs were available for CT or CT-workup. URDs were less likely to agree to CT if requested for non-EURO pts ( vs EUROs), if domestic ( vs international), or if lower DRS (p &amp;lt; .001 for each).At workup: Of URDs requested for workup after CT, while 461/598 (77%) agreed, URDs requested for non-EURO pts were less likely to agree (p &amp;lt; .001).Overall: Availability of the 3,843 URDs requested for the 455 pts was low, with less than half available (Fig. 1A). Notably, URDs requested for non-EURO pts had lower availability (p &amp;lt; .001).By ancestry sub-type: African &amp; non-Black Hispanic pts had the lowest URD availability.Over time: When examining 2020-2022, the worse URD availability for non-EURO pts is not improving in the post-pandemic era (Fig. 1B).URD provision: Of pts with ≥ 1 URD who agreed to workup, 12% did not have an URD available within 14 days of the 1st proposed collection date, &amp; of 263 5-8/8 URD recipients for whom a primary URD was selected, over one third (103/263, 39%) were not transplanted with that donor. Of transplanted pts, as expected, non-EURO pts were less likely to receive 8/8 URDs (p &amp;lt; .001) &amp;, for those who did, their URDs were older (p = .018), &amp; 5-7/8 URDs requested for non-EUROs were more HLA-mismatched (p &amp;lt; .001). Conclusions: We demonstrate significant ongoing disparities in URD access that have major implications for transplant center &amp; registry operations. Incorporating careful assessment of pt ancestry, transplant centers should pursue, &amp; registries should permit, simultaneous pursuit of multiple URDs, especially for non-EURO pts, deciding at the outset what degree of HLA-mismatch will be accepted if an URD is desired but an 8/8 URD is unlikely (Davis et al, TCT 2023). Moreover, centers are ethically obliged to inform pts if timely URD procurement is unlikely, especially as these pts are commonly from underserved racial/ ethnic groups. Registries need to address high URD attrition, &amp; prospective investigation of efforts to speed donor identification are needed. Finally, utilization of all alternative donors (5-7/8 URD, haploidentical &amp; cord blood) is needed to facilitate donors for all in the time required for optimized transplantation.

Structural readiness of health facilities in Mozambique: how is Mozambique positioned to deliver nutrition-specific interventions to women and children?

Background The health sector is essential in delivering high-quality nutrition interventions to women and children in low and middle-income countries, and Mozambique is no exception. Still, the quality and readiness of health services to deliver nutritional services have yet to be comprehensively mapped across the country. We assessed the accessibility and readiness of health facilities to deliver maternal and child nutrition services in Mozambique. Methods Using multiple data sources within a geographic information system (GIS) environment, we calculated facility readiness to deliver nutritional services, population access to health facilities, and health facilities ready to deliver nutrition services. Data from Mozambique’s 2018 Service Availability and Readiness Assessment (SARA) was used to calculate readiness scores for each facility in the country. We used geospatial data from the ´WorldPop´ initiative to estimate the proportion of people in Mozambique within 10 kilometers of a ready facility. For each province and the country as a whole, we calculated the proportion of people with access to a ready facility for maternal and child nutrition interventions. Results At the national level, 29.1% and 37.3% of the population were within 10 kilometers of a facility ready to deliver all maternal and child nutrition services, respectively. Pregnancy growth monitoring (73.8%) and vitamin A supplementation (72.4%) were the most available interventions to the population. In contrast, anemia testing/iron supplementation (45.1%) was the least available nutritional intervention. The Center (30.5%) and North (26.9%) regions of Mozambique had much lower coverage than the South region (71.7%) across the maternal and child nutrition interventions. Nampula (14.9%) and Zambézia (17.9%) provinces were the least ready to deliver maternal nutrition services while Nampula (20.4%) and Cabo Delgado (21.2%) provinces were the least ready to deliver nutrition services to children. Conclusions To achieve high coverage of nutrition interventions, facilities need a full suite of commodities and equipment. Currently, too many facilities in Mozambique have only some of these supplies, meaning that only a minority of the children and pregnant women will receive effective nutrition services when they need them. Multi-sectoral efforts, including those outside the health system, are necessary to improve nutrition in Mozambique.

The Association Between Pediatric Readiness and Mortality for Injured Children Treated at US Trauma Centers.

