Service Level Research Articles

The Influencing Factors of Knowledge Hiding Among Employees in the Construction Industry: A Psychological Contract Perspective

This study explores the factors influencing employee knowledge hiding in construction industry organizations. Utilizing quantitative methods, the research examines the impact of demographic factors, including gender, age, educational level, marital status, and duration of service, as well as psychological contract breaches on employee knowledge hiding. An independent samples t-test and multiple comparisons using the least significant difference (LSD) test were conducted to analyze the demographic factors. At the same time, a simple linear regression analysis was employed to assess the relationship between psychological contract breach and knowledge hiding. The results indicate that demographic factors significantly affect employee knowledge hiding, with females, older employees, those with lower educational levels, divorced or widowed individuals, and employees with longer service durations tending to hide knowledge more frequently. Furthermore, psychological contract breach is found to have a strong and positive relationship with employee knowledge hiding, suggesting that employees are more likely to engage in knowledge-hiding behaviors when they perceive a violation of their psychological contract. The findings have important managerial implications, emphasizing the need for tailored strategies to address knowledge hiding among different employee groups and maintaining a strong psychological contract with employees to foster a culture of knowledge sharing and innovation.

Exploring public perception and utilization of medication home delivery services in the United Arab Emirates: a cross-sectional study

IntroductionThe Medication Home Delivery (MHD) service from community pharmacies involves the safe and efficient delivery of pharmaceuticals (prescription and non-prescription medications), and health products directly to the patient’s/consumer’s home. There are several issues encountered by the users of the MHD service that have an impact on their satisfaction with the service. The study aimed to assess the public’s perceptions of the MHD service in the United Arab Emirates (UAE), their willingness to utilize it, and the practical use of the service.MethodA cross-sectional exploratory study was conducted in the UAE using a validated online survey. The inclusion criteria were adults residing in the UAE. Statistical analysis was performed to identify the association between the variables, the service use, and the level of service efficiency.ResultsA total of 556 participants filled out the survey, with 69.4% of them using the service. The majority of participants were females (75.9%) and aged less than 40 years old (71.6%). Three variables showed a statistically significant association with the use of the MHD service (P < 0.05): the participant’s educational level, their medical/health background, and the frequency of visits to community pharmacies. The most common issues raised were receiving the wrong order, delay in delivery, and paying delivery fees. Most participants agreed that the MHD service reduces the risk of exposure during pandemics, serves the elderly, serves disabled people, makes it more comfortable for parents with children at home, and reduces overcrowding in health facilities, as well as the MHD service making pharmacy services more efficient.ConclusionThe study indicated positive perceptions among the public in the UAE towards the MHD service. However, there was a concern that this service may diminish the communication between pharmacists and patients, which potentially minimizes the amount of information received by patients regarding their treatments.

Customer Responsiveness Strategy and the Performance of Kenya Revenue Authority in Mombasa County, Kenya

The customer is the primary growth determinant of an organization’s direction toward desirable performance. Proactive organizations that recognize the reality of customer focus contributions to business operations have significantly portrayed positive performance. This research aims to investigate how customer responsiveness influences the performance of an organization, with a specific focus on the Kenya Revenue Authority. To in aid establishing the foundational base of the study, theories such as the Resource Based View, Systems theory, Gap analysis Model and the Upper Echelon Theory were taken into account. The study employed the descriptive research design to comprehensively understand the current conditions and circumstances. The study's target population considered 445 KRA technical staff in Mombasa, including managers, supervisors, officers, and support staff. The study employed stratified sampling where 134 respondents were selected, who either had recently joined the company or altered their job roles according to duration of employment. To test the reliability of the study, the researcher employed Cronbach’s alpha coefficient which had a threshold of 0.7. The threshold of a coefficient should be between 0 to 1 to maintain an internal consistency indicating reliability. To accurately determine the validity of the data for factor analysis, the Kaiser-Meyer-Olkin (KMO) Test and Bartlett’s Test of Sphericity were conducted. The KMO test yielded a measure of sampling adequacy of 0.743, which indicates that the sample size was adequate for factor analysis. Data collection for the study was through the use of a close-ended questionnaire in the statement form. The data was analyzed through measures of central tendency such as mean, median, and mode. The analysis also included measures of dispersion such as variation, standard deviation, correlation analysis and regression analysis. It was observed that technology had the most substantial impact on KRA's performance. Indicating a strong positive relationship between technological implementation and performance outcomes. Service level agreements were found to be a significant predictor of performance suggesting that clear and well-structured SLAs contribute positively to the quality-of-service delivery, ensuring that customer expectations are met effectively. Top management support significance highlighted the importance of leadership and resource allocation in driving organizational success. Conversely, staff training indicated that while training is important, its direct influence on performance may be more nuanced or dependent on other mediating factors. Overall, the study found that customer responsiveness strategies significantly influence the performance of KRA in Mombasa County.

Military Medical Simulations-Scoping Review.

The military employs a wide variety of training paradigms to prepare a ready medical force. Simulation-based training is prominently used in the military for all roles of care to provide the knowledge, skills, and abilities needed to render care from the battlefield to the hospital. The purpose of this scoping review is to synthesize the body of research in military healthcare simulation, highlight trends in the literature, and identify research gaps. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis process, the databases of PubMed, Google Scholar, and targeted conferences were searched for articles focused on simulation-based training in the military healthcare community. Inclusion criteria required that the studies assessed a healthcare simulation intervention and had military participants. Data were gathered on population parameters (branch of service and provider level) as well as study parameter (simulation modality, medical domain, and outcome measures). Outcome measures were categorized according to the Kirkpatrick model of training evaluation. A total of 43 articles met inclusion criteria. Article summaries and descriptive data on the participant populations and study parameters are provided in Tables1, 2, and Supplementary Table S1. Participant populations were inclusive of all the services and roles of care, suggesting appropriate representation of the broad military healthcare community. The majority of literature has studied physical simulations, such as manikins or task trainers. Few studies employed augmented or virtual reality as the training intervention, likely because of the nascency of the technology. Trauma care was the focus of 65% of the studies; this is attributable to the criticality of trauma care within battlefield medicine and casualty response. Related to study outcomes, participant reactions, such as usability and user acceptance, and immediate learning outcomes were heavily studied. Retention and behavioral changes were rarely studied and represent a significant research gap. Future research assessing mixed reality technologies would be beneficial to determine whether the technology warrants inclusion in programs of instruction. Finally, studies with outcome measures including long-term knowledge and skills retention, behavioral change, or patient outcomes are strongly recommended for future research.

Derajat Aglutinasi pada Pemeriksaan Golongan Darah Metode Tabung Berdasarkan Masa Simpan Test Sel A dan Test Sel B Hari Ke-0, Ke-2, Ke-4, Ke-6 dan Ke-8

Blood group examination is an examination that aims to determine the type of blood group. Cell test is a blood group examination reagent used to detect antibodies in the serum being examined. The long shelf life of cell tests that can only last for two days is considered less effective for agencies with a high level of blood services. The purpose of this study was to describe the degree of agglutination in blood group examination with cell test A and B stored on the 0th, 2nd, 4th, 6th, and 8th days. This study is a descriptive study with a Quasi Experimental research design. Test cell A and test cell B were made from red blood cell specimens of 3 blood type A and 3 blood type B respectively. Test cells are stored in a refrigerator with a temperature of 2-6° C. Test cells were then examined on the 0th, 2nd, 4th, and 6th day of storage. Calculation of samples and repetitions using the Federer formula with the number of treatments in this study is 5 treatments. Based on the calculation, one sample of test cell A and test cell B was obtained with five repetitions of each examination. The results showed that on the 0th, 2nd, 4th, and 6th day of cell test storage, the results of blood type examination were obtained, namely the degree of agglutination 4+ with erythrocytes in the cell test clumping into one bond, cells forming large agglutination with clear supernatant. On the 8th day of storage, the result of agglutination degree is 3+ with erythrocytes in test cells not clumping perfectly, there are erythrocyte granules and cloudy supernatant. Based on the results of the study, it is concluded that test cell A and test cell B can be used optimally until day 6 storage.