To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness. Most children in the United States receive initial trauma care at nonpediatric centers. The aim of the National Pediatric Readiness Project (NPRP) was to ensure that all EDs are prepared to provide quality care for children. Trauma centers reporting the highest quartile of wPRS on the 2013 national assessment have been shown to have lower mortality. Significant efforts have been invested to improve pediatric readiness in the past decade. A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) from 2019 to 2021 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15 y) were calculated using Pediatric Trauma Quality Improvement Program models. Deterministic linkage was used for transferred patients to account for wPRS at the initial receiving center. Center-specific mortality odds ratios were then compared across quartiles of wPRS. A total of 66,588 children from 630 centers with a median (interquartile range) wPRS of 79 (66-93) were analyzed. The average observed-to-expected odds of mortality [1.02 (0.97-1.06)] for centers in the highest quartile (wPRS≥93) was lower than any of the lowest 3 wPRS quartiles [1.19 (1.14-1.23) (Q1), 1.29 (1.24-1.33) (Q2), and 1.28 (1.19-1.36) (Q3), all P <0.05). The presence of a pediatric-specific quality improvement plan was the domain with the strongest independent association with mortality [standardized beta -0.095 (-0.146 to -0.044)]. Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.

Do child mental &amp; physical health explain inequalities in adolescent NEET status? A UK Cohort Study

Abstract Around 1 in 10 young people (YP) (16-24 years) are Not in Education, Employment, or Training (NEET) in the United Kingdom (UK). Socioeconomically disadvantaged YP are more likely to become NEET. Poor physical and mental health and disability are known risk factors for NEET status, yet their potential to mediate the relationship between socioeconomic circumstances (SEC) and NEET status remains unclear. We aimed to quantify which childhood health pathways explain inequalities in adolescent NEET status. We analysed data on 5,786 YP from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life SEC was measured by highest parental occupational status at birth. NEET status was derived from four questions on education, employment, and training at 17 years. Mediators across childhood were grouped into family health (parental limiting illness, mental and general health, and young carer status) perinatal health (birth weight, smoking during pregnancy, school readiness score), physical health (weight status, asthma, general health, longstanding illness at 11 years), and mental health (mental health score, self-esteem, and ASD/ADHA statement). We used logistic regression to examine the total effect of SEC on adolescent NEET status whilst adjusting for confounders (sex, maternal age, and education), then adjusted for potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators. After adjustment for confounding, YP whose parents were unemployed were more than 8 times as likely to be NEET at 17 years compared with those whose parents had managerial occupations (Odds Ratio (OR) 8.55, 95% CI 3.73 to 19.64). After adjustment for all childhood health conditions, there was a 34% reduction to aOR 5.99 (95% CI 2.42 to 14.85). Childhood health conditions partially contribute to inequalities in adolescent NEET status. Key messages • Childhood mental and physical health are important for targeting interventions to reduce inequalities in adolescent NEET status. • More than a third of the social inequality in NEET status was explained by perinatal, physical, and mental health during childhood.

Association between antenatal care facility readiness and provision of care at the client level and facility level in five low- and middle-income countries

BackgroundDespite growing interest in monitoring improvements in quality of care, data on service quality in low-income and middle-income countries (LMICs) is limited. While health systems researchers have hypothesized the relationship between facility readiness and provision of care, there have been few attempts to quantify this relationship in LMICs. This study assesses the association between facility readiness and provision of care for antenatal care at the client level and facility level.MethodsTo assess the association between provision of care and various facility readiness indices for antenatal care, we used multilevel, multivariable random-effects linear regression models. We tested an inflection point on readiness scores by fitting linear spline models. To compare the coefficients between models, we used a bootstrapping approach and calculated the mean difference between all pairwise comparisons. Analyses were conducted at client and facility levels.ResultsOur results showed a small, but significant association between facility readiness and provision of care across countries and most index constructions. The association was most evident in the client-level analyses that had a larger sample size and were adjusted for factors at the facility, health worker, and individual levels. In addition, spline models at a facility readiness score of 50 better fit the data, indicating a plausible threshold effect.ConclusionsThe results of this study suggest that facility readiness is not a proxy for provision of care, but that there is an important association between facility readiness and provision of care. Data on facility readiness is necessary for understanding the foundations of health systems particularly in countries with the lowest levels of service quality. However, a comprehensive view of quality of care should include both facility readiness and provision of care measures.