Achieving and sustaining reduction in hospital-acquired complications in an Australian local health service

BackgroundReducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient’s recovery and health service delivery by diverting...

Study on Optimizing Inventory to Minimize Waste in the Fresh Produce Supply Chain

Abstract: The increasing demand for fresh produce, particularly greens, presents unique challenges in inventory management due to their short shelf life and susceptibility to spoilage. Inefficient management often results in significant waste, leading to financial losses for retailers and increased environmental burdens from the disposal of spoiled goods. Despite various strategies being employed in the agri-food sector, gaps remain in understanding how to optimize inventory levels to minimize waste at the retails level while maintaining high service levels for customers. This research aims to develop an inventory management model tailored to fresh produce that can mitigate these issues by balancing stock availability and minimizing wastage, particularly in large retail shops. To address the research problem, a mixed-integer linear programming (MILP) model was developed, focusing on three service levels—90%, 92%, and 95%—to evaluate the trade-offs between customer satisfaction and total inventory costs. The model incorporates key constraints, including stock balance, shelf-life limitations, and demand satisfaction. The model was validated using actual data, including stock, sales, and wastage records for the month of August, 2024. The objective function aimed to minimize total costs, encompassing holding costs, wastage, and lost revenue. The findings indicate that higher service levels, while reducing stockouts, significantly increase costs due to excess inventory and waste. The most cost-effective solution was observed at the 90% service level, which balanced waste reduction and customer satisfaction. The study also emphasizes the importance of integrating total cost reduction and minimize wastage. Future work should focus on incorporating consumer behavior patterns and extending the model to multi-echelon inventory systems, which include both distribution centers and retail outlets, to capture a more holistic view of the supply chain.

Development of conceptual provisions for implementing innovative technologies to quality standards of public passenger transport

This paper reports a study of the main principles for the formation of public passenger transport service quality standards. The object of the research is public passenger transport services. The task of the study is the development of conceptual foundations for the formation of quality standards using modern innovative technologies. It has been established that the main factor in achieving the quality of public passenger transport services is taking into account innovative technologies and compliance with the criteria and norms of EU standards. Features in the functioning of public passenger transport in the world have been studied, including the use of information platforms for tracking the movement of transport routes, Internet applications, ensuring safety and compliance with environmental requirements. The criteria that serve as indicators of improving the efficiency of the quality of services have been defined, among the main ones are the availability of transportation, comfort, frequency of traffic, and waiting time, quality of service, as well as safety. A system of forming the quality of public passenger transport services has been proposed, which involves determining the needs and requirements of consumers of public passenger transport services, ensures the development of measures to improve the quality of services and their certification. A comprehensive approach to the formation of the quality of public passenger transport services based on the introduction of innovative technologies has been formed, which could make it possible to determine the level of their innovative development, as well as ways to improve it. This approach takes into account the relationship between implemented measures, measuring the level of service quality and the distribution of obligations to ensure the level of services determined by quality criteria. This makes it possible to determine the required level of quality of public passenger transport services and to form a relationship between the level of innovative technologies and the stages of the approach. The practical significance of the results is the design of tools that would ensure the improvement of the quality of public passenger transport services.

Vision rehabilitation workforce in Italy: a country-level analysis

BackgroundResearch and monitoring of human resources available for vision rehabilitation services has been a neglected area of work in the past. This study aims to offer an overview of the vision rehabilitation workforce available in Italy, in order to profile the distribution and number of human resources for vision rehabilitation.MethodsData on the available vision rehabilitation professionals were collected from the yearly report on the state of implementation of policies relating to the prevention of blindness, education and vision rehabilitation, according to a law which was passed by the Italian Ministry of Health, Department of Health Prevention. The report presents a review of all professional workers dealing with low vision rehabilitation centers in Italy between January 2005 and December 2019. Data on the distribution and type of services of government-supported low vision centers across the country were also obtained and examined.ResultsOf the 289 low vision rehabilitation workers in 2019, 28% were ophthalmologists, 31% orthoptists, 19% psychologists, 17% nurses and 5% social workers.The health workforce densities across the Italian regions ranged from 1.62 to 0.12 per 100.000. The density of vision rehabilitation workers showed a no growing trend from 2006 to 2015. During the study period, it was found a weak but statistically significant association of workforce density with the number of government-supported low vision centers across the Italian territory (r2 = 0.3, p < 0.05). The vision rehabilitation workforce was not associated with the number of low vision patients who accessed to a vision rehabilitation center (r2 = 0.05, p < 0.0001).DiscussionA critical review has identified the following national situation: need-based shortages of workers in the vision rehabilitation service sector, as well as deficiencies in data sources. Based on our results, we would recommend increasing the development of human resources trained and dedicated to vision rehabilitation and improve data collection and analysis; provide structural enhancements, across all service levels. These considerations may contribute to the enhancement of policy decisions in order to guarantee an adequate vision rehabilitation workforce and meet national rehabilitation needs. Furthermore, this analysis should be used as a lesson learned by other countries, as low-income ones, in order to develop vision rehabilitation services.

Wazuh SIEM for Cyber Security and Threat Mitigation in Apparel Industries

Security of IT infrastructure is critical in the modern digital environment, particularly for industries that manufacture clothing. The application of the Wazuh Security Information and Event Management (SIEM) system to improve security monitoring and compliance for an IT system in the apparel industry is the main topic of this study. To improve the apparel industry cyber threat monitoring system in real-time monitoring, detecting the threat vectors that support the centralized management system, to meet these objectives of the company, an SIEM security management system has been installed and configured with the components of Wazuh manager, indexer, Wazuh agent, and Wazuh dashboard as well. An Oracle virtual lab environment was created to install and configure the Wazuh system a robust Linux operating system was installed at the server level and Windows 10 was installed on the client end to the authenticity failure of the security system. To implement the Wazuh system, the project management guideline was followed which ensured the planning and implementation of the project, testing phases, and along with review and maintenance. Wazuh security management system successfully identified the authentical failure reports and vulnerabilities and generated automated reports from the system that showed the result of 1 critical, 19 high, and 5 medium levels of vulnerabilities shown in Figure 6, and the necessary patch recommended to solve the critical issues. On the other hand, the system also generated security events as well as integrity monitoring system reports. The deployment of the Wazuh security management system ensured the robust cost-effective security management system with high quality for detecting cyber threats which supports the regulatory and compliance requirements and is a viable tool for the apparel industry to protect the stakeholders’ interest.

Development of a Machine-learning-based Framework to Assess the Performance of Water Distribution Systems

Recent statistics indicate that the national water supply coverage is approximately 99%, reflecting a high level of service. However, the aging infrastructure continues to cause issues such as pipe failures and water quality concerns, creating operational difficulties. To solve these issues, performance assessments are used to quantitatively evaluate the system conditions and ensure effective maintenance. In Korea, these assessments are based on a scoring system that combines direct and indirect assessments. However, direct assessment of all pipes is limited by cost and time constraints. To address this issue, a deep neural network is used to assess the aging of water distribution systems. This study develops a framework to estimate direct results from indirect data by analyzing the correlation between indirect and direct assessments. Additionally, data augmentation is considered to compensate for the lack of training data in direct assessments, improve the reliability of performance assessments, and support better prioritization in system maintenance.

The Measurement Method for Planning Green Campus Based on Bicycle

Although there are small buses and Damri (state-owned company bus) public transportation that some students use, the majority of traffic at the Indralaya Campus of Sriwijaya University consist of to support an eco-friendly college environment, the institution suggests enhancing bicycle riding as an alternative. The main purpose of this study is to develop strategic, secure and comfortable bike lanes and evaluate potential bicycle users’ interest. Bicycle Level of Service (LOS) was assessed using Vissim software under three scenarios. The results show that many road segments achieved LOS A. Scenario 2, which is based on the shortest public route, is identified as the best possible bicycle lane plan for city bikers. Out of 100 respondents who were interviewed, including students, faculty personnel and employees; about 80% were in favor of implementing bicycle lanes implementation on campus.