Psychometric properties and further validation of the emergency reaction questionnaire in a sample of Portuguese adults

Emergencies and disasters are abrupt, unexpected, dangerous events often traumatic. Individuals differ in the way they respond to this kind of adverse experience, depending on varied factors. This study used the Emergency Reaction Questionnaire (ERQ) to assess defensive mechanisms, feelings, and thoughts during emergency and disaster-related situations. The main objective of the present study was to confirm the factor structure and provide further support to the validity of the ERQ on a Portuguese sample. Here we replicated previous findings in showing that people who are more prone to react in an organized way in emergencies tend to have lower anxiety levels and a greater tendency for sensation seeking. We also found that females score lower than males; that ERQ specific readiness scores slightly increase with age and people who have risky jobs or routinely engage in extreme sports scored higher on the ERQ scales (meaning they act more readily and organized in an emergency). The ERQ and its Portuguese version show to be a psychometrically sound and valid measurement of emergency behavior, able to assess individual differences in the way people perform during various emergencies, and can be used in future research and in practice for screening or measuring training efficiency.

Estimation of cutoff score for the 7C of vaccination readiness scale

The 7C of the vaccination readiness scale provides a score to evaluate the willingness and readiness to get vaccinated (vaccination readiness). This cross-sectional study clarifies the cutoff vaccination readiness score to determine whether an individual is willing to be vaccinated. We conducted an online survey of 774 participants. The vaccination readiness scores for the full and short survey versions were calculated. The coronavirus disease 2019 vaccination status was used to determine whether the participant was willing to be vaccinated. Receiver operating characteristic curve analysis was performed using the Youden index. The Youden Index was at its maximum when the cutoff score was 4.02 for the full version (area under the curve [AUC]:0.94) and 4.07 for the short version (AUC:0.90). Vaccination readiness scores greater than 4 on both the full and short version may indicate a willingness to be vaccinated. This cutoff value facilitates the interpretation of the 7C scale results.

Health service readiness to provide care for HIV and cardiovascular disease risk factors in low- and middle-income countries.

Cardiovascular disease risk factors (CVDRF), in particular diabetes and hypertension, are chronic conditions which carry a substantial disease burden in Low- and Middle-Income Countries. Unlike HIV, they were neglected in the Millenium Development Goals along with the health services required to manage them. To inform the level of health service readiness that could be achieved with increased attention, we compared readiness for CVDRF with that for HIV. Using data from national Service Provision Assessments, we describe facility-reported readiness to provide services for CVDRF and HIV, and derive a facility readiness score of observed essential components to manage them. We compared HIV vs CVDRF coverage scores by country, rural or urban location, and facility type, and by whether or not facilities reported readiness to provide care. We assessed the factors associated with coverage scores for CVDRF and HIV in a multivariable analysis. In our results, we include 7522 facilities in 8 countries; 86% of all facilities reported readiness to provide services for CVDRF, ranging from 77-98% in individual countries. For HIV, 30% reported of facilities readiness to provide services, ranging from 3-63%. Median derived facility readiness score for CVDRF was 0.28 (IQR 0.16-0.50), and for HIV was 0.43 (0.32-0.60). Among facilities which reported readiness, this rose to 0.34 (IQR 0.18-0.52) for CVD and 0.68 (0.56-0.76) for HIV. Derived readiness scores were generally significantly lower for CVDRF than for HIV, except in private facilities. In multivariable analysis, odds of a higher readiness score in both CVDRF or HIV care were higher in urban vs rural and secondary vs primary care; facilities with higher CVDRF scores were significantly associated with higher HIV scores. Derived readiness scores for HIV are higher than for CVDRF, and coverage for CVDRF is significantly higher in facilities with higher HIV readiness scores. This suggests possible benefits from leveraging HIV services to provide care for CVDRF, but poor coverage in rural and primary care facilities threatens Sustainable Development Goal 3.8 to provide high quality universal healthcare for all.

Emergency Department Pediatric Readiness and Disparities in Mortality Based on Race and Ethnicity

Presentation to emergency departments (EDs) with high levels of pediatric readiness is associated with improved pediatric survival. However, it is unclear whether children of all races and ethnicities benefit equitably from increased levels of such readiness. To evaluate the association of ED pediatric readiness with in-hospital mortality among children of different races and ethnicities with traumatic injuries or acute medical emergencies. This cohort study of children requiring emergency care in 586 EDs across 11 states was conducted from January 1, 2012, through December 31, 2017. Eligible participants included children younger than 18 years who were hospitalized for an acute medical emergency or traumatic injury. Data analysis was conducted between November 2022 and April 2023. Hospitalization for acute medical emergency or traumatic injury. The primary outcome was in-hospital mortality. ED pediatric readiness was measured through the weighted Pediatric Readiness Score (wPRS) from the 2013 National Pediatric Readiness Project assessment and categorized by quartile. Multivariable, hierarchical, mixed-effects logistic regression was used to evaluate the association of race and ethnicity with in-hospital mortality. The cohort included 633 536 children (median [IQR] age 4 [0-12] years]). There were 557 537 children (98 504 Black [17.7%], 167 838 Hispanic [30.1%], 311 157 White [55.8%], and 147 876 children of other races or ethnicities [26.5%]) who were hospitalized for acute medical emergencies, of whom 5158 (0.9%) died; 75 999 children (12 727 Black [16.7%], 21 604 Hispanic [28.4%], 44 203 White [58.2%]; and 21 609 of other races and ethnicities [27.7%]) were hospitalized for traumatic injuries, of whom 1339 (1.8%) died. Adjusted mortality of Black children with acute medical emergencies was significantly greater than that of Hispanic children, White children, and of children of other races and ethnicities (odds ratio [OR], 1.69; 95% CI, 1.59-1.79) across all quartile levels of ED pediatric readiness; but there were no racial or ethnic disparities in mortality when comparing Black children with traumatic injuries with Hispanic children, White children, and children of other races and ethnicities with traumatic injuries (OR 1.01; 95% CI, 0.89-1.15). When compared with hospitals in the lowest quartile of ED pediatric readiness, children who were treated at hospitals in the highest quartile had significantly lower mortality in both the acute medical emergency cohort (OR 0.24; 95% CI, 0.16-0.36) and traumatic injury cohort (OR, 0.39; 95% CI, 0.25-0.61). The greatest survival advantage associated with high pediatric readiness was experienced for Black children in the acute medical emergency cohort. In this study, racial and ethnic disparities in mortality existed among children treated for acute medical emergencies but not traumatic injuries. Increased ED pediatric readiness was associated with reduced disparities; it was estimated that increasing the ED pediatric readiness levels of hospitals in the 3 lowest quartiles would result in an estimated 3-fold reduction in disparity for pediatric mortality. However, increased pediatric readiness did not eliminate disparities, indicating that organizations and initiatives dedicated to increasing ED pediatric readiness should consider formal integration of health equity into efforts to improve pediatric emergency care.

COVID‐19 booster dose vaccination of healthcare workers in Qatar: A web‐based cross‐sectional survey

AbstractBackgroundVaccines are an important public health measure and effective strategy to protect the population from COVID‐19. Front‐line healthcare personnel should receive priority in vaccination programs. However, the reported hesitancy among healthcare workers (HCWs) toward the COVID‐19 vaccines cannot be ignored. It widely influences the level of vaccine hesitancy in the general population. Hesitancy, fear, and anxiety were documented in first and second rounds of COVID‐19 vaccination. This study assessed the acceptance of COVID‐19 booster doses among the HCWs in Qatar.MethodsA web‐based cross‐sectional online survey was conducted using the 7C Vaccine Readiness Scale to evaluate the preparedness of the HCWs to receive COVID‐19 vaccines. Descriptive and inferential statistics were used to identify factors associated with preparedness for vaccination.ResultsA total of 382 participants completed the survey. Allied health professionals scored the least on the readiness score (−7.0 ± 9.9) compared to the physicians (3.1 ± 7.2) and nurses (3.0 ± 7.8). Physicians scored higher on confidence (58.8%), calculation (64.7%), and complacency (60.8%). Nurses scored higher on constraints (51.6%), collective responsibility (62.7%), and compliance (39.1%), and allied health professionals scored higher on (67.9%) conspiracy. There was a significant association between readiness score and not being infected with COVID‐19, post‐vaccine symptom experience, and hesitancy for the initial two doses.ConclusionThis study reports higher complacency and constraints with the perception of lower risks and the lack of interest in taking collective responsibility among the HCWs. Addressing vaccine hesitancy among them is critical to ensure successful vaccination campaigns and promote community safety during future pandemics.

Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal

ObjectiveThis study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4–15 years) in Greater Accra Region, the highly urbanised administrative...

Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review.

Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization. We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The I 2 statistic was calculated to quantify study heterogeneity. We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I 2 = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization. The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings. PROSPERO-CRD42020191149.

Australian rural medical students' perceived readiness for work as a junior doctor: A cross-sectional national survey.