Research on How the Digital Economy Contributes to Achieving A High-Level and Balanced Development of the Elderly Care Service Industry

Abstract China’s aging population has gained significant attention. Population aging implies that the demand for elderly care services will be on the rise. However, China’s aging exhibits a notable characteristic of getting old prior to achieving affluence, which directly constrains the enhancement of the level of elderly care services. The Communist Party of China and the government attach considerable importance to the issue of population aging and pensions. The Third Plenary Session of the 20th CPC Central Committee adopted the Decision of the CPC Central Committee on Further Comprehensively Deepening Reform and Promoting Chinese-Style Modernization, emphasizing that “we should actively respond to population aging and improve the development of elderly care and elderly care industry policy mechanisms.” Regarding the supply of pension services, due to the professional and long-term nature of pension services, the supply cost remains high. The contradiction between the low level of demand and the high cost of supply might lead to the “low-level equilibrium trap” of the elderly service industry. The digital economy has achieved remarkable effects in promoting the elderly care service industry. It has played a vital role in optimizing the allocation of elderly care resources, reducing the cost of elderly care services, and creating a superior elderly care ecosystem. In this context, it holds considerable academic value and practical significance to study the impact of the digital economy on the development of pension service industry, to analyze the digital divide and bridge the path for the development of the pension service industry, and to explore the countermeasures and ideas of the digital economy to facilitate the high-level, balanced, and high-quality development of the pension service industry.

The role conflict among Female teachers and employees of Raparin University

The aim of this study was to determine the level of role conflict among female teachers and employees of Raperin University in general and according to the variables (marital status, educational level, and years of service). The research community consists of all female teachers and employees in Raperin University, and the sample consists of (114) teachers and employees. The research tool consists of a role conflict scale consisting of 36 items prepared by the researchers. The statistical methods used were: one-sample t test and (ANOVA). The results showed that role conflict was low in the sample. According to the variables, the marital status variable did not show significant differences between the single and married groups, but there were significant differences according to education and years of service.

The Role of Agricultural Inputs on Crop Productivity: The Case of Zigam Woreda

In spite of the importance of agriculture in Ethiopia, it is characterized by low productivity and has been unable to produce sufficient quantities of output to feed the country’s population. In light of this various development strategies has been undertaken to improve the performance of agriculture. Intensification of agriculture through the use of new agricultural technologies has been emphasized over the last three decades. This study attempted to examine the contribution of agricultural input for crop productivity. The data for the study was collected from 91 sample farmers. This study was the study used both primary and secondary data. In this study researcher was used simple random sampling techniques. This research was use cross sectional approach and econometric method of data analysis to investigate the role of age, sex, land size, labor force, fertilizer, improved seed, extension service, and access to credit, education level and pesticides for crop production by collecting data from the household. In econometric method of data analysis researcher was used ordinary least square (OLS) Model. The econometric result show that land size, labor force, improved seed, fertilizer, credit service, extension service and education level have positive and significant effect on crop production. However, pesticide has a negative and significant impact on crop production. From the explanatory variables, education level has a higher coefficient. This indicates education level is more significant for crop production. According regression result &amp;lt;i&amp;gt;R&amp;lt;/i&amp;gt;&amp;lt;sup&amp;gt;&amp;lt;i&amp;gt;2&amp;lt;/i&amp;gt;&amp;lt;/sup&amp;gt; is 0.97, which implies 97% of output function is explained by the selected ten (10) explanatory variables. The policy implication is that to reduce farmers resistant to use farm inputs and to create knowledge about the optimal input use educate and training of farmers is necessary.

National census of UK endoscopy services in 2023

BackgroundThe Joint Advisory Group on Gastrointestinal Endoscopy (JAG) conducts a biennial census of UK endoscopy services. The 2023 census aimed to assess the current status of endoscopy services and compare them with pre-pandemic census benchmark data.MethodsAn electronic survey was sent to all JAG participating services in April 2023. Key domains included activity, waiting times, workforce and safety. Whole census and service level paired comparison was made with 2019 census data.ResultsThere were 334 census responses representing 443 JAG-participating services (86.7% response rate). NHS services were operating at 110% of pre-pandemic activity levels. In the first 3 months of 2023, 53.6% of NHS services met urgent suspected cancer waiting time targets, 26.5% met routine waits and 26.2% met surveillance waits. The proportion of NHS services meeting all three targets decreased from 40.9% to 21.9% between 2019 and 2023. Compared with 2019, the proportion of independent sector activity has significantly increased. Insourcing activity has significantly increased and is being used by 57.9% of NHS services. Staff shortages were the most cited reasons for services not meeting waiting time targets or providing training. Absence through sickness rates for Band 2–6 nursing and healthcare support workers were significantly higher in 2023 compared with 2019 (p&lt;0.001).ConclusionThe 2023 census presents a system under strain. While overall activity is above pre-pandemic levels, this is set against workforce concerns, increasing staff absences and reliance on insourcing for additional activity. This census re-emphasises the need to proactively plan for rising demand, while maximising all current available resources.

Urban Air Mobility Passengers’ Profiling: Evidence from Milan Airports, Italy

Urban air mobility (UAM) is expected to offer new travel options for passengers to and from airports in the near future, despite uncertainties associated with regulatory issues, environmental concerns, and societal impacts. This paper analyzes the socioeconomic and behavioral factors that could influence users’ modal choices (including UAM services) for accessing and egressing airports. Using revealed and stated preference data collected at Milan airports (Italy), mixed logit and hybrid choice modeling specifications are estimated and compared with profile potential UAM passengers. Our findings suggest that the level of service, socioeconomic factors, and trip-related variables explain passengers’ choices better than latent traits such as fear of flying, propensity for technological advances, and expectations about the safety of UAM services. In other words, the additional complexity of hybrid choice modeling is not justified by the slight gain in likelihood compared with the estimated mixed logit model. The results also indicate that high-income individuals traveling for business purposes are the most likely demand segment to use UAM services, at least initially. Moreover, highly educated individuals and employees who have their travel expenses reimbursed for work trips are less likely to choose UAM services for airport access or egress, preferring traditional ground taxis.

Machine-learning based prediction for high health care utilizers using a multi-institution registry

Abstract Background Rising healthcare costs worldwide have spurred interest in using machine learning to pinpoint major healthcare utilizers for population health efforts. Previous studies have focused on individuals who impose the highest financial burden, such as targeting high-need high-cost utilizers, a small group with limited potential for cost reduction. Therefore, we developed models to predict future healthcare utilization across various thresholds. Methods We leveraged data from a multi-institutional diabetes database to develop binary classification models capable of predicting healthcare utilization in the following year. The models predicted six different outcomes: patients with an annual total length of stay of ≥ 7, ≥14, and ≥30 days, and emergency department (ED) attendance of ≥ 3, ≥5, and ≥10 visits. To mitigate class imbalance, we applied random and synthetic minority oversampling techniques and compared against models trained without oversampling. Models were trained with 2019 data and tested on unseen data from 2020 and 2021. Results Models trained with random oversampling, including logistic regression, multivariate adaptive regression splines, boosted trees, and multilayer perceptron, consistently demonstrated high AUC (&amp;gt;0.80) and sensitivity (&amp;gt;0.60) across both training-validation and test datasets. Addressing class imbalance was found to be crucial, as models without oversampling displayed satisfactory AUC (&amp;gt;0.80) but significantly lower sensitivity (&amp;lt;0.10). Key predictors identified included age, number of ED visits in the present year, chronic kidney disease stage, inpatient bed days in the present year, and mean HbA1c levels. Conclusions Our machine learning models successfully predict high service level utilization with strong performance, offering valuable tools for policymakers and health planners to develop targeted health initiatives based on patient utilization patterns. Key messages • Machine learning models can be leveraged to predict future healthcare utilization and facilitate interventional program development. • Annual total length of stay and total emergency department visits are useful service level indicators.

Maternal near-miss and mortality associated with being referred: a case control study in Luanda

Abstract Background Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola. Methods A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value &amp;lt;0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI). Results Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89). Conclusions According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting. Key messages • Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola. • Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.