To report self-perceived readiness for work as a junior doctor in a national cohort of rural clinical school students. Cross-sectional study using a self-report questionnaire. Independent variables included 14 individual readiness items related to clinical and professional tasks, sociodemographic data and reported experience of rural clinical school (RCS) training. Participants were 668 medical students (55.3% females) completing a full academic year in rural Australia. Multivariable analysis explored factors associated with overall readiness for work as a junior doctor. 86% agreed that RCS experience prepared them to undertake the roles and responsibilities of a junior doctor. Self-ratings for specific clinical and professional tasks varied from a mean score of 5.9-8.0 out of 10, and 13 of the 14 items were associated with the outcome (p-value <0.001, except for performing spirometry). Lowest readiness scores were seen for some aspects including raising concerns about a colleague (mean score 6.1) or responding to workplace bullying (mean score 6.0). Aspects of the RCS experience that were strongly associated with overall readiness included: feeling a valued team-member (OR 9.28, 95%CI 2.43-35.39), feeling well-supported academically (OR 6.64, 95%CI 3.39-13.00), having opportunity for unsupervised but supported clinical practice (OR 4.67, 95%CI 1.45-15.00), having a rural mentor (OR 3.38, 95%CI 1.89-6.06) and having a previous health professional qualification (OR 2.7, 95%CI 1.32-5.54). Most RCS students felt ready for work as a junior doctor. Important aspects of RCS experience are likely to include students feeling integrated within the clinical team and having opportunities for authentic clinical roles. There remains a significant challenge for medical school curricula to address professional areas where graduates felt less prepared.

Service availability and readiness for basic emergency obstetric and newborn care: Analysis from Nepal Health Facility Survey 2021.

Although there has been a significant focus on improving maternal and newborn health and expanding services in Nepal, the expected positive impact on the health of mothers and newborns has not been achieved to the desired extent. Nepal not only needs to focus on improving access to and coverage of services but also the quality to achieve Sustainable Development Goals (SDG) by 2030. In this context, we aimed to analyze Basic Emergency Obstetric and Neonatal Care (BEmONC) service availability and readiness in Health Facilities (HFs) of Nepal. We analyzed data from nationally representative Nepal Health Facility Survey (NHFS), 2021. BEmONC service availability and readiness in HFs was measured based on the "Service Availability and Readiness" manual of World Health Organization (WHO). We measured service availability by seven BEmONC signal functions. The readiness score was calculated for three domains- guidelines and staff training, essential equipment/supplies, and essential medicines on a scale of 100, and the average score for the three domains was the overall readiness score. We performed weighted descriptive and inferential analysis to account complex survey design of NHFS 2021. We summarized continuous variables with descriptive statistics like mean, standard deviation, median and interquartile range whereas categorical variables with percent and 95% confidence interval (CI). We applied simple, and multivariate linear regression to determine factors associated with the readiness of HFs for BEmONC services, and results were presented as beta (β) coefficients and 95% CI. Of total 804 HFs offering normal vaginal delivery services, 3.1%, 89.2%, 7.7% were federal/provincial hospitals, local HFs, and private hospitals respectively. A total of 45.0% (95% CI: 34.9, 55.6) federal/provincial hospitals, 0.3% (95% CI: 0.2, 0.6), local HFs (district hospital, primary health care centers, health posts, urban health centers) and 10.5% (95% CI: 6.6, 16.4) private hospitals, had all seven BEmONC signal functions. The overall readiness of federal/provincial hospitals, local HFs, and private hospitals were 72.9±13.6, 54.2±12.8, 53.1±15.1 respectively. In multivariate linear regression, local HFs (β = -12.64, 95% CI: -18.31, -6.96) and private hospitals had lower readiness score (β = -18.08, 95% CI: -24.08, -12.08) compared to federal/provincial level hospitals. HFs in rural settings (β = 2.60, 95% CI: 0.62, 4.58), mountain belts (β = 4.18, 95% CI: 1.65, 6.71), and HFs with external supervision (β = 2.99, 95% CI:1.08, 4.89), and quality assurance activities (β = 3.59, 95% CI:1.64, 5.54) had better readiness scores. The availability of all seven BEmONC signal functions and readiness of HFs for BEmONC services are relatively low in local HFs and private hospitals. Accelerating capacity development through training centers at the federal/provincial level, onsite coaching, and mentoring, improving procurement and supply of medicines through federal/provincial logistic management centers, and regular supportive supervision could improve the BEmONC service availability and readiness in facilities across the country.